Neck Surgical Practice Research Articles

Considerations for environmentally sustainable head and neck surgical oncology practice.

To evaluate the potential role of head and neck oncologic surgeons in environmental protection, sustainability of health-care systems and avoidance of procedures contributing to climate change in the future. This literature review searched for relevant literature about the relevance of waste in surgical head and neck oncology practice and the innovative alternatives to decrease its effect on environment. Head and neck oncologic surgeons have a role in environmental protection, sustainability of health-care systems and avoidance of procedures contributing to climate change in the future. However, there exist only limited data on waste management and other procedures in surgical oncology to promote these practices. By increasing awareness of the corresponding issues of waste production within the healthcare environment, head and neck surgeons can have a pioneering role in considering how to reduce, recycle and reuse in a more efficient manner. As research in this field accumulates, healthcare providers can engage both managers and clinicians in this process. It remains imperative to provide these professionals opportunities for their work force to rethink current practices in a manner that prioritizes environmentally sustainable head and neck surgical practices.

Yutma güçlüğüne neden olan retrofarengeal kitle: servikal kordoma

Kordomalar, notokordun embriyolojik artıklarından kaynaklanan nadir primer kemik tümörleridir. Servikal bölge yerleşimli kordomalar oldukça nadir görülmektedir. Tüm kordomaların %5 kadarını oluşturan servikal kordomalar, komşu oldukları parafarengeal bölge, orofarenks gibi anatomik boşluklara uzanım gösterip; boyunda şişlik, orofarenkste kitle, yutma güçlüğü, nefes darlığı benzeri klinik bulgular verebilirler. Bu olgu sunumunda yutma güçlüğü şikayeti ile başvuran ve orofarenkste kitle olarak bulgu veren servikal kordoma olgusunun klinik özellikleri sunulmuş, tanıda yaşanan güçlükler ve cerrahi bulgular tartışılmıştır.

Current applications of ultrasound-guided wire localization in head and neck surgery

Ultrasound-guided wire localization (USGWL) was originally developed for the removal of impalpable breast lesions. More recently, USGWL has been described in head and neck surgical practice and it has a number of applications in this field, with the potential to guide surgical exploration and the benefits of reducing operative time and morbidity. This technical note describes the use of preoperative USGWL to facilitate the removal of an impalpable neck node. A review of the current literature relating to the present applications of this technique in head and neck surgery is reported, highlighting its advantages and disadvantages.

OP077: Feasibility and surgeon acceptability of visualisation with Lugol’s iodine (VILI) in the lihncs trial

Residual margin dysplasia is a cause of disease failure in SCCHN. The LIHNCS trial is a multicenter randomized controlled trial (RCT) assessing the effectiveness of visualization with Lugol’s iodine (VILI) vital staining to reduce margin dyplasia at resection of Oral and Oropharyngeal squamous cell carcinoma (SCC). As part of this investigation we are investigating feasibility of the technique in head and neck surgical practice and the acceptability of the technique to surgeons. Questionnaire survey and telephone interviews were conducted with surgeons participating in the LIHNCS randomized controlled clinical trial. Data collected included surgeon views on trial participation, difficulties encountered in the trial processes including consent, maintenance of equipoise and randomization. Specific information on acceptability of the VILI technique was obtained and analysed. Twenty-three surgeons were recruiting to the study when this data was obtained. There was a high proportion of recognition of the importance of involving patients in RCTs. Some surgeons reported cases where patients refused participation and requested use of VILI rather than randomization in the trial. The VILI technique did not add significantly to overall surgical time. Further detailed analysis of surgeon acceptability will be presented. UK Head and Neck Surgeons recognize the high level importance of recruitment to clinical trials in surgery. Difficulties encountered in this trial have not restricted recruitment of eligible patients. The VILI technique has high acceptability among surgeons recruiting to the LIHNCS trial.

Poor Outcomes in Head and Neck Non-Melanoma Cutaneous Carcinomas

Objectives: Head and neck nonmelanoma cutaneous carcinomas (NMCC) may have poor outcomes, such as metastasis and recurrence. It remains unclear which patients are at increased risk for poor outcomes. We characterize a population of NMCC seen in a head and neck surgical practice. We sought to identify predictors of poor outcome in head and neck NMCC. Study Design: A retrospective cohort study of 161 patients with head and neck NMCC who presented to a university based otolaryngology-head and neck surgery practice over a 13 year period was performed. The study group included 127 men and 34 women, age range: 33 - 92 years. Subjects and Methods: Tumor characteristics of the study population were recorded, and statistical analysis and Kaplan- Meier survival calculations were performed to determine predictors of poor outcomes. Results: 113 squamous cell carcinomas (SCC) and 48 basal cell carcinomas (BCC) were identified. Among SCC patients, there was a 44% incidence of metastasis and a 47% incidence of recurrence. Among BCC patients, there was a 10% incidence of metastasis and a 50% incidence of recurrence. Twenty percent of SCC patients had a history of immunosuppression. Among SCC patients with immunosuppression, 83% had metastasis or recurrence. Survival for SCC patients with metastatic disease was significantly worse than patients without metastases. The presence of parotid metastases in SCC conferred a survival advantage when compared to other sites of metastases. Conclusion: The incidence of poor outcomes in NMCC was higher in our series than reported in the literature. Survival patterns of our study parallel those of similar studies in the literature.

Syndrome of Inappropriate Antidiuretic Hormone Secretion in Cancer of the Head and Neck

The syndrome of inappropriate secretion of arginine vasopressin (AVP) known as the syndrome of inappropriate antidiuretic hormone secretion (SIADH) is characterized by hyponatremia that results from water retention attributable to persistent AVP release. It may occur in a variety of malignant and nonmalignant lesions, with small cell or oat cell carcinoma of the lung by far responsible for the largest number of these cases. Cancer of the head and neck may be a rare cause of SIADH, and only a few such cases have been reported. We describe four patients with advanced cancer of the head and neck region with coexisting SIADH. Diagnosis and treatment are reported and the literature is reviewed. The possible occurrence of SIADH in the head and neck surgical practice should be kept in mind. Since SIADH is usually transient, water restriction and parenteral sodium chloride may be sufficient in overcoming the acute phase.