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Department of Radiology, University College London Hospital, London, UKIntroduction:Interstitialphotodynamictherapyremainsan attractive remedial option in minimally invasivesurgery. Our aim in this prospective study was to evaluatethe outcome following ultrasound-guided iPDT of deep-seated pathologies. Patients’ reports on quality of life withclinicalandradiologicalevaluationwerethemainendpointparameters used to assess the outcome.Materials and Methods: Sixty-eight patients werereferredtotheUCLHHeadandNeckCentre fortreatmentof various deep-seated pathologies involving the head andneckregion,upperandlowerlimbs.Allpatientsunderwentinterstitial photodynamic therapy under general anaes-thesia, using 0.15mg/kg mTHPC as the photosensitisingagent.Followingtreatment,patientswerefollowed-upforamean of 7 months.Results: All three patients who presented with visualproblemsreportedimprovementaftertreatment.Also,14/17patients reported improvement of breathing. Improvementof swallowing was reported by 25/30 patients; while speak-ing improvement was evident in 16/22 patients and 33/40reported reduction in the disfigurement caused by theirpathology. All five patients with impeded limb functionreported some degree of improvement. Clinical assessmentshowed that half of the patients had ‘good response’ to thetreatmentandathirdreported‘moderateresponse’withtwopatients being free of disease. Radiological assessmentcomparingimaging6-weekpost-PDTtothebaselineshowedstable pathology with no change in size in 13 patients,minimal response in 18 patients, moderate response in23 patients and significant response in 11 patients.Conclusion: This study on 68 patients with deep-seatedpathologies undergoing interstitial photodynamic therapyprovided evidence that PDT can be the fourth modalityin the management of tissue disease. Lasers Surg. Med.41:612–621, 2009. 2009 Wiley-Liss, Inc.Key words: photodynamic therapy; ultrasound; headand neck; cancer treatment; tumour; vascular malforma-tion; hamartoma; interstitialINTRODUCTIONPhotodynamic therapy (PDT) remains an attractiveremedial option in oncology. In principle, light applicationto the target tissue leads to a non-thermal photochemicalreaction; this is usually initiated some hours following theadministrationofthephotosensitiser andleadstoselectivedamage to the target tissue. The efficacy of the treatmentdepends on the type and the concentration of the photo-sensitiser, light dose, fluence rate, the availability ofoxygen and cellular localisation. Several photosensitisersare currently being tested for better specificity of targettissue [1–3].Two generations of photosensitisers are currently beingused in oncological practice. Profimer sodium (Photofrin-first generation) is commonly used in Barrett’s high-gradedysplasia, cervical, gastric, oesophageal, endobronchialandpapillarybladdercancers.While5-aminolevulinicacid(5-ALA), a natural heme precursor, has been successfullyapplied in basal cell carcinoma, actinic keratosis and oraldysplasia. mTHPC (Foscan) a much more potent secondgeneration photosensitiser for cancer treatment, whencompared to Photofrin and ALA, is commonly used in headand neck cancer. Third generation photosensitisers (tinethyl etiopurpurin, mono

Photodynamic therapy, the fourth oncological intervention modality has proved its successfulness in the management of variety of pathologies involving the human body. Our aim in this prospective clinical study was to evaluate the outcome following ultrasound-guided iPDT of pathologies involving the head and neck region as well as the upper and lower limbs. Patients’ reports on quality of life with clinical and radiological evaluation were the main end point parameters used to assess the outcome.

Background The relationship between a surgeon's experience and the incidence of postoperative complications after third molar surgery is assessed in this prospective clinical study. Previous reports have shown this to be one the most influential factors on surgical outcome. Method In this study, 3,236 patients underwent surgical removal of impacted third molars. All patients included in the study were reviewed and the various postoperative complications were recorded and statistically compared to the surgeon's grade. Patients' demographics and pre-operative radiographic findings were also noted. Results The surgical procedures were performed by seven specialists and 12 residents. In the group of patients treated by the residents, the incidence of postoperative complications was found to be significant with regards to trismus, infection, alveolar osteitis and paraesthesia of the lingual and inferior alveolar nerves. In the group of patients treated by specialists, the incidence of postoperative bleeding was found to be statistically significant. Conclusion There is without doubt a relationship between the surgeon's experience and the postoperative complication in third molar surgery. The impact of the findings from this study upon the profession, education and research is as yet unrealised. The ethical and moral implications of our findings are discussed.

Interstitial photodynamic therapy remains an attractive remedial option in minimally invasive surgery. Our aim in this prospective study was to evaluate the outcome following ultrasound-guided iPDT of deep-seated pathologies. Patients' reports on quality of life with clinical and radiological evaluation were the main end point parameters used to assess the outcome.Sixty-eight patients were referred to the UCLH Head and Neck Centre for treatment of various deep-seated pathologies involving the head and neck region, upper and lower limbs. All patients underwent interstitial photodynamic therapy under general anaesthesia, using 0.15 mg/kg mTHPC as the photosensitising agent. Following treatment, patients were followed-up for a mean of 7 months.All three patients who presented with visual problems reported improvement after treatment. Also, 14/17 patients reported improvement of breathing. Improvement of swallowing was reported by 25/30 patients; while speaking improvement was evident in 16/22 patients and 33/40 reported reduction in the disfigurement caused by their pathology. All five patients with impeded limb function reported some degree of improvement. Clinical assessment showed that half of the patients had 'good response' to the treatment and a third reported 'moderate response' with two patients being free of disease. Radiological assessment comparing imaging 6-week post-PDT to the baseline showed stable pathology with no change in size in 13 patients, minimal response in 18 patients, moderate response in 23 patients and significant response in 11 patients.This study on 68 patients with deep-seated pathologies undergoing interstitial photodynamic therapy provided evidence that PDT can be the fourth modality in the management of tissue disease.

Chondrosarcoma;Hyoid;PhotodynamictherapyChondrosarcoma is a malignancy that is cartilaginous in ori-gin and represents approximately 25% of all primary osseousneoplasms. Chondrosarcomas are rare with 90 new cases ayearreportedintheUK.Ofthese,only10%occurintheheadandneck.Peakincidenceisbetweentheagesof30—50,withno apparent correlation with gender [1,2].There are two common grading systems for chondrosar-comas. They can be graded 1—3, with 1 being the leastaggressive and 3 the most. Alternatively, chondrosarcomasare graded low or high grade, with low grade tumours char-acterised by well-differentiated cells and high grade poorlydifferentiated, with a high mitotic rate [1,2].Approximately 90% of conventional chondrosarcomas arelow to intermediate grade that have low metastatic poten-tial, and the rest are high grade or grade 3 lesions with ahigh metastatic rate. The 5-year survival rate of patientswith grade 1, 2, and 3 tumors were 90%, 81%, and 43%

Objective Earlier reports, including a preliminary study within our unit, have shown that the surgeon's experience is one of the most influential factors in determining the likelihood of both permanent inferior alveolar nerve (IAN) and lingual nerve (LN) paresthesia, following third molar surgery. The effect of this and other factors influencing such prevalence are assessed in this study. Study design This prospective study involved 3236 patients who underwent surgical removal of impacted third molars. Patients' demographics and radiological parameters were recorded along with the grade of the treating surgeon. The prevalence of inferior alveolar and lingual nerves paresthesia at 1 month, 6 months, and 18 to 24 months postoperatively were also traced. Results At 1 month postoperatively, the incidence of IAN paresthesia was 1.5% and the LN was 1.8%. These figures decreased over time and 18 to 24 months postoperatively, the incidence of permanent dysfunction of the IAN was 0.6% and LN was 1.1%. With regard to inferior alveolar nerve paresthesia, risk factors included the patient's age (26-30 years), horizontally impacted teeth, close radiographic proximity to the inferior alveolar canal (IAC), and treatment by trainee surgeons. With regard to the lingual nerve, risk factors included male patients, distoangular impactions, close radiographic proximity to the IAC, and treatment by trainee surgeons. Conclusion One of the main risk factors of developing permanent sensory dysfunction in the distribution of these nerves is related to the surgical skills/experience of the operator. Other factors are associated with the type of impaction and the radiographic proximity of the tooth to the inferior alveolar nerve. Such long-term complications can affect the patient's quality of life; the impact on profession, education, and research is unknown.

Postoperatively the patients complained of a severe sore throat with evidence of significant palatal abrasions and uvular swelling on examination. On later review the sore throat was reported to have lasted around 5–10 days. At the six week outpatient review, all patients reported full recovery with no visible evidence of residual palatal or uvular scarring or other anaesthetic sequelae. Conclusion LMAs are useful and occasionally life saving airways adjuncts but are not without complications. Both the surgeon and anaesthetist should recognise and ensure trauma is minimised to the oropharynx during all stages of surgery. from 1st Scientific Meeting of the Head and Neck Optical Diagnostics Society London, UK. 14 March 2009

Materials and methods A controlled cohort involved 67 patients who were diagnosed with oral squamous cell carcinoma. The smoking and drinking habits of this groups was recorded, in addition cessation of smoking after diagnosis was assessed; these were compared to TNM, depth of invasion, pattern of invasion, dysplasia at margin, vascular and nerve invasion, recurrence, 3 and 5 years survival and cause of death.

The management of base of tongue carcinoma continue to be a major challenge in head and neck oncology. Our aim in this prospective study was to evaluate the outcome following ultrasound-guided interstitial photodynamic therapy (US-iPDT) of stage IV tongue base carcinoma. Patients’ reports on quality of life with clinical and radiological evaluation were the main end point parameters used to assess the outcome.

Methods: We look at recent neck dissections performed n our unit, using the same type of skin incision. Patients ere photographed by our medical illustration department nd questionnaires were posted out to both, patients and a roup of randomly selected individuals to rate the scars from he neck wounds. Results and discussion: Since Criles’s description of the adical neck dissection, numerous alternative incisions for eck dissections have been described. Most surgeons develop preference for a particular incision, their choice being influnced by access, morbidity, complications and aesthetics. We eview an incision routinely used in our unit, which fulfills ll the above criteria and demonstrates that aesthetics does ot compromise the nodal harvest.

Interstitial PDT was performed using a baseline MRI scan as a guide. Clinical and radiological assessments at follow-up showed a promising reduction in lesional size. Conclusion Conventional management of chondrosarcoma includes conservative, intra-lesional steroids, chemotherapeutic drugs, radiotherapy and surgical excision. Unfortunately none of which are curative as the lesion inevitably recurs. The authors commend PDT as a repeatable treatment option in management of these lesions. from 1st Scientific Meeting of the Head and Neck Optical Diagnostics Society London, UK. 14 March 2009