Nicholas P. McIvor

Plunging ranula: clinical observations.

The plunging ranula is a relatively uncommon phenomenon which represents a mucus escape reaction occurring from disruption of the sublingual salivary gland. We present a series of 20 patients managed at Green Lane Hospital (Auckland, New Zealand) over a 9‐year period.

Ultrasonography and ultrasound‐guided fine‐needle aspiration biopsy of head and neck lesions: A surgical perspective

A head and neck ultrasound‐guided fine‐needle aspiration clinic was set up to determine the role of ultrasound and ultrasound‐guided fine‐needle aspiration in the evaluation of patients with lesions in this region. One hundred ninety‐five lesions were biopsied by ultrasound‐guided fine‐needle aspiration in 203 patients. Ultrasound detected 2 or more lesions in 14 (48%) of 29 patients with a clinically solitary thyroid nodule. Three (8.8%) of 34 lesions thought to be within the parotid gland were determined to be external. A pronounced learning curve was evident in the technique of ultrasound‐guided fine‐needle aspiration, particularly for nonpalpable disease. Adequacy of sampling for each 3‐month period was 71%, 89%, and 94%, respectively. Seventy‐four percent of central aspirations were satisfactory compared to 54% of peripheral aspirations. Ultrasound‐guided fine‐needle aspiration did not alter the clinical staging of metastatic neck disease in 8 patients having 10 neck dissections but proved useful in detecting nodal recurrence in 3 irradiated necks that did not proceed to surgery. The smallest node to harbor malignancy had 4‐mm maximal axial diameter. We conclude that ultrasound and ultrasound‐guided fine‐needle aspiration are valuable adjuncts to the clinical examination.

Comparison of the use of endoscopic and radiologic gastrostomy in a single head and neck cancer unit.

Background:  Head and neck cancer patients frequently require gastrostomy feeding. Different insertion techniques have been described. The aim of the present study was to compare clinical results of percutaneous endoscopic and radiological gastrostomies in patients treated in a regional head and neck cancer unit.

EFFECT OF IMMUNOCOMPROMISE ON METASTATIC CUTANEOUS SQUAMOUS CELL CARCINOMA IN THE PAROTID AND NECK

Our aim was to examine the effect of a compromised immune state on the outcomes in patients treated for metastatic cutaneous squamous cell carcinoma (SCC).

Efficacy of neck dissection: are surgical volumes important?

Surgical volumes have been shown in many fields to reflect expertise and to be associated with improved clinical outcomes. We sought to test similar hypotheses that neck dissection is a volume‐sensitive procedure wherein the number of lymph nodes harvested and clinical outcomes are correlated with the number of neck dissections performed.

Quality of life after parotid and temporal bone surgery for cancer.

Objectives The purposes of this study were to examine the quality of life (QL) of patients who received treatment for cancer of the parotid or temporal region, and to identify factors contributing to it. The relationships between clinician‐based measures of treatment outcome and the patient‐based counterparts were also evaluated.

Endovascular treatment of epistaxis.

Aim:  Embolization of external carotid vessels in the treatment of intractable epistaxis is not well documented in Australasia. The aim of the present retrospective study was to audit our experience with the technique, and to compare it with other centres.

ACINIC CELL CARCINOMA OF THE PAROTID GLAND: AUCKLAND EXPERIENCE AND LITERATURE REVIEW

Acinic cell carcinoma is an uncommon malignancy of the salivary glands and as such it has been difficult to accurately delineate its natural history. The aim of this study is to assess the behaviour of acinic cell salivary cancer of the parotid gland presenting to a single head and neck surgical unit in Auckland. The study is a structured review of cases of acinic cell carcinoma of the parotid gland presenting from 2000 to 2006 to the Head and Neck Unit at Auckland Hospital, those identified from the pathology database and the Otobase head and neck database. Case records and pathology reports were reviewed. Fifteen patients were identified, 9 men and 6 women. The mean age was 67.2 years, with range 50–85 years. The mean follow up was 4.4 years and range 1.1–7 years. There was one case of local recurrence during study period and no deaths. Five of 15 patients received postoperative radiotherapy. Postoperative complications consisted of one wound haematoma and two cases of marginal mandibular weakness (one transient and one permanent). Current management strategies are obtaining appropriate rates of recurrence and postoperative complications within the Auckland population.

Audit in the management of T3 fixed-cord laryngeal cancer

PURPOSE To determine results of various treatments for T3 fixed-cord lesions and the subset T3 glottic cancer in Auckland from 1979 to 1995. PATIENTS AND METHODS Data were collected retrospectively from a departmental database, and the notes were reviewed. Because of the difficulty in determining the subsite of some fixed-cord lesions, the entire group of T3 fixed-cord lesions was examined, and those tumors that were considered to be definitely arising from the glottis were then analyzed as a specific subset. RESULTS Fixed-cord lesions were diagnosed in 75 patients (21 supraglottic, 54 glottic). Primary surgery (total laryngectomy) was performed on 46 patients, primary radical dose radiotherapy was undertaken on 25 patients, and four patients were treated palliatively. For T3 fixed-cord lesions, disease-specific survival for radiotherapy and surgery was 36% and 66%, respectively, and 32% and 67%, respectively, for T3 glottic lesions. For both T3 fixed-cord and T3 glottic lesions, surgery produced significantly better survival than did radiotherapy (<60 Gy; P = .0157). With radiotherapy greater than 60 Gy, cancer of the larynx has been controlled in seven of 13 patients, although only five patients are alive, with a median follow-up of 24 months (range, 12-49 months). CONCLUSION Radiotherapy less than 60 Gy produced markedly inferior results to surgery for T3 fixed-cord lesions and T3 glottis in Auckland. Radiotherapy at more than 60 Gy shows promise, but an ongoing audit is essential to ensure that survival is similar to surgery and to that reported by those promoting organ-preservation protocols.

Ultrasonography of the thyroid and parathyroid glands

High-frequency ultrasonography is ideally suited to imaging of the thyroid and parathyroid glands by virtue of their superficial location in the neck. Ultrasonography of the thyroid is most commonly used in the evaluation of the solitary nodule. Ultrasonography of the parathyroid glands is usually performed to evaluate and localise parathyroid abnormalities in patients with hypercalcemia. The increased diagnostic acumen offered by this modality allows a realistic working diagnosis and leads to a rational management strategy.