The paranasal sinuses may act simply to improve nasal function; certainly, it has been demonstrated that they may act as an adjunct in the production of nitric oxide and in aiding the immune defences of the nasal cavity. However, there is a distinction between utility and evolutionary origin. It may still be that the sinuses arose as an aid to facial growth and architecture, or persist as residual remnants of an evolutionary structure with an as yet unknown purpose, and in doing so have found an additional role as an adjunct to the nasal cavity.

BackgroundRecent reforms to the training grades have provoked debate about both quality and quantity of training. The bulk of previous research into this area has been qualitative, and little is known about the quantity of training opportunities. This study aimed to determine if the number of elective operations available to trainees was stable.MethodsThe number of elective procedures carried out in each surgical specialty (General & Vascular Surgery, Urology, Orthopaedics, ENT) in a large district general hospital was analysed in 6 month periods and adjusted for the number of basic surgical trainees in each specialty. In order to allow comparison between specialties, results for each 6 month period were calculated as a percentage of those for the first period.ResultsThe number of elective operations available per trainee fell in 3 of the 4 specialties, with a rise in Orthopaedics. Overall, the number of operations available to each trainee was 56% of that less than a decade ago.ConclusionThe number of operations available in a conventional hospital setting is decreasing. Introduction of the Modernising Medical Careers reforms must take account of this if they are to succeed in improving the quality of surgical training.

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INTRODUCTION Treatment of advanced neck disease (N2c/N3) in head and neck squamous cell carcinoma is contentious. The aim of this study was to review the survival outcome following surgical excision of neck disease and the complications of this surgery. PATIENTS AND METHODS A retrospective review of the case notes of 39 patients treated at the Oxford Radcliffe Infirmary Head and Neck Unit with squamous cell carcinoma and advanced neck metastases confirmed as either pN2c or pN3 on histological examination was performed. Patients were treated with surgery and, in some cases, with adjunctive postoperative radiotherapy at the centre between August 1996 and November 2004. The study sought to establish the demographics, UICC staging/pathology, method of treatment, complications, recurrence and survival. Kaplan-Meier curves were used for statistical analysis of survival. Comparisons were then made between the cohort and historical control groups. RESULTS All patients were UICC stage IV disease. The 2- and 5-year overall survival in patients with resectable disease was 63% and 52%, respectively. DISCUSSION Patients with advanced neck disease have traditionally been thought to have terrible prognosis and, therefore, treatment is controversial. In treating advanced head and neck cancer, there has been a recent trend away from surgery towards chemotherapy and/or radiotherapy. CONCLUSIONS Comparing this study group to historical controls that include chemotherapy and/or radiotherapy, the outcomes appear favourable. The use of a combination of radiotherapy and surgery is advocated; it is suggested that advanced neck disease can have an acceptable prognosis and morbidity and that local disease control may be achieved.

Optimisation of the endoscopic view during FESS may require correction of a deviated septum. The resulting incision leads to bleeding which could obscure the view of the endoscope. Repeated cleaning of the endoscope intraoperatively is time consuming and traumatisation of the lining of the nasal mucosa may lead to formation of adhesions post operatively. We discuss the use a segment of suction tubing that can act as a conduit or sleeve for the passage of the endoscope into the nasal cavity. This protects the endoscope tip from the bleeding area.

A subgroup of complex glomus jugulare tumours exists. This includes: multiple, giant or neuropeptide-secreting lesions; those associated with other lesions, such as dural arterio-venous malformation or an adrenal tumour; and tumours in which there has been previous treatment with adverse outcome. To our knowledge, we present the first case of a glomus jugulare tumour associated with a posterior fossa cyst. This entity should be included in the subgroup of complex glomus jugulare tumours.

There is no consensus for the management of paranasal sinus neuroendocrine carcinoma. Most cases are treated with surgery with or without chemoradiotherapy. This case shows that radiotherapy alone may be a viable treatment option for some cases.

Although uncommon, ocular complications of endoscopic sinus surgery have the potential to cause considerable morbidity. Direct intra-operative monitoring of the eye may alert the surgeon to potential complications at an early stage. We describe the use of Steri-strips during endoscopic sinus surgery as an aid to monitoring for ocular complications during surgery. This is a cheap, simple and effective method of intra-operative monitoring.