Surgical management of head and neck malignancy

More than 90% of head and neck tumours are squamous cell carcinomas. This review focuses on tumours arising from the mucosal surfaces of the upper aerodigestive tract. We discuss the aetiology, presentation and investigation of these tumours and give special attention to their management which may comprise surgical resection, chemoradiation or combined therapy. The surgical treatment of the clinically positive neck and the somewhat controversial topic of management of the N0 neck are also discussed.

Audit-derived guidelines for training in endoscopic sinonasal surgery (ESS)--protecting patients during the learning curve

The objective of the present study is to propose guidelines to ensure safe practice in teaching centres while allowing endoscopic sinonasal surgery (ESS) training to proceed. A prospective complications audit of ESS procedures was undertaken over a 5-year period (January 1996-December 2000). The results have been used to form specific guidelines for safe and effective ESS training. A total of 500 patients underwent ESS during the 5-year period. The senior author was the main surgeon in 55% of cases with the trainee observing or assisting. A supervised trainee was the main surgeon in 45% of cases. The overall complication rate was 1.2% (n = 6) (i.e. 0.7% for the 815 procedures performed). These were all minor complications. We encountered no major complications in 500 patients over the 5-year period. This audit shows that training need not compromise patient safety provided it is phased and structured. We propose appropriate phases and suggest the minimum requirements for units involved in ESS training.