Incidence and documentation of ear lobe numbness after parotidectomy: our 20 years' experience

Introduction: Parotidectomy carries a risk of postoperative complications including facial nerve palsy and Frey’s syndrome. Less attention, however, has been given to the management of the greater auricular nerve (GAN) during parotidectomy. Providing sensory supply to the auricle, the greater auricular nerve is often sacrificed for access to the parotid gland during surgery. This results in anaesthesia and paraesthesia of the ear lobe and significant patient morbidity. Aim: To review the electronically available documentation of post-parotidectomy ear lobe numbness in our follow-up clinic letters of the past 20 years. Methods: For this retrospective case series our departmental database of over 850 patients undergoing parotidectomy was used as the primary data source. The information collected from electronic records included documentation of intraoperative details, post-operative recovery and incidence of ear lobe numbness post-operatively. The current study was completed between October and November 2020. SPSS and Excel were used for data collection and analysis. Results: The incidence of ear lobe numbness was found to be higher in the patient cohort whose posterior branch of the GAN had been sacrificed during surgery (58% compared to 46%). This agrees with the published literature that preservation of the posterior branch of the GAN decreases the post-operative sensory deficit to the auricle. However, this audit was limited by the incomplete recording of GAN sacrifice intra-operatively and post-operative GAN dysfunction. Discussion: As any tissue removed, added or altered in surgery requires accurate record-keeping, the outcome of the greater auricular nerve during parotidectomy should always be included in the operation notes. A proforma made available within the department may allow for a standardised recording of recognised complications

Use of complementary and alternative medicine in pediatric otolaryngology patients attending a tertiary hospital in the UK

Objective: Little data is available on complementary and alternative medicine (CAM) use in children attending otolaryngology services. We investigated the prevalence and pattern of CAM use among children attending the pediatric otolaryngology department in a tertiary pediatric teaching hospital in Scotland. Design: A cross-sectional survey conducted by administering an anonymous questionnaire to the parents accompanying patients attending the pediatric otolaryngology department. Elective admissions and clinic attendees were included over a 3-month period in 2005/2006. Setting: Academic tertiary care referral centre in North-East Scotland. Patients: Five hundred and fifty-four consecutive patients aged less than 16 years were eligible. The response rate was 59% (n = 327). Main outcome measures: Prevalence of CAM use in children. Secondary measures include types of CAM used, indications for use and communication with family physicians. Results: Based on 327 responses, 93 patients (29%) had ever used CAM, 20% within the last year. Commonly used CAM preparations were cod-liver oil, echinacea, aloe vera, cranberry, primrose oil and herbal vitamin supplements. The popular non-herbal CAM included homeopathy, massage, aromatherapy, chiropractic, yoga and reiki. Nineteen percent used CAM for their admission illness. Sixty-one percent of parents thought that CAM was effective and 65% would recommend it to others. Fifty-one percent of parents stated that the family physician was unaware of CAM use by the child. Conclusions: Despite concerns regarding the efficacy, safety and cost effectiveness of complementary and alternative medicine, its use among the pediatric otolaryngology population is more common than many providers may realize. This has implications for all healthcare workers involved in their care

Evaluation of the vascular response to neoadjuvant chemotherapy in primary breast cancer.

Neoadjuvant chemotherapy (NAC) is being increasingly used in the treatment of primary breast cancer (PBC). With the primary tumour in situ, the neoadjuvant treatment setting allows an in vivo assessment of tumour chemo-responsiveness and permits an evaluation of the possible underlying biological mechanisms of response. Angiogenesis is critical for the growth and metastases of breast cancer and with the development of novel agents targeting this process, an understanding of the vascular effects of conventional chemotherapy will enable the rational design of future drug combinations. Functional magnetic resonance imaging (MRI) provides a non-invasive method for assessing tumour microvasculature. Using this technique, pre-treatment tumour vascularity and changes following two cycles of anthracycline-based NAC were measured in a series of patients with PBC. This demonstrated a significant reduction in the permeability and perfusion-related MRI parameters in tumours responding to treatment. The degree of change in K* was able to predict for pathological non-response with a positive predictive value of 84%. Further, an evaluation of the pathophysiological correlates of functional MRI demonstrated an association between the permability/perfusion-related parameters and aggressive tumour features. An evaluation of the effect of anthracycline-based NAC on immunohistochemically-derived measures of tumour angiogenesis was performed on a series of patients treated for PBC. A quantitative and a qualitative measure of tumour angiogenesis was performed (microvessel density MVD and pericyte coverage index PCI respectively), together with an assessment of VEGF expression. This demonstrated no change in MVD following treatment but a significant increase in PCI reflecting a reduction in the proportion of immature proliferating blood vessels. This was accompanied by a reduction in VEGF expression, which may be mediating this effect. These observations may have clinical importance as they may help identify patients who could benefit from alternative therapies early in their treatment course and they may assist in the rational design of combination cytotoxic and antiangiogenic treatment regimens

Palliative and supportive care in head and neck cancer: United Kingdom National Multidisciplinary Guidelines

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. It provides recommendations on the assessments and interventions for this group of patients receiving palliative and supportive care. Recommendations • Palliative and supportive care must be multidisciplinary. (G) • All core team members should have training in advanced communication skills. (G) • Palliative surgery should be considered in selected cases. (R) • Hypofractionated or short course radiotherapy should be considered for local pain control and for painful bony metastases. (R) • All palliative patients should have a functional endoscopic evaluation of swallowing (FEES) assessment of swallow to assess for risk of aspiration. (G) • Pain relief should be based on the World Health Organization pain ladder. (R) • Specialist pain management service involvement should be considered early for those with refractory pain. (G) • Constipation should be avoided by the judicious use of prophylactic laxatives and the correction of systemic causes such as dehydration, hypercalcaemia and hypothyroidism. (G) • Organic causes of confusion should be identified and corrected where appropriate, failing this, treatment with benzodiazepines or antipsychotics should be considered. (G) • Patients with symptoms suggestive of spinal metastases or metastatic cord compression must be managed in accordance with the National Institute for Health and Care Excellence guidance. (R) • Cardiopulmonary resuscitation is inappropriate in the palliative dying patient. (R) • 'Do not attempt cardiopulmonary resuscitation' orders should be completed and discussed with the patient and/or the family unless good reasons exist not to do so where appropriate. This is absolutely necessary when a patient's care is to be managed at home. (G)

Use of PerClot® in head and neck surgery : A Scottish Centre experience

The audit was registered with the institutional clinical effectiveness department.Peer reviewedPublisher PD

Evaluating Emergency ENT Admissions In Two Scottish Teaching Hospitals

Introduction: Ear, Nose and Throat (ENT) emergencies are common in all communities, with significant regional variations in published literature. Early diagnosis and prompt management results in reduction in morbidity and mortality. The management of ENT emergencies requires significant financial resources for admissions and surgical interventions. An awareness of the pattern of admissions will facilitate strategic planning of a department’s activity. Objective: To evaluate the pattern of emergency ENT admissions to our department. Our objectives were to register the common admission diagnoses; record the equipment required in the ward treatment room and to identify training requirements for nursing and medical staff involved in their management. Methods: Retrospective analysis of a prospectively maintained departmental database. All emergency admissions to our department over 8 years were recorded. The data collected included patients’ demographics and admission diagnoses. Results: The total patients identified were 3878 with 56% (2185) male and 44% (1693) female. The majority of the patients admitted had a diagnosis in the head and neck sub group (58%). Over the study period on average 41 emergency admissions were recorded per month. The commonest emergency requiring admission was epistaxis, followed by acute sore throat. Conclusions: The most common adult ENT emergencies requiring admission to our unit are epistaxis, quinsy and post-tonsillectomy complications

Consequences of massive river bank erosion to the local society at Pasir Parit, Kelantan

The population living near the river basin is at risk of river bank erosion. As a consequence of hydraulics and hydrological processes, as well as floods and development activities along the river, the morphology is changing. Many ecological characteristics, including flora and fauna, human life, basin structure, and so on, may be lost as a consequence of river bank erosion. The objectives of this research are to (1) identify the impact of soil texture on river bank erosion; (2) determine the consequences of river bank erosion on the local community; and (3) propose river bank erosion mitigation strategies for the study region. We use both quantitative and qualitative approaches to analyse data in this study. An observational technique, a questionnaire survey, and a personal interview were utilised to collect data. To support our findings, we acquired secondary data from government entities (Drainage and Irrigation Department). The river bank erosion in this case study affected 17 dwellings, totalling 103 people, and two homes were consumed by the river. The impacted area of river bank erosion at the site, according to the research conclusions based on aerial photography and departmental statistical data, is roughly 120 metres in a period of 6 months. The volume of sediment lost due to bank erosion was estimated to be 360,000 cubic metres, or 1.4 hectares. As a consequence of the massive river bank erosion, the victims endured loss and worry. The following technique for preventing river bank erosion is proposed: build a concrete river cliff or gabion as soon as possible, and change the low weir so that flowing and flood water is contained in the river's main channel

Cataract surgery redesign : meeting increasing demand, training, audit and patient-centered care

Objective: The demand for cataract surgery in Fife (a well-defined region in southeast Scotland) was steadily increasing over 15 years. Cataract surgery was therefore being outsourced to meet demand with consequences on list mix, training needs, patient experience and staff morale. We aimed to redesign our services to meet local demand, retain a patient-centered service and continue to fulfil training needs. Methods: We quantified cataract surgery delivery over an 18-month period: before, during and after redesign of services. We studied numbers of operations, trainee cases and number of outsourced cases. We also considered the economic implications of the redesign. Results: We studied three periods (each of six months duration): before redesign (BR), redesign period (RP) and post-redesign (PR). Data were collected on total operation numbers, number of cases performed by trainees, and numbers performed out with normal working hours (weekend lists) and external providers. An economic analysis examined the cost of outsourcing cataracts during BR and RP and the costs of the redesign, including building, equipment and additional nursing staff. Conclusion: Regional fulfilment of cataract surgery provision remains a continuous challenge within the NHS. We show that with minimal investment, smart redesign process and collaborative working, increased local provision is possible while fulfilling trainee needs and achieving the necessary clinical audits and national standards.Publisher PDFPeer reviewe