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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.
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.
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.
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.
Tympanostomy tube (grommet) insertion is a common procedure, with little guidance in the current literature regarding post-operative surveillance. Our institution implemented a protocol to follow up post-surgical grommet patients via audiology at six weeks.
A retrospective audit of all patients less than 16 years old who had undergone grommet insertion during a three-month period.
A total of 149 patients had grommets inserted. Exclusion criteria left a cohort of 123 individuals; 82 (67 per cent) were followed up by audiology. Of these, 13 (11 per cent) did not attend follow up, and were discharged; 53 (43 per cent) were discharged from audiology with normal thresholds; and 16 (13 per cent) were referred back to a consultant. Therefore, the overall reduction in patients followed up by an otolaryngologist was 54 per cent.
We recommend a six-week follow up with audiology following grommet insertion, allowing for referral back to ENT services in the event of related complications.
We report the first case of a laryngeal composite tumour consisting of a squamous cell carcinoma combined with an atypical carcinoid.
Case report and review of the literature concerning laryngeal composite tumours.
Primary laryngeal carcinoma is the most common malignancy of the upper aerodigestive tract. The vast majority are of the squamous cell type. Primary neuroendocrine neoplasms represent a rare, heterogeneous subset of laryngeal malignancies, comprising typical carcinoid, atypical carcinoid, small cell carcinoma and paraganglioma. Primary combined neuroendocrine and squamous cell carcinoma of the larynx is even more rarely encountered, with only 14 publications of this so-called composite tumour to date. In each case, the neuroendocrine component has been small cell carcinoma.
The treatment of primary neoplasms comprising more than one histological type is tailored to the most biologically aggressive tumour. Accurate diagnosis of the histological nature of laryngeal composite tumours is imperative to ensure optimal therapy.
We report the unique case of a 16-year-old man presenting with sudden and profound left-sided hearing loss following application of a Halo vest.
Case report and review of the world literature concerning spinal realignment procedures, spinal manipulation and Halo vest application.
A 16-year-old man presented to the ENT clinic with sudden and profound left-sided hearing loss after undergoing posterior release of a fixed flexion extension deformity of the cervical spine and Halo vest application. The hearing loss slowly improved until the patient disrupted the Halo vest while boarding a bus. Regular audiometry documented the progress of the patient's hearing loss.
Procedures that significantly alter the established bony anatomy of the neck can be associated with profound audiological deficit through disturbance of the vertebrobasilar arterial system. Such a phenomenon may be associated with application or disruption of a Halo vest.
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