Direct skin involvement of cervical lymph node metastasis from mucosal squamous cell carcinoma of the head and neck.

INTRODUCTION: Direct skin involvement of nodal metastasis from mucosal head and neck squamous cell carcinoma has traditionally been considered a poor prognostic indicator. METHODS: This retrospective review identified eight patients (five with mucosal upper aerodigestive and three with occult primary squamous cell carcinoma) who presented between 2000 and 2007 with direct skin involvement of nodal metastasis. RESULTS: Five patients were treated with extended radical and three with extended modified radical neck dissection. Closure was achieved directly (four cases), with local (two) or pedicled (two) flaps. Surgery was always followed by radiotherapy (pan-mucosal or to the primary site). The five-year recurrence-free and disease-specific survival rates were 100 per cent. CONCLUSION: It is exceptionally rare to encounter direct skin involvement of metastatic lymph nodes from mucosal head and neck squamous cell carcinoma without evidence of involvement of other anatomical structures. Surgical intervention is possible and combined modality treatment with curative intent is essential, as most patients can have a favourable outcome.

Is a head bandage useful after otoplasty? A quasi-randomized controlled study of complications and patient satisfaction.

We conducted a prospective, quasi-randomized, controlled study to evaluate the incidence of postoperative complications and the degree of long-term patient satisfaction associated with the use or nonuse of a head bandage following otoplasty (pinnaplasty). Our study population was made up of 84 consecutively presenting patients who had undergone bilateral otoplasty (either an antihelical or conchaplasty procedure) for the correction of prominent ears under general anesthesia from January 2000 through March 2005. Patients ranged in age from 5 to 56 years (median: 13); 69 patients (82%) were aged 19 years and younger. Of the 84 patients, 61 (73%) received a postoperative head bandage and 23 (27%) did not. Data on complications were collected prospectively from case notes. Data on long-term satisfaction were obtained prospectively on the basis of answers to a questionnaire survey (90% response rate) in which patients rated their satisfaction on a visual analog scale from 0 (not at all satisfied) to 10 (completely satisfied). We found no significant difference between the head-bandage group and the no-head-bandage group with respect to complication rates (36 and 26%, respectively; p = 0.3) or long-term patient satisfaction scores (6.56 and 8.46; p = 0.09). According to multiple regression analysis, the performance of conchaplasty (as opposed to antihelical procedures) appeared to be the only independent variable that influenced both of the outcomes measures (i.e., fewer complications and greater long-term patient satisfaction). Two independent variables were found to influence long-term patient satisfaction only: the presence/absence of any complication and the individual surgeon who performed the procedure. There was no correlation between individual surgeons and complications. We conclude that the use of a head bandage is not necessary or advantageous following otoplasty for the correction of prominent ears, particularly in patients who have undergone cartilage plication.

Diagnosis of recurrent laryngeal nerve palsy after thyroidectomy: a systematic review.

BACKGROUND: Recurrent laryngeal nerve palsy (RLNP) is a recognised possible complication after thyroid surgery. It may present with a variety of symptoms, such as voice change and respiratory symptoms. However, it may remain undetected and the true incidence may be under-reported. The aim of this study was to determine the reported incidence of temporary and permanent palsy after thyroid surgery using different vocal assessment methods. METHODS: A Medline search was performed. A systematic review was undertaken which included 27 articles and 25,000 patients. RESULTS: The average incidence of temporary RLNP after thyroid operations is 9.8% and the incidence of permanent RLNP is 2.3%. The RLNP rate varied according to the method of examining the larynx and ranged from 26% to 2.3%. Most of the reviewed studies recommend a follow-up period up to 1 year to assess and evaluate RLNP. CONCLUSION: Our study has identified that different methods are used to diagnose RNLP and that a wide variety of reported RLNP rates exist. We propose establishment of a 'gold standard' for assessing the voice after thyroidectomy to reduce reporting bias.

Natural radioactivity levels and radiation hazard indices in granite from Aswan to Wadi El-Allaqi southeastern desert, Egypt.

Studies on radiation level and radionuclide distribution in granite from Aswan to Wadi El-Allaqi area that is located in southeastern desert of Egypt were undertaken. The samples collected from five locations: Gabal El Mesala, Umm Hibal, Abu Herigle, Abu Marw and Deneibit El Quleib. The purpose of this study is to provide a baseline map of radioactivity background levels in the investigated area environment, and this study will be used as reference information to assess any changes in the radioactive background level due to geological processes. The highest average values of 226Ra and 232Th concentrations (24.00 and 31.28 Bq kg(-1), respectively) were observed at Abu Herigle region, whereas the highest average value of 40K concentration, 589.95 Bq kg(-1), was detected in Umm Hibal. The absorbed dose rate in air was found to be in the range between 5.40 and 45.11 nGy h(-1), and radium equivalent activity concentration was found in the range between 29.57 and 71.85 Bq kg(-1). Also the representative external hazard index values for the corresponding samples were also estimated and given.

Cochlear implant outcomes and quality of life in the elderly: Manchester experience over 13 years.

OBJECTIVES: To objectively evaluate the clinical and functional outcomes of cochlear implantation in an elderly population. DESIGN: Retrospective comparative study. SETTING: Neurotology unit at Manchester Royal Infirmary, a supraregional tertiary referral centre in collaboration with Adult Cochlear Implant Programme at The University of Manchester. PARTICIPANTS: All cochlear implant procedures (38) undertaken on post-lingually deafened elderly patients (age range at the time of implantation 65-80 years, n = 34) in the period from 1989 to 2002. MAIN OUTCOME MEASURES: Medical and surgical outcomes. Audiological performance outcomes for isolated words, words in sentences in quiet and noise. Functional outcome measures used are self-reported measures of the social, psychological and emotional aspects of quality of life, and the differences between expectations for functional outcomes and the realization of functional outcomes. They included expectation profiles, Glasgow Benefit inventory (GBI) and Glasgow Health Status Inventory Questionnaire (GHSI). RESULTS: There was statistically significant improvement post-implantation of both open and closed set test scores (P < 0.01). Eighty-two percentage of patients were completely satisfied with their cochlear implants. Patients judged that implantation restored half the loss of quality of life that they had experienced as a result of severe-profound deafness with a highly significant (P < 0.001) improvement in overall quality of life after implantation. The commonest post-operative observation was transient mild pyrexia. CONCLUSIONS: The age of a cochlear implant candidate should not be a factor in the candidacy decision-making process. The quality of life of our elderly recipients was significantly improved after cochlear implant.

The influence of the Internet on decision making in acoustic neuroma.

OBJECTIVE: To determine the access to and the use of the Internet by acoustic neuroma patients as a medical information source, and the influence of the Internet on decision-making, as well as the patients' views on the quality of particular sites. MATERIALS AND METHODS: A retrospective 27-item questionnaire was sent to 138 consecutive acoustic neuroma patients diagnosed between 1997 and 2002. The study included patients treated by conservative, radiotherapeutic and surgical modalities. MAIN OUTCOME MEASURES: Patient demographics, the extent of Internet use as well as quality and quantity of available information. RESULTS: There were 86.95 per cent questionnaires available for analysis. Twenty-four per cent accessed the Internet to obtain information about acoustic neuromas. Ninety-seven per cent of patients said that the information provided in the clinic matched with the information obtained from the websites, 49 per cent said that the information obtained from the Internet did not influence decision making regarding acceptance of treatment of their tumour. Some patients said the Internet information was depressing, devastating, and they would never look up the Internet again for medical information. CONCLUSION: A significant proportion of our patients accessed the Internet for information. Caution should be exercised when advising patients regarding websites as the information on the Internet is often not controlled or checked for accuracy. Acoustic neuroma specialists and ENT surgeons in general should familiarize themselves with related websites so that patients can then be directed to high-quality sites.

Stylomandibular tenotomy in the transcervical removal of large benign parapharyngeal tumours.

We used a simple modification of the transcervical approach in a selected group of nine patients with large benign parapharyngeal space tumours, all of whom met the following inclusion criteria: The tumour was benign on fine needle aspiration, the encapsulated tumour was not attached to skull base or great vessels in the parapharyngeal space on imaging. Adequate exposure was achieved by just dividing the stylomandibular ligament and retracting the mandible anteriorly. It was possible to remove the tumours successfully and safely in all nine patients without the need for mandibulotomy or superficial parotidectomy. In seven cases, the tumour crossed the midline. There were no major perioperative neurological or vascular complications. On subsequent follow up, there were no clinical or radiological signs of residual or recurrent tumour.