Emergency presentations of head and neck cancer: a modern perspective.

BACKGROUND: Head and neck cancer emergency presentations are uncommon but persistent. However, there is little published literature on this aspect of cancer and patient demographics. This study aimed to assess the incidence, patient profile, tumour site and stage of emergency cancer presentations in our region. METHOD: Retrospective review of regional cancer database over a five-year period. RESULTS: Emergency presentations accounted for 7 per cent of all cases. There was no difference in patient age and risk factors between the emergency and non-emergency presentations. The emergency presentation group showed a greater proportion of female patients compared to the non-emergency presentation group (30 vs 15 per cent). In all emergency presentations, the cancer was at advanced stages. Oropharyngeal cancer was the commonest emergency presentation of cancer, but the third commonest in the non-emergency group. CONCLUSION: Emergency presentations are increasing annually. Female patients and oropharyngeal cancer showed greater representation compared to male patients and laryngeal cancer.

Preservation of speech and swallowing after excision of a pharyngeal pouch tumour.

A pharyngeal pouch is not an uncommon cause of dysphagia in older population. However, finding a tumour in a pharyngeal pouch is very rare. A 79-year-old gentleman presented with dysphagia and a neck lump. Videofluoroscopy showed a pharyngeal pouch. Rigid endoscopy confirmed a tumour arising from the pharyngeal pouch. The histology showed it to be squamous cell carcinoma. The MRI scan based staging was T3N1M0. The patient underwent modified right radical neck dissection, partial pharyngectomy with primary repair and tracheostomy. He completed postoperative radiotherapy and remained disease-free at 4 years follow-up.

Open surgical management of auricular haematoma: incision, evacuation and mattress sutures.

OBJECTIVE: A large variety of techniques have been used for auricular haematoma management. The open surgical management of auricular haematoma involves incision, evacuation and the obliteration of dead space using biodegradable mattress sutures. Our goal was to describe open surgical management for primary, recurrent and spontaneous auricular haematoma. METHODS: Auricular haematoma patients who underwent open surgical management were prospectively audited (2010-2013). Information was collected on demographics, clinical presentation, aetiology, examination findings, previous interventions, details of open surgical management and post-operative follow up. RESULTS: In all, 12 male and 3 female patients with a mean age of 33 years (range 16-86 years) were evaluated. Contact sport injury was the most common aetiology. Ten patients had undergone previous unsuccessful interventions to treat auricular haematoma before open surgical management was performed. All patients were managed successfully without significant recurrence. One patient had a minor local reaccumulation which required reinsertion of a mattress suture. One elderly patient developed localised cellulitis which responded well to antibiotics. CONCLUSION: Open surgical management of auricular haematoma has been successful. The technique is simple and reliable, and can be accomplished in a clinical setting under local anaesthesia.

Modified midfacial translocation for access to ventral skull base tumours.

OBJECTIVE: To describe our technical modifications of midfacial translocation for access to the nasopharynx, and anterior, central and lateral skull base. DESIGN: Retrospective chart review of a prospective case series. SETTING: Department of Otolaryngology-Head and Neck Surgery, Aberdeen Royal Infirmary, Scotland, UK. METHODS: Along with demographics, other parameters studied were adequacy of exposure, completeness of resection, aesthetic outcome and complications. Our main outcome measures included adequacy of exposure, partial or total resection of tumour, aesthetic outcome, and complications related to surgical technique. RESULTS: A total of 48 patients underwent modified midfacial translocation at our institution for nasopharyngeal, parapharyngeal, and anterior, central and lateral skull base tumours. In all cases, the exposure was deemed to be adequate. Two patients developed wound dehiscence in previously irradiated fields. Other incisions healed very well and the aesthetic outcome was regarded as satisfactory. CONCLUSION: Modified midfacial translocation is based on the principle of temporary craniofacial disassembly for access to the skull base. Our modifications offer adequate access and a better aesthetic outcome. All incisions are placed through the aesthetic sub units of the nose with preservation of the lip. Preservation of the bony piriform aperture prevents airway compromise.

Neck abscess and vocal cord paresis: delayed complications of a self-extruded long fishbone stuck in throat.

A 57-year-old Caucasian man, otherwise fit and well, presented with a 2-week history of dysphagia, odynophagia. Two weeks prior to the presentation, he had felt a fishbone stuck in his throat which was self-extruded after 3 days. Subsequently he developed a right anterior neck swelling and hoarseness. Transnasal endoscopic examination of larynx revealed an injected and oedematous right hemilarynx with right vocal cord paresis. An ultrasound examination of the neck confirmed a collection in the neck on the right side, and frank pus was aspirated from the neck abscess and he responded well to conservative management. Subsequent examination in follow-up had shown complete recovery of vocal cord movement. The patient did not seek medical attention immediately after getting a 5 cm fishbone extruded from the throat which resulted in significant morbidity. All patients should be alerted to the possibility of delayed complications and they should be encouraged to seek urgent medical attention.

Pitfalls in neuroimaging of headache: a case report and review of the literature.

Headache is a common symptom, with a lifetime prevalence of over 90% of the general population in the United Kingdom (UK). It accounts for 4.4% of consultations in primary care and 30% of neurology outpatient consultations. Neuroimaging is indicated in patients with red flag features for secondary headaches. The guidelines recommend CT or MRI scan to identify any intracranial pathology. We present a unique case where the initial noncontrast CT scan failed to identify a potential treatable cause for headache. A middle aged man presented with headache and underwent a CT scan without contrast enhancement. The scan was reported as normal. The headache persisted for years and the patient underwent a staging CT scan to investigate an oropharyngeal cancer. This repeat CT scan utilized contrast enhancement and revealed a meningioma. Along with other symptoms, headache is an established presenting complaint in patients with meningioma. The contrast enhanced CT brain proved superior to a nonenhanced CT scan in identifying the meningioma. In a patient with persistent headache where other causes are excluded and a scan is to be requested, perhaps contrast enhanced CT is a better option than a plain CT scan of brain.