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A novel technique for nasogastric tube placement in head and neck surgery
Poster presentation / British Journal of Oral and Maxillofacial Surgery 49S (2011) S26–S116
S87
Reference Oral cancer treatment pathway (stage I/II) Surgery
SNB
Stage I
D 15,043–15,378*
SNB +ve
D 17,186–18,244**
Stage II
D 27,515*
SNB −ve (true −ve)
D 4715
SNB −ve (false −ve)
D 17,834–19,014**
*Less D 8020 without radiotherapy/chemotherapy. *Less D 7447–8020 without radiotherapy/chemotherapy.
The mean cost to treat 100 hypothetical patients using the SNB pathway was D 810,887–840985, and for the surgical pathway was D 1,794,096–1,817,566. Conclusions: Although the costs presented are an approximation, the SNB pathway appears to be economically viable, and is cheaper than the surgical pathway. Data from more participating centres are required to give a clearer representation of the cost. doi:10.1016/j.bjoms.2011.03.177 P171 Tumour recurrence following surgical removal of parotid pleomorphic salivary adenoma (PSA) using a retrograde facial nerve dissection (FND) technique B. O’Regan ∗ , G. Bharadwaj, I. Nawroz Queen Margaret Hospital, Dunfermline, United Kingdom Introduction: The recurrence rate of parotid PSA associated with retrograde FND is a poorly researched subject. We adopted this technique for parotid surgery as a standard procedure in 1995. Objective: To establish the rate of tumour recurrence associated with retrograde FND for primary parotid PSA removal. Method: We recruited 53 patients over 15 years. The data was collected prospectively. Male/female ratio was 17:36. Age range was 15–69 yrs. Mean tumour size was 23.3 mm. All surviving patients were contacted by telephone (2010) to exclude recurrence. 39 patients had a superficial parotidectomy, 9 patients a total and 5 patients a partial superficial parotidectomy. Results: The mean follow up time from the date of surgery was 103 months and the median follow up time was 97months.1 patient developed a solitary nodular recurrence 8 years. The recurrence rate was 1.9%. Discussion: RND is a useful technique and helps to limit unnecessary removal of healthy parotid tissue without compromising the tumour margins. This approach supports current trends in parotid surgery. We were unable to identify any prospective study which examined recurrence rates following the use of RND in PSA removal. Conclusion: The PSA recurrence rate after parotidectomy in our study is low and comparable with literature recurrence rates
1. McGurk M, Thomas BL, Renehan AG. Extracapsular dissection for clinically benign parotid lumps; reduced morbidity without oncological compromise. British Journal of Cancer 2003;89:1610–3.
doi:10.1016/j.bjoms.2011.03.178 P172 A novel technique for nasogastric tube placement in head and neck surgery N.J. Opie ∗ , R. Danha University Hospital Coventry & Warwickshire NHS Trust, United Kingdom Enteral feeding is often used in the immediate postoperative period for patients with a variety of head and neck pathologies. Nasogastric tube placement can prove technically difficult, especially in those patients with distorted oropharynegeal anatomy, impaired swallowing, or limited mouth opening. The authors describe a technique for nasogastric tube placement utilizing a fiberscope and ureteric stent guide-wire. The airway is secured via awake nasal intubation with an endotracheal tube. A size 4 mm internal diameter Olympus fiberscope is then introduced into the stomach through the opposite nostril. Once fiberscope position is confirmed, a ureteric stent guide-wire is inserted into the stomach through the suction port of the fiberscope. A fine bore feeding tube is then railroaded over the wire and fixed at the 60 cm mark at the nostril. Tube position may then be confirmed with chest radiograph in the usual manner. We report a case series of 10 successful nasogastric tube placements with this method. doi:10.1016/j.bjoms.2011.03.179 P173 Minimal Access Cranial Suspension (MACS) lift M.L. Goodson ∗ , L. Ormondroyd, R.J. Banks, J.M. Ryan Sunderland Royal Hospital, United Kingdom The MACS lift procedure described by Tonnard and Verpaele produces antigravitational vertical shifting of deep facial tissues and skin. Its main indications are for early age related changes of the jaw line and including early jowling. The MACS lift has low morbidity, requires a less extensive surgical dissection and lower risk of facial nerve damage. Operative and recovery time is also shorter than a conventional face lift. Materials and methods: A retrospective review of 20 patients who have undergone MACS facelift by a single surgeon was undertaken.
S87
Reference Oral cancer treatment pathway (stage I/II) Surgery
SNB
Stage I
D 15,043–15,378*
SNB +ve
D 17,186–18,244**
Stage II
D 27,515*
SNB −ve (true −ve)
D 4715
SNB −ve (false −ve)
D 17,834–19,014**
*Less D 8020 without radiotherapy/chemotherapy. *Less D 7447–8020 without radiotherapy/chemotherapy.
The mean cost to treat 100 hypothetical patients using the SNB pathway was D 810,887–840985, and for the surgical pathway was D 1,794,096–1,817,566. Conclusions: Although the costs presented are an approximation, the SNB pathway appears to be economically viable, and is cheaper than the surgical pathway. Data from more participating centres are required to give a clearer representation of the cost. doi:10.1016/j.bjoms.2011.03.177 P171 Tumour recurrence following surgical removal of parotid pleomorphic salivary adenoma (PSA) using a retrograde facial nerve dissection (FND) technique B. O’Regan ∗ , G. Bharadwaj, I. Nawroz Queen Margaret Hospital, Dunfermline, United Kingdom Introduction: The recurrence rate of parotid PSA associated with retrograde FND is a poorly researched subject. We adopted this technique for parotid surgery as a standard procedure in 1995. Objective: To establish the rate of tumour recurrence associated with retrograde FND for primary parotid PSA removal. Method: We recruited 53 patients over 15 years. The data was collected prospectively. Male/female ratio was 17:36. Age range was 15–69 yrs. Mean tumour size was 23.3 mm. All surviving patients were contacted by telephone (2010) to exclude recurrence. 39 patients had a superficial parotidectomy, 9 patients a total and 5 patients a partial superficial parotidectomy. Results: The mean follow up time from the date of surgery was 103 months and the median follow up time was 97months.1 patient developed a solitary nodular recurrence 8 years. The recurrence rate was 1.9%. Discussion: RND is a useful technique and helps to limit unnecessary removal of healthy parotid tissue without compromising the tumour margins. This approach supports current trends in parotid surgery. We were unable to identify any prospective study which examined recurrence rates following the use of RND in PSA removal. Conclusion: The PSA recurrence rate after parotidectomy in our study is low and comparable with literature recurrence rates
1. McGurk M, Thomas BL, Renehan AG. Extracapsular dissection for clinically benign parotid lumps; reduced morbidity without oncological compromise. British Journal of Cancer 2003;89:1610–3.
doi:10.1016/j.bjoms.2011.03.178 P172 A novel technique for nasogastric tube placement in head and neck surgery N.J. Opie ∗ , R. Danha University Hospital Coventry & Warwickshire NHS Trust, United Kingdom Enteral feeding is often used in the immediate postoperative period for patients with a variety of head and neck pathologies. Nasogastric tube placement can prove technically difficult, especially in those patients with distorted oropharynegeal anatomy, impaired swallowing, or limited mouth opening. The authors describe a technique for nasogastric tube placement utilizing a fiberscope and ureteric stent guide-wire. The airway is secured via awake nasal intubation with an endotracheal tube. A size 4 mm internal diameter Olympus fiberscope is then introduced into the stomach through the opposite nostril. Once fiberscope position is confirmed, a ureteric stent guide-wire is inserted into the stomach through the suction port of the fiberscope. A fine bore feeding tube is then railroaded over the wire and fixed at the 60 cm mark at the nostril. Tube position may then be confirmed with chest radiograph in the usual manner. We report a case series of 10 successful nasogastric tube placements with this method. doi:10.1016/j.bjoms.2011.03.179 P173 Minimal Access Cranial Suspension (MACS) lift M.L. Goodson ∗ , L. Ormondroyd, R.J. Banks, J.M. Ryan Sunderland Royal Hospital, United Kingdom The MACS lift procedure described by Tonnard and Verpaele produces antigravitational vertical shifting of deep facial tissues and skin. Its main indications are for early age related changes of the jaw line and including early jowling. The MACS lift has low morbidity, requires a less extensive surgical dissection and lower risk of facial nerve damage. Operative and recovery time is also shorter than a conventional face lift. Materials and methods: A retrospective review of 20 patients who have undergone MACS facelift by a single surgeon was undertaken.