Head and neck cancer: A 6-year retrospective analysis and review of three common triaging systems.

OBJECTIVES: In the United Kingdom, head and neck cancer (HNC) cases continue to rise and are the fourth commonest cancers in men. Additionally, in the last decade, the incidence rise in women is twice their male counterpart, signifying the need for robust and dynamic triaging systems to maintain high pick-up rates across both genders. This study investigates local risk factors associated with HNC and reviews the most commonly used guidelines and risk calculator tool for two-week-wait (2ww) HNC clinics. DESIGN: Six-year retrospective case-control analysis of 2ww HNC clinics within a district general hospital in Kent studying symptoms and risk factors. RESULTS: Two hundred cancer patients (128M:72F) were identified and compared against 200 randomised non-cancer patients (78M:122F). Increasing age, male gender, smoking, previous cancer and neck lumps were statistically relevant risk factors for HNC (p < .001). HNC mortality at 1 and 5 years was 21% and 26%, respectively. Adjusting guidelines to improve local services obtained the following area under curve (AUC) scores: NICE guidelines 67.3, Pan-London 58.0 and HNC risk calculator version 2 (HaNC-RC V.2) 76.5. Our adjusted HaNC-RC V.2 improved sensitivity by 10% to 92%, and theoretically reduces local general practice referrals by 61% when utilising triaging staff. CONCLUSION: Our data portray the primary risk factors as increasing age, male gender and smoking for this demographic. The presence of a neck lump was the most significant symptom within our cohort. This study demonstrates a critical balance when adjusting sensitivity and specificity of guidelines and proposes that departments adjust diagnostic tools for their local demographic to improve referral numbers and patient outcomes.

The effects of endoscopic sinus surgery on the postoperative outcomes of open rhinoplasty.

OBJECTIVE: Several studies have advocated concurrent endoscopic sinus surgery and rhinoplasty. However, concerns about increased surgical risk, complications, and unsuccessful cosmetic outcomes following the concurrent procedures have been reported. The aim of this study was to investigate the overall safety of concurrent endoscopic sinus surgery and rhinoplasty and to specifically examine the effect of endoscopic sinus surgery on cosmetic outcomes. METHODS: We retrospectively reviewed 57 patients who underwent concurrent open rhinoplasty and endoscopic sinus surgery (ESS). We then selected a control group of patients, who underwent rhinoplasty only and were matched with a study group for age, sex, external nose deformity, and implant graft material. The postoperative outcomes of the 2 groups were compared. RESULTS: Fifty-seven patients underwent concurrent open rhinoplasty and ESS. Postoperative assessment showed that a successful outcome was achieved in 82.5% of the patients who underwent concurrent procedures and in 87.7% of the patients who underwent rhinoplasty only (P = .56). The rate of revision due to a dissatisfied outcome was 5 patients (8.7%) in the concurrent surgery group and 3 patients (5.3%) in the rhinoplasty-only group (P = .36). Minor complications occurred in 6 patients (10.5%) from the group who underwent the concurrent procedures and 5 patients (8.8%) from the rhinoplasty-only group (P = .76). CONCLUSION: Combined rhinoplasty and endoscopic sinus surgery achieves a similar aesthetic outcome to rhinoplasty only, with no significant increase in rates of revision or complication.