Factors affecting timeliness in management of head and neck cancer.

BACKGROUND: Timeliness in the management of patients with head and neck cancer (HNC) can be affected by both patient and non-patient related factors. This study aims to investigate the factors associated with the timeliness of managing HNC. METHODS: A retrospective review was conducted on Western Health medical records including all new patients presenting to the Western Health HNC surgical outpatient clinic in the five-year period from first January 2017 to 31st December 2021 with the diagnosis of a HNC. Both patient and non-patient related factors were compared with the duration between a patient's referral to a HNC service and the commencement of their treatment. RESULTS: Two hundred and twenty-eight patients were included in this study. The median duration from referral to the commencement of treatment was 48 days. Lack of radiological or pathological investigations prior to referral to a HNC service as well as early staging were found to significantly impact timeliness in management. Socioeconomic factors such as non-English speaking backgrounds, distance from the hospital and lack of social supports were not found to negatively impact timeliness of management. CONCLUSION: The management of patients with HNC require careful consideration of all patient and non-patient related factors which may affect timeliness in management, particularly investigations performed prior to their referral to a HNC service.

Materials used for mastoid obliteration and its complications: a systematic review.

OBJECTIVE: The objectives of this review are to identify the types of materials with their associated complications and respective considerations when used to obliterate the mastoid cavity. METHODS: A systematic search was performed across PubMed, Embase, Medline and Cochrane databases from January 2009 to January 2020 for randomized controlled trials and observational studies of patients that underwent mastoid obliteration. Studies that fulfilled the inclusion criteria were screened and scored according to the MINORS and relevance scores to determine final inclusion. Types of complications were grouped into minor and major complications based on the Clavien-Dindo classification. RESULTS: Two thousand five hundred and seventy-eight ears were evaluated. There were a total of 165 (7.9%) minor and 142 (6.8%) major complications in the autologous group. Overall complication rate is 14.8%. The major complications were largely recurrent and residual disease requiring revision surgery. There were 10 (18.5%) minor complications and three (5.6%) major complications in the allogenic group. The cumulative complications risk is 24%. For the synthetic group, there were 39 (8.0%) minor and 34 (7.6%) major complications. The cumulative complication rate is 16.6%. CONCLUSION: Current evidence on materials for mastoid obliteration has been evolving. Each material has its strengths and limitations. The trend over the last decade favours the use of autologous materials. The principle of using a material remains being cautious of not reimplanting skin that can lead to the development of a cholesteatoma. The choice of materials is dependent on patient factors as well as the surgeons' preference and experience.

Introduction of surgeon-performed ultrasound to a head and neck clinic: indications, diagnostic adequacy and a new clinic model?

BACKGROUND: Surgeon-performed ultrasound (SUS) changes management and surgical decision-making. It allows for immediate ultrasound-guided fine-needle aspiration (US-FNA) for the work-up of neck masses, lymph node metastases and thyroid nodules. We examined the introduction of SUS to an Australian Head and Neck cancer unit, identifying situations where it was used, and evaluated the diagnostic adequacy and accuracy of US-FNA. METHODS: A prospective database was created for all patients undergoing SUS and US-FNA, performed by two head and neck surgeons, between September 2018 and June 2019. The data were retrospectively analysed to identify when SUS was performed. Diagnostic adequacy and accuracy of US-FNA were determined after evaluating formal cytology and histopathology reports. RESULTS: A total of 183 diagnostic, surveillance and interventional SUS scans were performed for multiple indications. A total of 100 US-FNAs were performed on a number of different sites. Diagnostic adequacy and accuracy were 92% and 85%, respectively. CONCLUSION: After the introduction of SUS to our weekly routine head and neck cancer clinic, we identified multiple situations where it can be used successfully within our clinical landscape. Our diagnostic US-FNA results compared favourably to current literature, without additional need for clinic attendance by consultant radiologists or pathologists, saving valuable hospital resources. This introduction proposes a promising alternative to current neck lump clinic models.

Leiomyosarcoma: a rare sinonasal malignancy.

Leiomyosarcomas (LMS) are rare sinonasal malignant tumours with 20 cases of nasal LMS previously reported in the literature. An 81-year-old man presented with an incidental left nasal lesion associated with left nasal obstruction and occasional left-sided blood-stained rhinorrhoea. Nasendoscopic examination showed green coloured polyps filling the left nasal cavity with biopsies showing LMS. CT imaging did not show any bony erosion. No metastases were found on positron emission tomography imaging. The patient underwent endoscopic resection and all surgical margins were clear of disease. The patient was declined postoperative radiotherapy, and serial follow-up has not shown any recurrence to date. Nasal LMS are rare sinonasal smooth muscle tumours and symptoms and radiological findings are often non-specific. Therefore, diagnosis is made on histopathological and immunohistochemical analysis. Due to their invasive nature, the treatment of choice is complete surgical resection, with adjuvant therapy reserved for patients with locally advanced or metastatic disease.

Median philtrum sinus: a rare presentation and review of management options.

Nasal dermoids are rare congenital abnormalities, and there is only one previously reported case of a philtrum sinus tract extending to the skull base. A 2-month-old boy was presented with an incidental finding of a median philtrum sinus with no infective features and no other abnormal clinical findings. MRI demonstrated a sinus tract extending from the philtrum to the crista galli. On multidisciplinary review, a conservative approach was taken due to the asymptomatic nature of the patient. Given the rarity of nasal dermoids, diagnosis requires precise clinical examination and MRI to identify the extent of the tract. Management options require a multidisciplinary case-specific approach and include non-surgical as well as surgical approaches.