Airway decision making in major head and neck surgery: Irish multicenter, multidisciplinary recommendations.

Major head and neck surgery poses a threat to perioperative airway patency. Adverse airway events are associated with significant morbidity, potentially leading to hypoxic brain injury and even death. Following a review of the literature, recommendations regarding airway management in head and neck surgery were developed with multicenter, multidisciplinary agreement among all Irish head and neck units.

The role of surgery for anaplastic thyroid carcinoma in the era of targeted therapeutics: A scoping review.

Background: Questions exist regarding patient selection for surgery in anaplastic thyroid carcinoma (ATC), particularly with the advent of neoadjuvant-targeted therapeutics. The present scoping review sought to evaluate what extent of surgical resection should be performed in ATC.

Methods: A scoping review was carried out in accordance with Joanna Briggs Institute and the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) protocols.

Non-conventional laryngeal malignancies: a multicentre review of management and outcomes.

Purpose: Non-conventional laryngeal malignancies (NSCC) often have limited published data to guide management despite individual histopathological subtypes often exhibiting heterogeneous behaviour, characteristics, and treatment responses compared to laryngeal squamous cell carcinoma (SCC). This study aimed to compare oncological outcomes with SCC, specifically disease-free survival (DFS), disease-specific survival (DSS) and overall survival (OS). Secondary objectives were to compare treatment differences and perform a state of the art review.

Pattern of nodal metastasis of cutaneous squamous cell carcinoma involving the temporal bone.

Objective: The objective of this study was to explore the pattern of lymph-node spread of SCCs involving the temporal bone.

Methods: We retrospectively reviewed all cutaneous SCCs involving the temporal bone over a 20-year time-period. Forty-one patients were eligible.

Use of the Portsmouth Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity ('P-POSSUM') to predict morbidity in patients undergoing surgery with reconstruction for temporal bone malignancy.

Objective: The Portsmouth Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity ('P-POSSUM') is a two-part scoring system that includes a physiological assessment and a measure of operative severity. This study sought to determine whether risk estimates for this scoring system could be used in major head and neck reconstructive surgery.

Method: A retrospective review was performed of patients undergoing resection for a temporal bone malignancy in a single head and neck centre in Dublin, Ireland, from 2002 to 2021.

Current trends in craniofacial reconstruction.

Reconstruction of the head and neck continues to pose a variety of difficult functional and aesthetic challenges to the plastic surgeon. While the surgical treatment for midfacial and skull base tumours continues to advance, the three-dimensional reconstruction predicaments continue to increase in complexity. Reconstructive strategies of the head and neck require the restoration of intricate skeletal architecture and large volumes of both internal and external soft tissue envelopes that can withstand adjuvant therapies.

Metastatic and locally aggressive BCC: Current treatment options.

The treatment of locally advanced and metastatic BCC presents a significant clinical challenge. Treatment options have evolved recently to include the use of hedgehog inhibitors Vismodigib and Sonidigib and immunotherapy with Cemiplimab.

The Royal College of surgeons multidisciplinary guidelines on elective tracheostomy insertion in COVID-19 ventilated patients.

Background: The current COVID-19 pandemic has placed enormous strain on healthcare systems worldwide. Understanding of COVID-19 is rapidly evolving. Pneumonia associated with COVID-19 may lead to respiratory failure requiring mechanical ventilation.

Out-of-Field Dose Calculation by a Commercial Treatment Planning System and Comparison by Monte Carlo Simulation for Varian TrueBeam.

Purpose: The calculation accuracy of treatment planning systems (TPSs) drops drastically when the points outside the field edges are considered. The real accuracy of a TPS and linear accelerator (linac) combination for regions outside the field edge is a subject which demands more study. In this study, the accuracy of out-of-field dose calculated by a TPS, used with a TrueBeam (TB) linac, is quantified.

Design and use of a novel substrate for simple, rapid, and specific early detection of anthrax infection.

Bacillus anthracis is a major biological warfare threat. The inhalation form of infection can kill quickly. While antibiotic treatment is effective, if diagnosis is delayed, the rapidly produced toxin may already be present in lethal amounts.

Infiltrative thyrotoxicosis: an unusual case of diffuse large B cell lymphoma.

Thyrotoxicosis is most commonly caused by Graves' disease, toxic multinodular goitre, a functioning thyroid adenoma, or thyroiditis. Extrinsic infiltrative conditions affecting the thyroid gland are typically destructive, and associated with thyroid hypofunction. We describe the case of a 61-year-old woman who presented to our hospital with symptoms of thyrotoxicosis, neck swelling and thyroid function tests consistent with hyperthyroidism.

Significant laryngeal destruction in a northern European cohort of Behçet's disease patients.

Objectives: Behçet's disease (BD) is a multisystem autoimmune disease of unknown origin typically affecting the triad of oral and genital mucosa and the eye. Limited data are available in the literature regarding the otolaryngology-related manifestations of BD, particularly in northern Europeans. This is a novel study detailing surprising and significant laryngeal structural changes in a northern European cohort of BD.

Unilateral Warthin's tumour in a patient of Afro-Caribbean descent.

Warthin's tumours are the second most common benign tumours of the parotid gland. The authors report the case of a 40-year-old man of Afro-Caribbean decent who presented with a painless mass at the angle of the right mandible. It was an incidental finding while shaving and was not associated with any symptoms.

Molecular assembly of botulinum neurotoxin progenitor complexes.

Botulinum neurotoxin (BoNT) is produced by Clostridium botulinum and associates with nontoxic neurotoxin-associated proteins to form high-molecular weight progenitor complexes (PCs). The PCs are required for the oral toxicity of BoNT in the context of food-borne botulism and are thought to protect BoNT from destruction in the gastrointestinal tract and aid in absorption from the gut lumen. The PC can differ in size and protein content depending on the C.

Advanced and rapidly progressing head and neck cancer: good palliation following intralesional bleomycin.

The authors herein report the case of a 61-year-old man undergoing adjuvant therapy for locally advanced laryngeal cancer, who developed parastomal recurrence in his radiation field around his tracheotomy site, while he was undergoing radiation therapy, and compromised the secure placement of his tracheotomy tube and maintenance of his upper airway. MRI restaging and biopsy confirmed recurrence and progressive disease in his mediastinum. He underwent local therapy with intralesional bleomycin with good palliation, and ability to maintain the patency of his upper airway.

Free tissue transfer versus pedicled flap reconstruction of head and neck malignancy defects.

Background: With the advent of microsurgery the pedicled flap is considered by many to be an outdated surgical option.

Aims: To explore the relationship between flap survival and pre-morbid risk factors, conduct a comparative analysis of flap and systemic morbidities and complete a cosmesis and functionality assessment for oral and oropharyngeal reconstruction patients.

Methods: 114 patients, over a 13-year period, who had a one-stage reconstructive procedure employing the pectoralis major myocutaneous flap (PMMF) or radial forearm-free flap (RFFF).

Complete traumatic laryngo-tracheal separation.

Laryngotracheal separation injuries are rare and potentially fatal. Immediate respiratory signs may include dysphonia, aphonia, hemoptysis, subcutaneous emphysema and a sucking wound. Patients with this injury usually die at the site of the trauma.

Transpalatal advancement pharyngoplasty for obstructive sleep apnea syndrome: results and analysis of failures.

Objective: To assess the polysomnographic outcomes of patients with obstructive sleep apnea undergoing transpalatal advancement pharyngoplasty for retropalatal collapse and to compare responders with nonresponders to surgery.

Design: Retrospective medical record review.

Setting: Tertiary referral teaching hospital and private practice.

Bilateral stapedectomy: association between first- and second-ear surgical findings and their effects on the second-ear outcome.

Objectives: We assessed the association between first-ear and second-ear surgical findings in patients undergoing second-ear stapedectomy for bilateral otosclerosis and the impact of such findings on the audiometric outcome of the second ear.

Methods: A retrospective chart review of all stapedectomy patients who underwent stapes surgery by one of two surgeons in a single tertiary referral institution from 1962 to 2001 was performed, and those patients who underwent bilateral stapedectomy were identified. Patient demographic data, surgical findings, procedure performed, and preoperative and postoperative audiometric data were recorded.

The "Propeller" incision for transpalatal advancement pharyngoplasty: a new approach to reduce post-operative oronasal fistulae.

Objective: To present a new soft tissue approach for transpalatal advancement pharyngoplasty (TPA), the propeller incision, and to compare the rates of post-operative oronasal fistula in those undergoing TPA with the traditional "Gothic Arch" incision described by Woodson and those with the propeller incision.

Methods: A prospectively maintained adult sleep apnoea surgery database was used to identify those patients undergoing TPA, either alone or in combination with other procedures, for obstructive sleep apnoea syndrome (OSAS) between February 2001 and September 2006 in a tertiary referral centre by a single surgeon (RHL). In addition to the incision used during TPA, patient demographic data, previous surgery of the upper airways, smoking history, pre-operative body mass index, respiratory disturbance index, oxygen saturation index and the occurrence of oronasal fistula post-operatively, were recorded.

Adenotonsillar surgery in morbidly obese children: routine elective admission of all patients to the intensive care unit is unnecessary.

Morbidly obese children undergoing adenotonsillectomy, often with co-morbid obstructive sleep apnoea, may be considered at a higher risk of postoperative respiratory compromise. This retrospective study aimed to assess the frequency and severity of postoperative respiratory complications in these patients and to identify preoperative risks factors for such morbidity. Medical and nursing chart review of all consecutive elective post-adenotonsillectomy admissions of morbidly obese children (defined as >95th centile for body mass index adjusted for age and gender) to our intensive care unit over a 30-month period was performed.

Adenotonsillectomy for obstructive sleep apnea in obese children: effects on respiratory parameters and clinical outcome.

Objective: To assess the efficacy of adenotonsillar surgery on respiratory sleep parameters and avoiding continuous positive airway pressure (CPAP) treatment in morbidly obese children with obstructive sleep apnea syndrome (OSAS).

Design: Retrospective.

Setting: Tertiary referral institution.

Solitary fibrous tumor of the floor of the mouth: case report and review of the literature.

Solitary fibrous tumor is an uncommon spindle cell neoplasm that is believed to be of mesenchymal origin. Rarely does it originate in the oral cavity, and only 1 case of this lesion in the floor of the mouth has been previously reported. We describe a new case of solitary fibrous tumor arising from the soft tissues of the floor of the mouth.

Airway management of three cases of congenital cervical teratoma.

Cervical teratomas are rare congenital tumors derived from all three germ cell layers. The vast majority are histologically benign, but the significant size they may attain can potentiate life-threatening upper airway obstruction. All cases require the specialist airway skills of the pediatric anesthetist.