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Objectives of this study were to assess the utility of intra-operative ultrasound to resolve discordant pre-operative imaging prior to a lateral approach mini-parathyroidectomy, by studying prospective case series in a head and neck endocrine unit. Patients with primary hyperparathyroidism due to a single adenoma with discordant pre-operative ultrasound and sestamibi were enrolled. They underwent a further intra-operative ultrasound by a head and neck radiologist with a view to proceed with a mini-parathyroidectomy. The main outcome measure was utility of intra-operative ultrasound compared to operative findings and pre-operative imaging. Secondary measures were complications of mini-parathyroidectomy, operative and ambulatory discharge time. Twenty-two patients underwent surgery with intra-operative ultrasound in the surgical position. The intra-operative ultrasound findings correlated with the operative findings in all cases (100 %). There were 16 inferior adenomas and 6 superior adenomas. Six inferior adenomas were in a retrosternal position, eight were obscured by benign thyroid lesions and a further two reported pre-operatively as superior. Three out of six superior adenomas were reported as inferior pre-operatively as the inferior thyroid artery was inadequately visualised, two were retro-carotid and one was retro-oesophageal. All patients were discharged within 23 h of surgery. There were no unsuccessful focused explorations. Histological analysis confirmed the adenomas. No morbidity (vocal cord palsy, haematoma, hungry bones) was noted. The results indicated that intra-operative ultrasound by a dedicated radiologist is a valuable tool in resolving discordance of pre-operative imaging. Appropriate patient positioning with neck extension and muscle relaxation allows placement of the probe in the obscure retro-carotid and retro-oesophageal locations and unmasks apparent 'mediastinal' parathyroids facilitating focused dissection. [ABSTRACT FROM AUTHOR]

There are insufficient data on swallowing and the consequences of its dysfunction in patients with cancers of the oral cavity (OC) and oropharynx (OP) that are treated with primary surgery. The study attempts to explore the effect of important clinico-demographic variables on post-treatment swallowing and related quality of life (QOL) in post-surgical OC and OP cancer patients. Sixty-two consecutive OC and OP cancer patients completed the MD Anderson Dysphagia Inventory (MDADI) questionnaire. Mean scores were computed. Comparison of scores based on mean ranks were performed using Mann-Whitney U test or Kruskal-Wallis test. Level of significance was set at P ≤ 0.02. Adjustments were made for multiple comparisons. Significantly worse mean (SD) QOL scores were observed in late T-stage (T3/T4) versus early T-stage (T1/T2) patients for global domain, physical domain, functional domain and emotional domains [44.4 (21.9) vs. 78.7 (22.7) ( P < 0.001); 50.0 (9.4) vs. 75.9 (16.3), ( P < 0.0001); 57.8 (20.6) vs. 84.1 (16.7), ( P < 0.001) and 55.2 (18.0) vs. 78.5 (16.3), ( P < 0.001)], respectively. Patients undergoing reconstruction versus without reconstruction had worse QOL scores; 58.8 (26.9) versus 79.5 (22.8), ( P < 0.01); 61.2 (15.1) versus 76.4 (17.5), ( P = 0.002); 65.4 (20.5) versus 86.3 (15.9), ( P < 0.0001) and 63.3 (18.8) versus 79.8 (16.3), ( P < 0.01), respectively, for global, physical, functional and emotional domains. Advanced T-stage, reconstruction, younger age and base of tongue tumours have a negative impact on post-treatment swallow function and related QOL in these patients. [ABSTRACT FROM AUTHOR]

The aim was to explore the impact of important clinico-demographic factors on the post-treatment quality of life (QOL) in surgically treated oral and oropharyngeal cancer patients. 63 consecutive follow-up oral and oropharyngeal cancer patients treated primarily with surgery were recruited. 55 patients sent the completed questionnaires and finally included in this study. QOL and important sub-domains of the QOL were assessed. Mean QOL scores (SD) were computed, level of significance was set at P < 0.05. The mean composite QOL score and standard deviation (SD) for oral and oropharyngeal cancer patients were 76.6 (15.2) and 73.4 (13.9), respectively. Patients with higher T-stage (T3 and T4) and higher overall-stage (III and IV) had lower mean QOL scores as against early T (T1 and T2) and overall early-stage (I and II); mean scores (SD) 64.3 (13.6) and 72.3 (13.8), and 76.6 (13.6) and 81.7 (14.1), respectively. Younger patients had lower mean scores (SD) than older patients; mean QOL scores (SD) 69.7 (14.0) and 79.6 (SD), respectively. Patients with reconstruction had lower mean QOL scores as compared to those without reconstruction; mean scores (SD) 67.6 (16.0) and 77.4 (12.5), respectively. In conclusion, tumor-stage, overall-stage, age of patients, and reconstruction had a significant direct effect on the post-treatment QOL of oral and oropharyngeal cancer patients. [ABSTRACT FROM AUTHOR]