The isolated symptom of unilateral tonsillar enlargement has limited value in adults with a suspected head and neck cancer pathway.

OBJECTIVE: Given the uncertainty regarding the predictive value of unilateral tonsillar enlargement and/or lesion in malignancies, this study aimed to evaluate the efficacy of unilateral tonsillar enlargement and/or lesion referral criterion in the adult suspected head and neck cancer pathway. METHODS: All two-week wait referrals received in 2018-2019 were reviewed. All patients referred with unilateral tonsillar enlargement and/or lesion were included and analysed for patient demographic data, presenting symptoms, initial clinic outcomes and final diagnoses. RESULTS: A total of 4934 urgent head and neck cancer referrals were analysed, and 1.9 per cent of these had unilateral tonsillar enlargement and/or lesion. Only 10 patients were diagnosed with tonsil cancer. All the positive tonsil cancer cases had at least one additional head and neck red flag symptom. CONCLUSION: The referral criterion for unilateral tonsillar enlargement and/or lesion may be of limited benefit in an already economically challenged National Health Service. Further multicentre studies should be undertaken to refine conclusions on the value of unilateral tonsillar enlargement and/or lesion alone as a criterion for the head and neck cancer two-week wait pathway.

Conservative management of laryngeal dog bite.

BACKGROUND AND AIMS: Dog bites represent an important public health issue, causing injuries from trivial to fatal. The true incidence is unknown due to the lack of national and local reporting system. School children, mostly male, are more commonly affected with the majority of injuries occurring in the head and neck area, followed by the limbs and trunk. METHODS: The conservative management of a 6-year-old girl who sustained a fracture of her laryngeal structure from an attack by her neighbours' dog is described. Only a 1 cm visible puncture wound in the midline of her neck with air escaping through the wound was seen at presentation. RESULTS: Ten days were spent in hospital including the first four in intubated Paediatric Intensive Care Unit. Initial microlaryngoscopy and bronchoscopy (MLB) showed a swelling in the right anterior subglottis not reducible by manipulation. She was re-intubated with progressively larger naso-tracheal tube until the fracture was fully reduced on her 3rd MLB. Three months post-injury, there is no evidence of airway narrowing. CONCLUSION: The literature advocates early surgical management of laryngeal trauma including dog bites. Conservative management of laryngeal fracture from a dog bite is feasible and associated with a good outcome and no long-term sequela.

Reversal of Young's procedure in hereditary haemorrhagic telangiectasia.

BACKGROUND: Hereditary haemorrhagic telangiectasia is an autosomal dominant condition characterised by multiple venous malformations of the skin and mucous membranes which can bleed on contact. A Young's procedure is used to control severe epistaxis in patients with this condition. However, there has been no previous report of a reversal of Young's procedure in such a patient. OBJECTIVE: A patient with hereditary haemorrhagic telangiectasia had his Young's procedure reversed under general anaesthetic by dividing the mucocutaneous flaps. Nasal vestibule patency was maintained using a custom-made silicone nasal mould. Intra-operative photographs show the patient's nasal mucosa shortly following reversal of his Young's procedure, and also illustrate the creation of the custom-made nasal mould. CONCLUSION: Stopping airflow through the nasal cavity via a Young's procedure prevents the telangiectasia from bleeding but does not make them disappear completely. Young's procedure does not seem to have any long-lasting effect on the nasal mucosa of patients with hereditary haemorrhagic telangiectasia.

Protection of tympanomeatal flaps using Visibility Background Material.

BACKGROUND: Over the years, various materials have been used by otologists to protect tympanomeatal flaps from damage by suction equipment or drills. OBJECTIVE: This report aims to describe the use of Mercian's Visibility Background Material (an inert, silicone-based material licensed for use in the human body, which does not get caught in drill flukes) to protect tympanomeatal flaps. CONCLUSION: We have used this material for over 12 months, without any complications.

Functional status after total laryngectomy: cross-sectional survey of 79 laryngectomees using the Performance Status Scale for Head and Neck Cancer.

INTRODUCTION: Total laryngectomy affects patients' post-operative speech and swallowing functions. We aimed to assess these outcomes. MATERIALS AND METHODS: Patients' normalcy of diet, ability to eat in public and speech comprehensibility were assessed using the Performance Status Scale for Head and Neck Cancer, in a cross-sectional survey of disease-free laryngectomees. RESULTS AND ANALYSIS: Seventy-nine laryngectomees (72 men and seven women), with a mean age of 64 years (range 37 to 96), were included. Mean scores were 81.6 (standard deviation 29.2) for normalcy of diet, 77.8 (standard deviation 30.2) for eating in public and 65.2 (standard deviation 23.5) for speech. Normalcy of diet achieved higher scores within six months of laryngectomy and remained stable. There was a statistically significant difference between scores for the speech and public eating domains, comparing patients less and more than six months post-laryngectomy. This trend was maintained beyond 12 months. CONCLUSIONS: In post-laryngectomy patients, Performance Status Scale for Head and Neck Cancer scores improved over time, especially those for the speech and public eating domains, reflecting increasing confidence in social interactions and familiarity with surgical voice restoration.