Recent advances in the management of nasopharyngeal carcinoma

Developments in serology tests, imaging studies and endoscopic examinations contribute to early diagnosis of nasopharyngeal carcinoma. The primary treatment modality is radiotherapy. When tumour recurs after radiation, then surgical salvage contributes to a better prognosis.published_or_final_versio

Reconstructive surgery: today and tomorrow

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Commentary: Head and neck carcinomas in the developing world

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Medialisation thyroplasty for unilateral vocal fold paralysis associated with chronic pulmonary tuberculosis

Improved hygiene and public awareness have led to a steady decline in the incidence of pulmonary tuberculosis in developed countries. Nonetheless, long-term sequelae like unilateral vocal fold paralysis should not be underestimated in a modern society. We report three patients with chronic lung fibrosis following pulmonary tuberculosis leading to unilateral vocal fold paralysis. All three patients had hoarseness and chronic aspiration on swallowing. Early diagnosis and prompt surgical intervention are essential if this potentially fatal complication is to be prevented.published_or_final_versio

Family physician and the specialist in contemporary medical practice

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Recurrence of carcinoma of tongue after irradiation-result of surgical salvage

Conference Theme: Challenges to specialists in the 21st centurypublished_or_final_versio

Minimally invasive treatment of oligometastasis in the liver in recurrent nasopharyngeal carcinoma

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Role of surgery in the treatment of radiation-induced sarcomas of the head and neck

Introduction: Radiation-induced sarcoma (RIS) is a well-known complication of radiotherapy. It is an aggressive tumour and the prognosis is often poor, despite radical treatment. We aim to investigate the role of surgery in the treatment of patients with RIS of the head and neck region. Method: We conducted a retrospective review of records of patients whom were treated for radiation-induced sarcoma at Queen Mary Hospital, Hong Kong, between the period 1999 to 2010. Data collected included patient age, gender, latency period for the development of RIS, site of RIS, symptoms, treatment given, pathology and survival. Results: Nineteen patients were included, (M=11, F=8). Eighteen received radiotherapy for treatment of primary nasopharyngeal carcinoma. One received radiotherapy for carcinoma of the parotid. The medial latency period for the development of sarcoma was 11.1 years (range 5.3-25.1). The most common site for development of RIS was the neck (n=8), followed by the oropharynx/oral cavity (n=4), nasopharynx (n=3) nasal cavity (n=2), maxilla (n=1) and mandible (n=1). The most common histology was undifferentiated sarcoma (n=6). Nine patients underwent surgical resection of the RIS with curative intent, three and six patients achieved R0 and R1 resection respectively. Chemotherapy was used in eleven instances after surgery. Radiotherapy was used in seven instances, three through brachytherapy, four through external beam irradiation. Overall medial survival from diagnosis of RIS was 1.74 years (95% CI 0.60-2.87), which improves to 2.47 years (95% CI 0.97-3.97) when only calculating those whom surgery was performed. Conclusions: Patients suffering from radiation-induced sarcomas have a poor prognosis, in keeping with existing literature. Treatment is mainly by surgery aiming at resection with a curative intent. If curative resection is impossible, surgery may still have a role in palliating the patients’ symptoms such as bleeding, fungation, or painpublished_or_final_versio

The role of elective neck dissection during surgical salvage for recurrent nasopharyngeal carcinoma

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Reconstructive surgery for burn patients

Reconstructive surgery in burn patients is difficult because of the intense scarring and the necessity to carry out multiple operative procedures for different reconstructive needs in a single patient. The primary aim of the surgeon is to prevent hypertrophic scar by early wound closure, and proper postburn treatment using a combination of silicone gel, splinting, and pressure therapy. Reconstructive procedures should be deferred until the wounds have matured. Accurate preoperative assessment and appreciation of the true tissue deficiency, appropriate application of different reconstructive options, and the establishment of the priorities of reconstruction in relation to individual requirements are essential for a successful outcome. In general, functional needs have to be met before attending to aesthetic concerns and priority should be given to restore active before passive function. Different reconstructive options using direct closure, skin grafts, flaps, free tissue transfer, and tissue expansion are discussed.published_or_final_versio