Meta-analysis and comparative systematic review confirm that FNAC is highly effective in the diagnosis of head and neck masses, with some limitations.

The prevalence of Young's syndrome is reported to be declining, and the level of evidence regarding sinus disease within this syndrome is limited to case series only. There is, in fact, little evidence to support Young's syndrome being a significant aetiological factor for sinus disease, nor indeed to support the existence of Young's syndrome as an entity in its own right. The only documented aetiological factor is mercury exposure in childhood, an event that is seldom currently encountered; this would support our theory of the extinction of the condition. As an incidental finding, we found that the term Young's syndrome refers to two different medical conditions.

The guidelines for treating cancer changed in December 2005 to no longer than 62 days from urgent referral to treatment, or 31 days from diagnosis to treatment. The use, by general practitioners, of suspected head and neck cancer proformas has reduced the time taken from referral to first outpatient appointment from 15 days in 2003 to 5.5 days in 2005. The introduction of specific radiology request forms for suspected malignancy has allowed easier identification of requests for imaging and subsequently a shorter waiting time for radiological investigations from 23 days in 2003 to 10 days in 2005. The appointment of a new dedicated head and neck cancer consultant at Aintree and the provision of another linear accelerator have reduced the waiting time for surgery from 68 days in 2003 to 39 days in 2005 and radiotherapy from 86 days in 2003 to 52.6 days in 2005. Patients not referred as suspected cancer patients who subsequently receive primary radiotherapy for a head and neck cancer fall outside the 62 day rule, being treated on average 70 days after referral.

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