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Advanced hypopharyngeal tumours present complex clinical challenges, and where resection is attempted, there is a requirement for major reconstruction. Despite advances in surgical technique, outcomes remain poor for this patient group, and optimum treatment has yet to be established. We aimed to assess the treatment and outcomes of patients in our institution in the context of previous studies. All patients from 2008 to 2018 who underwent surgical management for hypopharyngeal tumours with pharyngo-laryngo-esophagectomy and flap-based reconstruction were included in the study. Demographic and outcome data were collected, and patient-reported outcomes were solicited from surviving patients using the EORTC QLQ HN 43 questionnaire. Thirty patients were assessed, in which 12 had gastric pull-ups, 16 had free jejunum flaps, and 2 had free anterolateral thigh flaps. There was a 38% five-year survival rate. Overall, the rates of stricture (10.7%) and fistula (7.1%) were low. The majority of patients (53.6%) returned to a normal diet within three months with a soft or puree diet in 35.7% of patients. Some form of speech was possible in 92.9% of patients. The average questionnaire score for surviving patients was 87.3, with good outcomes related to eating and swallowing, but poorer outcomes for speech and communication. This study showed that outcomes for patients receiving complex reconstruction following hypopharyngeal tumour resection are improving over time. There is still scope for improvement of patient outcomes and refinement of optimum surgical management strategies.

The use of adjuvant radiotherapy remains controversial in the treatment of recurrent pleomorphic adenomas.The aim of this study was to provide the highest level of evidence possible by performing a systematic review and meta-analysis of the literature.We searched the English-language literature between 1985 and 2019.Inclusion criteria included any study on the treatment and outcome of recurrent pleomorphic adenomas. Exclusion criteria included the use of radiotherapy for residual tumors, case reports, and pleomorphic adenomas not arising from the parotid.A total of 522 abstracts were studied, data analyzed from 14 studies, on a total of 697 patients. When the data werepooled, the overall risk of further recurrence was 21%. In studies where surgery alone was undertaken this increased to 26% and decreased to 10% in those receiving adjuvant radiotherapy (These data support the use of radiotherapy to decrease the risk of re-recurrence in recurrent pleomorphic adenoma.This study is the highest level of evidence currently available in guiding management of recurrent pleomorphic adenoma.

Introduction Preoperative testing for COVID‐19 has become widely established to avoid inadvertent surgery on patients with COVID‐19 and prevent hospital outbreaks. Methods A prospective cross sectional study was carried out in two university hospitals examining the pre‐operative protocols for patients undergoing otolaryngology surgery and the incidence of COVID‐19 within 30 days of surgery in patients and the otolaryngologists performing surgery. Results One hundred and seventy‐three patients were recruited. One hundred and twenty‐three (71%) patients “cocooned” for 14 days prior to surgery. All completed a questionnaire prior to admission. One hundred and fifty‐six patients (90%) had reverse transcriptase‐polymerase chain reaction (RT‐PCR) nasopharyngeal swabs, 14 patients (8%) had CT thorax. No cases of COVID‐19 were detected among patients followed up at 30 days. Two surgeons developed COVID‐19 early during the study period. Conclusion Current pre‐operative testing protocols consisting primarily of questionnaires and RT‐PCR resulted in zero cases of COVID in this cohort. It is possible that COVID‐19 restrictions and high proportion of patients cocooning preoperatively were factors in ensuring a low rate of COVID‐19 post‐operatively.

Contains fulltext : 220257.pdf (Publisher’s version ) (Closed access) The speed and scale of the global COVID-19 pandemic has resulted in unprecedented pressures on health services worldwide, requiring new methods of service delivery during the health crisis. In the setting of severe resource constraint and high risk of infection to patients and clinicians, there is an urgent need to identify consensus statements on head and neck surgical oncology practice. We completed a modified Delphi consensus process of three rounds with 40 international experts in head and neck cancer surgical, radiation, and medical oncology, representing 35 international professional societies and national clinical trial groups. Endorsed by 39 societies and professional bodies, these consensus practice recommendations aim to decrease inconsistency of practice, reduce uncertainty in care, and provide reassurance for clinicians worldwide for head and neck surgical oncology in the context of the COVID-19 pandemic and in the setting of acute severe resource constraint and high risk of infection to patients and staff.

Purpose The objective of this report is to outline our early experience with head and neck cancer patients in a tertiary referral center, during the SARS-Cov2 pandemic, and to describe the poor outcomes of patients who acquired the infection. Methods In this case series from a single-center, national tertiary referral center for head and neck cancer we describe three consecutive head and neck cancer patients who contracted SARS-Cov2 during their inpatient stay. Results Of the three patients described in our case series that contracted SARS-Cov2, two patients died from SARS-Cov2 related illness. Conclusion We have demonstrated the significant implications that SARS-Cov2 has on head and neck cancer patients, with 3 patients acquiring SARS-Cov2 in hospital, and 2 deaths in our that cohort. We propose a complete separation in the location of where these patients are being managed, and also dedicated non-SARS-Cov2 staff for their peri-operative management. Level of evidence IV.

Objective: Preoperative testing for COVID-19 has become widely established to avoid inadvertent surgery on patients with COVID-19 and prevent hospital outbreaks, however, there is limited evidence underpinning new protocols. We wished to study the effectiveness of preoperative COVID-19 testing during and after the first wave of the pandemic in Ireland. Design Prospective cohort study. Setting: 2 university hospitals in the Republic of Ireland. Participants: Patients undergoing otolaryngology surgery and the otolaryngologists performing surgery. Main outcome measure: Incidence of COVID-19 within 30 days of surgery. Results: 173 patients (56% male) were recruited. 123 (71%) patients “cocooned” for 14 days prior to surgery. All patients completed a questionnaire prior to hospital admission. 156 patients (90%) had reverse transcriptase-polymerase chain reaction (RTPCR) nasopharyngeal swabs, 14 patients (8%) had CT thorax. No cases of COVID-19 were detected among patients followed up at 30 days. Two surgeons developed COVID-19 early during the study period not considered to be related directly to contact within the hospital. Conclusion: Current pre-operative testing protocols consisting primarily of questionnaires and RT-PCR resulted in zero cases of COVID reported in this cohort. It is possible that COVID-19 restrictions and high proportion of patients cocooning preoperatively were factors in ensuring a low rate of COVID-19 postoperatively. Ongoing data collection is required to confirm these findings in the setting of further disease surges.

A high level of transparency in reported research is critical for several reasons, such as ensuring an acceptable level of trustworthiness and enabling replication. Transparency in qualitative research permits the identifcation of specifc circumstances which are associ ated with fndings and observations. Thus, transparency is important for the repeatability of original studies and for explorations of the transferability of original fndings. There has been no investigation into levels of transparency in reported technology education research to date. With a position that increasing transparency would be benefcial, this article pre sents an analysis of levels of transparency in contemporary technology education research studies which employed interviews within their methodologies, and which were published within the International Journal of Technology and Design Education and Design and Technology Education: An International Journal (n=38). The results indicate room for improvement, especially in terms of documenting researcher positionality, determinations of data saturation, and how power imbalances were managed. A discussion is presented on why it is important to improve levels of transparency in reported studies, and a guide on areas to make transparent is presented for qualitative and quantitative research. yes

Background The management of patients with incidentally discovered metastatic thyroid cancer in cervical lymph nodes in neck dissection specimens for other pathologies is unclear. Methods Retrospective review of neck dissection specimens for nonthyroid malignancy during a 30-year period was undertaken to identify incidental metastatic papillary thyroid cancer (PTC). Results Twenty-six patients had an incidental finding of PTC in lymph node(s) in neck dissection specimens. Subsequent ultrasound of the thyroid showed nodules in 20 patients. Eleven (42%) underwent total thyroidectomy, 1 (4%) had a lobectomy, and 14 (54%) were kept under active surveillance only. At a median follow-up of 48 months (range 10-189 months), all patients who had undergone surgery and those under surveillance were free of PTC recurrence. Conclusion Evaluation for detection of a primary thyroid tumor is essential in all patients with incidentally discovered metastatic PTC. Decision regarding surgery or surveillance is dependent on clinical and radiological tumor features and patient factors.

Background Tracheal stoma recurrence following oral cavity surgery is exceedingly rare. Although several different mechanisms for this have been described, the pathogenesis still remains uncertain. Methods We present the case of a gentleman who presented 6-months following oral cavity SCC resection with a large fungating mass at his previous tracheostomy site, and also review the reported literature on this rare phenomenon. Results Four weeks after diagnosis of his recurrence he underwent a total laryngectomy, wide-local skin excision and reconstruction with a pectoralis major pedicled flap. He recovered well initially following his operation, however unfortunately contracted nosocomial SARS-Cov2 and succumbed from respiratory complications during his post-operative recovery. Conclusion Stomal recurrence after temporary tracheostomy for oral cavity malignancies are very rare. Previously reported management of these can vary from surgical to palliative treatment. Methods to prevent these include delaying tracheostomy until after surgical resection, packing the pharynx during resection and adjuvant radiotherapy.

The authors report the first published case of a patient presenting with stridor from an acute, near complete, airway obstruction with normal biochemical markers, as the initial presentation of a parathyroid adenoma, which required immediate surgical intervention. The learning point from this case is to ensure a broad differential is placed forward when dealing with acute neck swelling. Routine Head and Neck pathology can present in an unusual fashion, with resultant challenging presentations.

Carotid artery blowout syndrome is a rare complication of head and neck cancer treatment. It defines a rupture of the carotid artery wall through vessel wall necrosis. This is typically precipitated by radiotherapy, direct tumour invasion, or a combination of these factors. We describe a rare case of three consecutive carotid artery blowouts in a head and neck cancer patient.A 58-year-old man with a history of T3NO hypopharyngeal squamous cell carcinoma (SCC) treated with chemotherapy and radiation presented with a four-month history of progressive dysphagia and right sided neck pain. Flexible nasendoscopy revealed laryngeal oedema and slough. A panendoscopy and biopsy showed no evidence of tumour recurrence. The patient was discharged and represented with worsening dyspnoea. He subsequently experienced a large volume hemorrhage necessitating ligation of his right external carotid artery. He underwent pharyngolaryngectomy indicated due to the extent of laryngeal radiation necrosis. Thereafter he suffered two additional acute carotid bleeds from his right common carotid necessitating ligation in theatre.This case report illustrates the key issues to be considered in patients with locally advanced hypopharyngeal squamous cell carcinoma and subsequent management of acute carotid blowout syndrome, which without prompt management, can be fatal.

An introductory textbook that assumes no prior knowledge of linguistics or second language acquisition, this book presents a comprehensive overview of the theoretical foundations, methods and practices of Teaching English as a Foreign Language (TEFL) for pre-service teachers. Lennon covers the theoretical bases for TEFL and addresses second language-acquisition research, past and present EFL teaching methodology, as well as psychological and social approaches to individual language-learner variation. Further chapters provide extensive yet accessible coverage on essential foundational topics, including chapters on pronunciation, grammar, vocabulary, literature and testing. Offering a sociocultural approach in which the teacher is seen as a facilitator and supporter of students’ self-directed learning, this text provides the prospective teacher with the knowledge and skills to be an effective educator in the EFL classroom. The targeted EFL focus makes this book ideal for pre-service teachers and for teacher training programmes around the world. Each chapter includes a Food for Thought section with questions for reflection and a Further Reading list.

Ameloblastoma is a locally aggressive tumor that most commonly arises in the mandible. It has a high rate of recurrence if inadequately excised. We report a case of a patient who developed recurrence of his ameloblastoma in his fibula flap mandibular reconstruction despite clear resection margins 23 years after resection. This is the first reported case of recurrent ameloblastoma in a neo-mandible reconstruction in the setting of negative margins. We discuss its surgical management using digital planning and reconstruction using a contralateral free fibula flap. Ameloblastoma is a locally aggressive entity that requires complete excision. Recurrence can even occur in the reconstruction, which can present a challenge to manage. Consideration should be given to repeat excision and second osseous flap reconstruction.

BackgroundA lack of public awareness of palliative care (PC) has been identified as one of the main barriers to appropriate PC access. Internet search query analysis is a novel methodology, which has been effectively used in surveillance of infectious diseases, and can be used to monitor public awareness of health-related topics.ObjectivesWe aimed to demonstrate the utility of internet search query analysis to evaluate changes in public awareness of PC in the USA between 2005 and 2015.MethodsGoogle Trends provides a referenced score for the popularity of a search term, for defined regions over defined time periods. The popularity of the search term ‘palliative care’ was measured monthly between 1/1/2005 and 31/12/2015 in the USA and in the UK.ResultsResults were analysed using independent t-tests and joinpoint analysis. The mean monthly popularity of the search term increased between 2008–2009 (pDiscussionAlthough internet search query surveillance is a novel methodology, it is freely accessible and has significant potential to monitor health-seeking behaviour among the public. PC is rapidly growing in the USA, and the rapidly increasing public awareness of PC as demonstrated in this study, in comparison with the UK, where PC is relatively well established is encouraging in increasingly ensuring appropriate PC access for all.

We report an extremely rare case of a hybrid tumour of the maxillary sinus. A 51-year-old man presented with a 6-week history of nasal congestion and epiphora. Radiological imaging demonstrated a maxillary sinus tumour, with extensive local invasion. Surgical excision included maxillectomy, left eye exenteration and free flap closure. Histology of the excised specimen showed a rare hybrid tumour containing adenoid cystic carcinoma, salivary duct carcinoma, epithelial-myoepithelial carcinoma and basal cell adenoma. Hybrid tumours are very rare tumour entities which are composed of at least two distinct tumour types. Each tumour entity conforms with a defined tumour type. The tumour entities of a hybrid tumour are not separated but have an identical origin within a definite topographical area. Diagnosis and appropriate management requires high index of suspicion, pathological endeavour to look for a more aggressive accompanying tumour and adequate oncological treatment according to the highest grade of tumour.

This study aims to determine the survival impact of patient characteristics and treatment options associated with the early stage oral cavity squamous cell carcinoma, OCSCC. The methods are analysis of Irish cancer database examining T1/2, N0, and M0 cases of OCSCC from 1997 to 2007 inclusive. In total, 397 cases were identified. Anterolateral tongue accounted for 52.9 % of cases. Increased age at diagnosis and smoking are independent prognostic survival indicators associated with poorer outcomes. Surgery as the initial intervention was associated with significantly better survival outcomes, while surgery and adjuvant radiotherapy significantly worse outcomes. Surgical intervention is recommended as the first-line treatment in the early stage OCSCC in combination with elective neck dissection.

Obstructive sleep apnoea is common in children and, if untreated, can lead to multiple medical sequelae. The Childhood Adenotonsillectomy Trial demonstrated benefit from early surgical intervention, but rapid access to such treatment is not always available.To examine the recent literature on non-surgical aspects of the management of paediatric obstructive sleep apnoea (OSA).The English language literature was searched for articles on the conservative management of OSA.In mild cases of OSA, intra-nasal steroids and other anti-inflammatory medications may give relief in mild cases of OSA, but the long-term safety of these treatments has not been established. Weight loss in obese children has been shown to be effective in selected patients but is limited in practice. Non-invasive ventilation may be effective but compliance can be a major obstacle. Oral appliances are effective by stenting the pharyngeal airway, but research in this area is limited.There are number of potential, if not proven, alternative management strategies for children with OSA, which could be considered in the absence of early surgical intervention.

Background Anaplastic thyroid cancer has a median survival between 1.2 and 10 months. The purpose of our study was to evaluate the outcomes of patients with anaplastic thyroid cancer in Ireland. Methods We carried out a retrospective analysis of the Irish National Cancer Database for patients with anaplastic thyroid cancer between 2000 and 2010. Results Of a total of 64 patients (40 women, 24 men), the median age was 69 years, and 29.7% of the patients had distant metastases. The overall median survival was 2.3 months and the 1, 2, and 5-year survival was 12.5%, 6.25%, and 4.69%, respectively. On univariate analysis age, sex, metastases at diagnosis, and multimodality treatment were statistically significant indicators of prognosis, and metastases at diagnosis remained statistically significant on multivariate analysis. Conclusion These results correlate with the American Thyroid Association (ATA) guidelines, in which, when possible, multimodality therapy offers a survival advantage to a select group of patients. Novel therapies may offer the greatest hope for these patients. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

I know there’s some real scary, hardcore stories of people selling vouchers, but I’ve never experienced anything like that. If I got a voucher, I would often see it as a bonus. If it was for a shop I didn’t use, I would sell it to someone I knew for the same amount of money – them just doing me a favour really. I wouldn’t sell a voucher for less than its value.