A detailed anatomical assessment of the lateral tongue extrinsic musculature, and proximity to the tongue mucosal surface. Does this confirm the current TNM T4a muscular subclassification?

PURPOSE: The current T4a subclassification of the TNM staging system for oral malignancies has been criticised as based almost exclusively on anatomical data. The aim of this study was to provide anatomical confirmation of the muscular constraints of T4a classification of oral tongue tumours. METHODS: A detailed anatomical study describing and measuring the adjacency of the named extrinsic tongue muscles to the lateral tongue surface was completed on the Visible Human Female (VHF). The distance of styloglossus and hyoglossus to the over lying mucosa were determined. RESULTS: The appearance, position, orientation and anatomical relationships of the lateral tongue extrinsic muscles, with comparison to their classical descriptions are described. The right VHF styloglossus was 1.3 mm (0.33-1.48) and left 2.91 mm (0.66-7.68) from the mucosal surface in the axial plane. The right VHF hyoglossus was 2.93 mm (1.48-4.96) and left 4.33 (1.68-8.71) from the mucosal surface in the axial line. CONCLUSIONS: In the lateral tongue, styloglossus and hyoglossus are very superficial. The inclusion criteria of hyoglossus and styloglossus in the T4a staging does not appear justified based upon their anatomical position.

Quality improvement in action. Direct general practitioner referrals to audiology for the provision of hearing aids: a single centre review.

Direct referral audiology clinics (DRACs) for the assessment and provision of hearing aids in those over 60 years of age were initially introduced in the National Health Service (NHS) as a method to decrease outpatient waiting times and reduce demand on ear, nose and throat (ENT) appointments. We retrospectively reviewed the electronic records of 353 patients referred to the DRACs at our hospital over a four-month period to determine the continued benefits of a DRAC service, in terms of impact upon ENT appointments, and appropriate general practitioner (GP) use of the clinics. Of the 353 patients seen within the DRAC clinics, 320 were ultimately provided with a hearing aid. Fifty five patients required review by an otolaryngologist, either being referred directly by the audiology department or referred back to their GP for re-referral. The greatest lack of adherence to the referral criteria for DRAC appointments related to appropriate treatment of wax within the community, with two patients declining an aid when their perceived improvement in hearing was significant following microsuctioning. DRACs appear to continue to provide a cost-benefit to the NHS, reducing demand on ENT appointments, but further improvements could be made within primary care to further utilise this service.