Transoral robotic surgery in head neck cancer management.

Head and Neck cancer can be treated by non-surgical or surgical modalities. Current surgical techniques include open surgery and transoral resections. The latter have the distinct advantage of quicker recovery and reduced hospital stay. The further down the aerodigestive tract tumours are sited, the more difficult is the transoral access, requiring techniques that combine magnification and finer instrumentation. Thus, while oral cavity tumours can be removed transorally without special equipment, the need to address oropharyngeal and laryngeal cancers led to the evolution of transoral laser microsurgery. Transoral robotic surgery (TORS) improves the visualisation, the instrumentation and the ergonomics in transoral resections and is also used primarily in the treatment of oropharyngeal and laryngeal cancer. Current evidence suggests that the oncologic and functional outcome of TORS surgery is good as speech and swallowing mechanisms are better preserved. This review will provide the reader an insight into the role of TORS in head and neck practice.

A comparison of the shrinkage of commercial bone cements when mixed under vacuum.

The outcome of a cemented hip arthroplasty is partly dependent on the type of cement which is used. The production of an interface gap between the stem and the cement mantle as a result of shrinkage of the cement, may be a factor involved. Palacos R, Palacos LV (both with gentamicin), CMW 1, CMW 2, CMW Endurance (CMWE) and Simplex were prepared under vacuum and allowed to cure overnight in similar cylinders. The next day this volume was determined by the displacement of water. Shrinkage varied between 3.82% and 7.08% with CMWE having the lowest and Palacos LV the highest. This could be a factor to consider when choosing a cement for a shape-closed stem.

Incidence of infection with the use of non-irradiated morcellised allograft bone washed at the time of revision arthroplasty of the hip.

Implantation of allograft bone is an integral part of revision surgery of the hip. One major concern with its use is the risk of transmission of infective agents. There are a number of methods of processing allograft bone in order to reduce this risk. One method requires washing the tissue using pulsed irrigation immediately before implantation. We report the incidence of deep bacterial infection in 138 patients (144 revision hip arthroplasties) who had undergone implantation of allograft bone. The bone used was fresh-frozen, non-irradiated and pulse-washed with normal saline before implantation. The deep infection rate at a minimum follow-up of one year was 0.7%. This method of processing appears to be associated with a very low risk of allograft-related bacterial infection.

Pharyngeal angiosarcoma following multimodal treatment for oropharyngeal squamous cell carcinoma.

It is well established that angiosarcoma can develop following radiotherapy. We present an unusual case of angiosarcoma of the pharynx that developed three years after treatment with surgery and adjuvant chemoradiotherapy for a T2N2bM0 squamous cell carcinoma of the oropharynx. The patient was tumour free until developing dysphagia, which was found to be caused by an angiosarcoma. The patient underwent surgery of the pharyngeal angiosarcoma by laryngopharyngectomy, tongue base resection, selective neck dissection and radial forearm microvascular free flap reconstruction. Angiosarcoma following head and neck malignancy is rare but must be considered as part of the differential diagnosis in patients with new symptoms after radiotherapy.