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Although current probe design limits the potential for resection of some tumors, radiofrequency coblation appears to be an attractive evolving technique for the endoscopic resection of selected upper aerodigestive tract malignancies.

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BackgroundTechniques for detecting circulating tumor cells in the peripheral blood of patients with head and neck cancers may identify individuals likely to benefit from early systemic treatment.MethodsReconstruction experiments were used to optimise immunomagnetic enrichment and RT-PCR detection of circulating tumor cells using four markers (ELF3, CK19, EGFR and EphB4). This method was then tested in a pilot study using samples from 16 patients with advanced head and neck carcinomas.ResultsSeven patients were positive for circulating tumour cells both prior to and after surgery, 4 patients were positive prior to but not after surgery, 3 patients were positive after but not prior to surgery and 2 patients were negative. Two patients tested positive for circulating cells but there was no other evidence of tumor spread. Given this patient cohort had mostly advanced disease, as expected the detection of circulating tumour cells was not associated with significant differences in overall or disease free survival.ConclusionFor the first time, we show that almost all patients with advanced head and neck cancers have circulating cells at the time of surgery. The clinical application of techniques for detection of spreading disease, such as the immunomagnetic enrichment RT-PCR analysis used in this study, should be explored further.

Suturing of the nasal septum after septal surgery is a commonly performed procedure designed to prevent complications such as septal haematoma and bleeding. It is also useful for closing any inadvertent tears of the septal mucosa and providing additional support for the cartilage pieces retained in septoplasty. In addition, the suture can be placed through the middle turbinates, stabilising them during the healing process. Placing knots for interrupted sutures in the posterior and middle part of the nasal septum can be technically difficult. We describe a continuous suturing technique for approximating the mucosal flaps following septal surgery.Key words: Nasal Septum; Otorhinolaryngologic Surgical Procedures; Sutures; Haematoma Introduction Many surgeons are adopting an increasingly conservative approach to septal surgery, such that only the deviated portion of the septum is addressed by the surgery. A number of centres are practising endoscopic techniques to perform septal surgery. Following removal of the deviated cartilage or bony septum, a dead space exists. In order to reduce this dead space, and therefore reduce the risk of developing a septal haematoma, surgeons have used nasal packing and suturing techniques. Several suturing techniques have been described to approximate the mucosal flaps after septal procedures, 1 -3 in order to reduce the complication rate. Many surgeons use interrupted sutures using absorbable suture materials to keep the flaps together. In 1984, Sessions 1 reported continuous suture quilting, using 4.0 plain catgut on a small cutting needle to approximate the mucosal flaps. A similar technique using a curved needle was described by Lee and Vukovic. 2 These techniques also help to close any mucosal tears and support the remaining cartilage. Many surgeons use suturing techniques to obviate the need for packing after surgery. 1 In addition, this suturing technique can be used to stabilise the middle turbinates during the healing process, preventing early lateralisation of the turbinate with adhesion formation.We describe a new, endoscopic suturing method for septal mucosal flaps following septal surgery.

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To our knowledge, this is the first report of ectopic thyroid tissue presenting as a submandibular mass and causing hyperthyroidism. Removal of the submandibular mass resulted in normalisation of thyroid function, and subsequent reduction in the patient's antithyroid medication dosage. Ectopic thyroid tissue should be suspected in any patient with a submandibular mass. Prior to resection of such a lesion, it is essential to ensure that normal, functioning thyroid tissue is present elsewhere. Ectopic thyroid tissue can also present with pathology similar to that affecting the normal thyroid gland.