The stylomastoid artery as an anatomical landmark to the facial nerve during parotid surgery: a clinico-anatomic study.

BACKGROUND: The identification of the facial nerve can be difficult in a bloody operative field or by an incision that limits exposure; hence anatomical landmarks and adequate operative exposure can aid such identification and preservation. In this clinico-anatomic study, we examined the stylomastoid artery (SMA) and its relation to the facial nerve trunk; the origin of the artery was identified on cadavers and its nature was confirmed histologically. METHODS: The clinical component of the study included prospective reviewing of 100 consecutive routine parotidectomies; while, the anatomical component of the study involved dissecting 50 cadaveric hemifaces. RESULTS: We could consistently identify a supplying vessel, stylomastoid artery, which tends to vary less in position than the facial nerve. Following this vessel, a few millimetres inferiorly and medially, we have gone on to identify the facial nerve trunk, which it supplies, with relative ease. The origin of the stylomastoid artery, in our study, was either from the occipital artery or the posterior auricular artery. CONCLUSION: This anatomical aid, the stylomastoid artery, when supplemented by the other more commonly known anatomical landmarks and intra-operative facial nerve monitoring further reduces the risk of iatrogenic facial nerve damage and operative time.

Ethical and technical considerations for the creation of cell lines in the head & neck and tissue harvesting for research and drug development (Part I): techniques of tissue harvesting and propagation.

BACKGROUND: Although much has been published for the development of cell lines, these were lab based and developed for scientific technical staff. OBJECTIVE OF REVIEW: We present a simple and successful protocol for the development of cell lines and tissue harvesting for the clinical scientist. We also discuss the ethical implications of tissue retention and present a generic consent form. CONCLUSION: The advantages of hospital-based cell line creation are numerous. We can be more certain that cell lines are developed from the particular tissues of interest and accurate anatomical and appropriate clinico-pathological control tissues are also harvested. We can also be certain of less cell line cross contamination.

Ethical and technical considerations for the creation of cell lines in the head & neck and tissue harvesting for research and drug development (Part II): ethical aspects of obtaining tissue specimens.

BACKGROUND: Although much has been published for the development of cell lines, these were lab based and developed for scientific technical staff. OBJECTIVE OF REVIEW: We discuss the ethical implications of tissue retention and present a generic consent form (Part II). We also present a simple and successful protocol for the development of cell lines and tissue harvesting for the clinical scientist (Part I). CONCLUSION: Consent is also more proximate and assurance can be given of appropriate usage. Ethical questions concerning tissue ownership are in many institutions raised during the current consenting procedure. We provide a robust ethical framework, based on the current legislation, which allows clinicians to be directly involved in cell and tissue harvesting.

Salivary VEGF: a non-invasive angiogenic and lymphangiogenic proxy in head and neck cancer prognostication.

BACKGROUND: Saliva is an enriched milieu containing biologically active proteins, including growth factors and cytokines. The endothelial growth factor family of proteins is important for the development of blood and lymphatic vessels in a healthy individual but also can aide tumour growth.The aim of this study is to develop an independent normative database of values of salivary VEGF in a healthy population and to test the hypothesis that values would be raised in the saliva of patients with oral cancer. METHODS: Twenty-one participants (12 males and 9 females) of whom 14 were healthy and 7 had oral squamous cell carcinoma took part in this study.An immunoassay was employed to quantify a range of specific vascular endothelial and lymphatic endothelial growth factors in various body fluid compartments (blood, saliva). This was correlated to tumour factors and patient outcomes. RESULTS: The mean salivary levels and serum VEGF A165 levels were significantly correlated in the sample as a whole. Additionally, both saliva and serum VEGF A165 levels were significantly correlated with age. There were significant differences in the salivary and serum levels of the control group and the cancer group. CONCLUSION: We present independent normative data on the levels of endothelial growth factor in the saliva of a healthy control population. We also suggest the use of simple non-invasive tests in helping to predict head and neck tumour biology and outcomes.