This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. Salivary gland tumours are rare and have very wide histological heterogeneity, thus making it difficult to generate high level evidence. This paper provides recommendations on the assessment and management of patients with cancer originating from the salivary glands in the head and neck.Recommendations• Ultrasound guided fine needle aspiration cytology is recommended for all salivary tumours and cytology should be reported by an expert histopathologist. (R)• Adjuvant radiotherapy (RT) following surgery is recommended for all malignant submandibular tumours except in cases of small, low-grade tumours that have been completely excised. (R)• For benign parotid tumours complete excision of the tumour should be performed and offers good cure rates. (R)• In the event of intra-operative tumour spillage, most cases need long-term follow-up for clinical observation only. These should be raised in the multidisciplinary team to discuss the merits of adjuvant RT. (G)• As a general principle, if the facial nerve function is normal pre-operatively then every attempt to preserve facial nerve function should be made during parotidectomy and if the facial nerve is divided intra-operatively then immediate microsurgical repair (with an interposition nerve graft if required) should be considered. (G)• Neck dissection is recommended in all cases of malignant parotid tumours except for low-grade small tumours. (R)• Where malignant parotid tumours lie in close proximity to the facial nerve there should be a low threshold for adjuvant RT. (G)• Adjuvant RT should be considered in high grade or large tumours or in cases where there is incomplete or close resection margin. (R)• Adjuvant RT should be prescribed on the basis of clinical factors in addition to histology and grade, e.g. stage, pre-operative facial weakness, positive margins, peri-neural invasion and extracapsular spread. (R)

Pharyngeal pouches occur most commonly in elderly patients (over 70 years) and typical symptoms include dysphagia, regurgitation, chronic cough, aspiration, and weight loss. The aetiology remains unknown but theories centre upon a structural or physiological abnormality of the cricopharyngeus. A diagnosis is easily established on barium studies. Treatment is surgical via an endoscopic or external cervical approach and should include a cricopharyngeal myotomy. Unfortunately pharyngeal pouch surgery has long been associated with significant morbidity, partly due to the surgery itself and also to the fact that the majority of patients are elderly and often have general medical problems. External approaches are associated with higher complication rates than endoscopic procedures. Recently, treatment by endoscopic stapling diverticulotomy has becoming increasingly popular as it has distinct advantages, although long term results are not yet available. The small risk of developing carcinoma within a pouch that is not excised remains a contentious issue and is an argument for long term follow up or treating the condition by external excision, particularly in younger patients. (Postgrad Med J 2001;77:506-511)

Introduction: Many surgical techniques have been described for the treatment of pharyngeal pouches but there is no single treatment of choice. The aim of this study was to determine current practice in pharyngeal pouch surgery by UK otolaryngologists. Methods: A postal questionnaire was sent to all UK-based consultant members of the British Association of Otolaryngologists -Head and Neck Surgeons (BAO-HNS).Results: Endoscopic stapling diverticulotomy is the most commonly performed procedure, performed by 89% of surgeons, followed by excision. Of those consultants that considered there to be a treatment of choice, 83% stated endoscopic stapling as their preference. Practices differ regarding the insertion of nasogastric tubes after endoscopic procedures and the need for postoperative barium studies. The length of in-patient stay tends to be short with 80% of surgeons discharging patients by day 2. Conclusions: Endoscopic stapling diverticulotomy is now the most commonly performed procedure for the management of pharyngeal pouches by UK otolaryngologists and is now considered by many to be the treatment of choice.

Head and neck cancers (HNC), 90% of which are squamous cell carcinomas (SCC), rank sixth among all malignancies worldwide and comprise 40-50% of the total number of malignancies in India. In addition to alcohol and tobacco usage, which is the major source of oral carcinogens, viruses such as human papilloma virus (HPV) may also contribute to development of the malignancy. The aim of this study was to identify the prevalence of HPV in head and neck cancers using material from metastatic site. A total of 111 cases of neck nodal metastases were included in this study. The primary was identified as oral cavity, oropharynx and nasopharynx. In a subset, the primary remained "unknown." Polymerase chain reaction was carried out to detect HPV DNA on the fine needle aspirates. HPV was detected in 32.4% cases. Maximum positivity was observed in metastases from primary in the oral cavity (47.1%) with tongue (55%), followed by oropharynx (25%) and nasopharynx (5%) cases. In the unknown primary group, HPV was detected in 52.9% cases. Study defines the association of HPV with HNC in population of northern India. There was varied association of HPV depending on site of primary tumor arising in mucosal surfaces of head and neck region.

Twenty stricture-plasties have been performed for multiple tubercular strictures of the gastro-intestinal tract in 9 patients, who in total had 35 strictures. The procedure has been found to be safe, simple and effective in relieving obstructive symptoms. It does not appear to carry the disadvantages of entero-anastomosis or multiple and/or massive resections in cases of multiple tubercular strictures of the small bowel.