A carotid artery rupture should never occur. The figures presented strongly indicate that elective ligation of an impending rupture is the procedure of choice; however, this should seldom be necessary if nutritional deficiencies have been corrected; if pre‐operative radiation has been properly planned and timed, and if safe incisions are utilized with dermal graft protection, the carotid artery rupture should not occur, and an impending carotid rupture should become a rare event. The surgeon responsible for the patient must have the courage to resect electively an area of impending rupture and cover the region with a split thickness skin graft or with an adjacent skin flap.
The search for distant metastases in head and neck cancer patients, at the time of initial presentation and evaluation, is justified in order not to subject a patient to radical local therapy if cure cannot be attained. This study reviews 897 consecutive cases of squamous carcinoma of the larynx, oropharynx, hypopharynx and oral cavity, presenting to the Department of Otolaryngology — Head and Neck Surgery. One hundred and twenty‐one patients presented with advanced disease or other factors that suggested distant metastases were highly likely to be present. These patients underwent extensive metastatic work‐up, consisting of biochemical profiles, liver scan, bone scan and chest X‐ray. The value of this extensive evaluation is assessed in terms of the patient‐derived benefit, rather than the traditional incidence of metastases and predictive accuracy. Evidence of metastases was identified in 15 patients (12.4%) of this high risk group, but were of significance in the selection of appropriate therapy in only three patients (2.5%). Due to shortcomings in the investigative modalities currently in use and difficulties in their interpretation, erroneous therapeutic decisions were made in two of these three cases. In view of this low positive yield, the rationale between routine screening in head and neck cancer is discussed with its effect on therapeutic decisions.
\s=b\The hemilaryngectomy procedure includes the entire hemithyroid cartilage with the extent of the cartilage cut beyond the midline determined by endosquires a maturity in preoperative evaluation, endoscopy, and surgical skills that challenges most head and neck surgeons.
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