Bilateral transverse cordotomy is a reliable treatment option for patients with bilateral vocal fold paralysis, and aims to avoid the morbidity associated with a permanent tracheostomy.
To assess the quality of operative note keeping and compare the results with the Royal College of Surgeons (RCS) of England guidelines 'Good Surgical Practice' as the gold standard. ENT Department at Hull Royal Infirmary, University Hospital. A hundred consecutive operative notes were selected between November 2005 and January 2006. The documentation of the operative notes in each case was compared with the RCS of England guidelines. All surgeons were made aware of the results of the first cycle and the guidelines were made available in all ENT theatres in the form of a printed aide-memoir. A second audit cycle was then carried out prospectively between April and June 2006. The results demonstrated a change in practice in key areas. The 1st cycle results showed the documentation of patient identification (94%), name of surgeon (98%) and clearly written postoperative instructions (94%). However, surgeons performed suboptimally at recording the name of assistant (82%), operative diagnosis (46%), the incision type (87%) and the type of wound closure (83%). After introducing the aide-memoir, the second cycle demonstrated a change in practice with 100% documentation in most of the assessed parameters except that the time of surgery and the type of surgery (emergency or elective) were not adequately recorded. We recommend that all surgical departments should have the RCS guidelines as an aide-memoir in theatres to enhance the quality and standardise operative note recording.
Background: Controversy exists as to the management of advanced laryngeal carcinoma. In general primary radical surgery is favoured. Objective: The aim of this study was to analyse the clinical outcome of patients having total laryngectomy for cancer of larynx. Materials and methods: This study was a retrospective case note review and questionnaires were used for evaluating voice handicap. These laryngectomies included in this study were performed by the senior author (CJW) from January 2001 till June 2007 at Leeds General Infirmary, Leeds. Some of the patients had partial or total pharyngectomy in addition to total laryngectomy. Results: In this study a total of 59 patients were included. Seventeen (28.8%) of these patients had preoperative radiotherapy and laryngectomy was performed for residual or recurrent disease. The initial TNM staging of the tumour ranged from T1N0 to T4N2C. Tracheoesophageal puncture for speech prosthesis was done in 48/59 (81.4%) patients. Post-operative complications were seen in 30.5% (18/59) patients. In this study group 9 patients (15.2%) developed pharyngocutaneous fistulas. For communication 31/51 (60.8%) patients were using speech valves. In this study 30.4% had minimal, 26.1% moderate and the rest 43.4% feeling severely handicapped with regards to voice use after total laryngectomy. Five year survival after laryngectomy in this study was 65.2%. Conclusion: Long term disease control and survival is achievable with total laryngectomy with or without postoperative radiotherapy with minimal risks in patients with advanced carcinoma of larynx. Key words: Laryngectomy; Larynx; Carcinoma DOI: 10.3126/kumj.v7i3.2734 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 258-262
Introduction Nasopharyngeal carcinoma is a rare neoplasm in the UK. The current gold standard for detection is endoscopic examination under anaesthesia of the nasopharynx with biopsy. Many clinicians are now advocating cross-sectional imaging as the primary investigation. The objective of this study is to evaluate the role of cross-sectional imaging in detecting nasopharyngeal carcinoma and ultimately to avoid unnecessary biopsy. Material and methods This is a retrospective uncontrolled case series review of patients who were investigated for suspected nasopharyngeal carcinoma between 2009 and 2017 at York Teaching Hospital NHS Foundation Trust. At present, any suspected nasopharyngeal carcinoma requires biopsy. Search terms used were ‘endoscopic biopsy of nasopharynx’, ‘endoscopic examination + biopsy nasopharynx’. The main outcome measures are reported histological and radiological features of malignancy. Only patients who had imaging prior to the biopsy were included. Results A total of 144 patients had endoscopic examination under anaesthesia of the nasopharynx with biopsy. Approximately one-third of these patients had cross-sectional imaging before the biopsy. The study revealed that magnetic resonance imaging had 100% sensitivity and 84% specificity; however, the endoscopic examination under anaesthesia and biopsy had only 88% sensitivity. This is due to a negative histological finding despite radiological characteristics of nasopharyngeal carcinoma in some patients. However, the specificity was 100%. Conclusion The study supports magnetic resonance imaging as the primary investigation in patients with suspected nasopharyngeal carcinoma followed by endoscopic examination under anaesthesia and biopsy in cases with suspicious findings on imaging only.
Rhabdomyosarcoma is relatively seen in the pediatric age group with the head and neck region as the commonest site. To the best of our knowledge, few cases of laryngeal involvement in adult have been described in the literature. Biologically, rhabdomyosarcoma is different from squamous cell carcinoma, which is the commonest tumor of the larynx. A previously healthy non-smoker 77-year-old lady presented to the ENT outpatient with a six weeks history of intermittent alteration of voice quality. She had no history of sore throat, or any symptoms suggesting laryngo-pharyngeal reflux. Examination showed asymmetry of the left arytenoid cartilage and aryepiglottic fold. She subsequently had a direct laryngoscopy and biopsy. Histology and immunohistochemistry examination suggested the diagnosis of mesenchymal neoplasm. Following discussion at MDT she subsequently had a total laryngectomy. Histology confirmed a completely excised laryngeal rhabdomyosarcoma. Rhabdomyosarcoma of larynx in adult is a rare disease. Surgical treatment with or without adjuvant radiotherapy is currently the treatment of choice for this disease. Key words: Rhabdomyosarcoma, larynx cancer RésuméLe Rhabdomyosarcome est relativement connu dans le groupe d'âge pédiatrique et les régions les plus touchées sont la tête et le cou. A notre connaissance, peu de cas de l'implication du larynx chez des adultes ont été cités dans la littérature. Biologiquement, rhabdomyosarcome est différent de la cellule squameuse carcinome, qui est la tumeur de larynx la plus ordinaire. Une femme non-fumeuse, âgée de 77 ans d'une très bonne santé au départ, s'est présentée à l'ORL ambulatoire avec une période de six semaines histoires de l'altération répétée de la qualité de la voix. Elle n'avait pas d'antécédente de maux de gorge ou aucun symptômes suggestifs le reflux laryngo-pharyngien. L'examen a montré l'asymétrie de la gauche aryténoïde cartilage aryepiglottique pli. Elle a par la suite eu une laryngoscopie directe et la biopsie. L'examen histologique et immunohistochimie a suggéré le diagnostique des tumeurs mesenchymteuses, néoplasme. A la suite d'une discussion au MDT elle a ensuite eu une laryngectomie totale. L'histologie a confirmé une excisée larynx chez des adultes qui est une maladie rare. Le traitement chirurgical avec ou sans radiothérapie adjuvante est actuellement le traitement du choix pour cette maladie.
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