Transoral laser microsurgery is a cost-effective strategy to adopt in the management of T1a laryngeal cancers. Uncertainty remains over the optimal strategy to adopt in T1b-T2 laryngeal cancers.

INTRODUCTION Although examination under anaesthesia and panendoscopy (EUAP) has traditionally been used in the assessment of patients presenting with oral cavity and oropharyngeal squamous cell carcinoma (SCC), the era of modern medicine with its advanced imaging techniques has meant that the indications for this technique have potentially reduced. SUBJECTS AND METHODS In an attempt to quantify the current use of EUAP in the UK, a structured telephone questionnaire was undertaken of 50 maxillofacial units. Information was gathered regarding whether the technique was adopted on a routine or selective basis. Likewise perceived disadvantages were sought. RESULTS Twenty-two units (44%) carried out EUAP on all patients presenting with oral cavity and oropharyngeal SCC. Of the remaining 28 units, all employed EUAP on a selective basis, the most commonly for the assessment of the primary tumour. The most common perceived disadvantage of carrying out EUAP routinely was its potential to increase the waiting time to definitive treatment. CONCLUSIONS These results suggest a gradual move towards the selective use of EUAP in patients presenting with oral cavity and oropharyngeal SCC. KERAWALA BISASE LEE EUAP IN ORAL CAVITY AND OROPHARYNGEAL SQUAMOUS CELL CARCINOMA PATIENTSAnn R Coll Surg Engl 2009; 91: 609-612 610 on a selective basis. For the purposes of the study 'panendoscopy' was defined as the endoscopy of the nasal cavity, nasopharynx, oropharynx, larynx and upper oesophagus, with or without bronchoscopy. The indications for EUAP were obtained in terms of index tumour assessment, detection of simultaneous disease in the asymptomatic individual and its use as a 'test anaesthetic'. In units with a selective approach, further information regarding that process was elicited, e.g. did a patient's exposure to risk factors influence its use? Finally, the perceived advantages of EUAP were obtained where relevant. ResultsRepresentatives from 50 maxillofacial units were questioned. Of these, 22 (44%) employed EUAP on all patients. Of the remaining 28 units, the most common indication for EUAP was the assessment of the index tumour (Fig. 1). Around one in four units still felt that the use of EUAP as a 'test anaesthetic' was justified.For those units adopting a selective approach, the most commonly perceived disadvantage of routine EUAP was a potential increase in waiting time to definitive treatment (Fig. 2). One-third of units also expressed concern regarding the cost implications of a second anaesthetic. DiscussionEUAP was introduced in the management of head and neck malignancy in the late 1970s and is still used in many units throughout the world on a routine basis. It requires little in the way of equipment and remains less expensive than some of the alternative modes of staging patients such as computed tomography (CT), magnetic resonance imaging (MRI) and positron imaging tomography. The morbidity and mortality is low.1 In this day and age, it may still be the most sensitive way of detecting superficial mucosal ...

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