This month’s issue of The Journal of Laryngology & Otology includes many articles focused on head and neck surgery, some of which have been published with Open Access.Reference Fitzsimons, O’Flanagan, Brennan, O’Driscoll, Kennedy and Timon1, Reference Atabey and Arik2 In the first of these, Fitzsimons et al. describe their study of patients undergoing treatment for human papillomavirus-positive oropharyngeal squamous cell carcinoma. Although studies have suggested that tumour-infiltrating lymphocytes may have a positive predictive effect,Reference Baudouin, Hans, Lisan, Morin, Adimi and Martin3 they could not demonstrate that this was the case in their retrospective study of 57 patients.
In our next head-and-neck-themed article, Jayakody et al.Reference Jayakody, Brown, Findlay and Patel4 carried out a systematic review of the evidence regarding the management of the serious complication of chyle leak following injury to the thoracic or lymphatic duct in head and neck surgery. They found numerous nutritional interventions used in the studies identified, each with different rationales behind them. The evidence they found supported nutritional interventions over surgical interventions; however, no clear nutritional intervention could be shown to be better than another, which may be an appropriate area for future studies. This article could be considered alongside the study published in the March issue of The Journal by Picton et al.Reference Picton, Mouratidou, Al-lami, Nixon, Jeannon and Rovira5 and the latest issue of the United Kingdom National Multidisciplinary GuidelinesReference Homer, Winter, Abbey, Aga, Agrawal and ap Dafydd6 on decision-making in the management of post-operative chyle leak.
Abbud et al.Reference Abbud, Kirby, Edafe and Balasubramanian7 present an interesting study observing a protocol-driven change in practice in their unit in an attempt to reduce the rate of bleeding and return to the operating theatre in thyroid and parathyroid surgery. By introducing a checklist of seven steps at the end of the procedure, they have demonstrated that post-operative haemorrhage rates can be reduced, although in the cohort included, statistical significance was not achieved. The authors consider whether this protocol may be a valuable tool for training resident doctors in thyroid surgery.
Trivedi et al.Reference Trivedi, Rathod, Upadhyay and Bayra8 describe an approach to the tongue base via an external incision and the pharynx for use in patients unsuitable for a transoral robotic surgical approach, for example because of severe trismus. Their article includes very clear intra-operative images demonstrating the approach and the most important anatomy. Their small series of patients using this approach is also included and shows that the technique shows promise for this group of patients.
The remaining head-and-neck-related study in this issue of The Journal, by Zhu et al., relates to quality of lifeReference Zhu, Gong and Liu9 and uses questionnaire assessments of new patients undergoing laryngectomy over the period from pre-surgery to six months after surgery. They assess their care needs, function and social support. They demonstrate decreased quality of life and social support, and increasing unmet care needs in these patients. In their study, they identify that few of their patients underwent surgical voice restoration and suggest that addressing management of loss of voice may be a factor in their outcomes. They highlight, however, that rehabilitation and support are needed for this group of patients.
On a final note, The Journal is also calling for new reviewers. If any readers have an interest in reviewing for The Journal, please look at https://www.jlo.co.uk/about-us/become-a-reviewer/ or get in touch with the managing editor, Catherine Hyland, at managing-editor@jlo.co.uk.
STEPHEN JONES
ANN-LOUISE MCDERMOTT
JONATHAN FISHMAN
Senior Editors
