Langerhans' cell histiocytosis of the retropharynx: first reported case.

Langerhans' cell histiocytosis (LCH) is a rare condition characterised by histiocyte proliferation leading to destructive granulomatous lesions. It may occur anywhere in the body but extraosseous manifestations affecting the head and neck are particularly uncommon. Here, we present the first reported case of a mass arising in the retropharyngeal space caused by LCH. The patient was a 33-year-old man with various symptoms which are presented. Although rare, LCH can affect a variety of tissues in the head and neck. Clinicians need to be cognisant of its inclusion in the differential diagnoses for similar cases in their practice, in particular because of potential difficulties in diagnosis.

Management of parapharyngeal space cavernous sinus haemangioma using transoral robotic surgery.

Cavernous haemangiomas are a very rare occurrence in the parapharyngeal space (PPS). Here, we present a case of a 58-year-old woman with an incidentally identified left PPS mass thought to be a pleomorphic adenoma that underwent excision by transoral robotic surgery (TORS). Intraoperative findings demonstrated no solid mass present and histological assessment of resected tissue confirmed a cavernous haemangioma. We discuss our experience in the management of a radiological and surgical mismatch of a PPS mass in what we believe to be the first cavernous haemangioma to be excised by TORS in this region.

Patient classification of two-week wait referrals for suspected head and neck cancer: a machine learning approach.

BACKGROUND: Machine learning algorithms could potentially be used to classify patients referred on the two-week wait pathway for suspected head and neck cancer. Patients could be classified into 'predicted cancer' or 'predicted non-cancer' groups. METHODS: A variety of machine learning algorithms were assessed using the clinical data of 5082 patients. These patients had previously been referred via the two-week wait pathway for suspected head and neck cancer to two separate tertiary referral centres in the UK. Outcomes from machine learning classification were analysed in comparison to known clinical diagnoses. RESULTS: Variational logistic regression was the most clinically useful technique of those chosen to perform the analysis and patient classification; the proportion of patients correctly classified as having 'non-cancer' was 25.8 per cent, with a false negative rate of 1 out of 1000. CONCLUSION: Machine learning algorithms can accurately and effectively classify patients referred with suspected head and neck cancer symptoms.

Revisiting the sternocleidomastoid flap as a reconstructive option in head and neck surgery.

BACKGROUND: The sternocleidomastoid can be used as a pedicled flap in head and neck reconstruction. It has previously been associated with high complication rates, likely due in part to the variable nature of its blood supply. OBJECTIVE: To provide clinicians with an up-to-date review of clinical outcomes of sternocleidomastoid flap surgery in head and neck reconstruction, integrated with a review of vascular anatomical studies of the sternocleidomastoid. METHODS: A literature search of the Medline and Web of Science databases was conducted. Complications were analysed for each study. The trend in success rates was analysed by date of the study. RESULTS: Reported complication rates have improved over time. The preservation of two vascular pedicles rather than one may have contributed to improved outcomes. CONCLUSION: The sternocleidomastoid flap is a versatile option for patients where prolonged free flap surgery is inappropriate. Modern vascular imaging techniques could optimise pre-operative planning.

Swallowing outcomes for patients with oropharyngeal squamous cell carcinoma treated with primary (chemo)radiation therapy receiving either prophylactic gastrostomy or reactive nasogastric tube: A prospective cohort study.

OBJECTIVES: There is currently no consensus on the optimal feeding route for an oropharyngeal squamous cell cancer (OPSCC) patient without pre-existing dysphagia undergoing chemoradiotherapy. This study aimed to compare the swallowing outcomes for OPSCC patients fed via either prophylactic RIG (pRIG) or reactive nasogastric tube (rNGT). DESIGN: A prospective cohort study. SETTING: Four head and neck cancer centres in the North of England Cancer Network. PARTICIPANTS: Fifty-three participants with OPSCC, on a normal diet pre-(chemo) radiotherapy. MAIN OUTCOME MEASURE: Swallowing outcomes for patients with rNGT and pRIG were compared using the following outcome measures administered prospectively at pre-treatment, three and 12 months post-treatment: MD Anderson Dysphagia Inventory (MDADI), Performance Status Scales (Normalcy of Diet), timed water swallow test. RESULTS: Twenty-three patients received pRIG while 30 were planned for a rNGT. No differences in demographics were found between the groups. The rNGT group had a clinically significant higher score on MDADI at 12 months post-treatment. No significant difference was found on a timed water swallow test or diet texture scale. CONCLUSIONS: There is no statistical difference for swallowing outcomes in either group. However, patients' in the rNGT group reported a clinically meaningful difference at 1 year, with a trend for them to do better across all measures. Neither group returned to their baseline swallowing function. Further research with a larger sample size is indicated.

Factors affecting duration of gastrostomy tube retention in survivors following treatment for head and neck cancer.

BACKGROUND: Many patients treated for head and neck cancer require nutritional support, which is often delivered using a gastrostomy tube. It is difficult to predict which patients will retain their gastrostomy tube in the long term. This study aimed to identify the factors which affect the duration of gastrostomy tube retention. METHOD: In this retrospective study, 151 consecutive patients from one centre were audited. All patients had a mucosal tumour of the head and neck, and underwent gastrostomy tube insertion between 2003 and 2007. RESULTS: There were near-complete data sets for 132 patients. The gastrostomy tube was retained in survivors (n = 66) for a mean of 21.3 months and in non-survivors (n = 66) for 11.9 months. Univariate analysis showed that co-morbidity was the only factor which significantly increased duration of gastrostomy tube retention in survivors (p = 0.041). CONCLUSION: Co-morbidity alone was associated with a significant increase in gastrostomy tube retention. It is suggested that co-morbidity be included as a variable in future relevant research. Co-morbidity should also be considered when counselling patients about their long-term function following cancer treatment. Gastrostomy tube retention is likely to be affected by many factors, with few single variables having importance independently.

Throat-related quality of life in peritonsillar abscess sufferers: application of the adult tonsil outcome inventory.

OBJECTIVE: To investigate throat-related quality of life in peritonsillar abscess sufferers. METHOD: The adult tonsil outcome inventory questionnaire, which is a validated throat-related quality of life tool, was administered to individuals who had recently suffered a peritonsillar abscess and to control subjects. RESULTS: The mean inventory score was significantly higher (reflecting poorer throat-related quality of life) in peritonsillar abscess sufferers (n = 55, mean score 25.8 out of 100) than in age- and gender-matched controls (n = 55, mean score 8.7) (p < 0.001). Neither gender nor interval between episode of peritonsillar abscess and inventory completion date were significantly correlated with the overall questionnaire scores. However, younger abscess sufferers reported greater symptom severity and throat-related quality of life impact than older abscess sufferers. CONCLUSION: Peritonsillar abscess had a significant impact on throat-related quality of life. In many, peritonsillar abscess represented an acute episode on a background of chronic throat problems. For optimal management, notably the place and timing of tonsillectomy, this impact should be taken into account. The adult tonsil outcome inventory is an ideal tool for use in clinical practice.

Prophylactic gastrostomy before chemoradiation in advanced head and neck cancer: a multiprofessional web-based survey to identify current practice and to analyse decision making.

AIMS: Patients with advanced squamous carcinoma of the head and neck who are treated with concurrent chemoradiotherapy schedules are often referred for gastrostomy tube (G-tube) insertion. Decision making to select appropriate patients is inconsistent and the factors that lead healthcare workers to make this recommendation are not well understood. Therefore, by means of a web-based questionnaire we sought the views of a variety of healthcare professionals as to their current practice with regard to various issues surrounding the recommendation of G-tube insertion use in these patients and analysed the responses with regard to decision making. MATERIALS AND METHODS: Questions were generated after discussion among and agreement from all members of a single National Health Service Trust head and neck multidisciplinary team and were hosted on a website. Appropriate individuals were identified through their governing body organisations and invited by e-mail to complete the questionnaire. The results were pooled and analysed. RESULTS: Recommendations for gastrostomy were not based on tumour subsite. Four of 14 patient-related factors were significantly associated with the recommendation for gastrostomy. Medical and allied healthcare professionals (including nursing staff) significantly differed in their opinions as to the effect of G-tubes on the resumption of oral intake (P=0.009). CONCLUSIONS: There is no national consensus on which patients to recommend for gastrostomy and consideration should be given to the development of clinical decision-making models in an attempt to systematise the decision-making process.

Biopsy examination of squamous cell carcinoma of the tongue: source of significant prognostic information?

Histological analysis of tumour resection for squamous cell carcinoma (SCC) of the tongue yields prognostic information. We analysed histological slides of biopsy and tumour resection specimens using an adapted malignancy grading score and analysed variables of neck dissections. There was moderate correlation between biopsy and tumour resection using malignancy grading scores (correlation coefficient 0.45); good agreement of tumour grade (79%), tumour depth (76%), and type of invasive front (80%), but correlation was only fair to moderate (κ=0.38, κ=0.51, and κ=0.41, respectively). Correlation of the biopsy grading score and invaded nodes in the neck, extra capsular spread, and soft tissue disease was not significant.

Can laryngectomees smell? Considerations regarding olfactory rehabilitation following total laryngectomy.

Total laryngectomy is performed for patients with advanced malignancy of the larynx and pharynx, and disconnects the nose and mouth from the lower respiratory tract. Rehabilitation of olfactory function in these patients is often neglected, despite recognition that anosmia and hyposmia are common and can readily be addressed. This paper reviews the literature concerning olfactory loss post-laryngectomy, methods of olfactory rehabilitation, assessment of olfactory function and quality of life issues.

Aggressive angiomyxoma of larynx: case report and literature review.

OBJECTIVE: We report the second known case of aggressive angiomyxoma of the larynx. METHOD: Case report and a review of the world literature concerning angiomyxoma of the larynx and recent advances in the immunohistochemical, cytogenic and clinical study of its female pelvic counterpart. RESULTS: Aggressive angiomyxoma is a rare mesenchymal tumour originally thought only to occur in the female pelvis and peritoneum, or rarely in the male genital tract. A 47-year-old man presented with a one-month history of dysphonia. He was found to have a supraglottic mass on endoscopic examination, and underwent a laryngofissure approach excision biopsy and covering tracheostomy. Histological analysis showed a characteristic proliferation of spindle cells widely separated by loose, myxoid stroma with a prominent vascular component. Aggressive angiomyxoma was diagnosed. CONCLUSION: To our knowledge, this is the second report in the world literature of aggressive angiomyxoma of the larynx. Comparison with the female pelvic counterpart facilitates diagnosis, aided by recent advances, and suggests that complete surgical excision with a wide margin is the treatment of choice.

A quartet of lateral sinus thrombosis, extradural abscess, subdural abscess and occipital abscess: complications of acute mastoiditis in a pre-adolescent child.

Neurological complications of acute mastoiditis are rare but can be life threatening. Their presentation may be masked by the use of antibiotics. We present a unique case of acute otitis media progressing to occipital, extradural and subdural abscess formation and lateral sinus thrombosis in a child. The clinical course and management of a pre-adolescent male is presented and discussed. We review the incidence, presentation and treatment of occipital abscesses and lateral sinus thrombosis with acute mastoiditis. Following extended cortical mastoidectomy, neck exploration and broad spectrum intravenous antibiotics, the patient made a full recovery. This is the first reported case of acute mastoiditis associated with occipital abscess in a child. Early, aggressive treatment is required for a successful outcome. The rarity of neurological complications, in addition to the insidious onset and subtle symptoms associated with antibiotic therapy, can make diagnosis extremely difficult. Patients with acute otitis media who fail to respond fully to treatment should be referred early for a specialist otology opinion.

Limited form of Churg-Strauss syndrome presenting as a mass in the neck.

A 53-year-old man was referred to the ENT department with a large mass in the left supraclavicular fossa. The histological diagnosis showed the mass to have arisen due to a granulomatous vasculitis consistent with Churg-Strauss syndrome (CSS). CSS usually comprises asthma, eosinophilia and systemic vasculitis although limited forms of the disease exist where one of these diagnostic criteria is missing. This is one such case as the patient was non-asthmatic.