Blindness: a potential complication of bilateral neck dissection

Permanent blindness, is a very rare, but devastating complication of simultaneous bilateral neck dissection. Most otolaryngologists/head and neck surgeons are unaware that amaurosis can result from this surgery, and this paper is meant as a poignant reminder of that end. A case report is presented, followed by a discussion of possible aetiology; a management protocol is proposed.

Interstitial irradiation for squamous carcinoma of the oral cavity

Interstitial radiation delivered by iridium 192 implants was used to treat 38 patients with squamous carcinoma of the oral cavity. Thirty-six patients had either T1 or T2 tumours and no patient had palpable nodes at the time of implantation. Control of the primary tumour was achieved in all but 2 patients; these 2 were successfully treated by surgery. Fifteen patients (39%) went on to develop metastatic neck nodes. Nine were cured by radical neck dissection but the remaining 6 died of their disease. This gives a 5-year actuarial survival of 81%. Since all deaths occurred after the development of metastatic disease in the neck with control of the primary lesion, the evidence for and against prophylactic treatment of the neck lymphatics in clinically negative necks was reviewed. Prophylactic irradiation of the neck is probably preferable to any form of neck dissection but clear evidence that this improves long-term survival compared with careful follow-up and radical neck dissection for palpable nodes is still lacking.

Cancer of the paranasal sinuses and nasal cavities. Part II. Results of treatment

Part I of this account of a large consecutive series of 561 patients with cancer of the paranasal sinuses and nasal cavities treated at the Royal Marsden Hospital reveals some significant clinical and radiological features. The histopathology of every case has been carefully reviewed by one pathologist. Carcinoma was found to account for almost 80 per cent of tumours. An account is given of treatment methods in present use. End-results are reported in Part II of the paper and demonstrate that patients with sinus cancer receiving combined treatment in one centre have a better prognosis than when it is given in two or more hospitals. The discussion also concentrates on the use of main treatment methods and emphasizes some advances in surgical techniques. The value of initial cytotoxic chemotherapy is unproven but may offer some further advantage in prognosis. Precise comparison with the results of other series is not possible owing to lack of agreement on classification, variable case selection and differing treatment techniques.

Regional node involvement and distant metastases in carcinoma of the nasal cavity and paranasal sinuses

Of 624 cases of carcinoma of the nasal cavity and paranasal sinuses the presence or absence of metastasis to the regional nodes or to distant sites was recorded. Regional nodes were involved in 14.3 per cent, varying according to site and histological type. Disseminated metastases were found in 1.6 per cent. The prognosis for those with involved nodes was severely reduced, and for those with distant metastases it was negligible. This bleak outlook should be considered when treatment is being planned.

The management of squamous cell cancer of the mouth and throat

Until chemotherapy is proved more effective in the initial management of squamous cell cancer of the mouth and throat, radiation and surgery will remain the principal treatment modalities. This paper documents a treatment selection process which is used in the Head and Neck Clinic of the Peter MacCallum Hospital. Anatomical resectability, potential of control by radiation, disability and deformity produced by surgery, presence of metastases, psychological factors, and concurrent disease, as well as tumour behaviour, are all factors which influence the choice of radiation or surgery, alone, or in combination, in the treatment of each patient.