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Objective: The ENT Scotland society (formerly known as the Scottish Otolaryngological Society) has two meetings a year and accepts oral presentations from trainees. This study aimed to identify publication rates from these meetings. Methods: Abstracts of the presentations are published in The Journal of Laryngology and Otology. A structured search on PubMed and Google Scholar was undertaken to identify which presentations from the 2005 to 2014 meetings have been published. Results: Of the 145 abstracts found, 60.7 per cent were presenting clinical research and 44.1 per cent were related to the head and neck subspecialty. Seventy-three abstracts (50.3 per cent) were associated with publication as a peer-reviewed article; otology papers were more likely to be published than those focusing on other subspecialties (64.3 per cent, p = 0.036). No correlation was found between publication and other factors. Conclusion: Presentations at the ENT Scotland meetings undergo unbiased peer review and are as likely to be published as those of other conferences. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to highlight the key studies that have led to the current understanding and treatment of head and neck cancer. Method: The Thomson Reuters Web of Science database was used to identify relevant manuscripts. The results were ranked according to the number of citations. The 100 most cited papers were analysed. Results: A total of 63 538 eligible papers were returned. The median number of citations was 626. The most cited paper compared radiotherapy with and without cetuximab (3205 citations). The New England Journal of Medicine had the most citations (23 514), and the USA had the greatest number of publications (n = 66). The most common topics of publication were the treatment (n = 45) and basic science (n = 19) of head and neck cancer, followed by the role of human papillomavirus (n = 16). Conclusion: This analysis highlighted key articles that influenced head and neck cancer research and treatment. It serves as a guide as to what makes a 'citable' paper in this field. [ABSTRACT FROM AUTHOR]

Background: Ex utero intrapartum treatment ('EXIT' procedure) is a well described method for maintaining maternal–fetal circulation in the setting of airway obstruction from compressive neck masses. When ex utero intrapartum treatment to airway is not feasible, ex utero intrapartum treatment to extracorporeal membrane oxygenation ('ECMO') has been described in fetal cardiopulmonary abnormalities. Objective: This paper presents the case of a massively compressive midline neck teratoma managed with ex utero intrapartum treatment to extracorporeal membrane oxygenation, allowing for neonatal survival, with controlled airway management and subsequent resection. Case report: A 34-year-old-female presented with a fetal magnetic resonance imaging scan demonstrating a 15 cm compressive midline neck teratoma. Concern for failure of ex utero intrapartum treatment to airway was high. The addition of the ex utero intrapartum treatment to extracorporeal membrane oxygenation procedure provided time for the planned subsequent resection of the mass and tracheostomy. Conclusion: Ex utero intrapartum treatment procedures allow for securement of the difficult neonatal airway, while maintaining a supply of oxygenated blood to the newborn. Ex utero intrapartum treatment circulation lasts on average less than 30 minutes. The arrival of extracorporeal membrane oxygenation has enabled the survival of neonates with disease processes previously incompatible with life. [ABSTRACT FROM AUTHOR]

The article presents abstracts of studies presented at the ENT Scotland Winter Meeting on November 21, 2014 in Sterling, Scotland, including topics on congenital nasal pyriform aperture stenosis, ear, nose and throat (ENT) smartphone applications, and infantile laryngomalacia.

Objectives: Electrochemotherapy uses electric fields to facilitate the influx of chemotherapy into cancer cells, producing a targeted effect. For head and neck cancer, it is mainly used for palliation of non-skin-origin metastases. It is used infrequently in the UK. This paper presents our experience and a UK survey to identify its frequency of use. Methods: Between 2016 and 2019, a prospective database was created and reviewed. Only patients with non-skin-origin metastatic head and neck cancer, with no other palliative options, were included. Survival length, complications and symptomatic benefit were assessed. The survey was conducted via e-mail. Results: Five patients were included: three with squamous cell carcinoma, one with esthesioneuroblastoma and one with hepatocellular carcinoma. Survival ranged from 1 month to over 20 months. Minor complications were seen. Only 15 out of 69 UK head and neck multidisciplinary teams offer electrochemotherapy. Conclusion: Electrochemotherapy is a well-tolerated adjunct to standard palliation of metastatic head and neck cancer, and is offered by a limited number of UK multidisciplinary teams. [ABSTRACT FROM AUTHOR]

Background: Extracranial internal carotid artery pseudoaneurysm is very rare in children. Method: This paper discusses the case of a boy, aged two years and six months, who presented with an enlarging neck mass and unilateral bloody otorrhoea. Special investigations revealed an extracranial internal carotid artery pseudoaneurysm. Results: The patient made a full recovery after endovascular occlusion of the internal carotid artery and pseudoaneurysm using coils. At six months' follow up, the internal carotid artery and pseudoaneurysm remained excluded from the circulation. The patient did not display any neurological deficits during hospital stay or follow up. Conclusion: This paper reports on one of the youngest patients documented to date who presented with an internal carotid artery pseudoaneurysm, possibly secondary to ear infection. Although rare, this condition should be excluded in children presenting with a mass of the neck or pharynx because of the dire consequences if left undiagnosed and untreated. [ABSTRACT FROM AUTHOR]

Background:Radiation therapy is a commonly used treatment in head and neck oncology, whether used alone or as an adjunct to other treatments. Osteoradionecrosis and radiation-induced malignancy are both rare, late complications of radiation therapy.Methods:This paper describes a case of radiation-induced sarcoma of the mandible initially presenting as osteoradionecrosis. In addition, the literature on the identification and treatment of these entities is reviewed.Results:The patient underwent excision and reconstruction of the presumed osteoradionecrosis. Final pathology demonstrated radiation-induced sarcoma. The patient suffered tumour recurrence at seven months post-operatively.Conclusion:When evaluating a patient with osteoradionecrosis, clinicians should be cognisant of the risk of malignancy. This paper describes the first case of radiation-induced sarcoma presenting as osteoradionecrosis. Primary treatment of radiation-induced sarcoma is wide surgical extirpation, with a very limited role for chemotherapy. Overall survival for this entity is poor. [ABSTRACT FROM PUBLISHER]

Objective: The coronavirus disease 2019 pandemic resulted in the cessation of elective surgery. The continued provision of complex head and neck cancer surgery was extremely variable, with some UK centres not performing any cancer surgery. During the pandemic, Guy's and St Thomas' NHS Foundation Trust received high numbers of coronavirus disease 2019 admissions. This paper presents our experience of elective complex major head and neck cancer surgery throughout the pandemic. Methods: A head and neck cancer surgery hub was set up that provided a co-ordinated managed care pathway for cancer patients during the pandemic; the Guy's Cancer Centre provided a separate, self-enclosed coronavirus-free environment within the hospital campus. Results: Sixty-nine head and neck cancer patients were operated on in two months, and 13 patients had a microvascular free tissue transfer. Nosocomial infection with coronavirus disease 2019 was detected in two cases (3 per cent), neither required critical care unit admission. Both patients made a complete recovery and were discharged home. There were no deaths. Conclusion: Performing major head and neck surgery, including free flap surgery, is possible during the pandemic; however, significant changes to conventional practice are required to achieve desirable patient outcomes. [ABSTRACT FROM AUTHOR]

Background:Biomarkers are increasingly being used in many cancers to select patients for oncological treatment paradigms based on their inherent genetic properties. However, in head and neck cancers, there are no personalised therapies available outside the context of a clinical trial. A number of studies suggest there are intrinsic tumour properties of head and neck cancers that affect their response to chemotherapeutic agents. This paper aimed to review their evidence base.Method:A narrative review was conducted following a search of the PubMed database.Results and conclusion:The review identified a number of biomarkers predicting response to chemotherapy in head and neck cancers. The paper discusses these in detail, and explores where future research could be directed in order to deliver personalised therapies for patients with head and neck cancers. [ABSTRACT FROM PUBLISHER]

Background: Cervical metastasis from an unknown primary site invariably results in pan-mucosal irradiation if a primary tumour is not identified. Transoral robotic and laser-assisted mucosectomy are valid techniques to increase diagnostic rates, but these remain restricted to certain centres. This paper describes, in detail, a technique in which mucosectomy is performed via endoscopic electrocautery. Methods: Patients were prospectively recruited between May 2017 and June 2018. Inclusion criteria stipulated biopsy-proven metastatic cervical squamous cell carcinoma, with negative findings on magnetic resonance imaging and positron emission tomography/computed tomography, in addition to examination under anaesthetic, tonsillectomy and 'blind' tongue base biopsies without tumour identification, prior to mucosectomy. Results: Of nine patients, a mucosal primary was identified in four (44.4 per cent), for which ipsilateral intensity-modulated radiotherapy was advocated in three and completion tongue base resection in the fourth. Dysplasia was demonstrated in two further patients, which provided information relevant to radiotherapy fields and post-treatment surveillance. No surgical complications were identified. Conclusion: Tongue base mucosectomy using electrocautery and conventional tonsillectomy equipment is a safe, effective technique in the identification of cervical metastasis from an unknown primary site. It expands the potential breadth of use, quickens prolonged diagnostic pathways and obviates the necessity for pan-mucosal irradiation. [ABSTRACT FROM AUTHOR]

Background:The ablation of advanced head and neck cancer often results in large three-dimensional defects that require free tissue transfer to optimally address functional and cosmetic issues. The subscapular system is a highly versatile donor site for flaps used for head and neck reconstruction. Traditional methods of harvesting subscapular flaps require repositioning and re-preparing, which significantly increases the operative time and prevents simultaneous harvesting of the flap.Method:This paper presents our experience of a single-stage ‘sit and tilt’ technique, which provides a convenient method for harvesting subscapular system free flaps without significant repositioning.Results and conclusion:This technique was used for a variety of head and neck defects, and body habitus did not seem to affect free tissue harvesting. It is hoped that utilisation of this preparation and harvesting technique will make head and neck surgeons more willing to take advantage of the subscapular system. [ABSTRACT FROM PUBLISHER]

Objective: This study aimed to determine the number, reasons and costs of surgical voice restoration related tracheoesophageal valve attendances over 36 months at a head and neck oncology unit. Method: Demographic, medical and valve related details from all patient contacts were recorded, including self-change information, urgent appointment information, modifications required and costs of prostheses. Results: Over 3 years, 99 patients underwent 970 valve changes. The main reasons for changes were central leakage, prophylactic change and self-change at home. Changes were significantly more frequent in the first 12 months (mean, 42 days) compared with longstanding patients (mean, 109.96). Intervals between changes were unpredictable; no predictive factors reached statistical significance. Mean expenditure on valves was £966.63 per week (including value added tax and in-house customisation). Conclusion: Valve lifespan is comparable with outcomes in similar units despite more pre-emptive and patient-led changes and more comprehensive data inclusion. Investigation into how patient satisfaction and costs relate to valve selection and units' service delivery models is needed. [ABSTRACT FROM AUTHOR]

Objective: To report intensive care unit admission outcomes for head and neck cancer patients. Methods: A retrospective, observational cohort analysis of all Australian and New Zealander head and neck cancer patient intensive care unit admissions from January 2000 to June 2016, including data from 192 intensive care units. Results: There were 10 721 head and neck cancer patients, with a median age of 64 years (71.6 per cent male). Of admissions, 76.4 per cent were in public hospitals, 96.9 per cent were post-operative and 43.6 per cent required mechanical ventilation. Annual head and neck cancer admissions increased from 2000 to 2015 (from 348 to 1132 patients), but the overall proportion of intensive care unit admissions remained constant. In-hospital mortality was 2.7 per cent, and intensive care unit mortality was 0.7 per cent. The in-hospital mortality risk decreased three-fold (p < 0.001). Conclusion: Head and neck cancer patients had low mortality in the intensive care unit and in hospital. Risk of dying decreased despite more intensive care unit admissions. This is the first large-scale cohort study quantifying intensive care unit utilisation by head and neck cancer patients. It informs future work investigating alternatives to the intensive care unit for these patients. [ABSTRACT FROM AUTHOR]

An editorial is presented to the article Nasal douching has re-emerged in decades as a popular means of controlling nasal symptoms and facilitating post-operative care in patients nasal and sinus surgery. Topics include the Journal of Laryngology & Otology recently published a paper comparing different douche solutions; and radical policy change has not seem to have translated into an increase in progression to deep neck space abscesses.

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. This paper provides recommendations on the management of thyroid cancer in adults and is based on the 2014 British Thyroid Association guidelines. [ABSTRACT FROM AUTHOR]

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the United Kingdom. This paper provides consensus recommendations on the management of melanomas arising in the skin and mucosa of the head and neck region on the basis of current evidence. [ABSTRACT FROM AUTHOR]

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. This paper summarises the role of chemotherapy in head and neck cancer management, recent advances and what the future holds for this modality. [ABSTRACT FROM AUTHOR]

This is the official guideline endorsed by the surgical specialty associations involved in the care of head and neck cancer patients in the UK. This paper summarises the current state of play in the organisation and provision of head and neck cancer surgical services in the UK. [ABSTRACT FROM AUTHOR]

Since the previous edition of these guidelines, significant changes have taken place in the training and assessment of surgeons and oncologists who treat patients with head and neck cancer. For those intending to become head and neck surgeons, a fellowship in head and neck surgery is virtually mandatory. This paper summarises the current career structure to specialise in head and neck oncology and surgery in the UK. [ABSTRACT FROM AUTHOR]

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. In the absence of high-level evidence base for follow-up practices, the duration and frequency are often at the discretion of local centres. By reviewing the existing literature and collating experience from varying practices across the UK, this paper provides recommendations on the work up and management of lateral skull base cancer based on the existing evidence base for this rare condition. [ABSTRACT FROM AUTHOR]

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. The reconstructive needs following ablative surgery for head and neck cancer are unique and require close attention to both form and function. The vast experience accrued with microvascular reconstructive surgery has meant a significant expansion in the options available. This paper discusses the options for reconstruction available following ablative surgery for head and neck cancer and offers recommendations for reconstruction in the various settings. [ABSTRACT FROM AUTHOR]

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. The disease itself and the treatment can have far reaching effects on speech and swallow function, which are consistently prioritised by survivors as an area of concern. This paper provides recommendations on the assessments and interventions for speech and swallow rehabilitation in this patient group. [ABSTRACT FROM AUTHOR]

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. Salivary gland tumours are rare and have very wide histological heterogeneity, thus making it difficult to generate high level evidence. This paper provides recommendations on the assessment and management of patients with cancer originating from the salivary glands in the head and neck. [ABSTRACT FROM AUTHOR]

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. The anaesthetic considerations for head and neck cancer surgery are especially challenging given the high burden of concurrent comorbidity in this patient group and the need to share the airway with the surgical team. This paper provides recommendations on the anaesthetic considerations during surgery for head and neck cancer. [ABSTRACT FROM AUTHOR]

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. This paper provides consensus recommendations on the management of cutaneous basal cell carcinoma and squamous cell carcinoma in the head and neck region on the basis of current evidence. [ABSTRACT FROM AUTHOR]

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. With only limited high-level evidence for management of nasal and paranasal sinus cancers owing to low incidence and diverse histology, this paper provides recommendations on the work up and management based on the existing evidence base. [ABSTRACT FROM AUTHOR]

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. With an age standardised incidence rate of 0.63 per 100 000 population, hypopharynx cancers account for a small proportion of the head and neck cancer workload in the UK, and thus suffer from the lack of high level evidence. This paper discusses the evidence base pertaining to the management of hypopharyngeal cancer and provides recommendations on management for this group of patients receiving cancer care. [ABSTRACT FROM AUTHOR]

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. Although much commoner in the eastern hemisphere, with an age-standardised incidence rate of 0.39 per 100 000 population, cancers of the nasopharynx form one of the rarer subsites in the head and neck.¹ This paper provides recommendations on the work up and management of nasopharyngeal cancer based on the existing evidence base for this condition. [ABSTRACT FROM AUTHOR]

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. There has been significant debate in the management of oropharyngeal cancer in the last decade, especially in light of the increased incidence, clarity on the role of the human papilloma virus in this disease and the treatment responsiveness of the human papilloma virus positive cancers. This paper discusses the evidence base pertaining to the management of oropharyngeal cancer and provides recommendations on management for this group of patients receiving cancer care. [ABSTRACT FROM AUTHOR]

This guideline is endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. This paper summarises the current imaging modalities in use for head and neck cancer evaluation. It highlights their role in the management with recommendations on modality choice for each cancer subsite. [ABSTRACT FROM AUTHOR]

Nutritional support and intervention is an integral component of head and neck cancer management. Patients can be malnourished at presentation, and the majority of patients undergoing treatment for head and neck cancer will need nutritional support. This paper summarises aspects of nutritional considerations for this patient group and provides recommendations for the practising clinician. [ABSTRACT FROM AUTHOR]

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. This paper provides recommendations on the pre-treatment clinical assessment of patients presenting with head and neck cancer. [ABSTRACT FROM AUTHOR]

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. Recurrent cancers present some of the most challenging management issues in head and neck surgical and oncological practice. This is rendered even more complex by the poor evidence base to support management options, the substantial implications that treatments can have on the function and quality of life, and the difficult decision-making considerations for supportive care alone. This paper provides consensus recommendations on the management of recurrent head and neck cancer. [ABSTRACT FROM AUTHOR]

In general, the first decision to be made in a patient with a confirmed head and neck cancer is whether or not to treat the patient before deciding what form of management strategy is appropriate. There is no more important an aspect of head and neck cancer care than the initial evaluation of the patient and the patient's tumour. The practice requires specific expertise and judgement. The current tumour-node-metastasis system relies on morphology of the tumour (anatomical site and extent of disease) but the final decision on treatment hinges on a full assessment of the patient including physiological age and general condition. The aim of this paper is primarily to describe why and how we appraise a patient and their tumour. It addresses the general principles applicable to the topic of evaluation, classification and staging. In addition, the limitations and pitfalls of this process are described. [ABSTRACT FROM AUTHOR]

Background:Tissue engineering using biocompatible scaffolds, with or without cells, can permit surgeons to restore structure and function following tissue resection or in cases of congenital abnormality. Tracheal regeneration has emerged as a spearhead application of these technologies, whilst regenerative therapies are now being developed to treat most other diseases within otolaryngology.Methods and results:A systematic review of the literature was performed using Ovid Medline and Ovid Embase, from database inception to 15 November 2014. A total of 561 papers matched the search criteria, with 76 fulfilling inclusion criteria. Articles were predominantly pre-clinical animal studies, reflecting the current status of research in this field. Several key human research articles were identified and discussed.Conclusion:The main issues facing research in regenerative surgery are translation of animal model work into human models, increasing stem cell availability so it can be used to further research, and development of better facilities to enable implementation of these advances. [ABSTRACT FROM PUBLISHER]

Objective:This paper attempts to chart the history of head and neck cancers and their surgical treatment, starting from ancient Egypt and concluding with Galen.Conclusion:The ancient Egyptians appear to have treated head and neck cancers with local applications. The ancient Greek corpus contains a reference to treating pharyngeal carcinoma with cautery, but the description is too vague to establish the diagnosis conclusively. The ancient Romans moved away from surgical treatments, with Galen establishing a prejudice against surgery that would last through the Middle Ages. [ABSTRACT FROM PUBLISHER]

Background:Viral gene therapy is a promising new treatment modality for head and neck cancer. This paper provides the reader with a review of the relevant literature in this field.Results:There are government licensed viral gene therapy products currently in use for head and neck cancer, utilised in conjunction with established treatment modalities. The viruses target tumour-associated genes, with the first licensed virus replacing p53 gene function, which is frequently lost in tumourigenesis. Oncolytic viruses selectively destroy cancer cells through viral replication and can be armed with therapeutic transgenes.Conclusion:Despite considerable advances in this field over the last 40 years, further research is needed to improve the overall efficacy of the viruses and allow their widespread utilisation in the management of head and neck cancer. [ABSTRACT FROM PUBLISHER]

Background: The coronavirus disease 2019 pandemic has necessitated almost exclusive National Health Service focus on emergency work and cancer care. There are concerns that increased hospital and community pressures will lead to decreased referrals and worse outcomes for head and neck cancer patients. Method: This is a retrospective review of all cases referred for suspected head and neck cancer to our institution in January and April 2020. Results: There was a 55 per cent decrease in referrals but diagnostic yield rose from 2.9 per cent in January to 8.06 per cent in April. In both months, 100 per cent of patients met the 31- and 62-day targets, with similar 14-day wait time success (97.83 per cent for January vs 98.33 per cent for April). Referrals for laryngopharyngeal reflux rose from 27.5 per cent to 41.9 per cent. Referrals for those aged over 60 years fell from 42 per cent to 26 per cent. Conclusion: It is suggested that further research be conducted into the reasons why fewer patients were referred, particularly elderly patients, and why laryngopharyngeal reflux is so prevalent in fast-track referrals. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 pandemic requires urgent modification to existing head and neck cancer diagnosis and management practices. A protocol was established that utilises risk stratification, early investigation prior to clinical review and a reduction in aerosol generating procedures to lessen the risk of coronavirus disease 2019 spread. Methods: Two-week wait referrals were stratified into low, intermediate and high risk. Low risk patients were referred back to primary care with advice; intermediate and high risk patients underwent investigation. Clinical encounters and aerosol generating procedures were minimised. A combined diagnostic and therapeutic surgical approach was undertaken where possible. Results: Forty-one patients were used to assess feasibility. Thirty-one per cent were low risk, 35 per cent were intermediate and 33 per cent were high risk. Thirty-three per cent were discharged with no imaging. Conclusion: Implementing this protocol reduces the future burden on tertiary services, by empowering primary care physicians to re-refer low risk patients. The protocol is applicable across the UK and avoids diagnostic delay. [ABSTRACT FROM AUTHOR]

Objective: To study the impact of a clinical care pathway and computerised order set on short-term post-operative outcomes for patients undergoing head and neck free tissue transfer. Methods: In this retrospective cohort study, patients who underwent head and neck free tissue transfer by a single reconstructive surgeon between January 2007 and July 2009 were assigned to one of two cohorts based on the timing of their surgery: pre- or post-clinical care pathway implementation. Measured outcomes included peri-operative complications and mortality, length of hospital stay and costs, unplanned reoperations, and readmissions within 30 days of discharge. Results: The pre-clinical care pathway cohort included 81 patients and the post-clinical care pathway cohort comprised 46. Implementation of the clinical care pathway was associated with decreased variability in length of hospital stay (median (interquartile range) = 8 (6, 11) vs 7 (6, 9) days). The post-clinical care pathway cohort also had a significantly lower unplanned reoperation rate (15.2 vs 35.8 per cent, p = 0.01). Conclusion: A clinical care pathway is a successful means of standardising and improving complex patient care. In this study, care pathway implementation in head and neck free tissue transfer patients improved efficiency and the quality of patient care. [ABSTRACT FROM AUTHOR]

Background: Head and neck soft tissue sarcoma is uncommon. It is both histologically and clinically heterogeneous, ranging from an indolent, locally destructive tumour, to a locally aggressive neoplasm with metastatic potential. Methods: A retrospective review was conducted of all adult head and neck soft tissue sarcomas, including cases of malignant soft tissue sarcoma and all intermediate type tumours, diagnosed between 1997 and 2012. Results: Sixty-eight cases were identified in this series from the sarcoma multidisciplinary team. Seventeen different histological subtypes of sarcoma were identified. Neither age, gender nor tumour size were significant prognostic indicators for survival in this series. Conclusion: Prognosis is dependent on histological subtype, underscoring the importance of histological classification. Some histological subtypes occur only once or twice in a decade, even within a large regional referral centre. An accumulation of evidence from relatively small case series is key in the long-term development of treatment strategies. [ABSTRACT FROM AUTHOR]

Background:Ultrasound-guided wire localisation is a technique that is well established in breast surgery, but is not well described in head and neck practice. It can be used to locate impalpable lesions for surgical removal, without the need for more extensive surgery.Method:This paper describes a case where the technique was used to assist in the removal of an impalpable but radiologically abnormal lymph node.Conclusion:The technique offers a safe and effective method for removing lesions within the head and neck. [ABSTRACT FROM AUTHOR]

The multidisciplinary management of head and cancer has changed radically in the last decade. This paper provides a glimpse of the emerging surgical and oncological interventions that may play major roles in the treatment paradigms of tomorrow. [ABSTRACT FROM AUTHOR]

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. Surgery is one of the key modalities used in head and neck cancer treatment. Recent advances and a greater awareness of the short- and long-term toxicities associated with non-surgical modalities and newer technologies that permit minimal access resections have led to a resurgence in surgery. This paper provides an overview of the role of surgery in head and neck cancer practice. [ABSTRACT FROM AUTHOR]

Background:Coincident thyroid and head and neck squamous cell carcinomas are rare. This paper presents a case of synchronous laryngeal squamous cell carcinoma, follicular thyroid carcinoma and micropapillary thyroid carcinoma.Methods:A PubMed search was performed for articles describing synchronous thyroid and head and neck squamous cell carcinomas, using the search terms ‘thyroid cancer’, ‘cancer of the head and neck’, ‘synchronous’ and ‘synchronous neoplasm’.Results:The literature suggests that the head and neck squamous cell carcinoma stage is a better predictor of outcome than the extent of surgical treatment of the thyroid gland in synchronous malignancies.Conclusion:The decision regarding surgical treatment of the thyroid in synchronous thyroid and head and neck squamous cell carcinomas should take several factors into account. The head and neck squamous cell carcinoma stage is the strongest predictor of outcome, although patient-related factors and the location of malignant thyroid tissue may also affect management. [ABSTRACT FROM PUBLISHER]

Objectives: This study aimed to assess head and neck cancer patient satisfaction with the use of a touch-screen computer patient-completed questionnaire for assessing Adult Co-morbidity Evaluation 27 co-morbidity scores prior to treatment, along with its clinical reliability. Methods: A total of 96 head and neck cancer patients were included in the audit. An accurate Adult Co-morbidity Evaluation 27 co-morbidity score was achieved via patient-completed questionnaire assessment for 97 per cent of participants. Results: In all, 96 per cent of patients found the use of a touch-screen computer acceptable and would be willing to use one again, and 62 per cent would be willing to do so without help. Patients were more likely to be willing to use the computer again without help if they were aged 65 years or younger (χ2 test; p = 0.0054) or had a performance status of 0 or 1 (χ2 test; p = 0.00034). Conclusion: Use of a touch-screen computer is an acceptable approach for assessing Adult Co-morbidity Evaluation 27 scores at pre-treatment assessment in a multidisciplinary joint surgical-oncology clinic. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses articles in the issue on topics including rate of second lung primaries in head and neck cancer, along with supraglottic tumours were associated with an increased risk of second primary lung cancer compared to glottic tumours.

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. Radiotherapy is one of the key treatment modalities used in head and neck cancer management. This paper summarises the current role and some of the recent advances in radiotherapy in head and neck cancer management. [ABSTRACT FROM AUTHOR]

Background: The impact of coronavirus disease 2019 extends far beyond the immediate burden on healthcare systems caused by hospitalisation of patients with the disease itself. Objective: To investigate the impact of the coronavirus disease 2019 pandemic on the referral rate of patients to the suspected head and neck cancer two-week-wait clinic. Methods: A multicentre retrospective study was performed investigating data collected for all patients attending the suspected head and neck cancer two-week-wait clinic in ENT departments in the West Midlands. Results: A total of 509 fast-track referrals were received from February to April in 2019, compared to 399 referrals in 2020. April 2020 saw a 62.4 per cent reduction in referral rate compared to April 2019. Conclusion: The coronavirus disease 2019 pandemic has resulted in changes to health-seeking behaviours, and healthcare provision and delivery. Urgent policy interventions may be required to compensate for the hidden impact that the coronavirus disease 2019 pandemic has had on those with cancer. [ABSTRACT FROM AUTHOR]

AbstractAn understanding of the immune system and its modes of action is fundamental to understanding the causes, natural history, management and treatment of many diseases. As such, a grasp of the principles of immunology is essential for every physician.This paper represents a succinct overview of the immune system, discussing the major components in turn, in respect of structure, function and integrated organisation, in relation to head and neck cancer. [ABSTRACT FROM AUTHOR]