Peter C.W. Pang

Nasopharyngectomy for Recurrent Nasopharyngeal Carcinoma: A Review of 31 Patients and Prognostic Factors

Objectives/Hypothesis Nasopharyngectomy is a well‐established treatment option for recurrent nasopharyngeal carcinoma. Over a period of 4 years and 3 months, in a total of 43 patients, 45 nasopharyngectomies were performed. Thirty‐one patients with follow‐up ranging from 12 to 58 months were studied. Twenty‐two patients (58%) survived; of these, 18 patients (82%) remained disease free. All patients who developed repeat recurrence or died (n = 12) had a high recurrent T‐stage tumor, skull base involvement, multiple recurrences, positive surgical margins, or concurrent neck node metastasis. These factors are poor prognostic parameters and might mitigate the indications for aggressive salvage surgery. However, low recurrent T‐stage tumor without neck metastasis carries a good prognosis. Modern minimally invasive surgery carries minimal morbidity.

Fibromatosis of the Head and Neck Region

OBJECTIVE: Five cases of head and neck fibromatosis were analyzed. The imaging and pathologic findings, surgical management, and clinical outcome were discussed. STUDY DESIGN AND SETTING: A retrospective study of 5 adult head and neck fibromatosis cases, evaluating long-term follow-up results of conservative treatment. RESULTS: The 5 patients (2 male and 3 female) ranged in age from 16 to 51 years. The lesion size ranged from 1 to 8 cm. Four cases had limited surgical resection; 1 case was followed only. One of the surgically treated cases had a recurrence that was irradiated. All patients were well for a follow-up period of 2 to 8 years. CONCLUSION: Aggressive excision of head and neck fibromatosis cannot be achieved easily. Vigilant follow-up with or without conservative surgical excision achieves good disease control. Low dose radiotherapy can be used for inoperable cases. SIGNIFICANCE: Judicious conservative treatment should be attempted for head and neck fibromatosis to achieve optimal functional preservation.

Surgical reconstruction of attempted suicide charcoal burns.

Burning charcoal in an enclosed space is now the second most-common method of committing suicide in Hong Kong. When the suicide is unsuccessful, the patients can still sustain extensive tissue destruction from both direct and indirect thermal burns. We report a series of three patients who sustained deep injuries that, after débridement, left exposed bones and joints needing acute coverage. Free tissue transfer was required in each case to close the wounds. This short series illustrates the extensive destruction that can occur from both contact burns and radiant heat injury and the reconstructive challenges that can result. Of particular note was that serial débridment was necessary in the radiant heat injury because of the evolving and more extensive nature of the wound.

Reconstruction Challenge — Combined Use of Pectoralis Major and Gastric Pull-up Flaps for Massive Naso-oropharyngeal/Oesophageal Defects

Massive defects of the upper aerodigestive tract present a reconstructive challenge. We report a case in which a large defect of the naso-oropharyngeal and oesophagus was reconstructed with a combination of a gastric pull-up and a pectoralis major muscle flap. Postoperative function was good and survival was in excess of 16 months. The history of such reconstructions and possible alternative techniques are also discussed.

Nasogastric‐tube‐induced unilateral vocal cord palsy

Decontamination of medical equipment, the combination of cleaning, disinfecting and/or sterilisation is used to render a reusable item safe for further use. The alternative is single use followed by disposal. There is currently much variation in decontamination practice for laryngoscopes and the majority of hospitals do not have local guidelines [1]. General guidelines for the decontamination of medical equipment are available [2] but, as Ballin and McCluskey have pointed out, these do not specifically refer to laryngoscopes [3]. The Editor of this Journal has announced that the Association of Anaesthetists has formed a group to advise on appropriate decontamination procedures for laryngoscopes [3]. While we welcome this move, we write to warn that times are changing and that new guidance is urgently needed, not only in relation to laryngoscopes, but for all reusable airway equipment. We now face the presently unquantified risk of our equipment transmitting variant Creutzfeldt±Jakob disease (vCJD). The transmissible agent, an altered form of prion protein, has been isolated from tonsillar and lymphoreticular tissue of human victims [4]. It has also been found in the appendix removed from a patient who subsequently developed the disease [5]. The prion protein is remarkably resistant to common techniques of decontamination, with complete removal considered very difficult [6]. The Department of Health has recently announced that they will follow the advice of the Spongiform Encephalopathy Advisory Committee and introduce single-use instruments for tonsil surgery [7]. Tonsillectomy is currently one of the most frequently performed surgical procedures in the United Kingdom, amounting to about 20% of all ENT operations [8] and this announcement may have major implications for anaesthetic practice. The mainstay of our practice involves airway control, currently using reusable equipment such as laryngoscopes and laryngeal mask airways. Soiling of this equipment with blood is common during ENT procedures such as tonsillectomy. It has been suggested that laryngoscopes used on patients with suspected vCJD are destroyed [1]. In light of the recommendation of single-use surgical equipment for tonsil surgery, we believe that there is an urgent need for national guidance on best practice regarding the decontamination of all airway equipment and advice on the need for singleuse, disposable equipment.

Vascular complications of central venous line insertion.

Edward W.H. To,1 Peter C.W. Pang,2 W.M. Tsang,3 Michael D. Williams,4 Jack H.H. Cheng2 and Anil Ahuja,6 1Oral and Maxillofacial Surgery Center, St. Teresa’s Hospital, 2Division of Head & Neck/Plastic & Reconstructive Surgery, Department of Surgery, Chinese University of Hong Kong, Hong Kong, 3Oral Maxillofacial Surgery & Dental Unit, Prince of Wales Hospital, Hong Kong, 4Department of Maxillofacial Surgery, Kings College Hospital, London and 6Department of Diagnostic Radiology & Organ Imaging, Chinese University of Hong Kong, Hong Kong.