ABSTRACT
BACKGROUND: Computed tomography is the standard pre-operative imaging modality for sinonasal papilloma. The complementary use of magnetic resonance imaging as an additional investigation is debated. This study aimed to establish whether magnetic resonance imaging can accurately detect tumour extent and is a useful adjunct to computed tomography. METHODS: A retrospective review was conducted on 19 patients with sinonasal papilloma. The interpretation of computed tomography and magnetic resonance imaging scans, by three clinicians, was conducted by comparing prediction of tumour extent. The perceived necessity of magnetic resonance imaging was compared between clinicians. RESULTS: The addition of magnetic resonance imaging improved accuracy of pre-operative interpretation; specifically, this finding was significant in cases with frontal sinus involvement. Surgeons were more likely than a radiologist to request magnetic resonance imaging, particularly when computed tomography indicated frontal sinus disease. CONCLUSION: Pre-operative combined magnetic resonance imaging and computed tomography helped predict disease in the frontal sinus better than computed tomography alone. A close working relationship between the ENT and radiology departments is important for accurate tumour localisation.
Subject(s)
Magnetic Resonance Imaging/methods , Multimodal Imaging/statistics & numerical data , Papilloma/diagnostic imaging , Paranasal Sinus Neoplasms/diagnostic imaging , Tomography, X-Ray Computed/methods , Adult , Aged , Clinical Decision-Making , Female , Frontal Sinus/diagnostic imaging , Humans , Logistic Models , Male , Middle Aged , Multimodal Imaging/methods , Papilloma/pathology , Paranasal Sinus Neoplasms/pathology , Predictive Value of Tests , Retrospective Studies , Single-Blind MethodABSTRACT
BACKGROUND: Inverted papilloma is the most common benign tumour affecting the nose. There is a high rate of recurrence and a potential of malignant transformation. This review article aimed to identify the best available management of this pathology today. METHOD: A systematic review of the current English-language literature was performed. Only original articles with a minimum follow up of one year and an average follow up of two years were included. RESULTS: A total of 1385 patients from 16 case series were identified. The total recurrence rate for all patients was 11.5 per cent. Significantly lower recurrence rates were found for procedures using an attachment-oriented excision (recurrence of 6.9 per cent; p = 0.0001) and utilising frozen sections (recurrence of 7.0 per cent; p = 0.0001). CONCLUSION: There is a general trend towards endoscopic surgery. There may be some benefit to the use of attachment-oriented surgery and frozen sections. Multi-centred randomised controlled trials are required.
Subject(s)
Disease Management , Frozen Sections/methods , Nasal Surgical Procedures/methods , Nose Neoplasms/surgery , Papilloma, Inverted/surgery , Endoscopy/methods , Humans , Neoplasm Recurrence, Local/epidemiology , Nose Neoplasms/pathology , Papilloma, Inverted/pathologyABSTRACT
BACKGROUND: Acute mastoiditis is a significant cause of morbidity in the paediatric population. This paper reviews our experience with this condition over the last 10 years and compares it with historical data from Alder Hey Children's Hospital, Liverpool, UK. METHOD: A retrospective case note review of patients who presented between 2003 and 2012 was performed. RESULTS: Forty-six patients with acute mastoiditis were identified. Imaging with computed tomography and magnetic resonance imaging was carried out in 14 cases (30.4 per cent). Intracranial complications were identified in six patients (13.0 per cent), one of whom required neurosurgical intervention. In 27 cases (58.7 per cent), a surgical procedure was performed. Data from 1995 to 2000 revealed similar rates of imaging (30.0 per cent), but significantly lower rates of surgical intervention (23 per cent). A lower rate of intracranial complications (4.8 per cent) in the historical cohort did not prove to be statistically significant (p = 0.419). CONCLUSION: The numbers of paediatric patients presenting with acute mastoiditis appears essentially unchanged. Improvement in imaging technology and aids to interpretation may explain the apparent increase of intracranial complications.
Subject(s)
Mastoid/pathology , Mastoiditis/epidemiology , Acute Disease , Adolescent , Anti-Bacterial Agents/therapeutic use , Child , Child, Preschool , Cohort Studies , Epidural Abscess/diagnosis , Epidural Abscess/etiology , Epidural Abscess/therapy , Female , Humans , Infant , Lateral Sinus Thrombosis/diagnosis , Lateral Sinus Thrombosis/etiology , Lateral Sinus Thrombosis/therapy , Magnetic Resonance Imaging , Male , Mastoid/diagnostic imaging , Mastoiditis/complications , Mastoiditis/diagnosis , Mastoiditis/therapy , Neurosurgical Procedures , Retrospective Studies , Tomography, X-Ray Computed , United Kingdom/epidemiologyABSTRACT
BACKGROUND: Multimodal treatment options in head and neck squamous cell carcinoma have allowed for greater control of locoregional disease, but this has not translated into a significant overall survival advantage for patients. This is partially because these treatment modalities have no influence over the rate of development of distant metastases. OBJECTIVE: This article summarises the current methods of detecting circulating and disseminated tumour cells. It also discusses how these cells can offer prognostic value in head and neck squamous cell carcinoma, and considers questions posed by the identification of these cells. METHODS: A literature search of relevant journal articles was performed using ScienceDirect and PubMed databases, and a general article search was conducted using the online search engine Google. RESULTS AND CONCLUSION: The evidence presented in this article indicates that circulating tumour cells and disseminated tumour cells may be clinically useful as prognostic markers or in the assessment of response to treatment in head and neck squamous cell carcinoma.
Subject(s)
Carcinoma, Squamous Cell/pathology , Neoplasm Metastasis/pathology , Neoplasm Metastasis/therapy , Neoplastic Cells, Circulating/pathology , Otorhinolaryngologic Neoplasms/pathology , Otorhinolaryngologic Neoplasms/therapy , Carcinoma, Squamous Cell/therapy , Combined Modality Therapy , Humans , Neoplasm Staging , PrognosisABSTRACT
OBJECTIVES: To establish the prevalence of external auditory canal exostosis ('surfer's ear') in Cornish surfers and investigate the potential impact on healthcare. METHOD: A total of 105 surfers were interviewed and otologically assessed on popular Cornish beaches. The degree of exostosis was graded as mild, moderate or severe. RESULTS: The prevalence of external auditory canal exostosis was 63.81 per cent (33.33 per cent mild, 18.10 per cent moderate and 12.38 per cent severe). The degree of exostosis showed a significant correlation with absolute cold-water exposure time. However, there was individual variation in susceptibility to external auditory canal exostosis; 12 per cent of surfers with excessive cold-water exposure showed no exostosis. Regression analysis of surgical operations performed at the Royal Cornwall Hospital for exostosis over the last 13 years revealed an average increase of 1.23 operations per year, with an average of 13 cases per year over the last 9 years. CONCLUSION: Exostosis of the external auditory canal is common in Cornish surfers. There appears to be individual variation in terms of susceptibility to this condition. The possible reasons for this are discussed. The increase in the technically difficult surgical operations performed for exostosis is likely to have implications for health resources in the future.
