- Email: [email protected]
Re: Andi KA, et al. Infraorbital orbitotomy: modification of the Weber–Ferguson approach. Br J Oral Maxillofac Surg 2010;48:44–5
398
Letters to the Editor / British Journal of Oral and Maxillofacial Surgery 48 (2010) 394–399 ∗ Tel.:
+44 01904 726567; fax: +44 01904 726346. E-mail address: [email protected] Available online 11 February 2010
doi:10.1016/j.bjoms.2010.01.007
Re “Prognostic factors in malignant tumours of the salivary glands” by Speight and Barrett [Br. J. Oral Maxillofac. Surg. 47 (8) (2009) 587–593] Sir, In the recent review of prognostic factors in salivary malignancy, Speight and Barrett repeat the assertion that tumours exceeding 4 cm in diameter carry a poorer prognosis regardless of management strategy.1 In considering how such information might influence the treating surgeon, we are concerned that the readership might be moved to decline radical treatment with curative intent in these circumstances. There is a growing body of evidence that the historical dogma regarding prognosis in salivary gland malignancy may not be accurate. For example, data from large observational series has led to low rates of neck dissection in the cN0 neck in salivary tumours despite the observed powerful influence of positive cervical nodes on outcome. The recent cohort study by Zbaren et al. reveals a reduction in disease recurrence from 26% to 12% when selective neck dissection was performed, regardless of tumour size.2 Indeed tumour size, T stage and tumour grade were not predictive of occult cervical nodes. Many of the cN0 patients who underwent neck dissection were also pN0, yet had reduced rates of disease failure. Furthermore, where management of parotid malignancy includes completion parotidectomy and neck dissection, improved outcomes have been demonstrated.3 Our concern is that the 4 cm tumour size rule might dissuade colleagues from performing surgery which may improve outcomes. Clearly, the value of such interventions would best be tested in a randomised controlled trial. Current data is clearly in favour of intervention in salivary malignancy, whether larger than 4 cm or not.
Conflict of interest Neither of these authors have any financial or other conflict of interest which might affect this work.
References 1. Speight PM, Barrett AW. Prognostic factors in malignant tumours of the salivary glands. Br J Oral Maxillofac Surg 2009;47(8):587–93.
2. Zbaren P, Schupbach J, Nuyens M, Stauffer E. Elective neck dissection versus observation in primary parotid carcinoma. Otolaryngol Head Neck Surg 2005;132(3):387–91. 3. Klussmann JP, Ponert T, Mueller RP, Dienes HP, Guntinas-Lichius O. Patterns of lymph node spread and its influence on outcome in resectable parotid cancer. Eur J Surg Oncol 2008;34(8):932–7.
James A. McCaul ∗ Maxillofacial Unit, Bradford Teaching Hospitals NHS Foundation Trust, St Lukes Hospital, Little Horton Lane, Bradford BD5 0NA, West Yorkshire, United Kingdom Cyrus J. Kerawala Royal Marsden NHS Trust, Fulham Road, London SW3, United Kingdom ∗ Corresponding author. Tel.: +44 01274 365114; fax: +44 7801 350191. E-mail addresses: [email protected], [email protected] (J.A. McCaul), [email protected] (C.J. Kerawala) Available online 4 March 2010 doi:10.1016/j.bjoms.2010.02.002
Re: Andi KA, et al. Infraorbital orbitotomy: modification of the Weber–Ferguson approach. Br J Oral Maxillofac Surg 2010;48:44–5 Sir, Although this article itself was interesting, both of the references quoted unfortunately appear to have errors in them. These are as follows: 1. Sir William Fergusson definitely had two s’s in his last name (the traditional Scottish spelling). He was a very well known surgeon in Edinburgh and later in London in the 19th century, and there are many case reports of his where the incision is clearly described. The reference used is applicable, but there is also a slightly earlier one in the 1841–2 Lancet (pp. 710–711) which also describes the operation that he performed. 2. The reference of Weber O. is always a difficult one. The reference quoted by the authors (which is the one often quoted) actually refers to a mandibular procedure (almost certainly for an odontogenic cyst), and the only incision made was an extended submandibular incision. However, the preceding article in the same book (it is actually the minutes of a semi-private medical club in Heidelberg) (pp. 77–80) does in fact describe a maxillary and orbital procedure, where with a little imagination, the incision described (there are no figures) does somewhat correspond to the so-called Weber–Fergusson approach. Otherwise, one has to accept the statement of Phillip Stell (who spoke German) in “Tumors of the Upper Jaw” ed Donald Harrison and Valerie Lund (Churchill Livingstone, 1993, p. 8) where he states that after a careful search he could find no
Letters to the Editor / British Journal of Oral and Maxillofacial Surgery 48 (2010) 394–399
article by Weber that could be used as a reference for this incision. He did state that the reference commonly used before the early 1990s referring to an article in 1866 was definitely incorrect and concerned mandibular trauma. I’m afraid that as one gets older the past seems to become more important.
M. Anthony Pogrel ∗ Department of Oral and Maxillofacial Surgery, Room C-522, Box 0440, 521, Parnassus Avenue, University of California, San Francisco, San Francisco, CA 94143-0440, United States ∗ Tel.: +1 415 476 8226; fax: +1 415 476 6305. E-mail address: [email protected]
Conflict of interest The author has no conflict of interest.
399
Available online 24 March 2010 doi:10.1016/j.bjoms.2010.02.011
Letters to the Editor / British Journal of Oral and Maxillofacial Surgery 48 (2010) 394–399 ∗ Tel.:
+44 01904 726567; fax: +44 01904 726346. E-mail address: [email protected] Available online 11 February 2010
doi:10.1016/j.bjoms.2010.01.007
Re “Prognostic factors in malignant tumours of the salivary glands” by Speight and Barrett [Br. J. Oral Maxillofac. Surg. 47 (8) (2009) 587–593] Sir, In the recent review of prognostic factors in salivary malignancy, Speight and Barrett repeat the assertion that tumours exceeding 4 cm in diameter carry a poorer prognosis regardless of management strategy.1 In considering how such information might influence the treating surgeon, we are concerned that the readership might be moved to decline radical treatment with curative intent in these circumstances. There is a growing body of evidence that the historical dogma regarding prognosis in salivary gland malignancy may not be accurate. For example, data from large observational series has led to low rates of neck dissection in the cN0 neck in salivary tumours despite the observed powerful influence of positive cervical nodes on outcome. The recent cohort study by Zbaren et al. reveals a reduction in disease recurrence from 26% to 12% when selective neck dissection was performed, regardless of tumour size.2 Indeed tumour size, T stage and tumour grade were not predictive of occult cervical nodes. Many of the cN0 patients who underwent neck dissection were also pN0, yet had reduced rates of disease failure. Furthermore, where management of parotid malignancy includes completion parotidectomy and neck dissection, improved outcomes have been demonstrated.3 Our concern is that the 4 cm tumour size rule might dissuade colleagues from performing surgery which may improve outcomes. Clearly, the value of such interventions would best be tested in a randomised controlled trial. Current data is clearly in favour of intervention in salivary malignancy, whether larger than 4 cm or not.
Conflict of interest Neither of these authors have any financial or other conflict of interest which might affect this work.
References 1. Speight PM, Barrett AW. Prognostic factors in malignant tumours of the salivary glands. Br J Oral Maxillofac Surg 2009;47(8):587–93.
2. Zbaren P, Schupbach J, Nuyens M, Stauffer E. Elective neck dissection versus observation in primary parotid carcinoma. Otolaryngol Head Neck Surg 2005;132(3):387–91. 3. Klussmann JP, Ponert T, Mueller RP, Dienes HP, Guntinas-Lichius O. Patterns of lymph node spread and its influence on outcome in resectable parotid cancer. Eur J Surg Oncol 2008;34(8):932–7.
James A. McCaul ∗ Maxillofacial Unit, Bradford Teaching Hospitals NHS Foundation Trust, St Lukes Hospital, Little Horton Lane, Bradford BD5 0NA, West Yorkshire, United Kingdom Cyrus J. Kerawala Royal Marsden NHS Trust, Fulham Road, London SW3, United Kingdom ∗ Corresponding author. Tel.: +44 01274 365114; fax: +44 7801 350191. E-mail addresses: [email protected], [email protected] (J.A. McCaul), [email protected] (C.J. Kerawala) Available online 4 March 2010 doi:10.1016/j.bjoms.2010.02.002
Re: Andi KA, et al. Infraorbital orbitotomy: modification of the Weber–Ferguson approach. Br J Oral Maxillofac Surg 2010;48:44–5 Sir, Although this article itself was interesting, both of the references quoted unfortunately appear to have errors in them. These are as follows: 1. Sir William Fergusson definitely had two s’s in his last name (the traditional Scottish spelling). He was a very well known surgeon in Edinburgh and later in London in the 19th century, and there are many case reports of his where the incision is clearly described. The reference used is applicable, but there is also a slightly earlier one in the 1841–2 Lancet (pp. 710–711) which also describes the operation that he performed. 2. The reference of Weber O. is always a difficult one. The reference quoted by the authors (which is the one often quoted) actually refers to a mandibular procedure (almost certainly for an odontogenic cyst), and the only incision made was an extended submandibular incision. However, the preceding article in the same book (it is actually the minutes of a semi-private medical club in Heidelberg) (pp. 77–80) does in fact describe a maxillary and orbital procedure, where with a little imagination, the incision described (there are no figures) does somewhat correspond to the so-called Weber–Fergusson approach. Otherwise, one has to accept the statement of Phillip Stell (who spoke German) in “Tumors of the Upper Jaw” ed Donald Harrison and Valerie Lund (Churchill Livingstone, 1993, p. 8) where he states that after a careful search he could find no
Letters to the Editor / British Journal of Oral and Maxillofacial Surgery 48 (2010) 394–399
article by Weber that could be used as a reference for this incision. He did state that the reference commonly used before the early 1990s referring to an article in 1866 was definitely incorrect and concerned mandibular trauma. I’m afraid that as one gets older the past seems to become more important.
M. Anthony Pogrel ∗ Department of Oral and Maxillofacial Surgery, Room C-522, Box 0440, 521, Parnassus Avenue, University of California, San Francisco, San Francisco, CA 94143-0440, United States ∗ Tel.: +1 415 476 8226; fax: +1 415 476 6305. E-mail address: [email protected]
Conflict of interest The author has no conflict of interest.
399
Available online 24 March 2010 doi:10.1016/j.bjoms.2010.02.011