Peter M. Clarke

Role of Planned Postchemoradiotherapy Selective Neck Dissection in the Multimodality Management of Head and Neck Cancer

Objective/Hypothesis: To assess the oncologic efficacy and functional outcome of selective postchemoradiotherapy neck dissection for stage IV head and neck squamous cell carcinoma.

Cricothyroid Approximation and Thyroid Chondroplasty: A Patient Survey

OBJECTIVE Cricothyroid approximation is performed in male-to-female transsexuals to raise the pitch of the voice often accompanied by a thyroid chondroplasty, an aesthetic reduction of the thyroid cartilage. The survey was conducted to ascertain patient satisfaction with the procedures. STUDY DESIGN AND SETTING Fifty-four patients had the procedures performed in our department over an 8-year period; 45 patients were sent postal questionnaires to evaluate patient satisfaction with the appearance of the laryngeal prominence, pitch of the voice, and which they found more beneficial, the surgery or speech therapy. RESULTS A response rate of 93% was obtained; 86% of patients thought their laryngeal profile had improved, 79% thought their voice had improved, and 55% thought that surgery and 21% thought that speech therapy had helped more in improving the voice. Overall, 79% were satisfied with the results of the surgery. CONCLUSIONS Cricothyroid approximation and thyroid chondroplasty have a high patient satisfaction rate.

A national analysis of the outcome of major head and neck cancer surgery: implications for surgeon-level data publication

To undertake a national outcomes analysis following major head and neck cancer surgery in order to identify risk factors for complications and in‐hospital mortality, as well as areas whose closer examination and formal benchmarking in the context of local and national quality assurance audits may lead to improved results for this condition.

Incidence and Significance of Myocardial Injury After Surgical Treatment of Head and Neck Cancer

Objective/Hypothesis: To review the incidence of, and risk factors for myocardial injury after head and neck surgery to help optimize patient care and develop perioperative cardioprotective strategies.

Intracranial polyps in patients with Samter's triad

Background We describe three patients with Samters triad (nasal polyps, aspirin intolerance, and asthma) with skull base dehiscence in whom the polyps extended into the extradural space and also resulted in hypertelorism and widening of the nasal bridge. Methods One patient died in a road traffic accident while awaiting surgery. The other two patients underwent endoscopic resection of the polyps with a combined osteoplastic flap. Results Histology confirmed benign eosinophilic polyps with edematous stroma and a markedly thickened basement membrane. There were no complications or revision procedures. Both are symptomatically well with improvement of the hypertelorism. Conclusion These cases indicate that polyps in Samters triad may be extremely aggressive, resulting in intracranial extension. A combined endoscopic and osteoplastic flap approach is a safe and effective surgical option.

How we do it: a method of neck dissection for histopathological analysis

BackgroundDissection of the lymphatic structures in the neck is an integral part of the management of many head and neck cancers.We describe a technique of surgical dissection, preparing the tissue for more precise histological analysis while also reducing operative time and complexity.MethodsWhen dissected, each level is excised between lymph nodes groups and put into a separate pot of formalin taking care to avoid rupture of any obvious pathological nodes.ResultsThis makes for a simpler dissection as the surgeon progresses, as a larger more cumbersome specimen is avoided and manipulation of involved nodes is actually reduced with a reduced risk of tumour spillage.ConclusionWe feel that our technique provides several advantages for the histopathologist as well as the surgeon. As the dissection of the specimen into the relevant levels has already been performed, time is saved in orientating and then dissecting the specimen. Accuracy of dissection is also improved and each piece of tissue is a more manageable size for processing and analysis.This technique may also have several surgical advantages when compared with the commonly practiced techniques e.g. with reducing in-vivo specimen manipulation, hence reducing the risk of inadvertent injury to important structures and tumour spillage.

Development and validation of a health informatics algorithm for identifying major head and neck cancer surgery amidst Hospital Episode Statistics data

1 MullaceM., Gorini E., SbroccaM. et al. (2006)Management of nasal septal perforations using silicone nasal septal button. Acta Otorhinolaryngol. Ital. 26, 216–218 2 Blind A., Hulterstr€ om A. & Berggren D. (2009) Treatment of nasal septal perforations with a custom-made prosthesis. Eur. Arch. Otorhinolaryngol. 266, 65–69 3 Døsen L.K. & Haye R. (2008) Silicone button in nasal septal perforation. Long term observations. Rhinology 46, 324–327

Use of posaconazole in the treatment of infective rhinocerebral mucormycosis

INTRODUCTION A patients with undiagnosed type II diabetes mellitus presented with infective rhinocerebral mucormycosis. INVESTIGATION RESULTS: Initial magnetic resonance imaging scans demonstrated an aggressive disease process involving the left orbit and paranasal sinuses. A repeated scan following treatment excluded intracranial spread or recurrence. Pus from the paranasal sinuses grew Rhizopus arrhizus on microbiological culture. MANAGEMENT Initial treatment comprised intravenous liposomal amphotericin B, intravenous co-amoxiclav and surgical debridement. The patients diabetes was managed medically. The development of drug-induced transaminitis required a change of medication. The dose of liposomal amphotericin B was reduced, and then titrated back up as the liver function test results improved. Posaconazole was also introduced and the patient was eventually discharged on this alone, as the maximum recommended cumulative dose of liposomal amphotericin B had been reached. CONCLUSIONS Posaconazole may be used effectively in conjunction with surgical debridement in the treatment of patients with infective rhinocerebral mucormycosis who develop hepatotoxic side effects to liposomal amphotericin B. Posaconazole may also allow a reduction in the dose of liposomal amphotericin B, resulting in better tolerance.

Prophylaxis of nasolacrimal duct obstruction after major sinus surgery using a silicone stent

Damage to the nasolacrimal duct during major sinus procedures results in troublesome symptoms of epiphora and acute infection. Prophylactic stenting of the lacrimal apparatus using a silicone stent is described as a means of preventing such complications.

Craniofacial resection and its role in the management of sinonasal malignancies

Sinonasal malignancy is rare, and its presentation is commonly late. There is a wide variety of pathologies with varying natural histories and survival rates. Anatomy of the skull base is extremely complex and tumors are closely related to orbits, frontal lobes and cavernous sinus. Anatomical detail and the late presentation render surgical management a challenging task. A thorough understanding of anatomy and pathology combined with modern neuroimaging and reliable reconstruction within a multidisciplinary team is imperative to carry out skull base surgery effectively. While endoscopic approaches are gaining credibility, clearly, it will be some time before meaningful comparisons with craniofacial resection can be made. Until then, craniofacial resection will remain the gold standard for managing the sinonasal malignancies of the anterior skull base, as it has proved to be safe and effective.