Day 1 :
Keynote Forum
Sanith Cheriyan
University of Tasmania, Australia
Keynote: Prognostic and predictive value of routine blood markers in oropharyngeal squamous cell carcinomas: A Flinders experience
Biography:
Sanith completed his MBBS from the University of Tasmania in 2015 and is currently completing a Masters of Surgery from the Flinders University. He is currently an Unaccredited Registrar in Adelaide, South Australia.
Abstract:
Introduction
Blood inflammatory makers are thought to reflect the local tumour microenvironment and therefore could predict tumour progression and response to treatment [1]. Therefore, we aimed to study the association between various markers (neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR) and lymphocyte-to-monocyte ratio (LMR) and overall survival (OS)/disease-free survival (DFS), in the fastest rising head and neck subsite in Australia, oropharyngeal squamous cell carcinoma (OPSCC).
Methods
Retrospective institutional database analysis in a South Australian tertiary referral centre.
Data was collected retrospectively from departmental and electronic medical records (following ethics). Oropharyngeal squamous cell carcinomas cases treated with curative intent (January 2012 to December 2018). Serum tests conducted within 4 weeks before the commencement of primary treatment were collated (neutrophils, lymphocytes, haemoglobin, albumin and monocytes) which were used to calculate the NLR, PLR and LMR. Receiver Operating Characteristic (ROC) and Kaplan-Meier curves were generated to assess the relationship between the markers and survival.
Results
A total of 104 patients (91 males [87.5%], mean age 58 [SD 0.1], median follow up time of 37 months (range 4-90) were analysed. The tonsil was the most common oropharyngeal subsite affected (59%) and 80.6% of cases were p16 positive. Chemoradiotherapy was the most common treatment modality (61%). Treatment failure occurred for 28 patients (27%) (progression of disease during treatment, residual disease at 3 months post-treatment or post-treatment recurrence). Albumin and haemoglobin were found to have a survival benefit for prolonged DFS (p=0.005 and 0.039 respectively). Area under the ROC curve was less than 0.55 for all markers.
Conclusion
Our results did not support the predictive role of blood biomarkers, although albumin and haemoglobin had a survival benefit in OPSCC. Further research with an increased sample size is required to appropriately validate these markers.
Keynote Forum
Lok Ka Cheung
Aberdeen Royal Infirmary, UK
Keynote: Congenital nasal dermoid cysts: Comprehensive review and management guidelines proposal
Biography:
Lok Ka Cheung working in one of the largest hospital in united kingdom i.e. Aberdeen Royal Infirmary, UK
Abstract:
Background
Nasal dermoid cysts are rare congenital cysts presenting in 1 per 20,000 to 40,000 births. The pathophysiology and anatomy of nasal dermoid cysts are well described. However, there is no agreed standard approach for the management of nasal dermoid cysts in the United Kingdom. To address this, we conducted a systematic review and provide a management algorithm.
Methods
A systematic review of nasal dermoid cyst presentation, investigation, management and cosmetic outcomes was performed using the search engines PubMed, EMBASE and Medline.
Results
A total of 75 citations were reviewed, yielding 35 articles which discussed the presentation, investigation, management and cosmetic outcome of nasal dermoid cysts. 13 were case series and 22 were case reports. The most frequent presenting complaint was nasal swelling. Imaging modalities included magnetic resonance imaging, MRI and/or computed tomography, CT for the majority of cases. Most cases had no intracranial extension and the majority were repaired through dorsal midline nasal incision. Those with intracranial extension underwent intracranial, subcranial or endoscopic resection.
Conclusions
A clear approach to the surgical resection of nasal dermoid cysts is unclear. Both MRI and CT have indications in the preoperative assessment and surgical planning. We have developed an algorithm which aims to clarify the management pathway in nasal dermoid cysts.
Keynote Forum
Fiona Chen
Alfred Health, Australia
Keynote: The recalcitrant ranula-a new management approach
Biography:
Fiona Chen is a surgical resident working at the Alfred Hospital in Melbourne, Australia. Her interests are in Head and Neck surgery. She has completed a Bechelor of Medicine/Bachelor of Surgery as well as Bachelor of Medical Sciences at Monash University. She also has a Masters of Public Health from James Cook University.
Abstract:
Introduction
A plunging ranula is a pseudocyst that develops from the sublingual salivary glands, extending through the mylohyoid muscle into the submandibular region. The gold standard treatment is excision of the sublingual gland, the source of saliva. For recurrent plunging ranulas, residual salivary gland tissue is difficult to identify. We describe the use of Prostate Specific Membrane Antigen (PSMA) Positron Emission Tomography (PET) to identify residual salivary tissue causing recurrent ranula.
Aim
To illustrate the surgical management of plunging ranulas and demonstrate PSMA PET scanning to identify persistent salivary tissue that has caused treatment failure.
Methods
A retrospective review of the surgical management of three plunging ranula cases illustrating the techniques and outcomes and an approach to failed treatment.
Results
Case 1
A case of plunging where the ranula sac and gland was resected entirely intact.
Case 2
A case where intraoral sublingual gland excision collapsed the pseudocyst with no recurrence.
Case 3
A case of plunging ranula that had recurred despite six resections. PSMA PET scanning identified residual salivary tissue. Targeted intra-oral excision of floor of mouth was performed. Histological analysis confirmed salivary gland parenchyma in the sample.
Conclusion
Removing both the sublingual gland and ranula sac will avoid the risk of recurrent ranula, however this is not often possible. Excision of the salivary gland alone, the source of saliva, will collapse the pseudocyst. In recurrent plunging ranulas where residual salivary tissue is difficult to identify, PSMA PET scanning can be successful in locating residual tissue for targeted excision.
Keynote Forum
Mohamed Abdelaziz
Fayoum University, Egypt
Keynote: Identification of the Facial Nerve Trunk during Superficial Parotidectomy by Trident Landmark
Biography:
Mohamed Abdelaziz working in one of the largest university in Egypt i.e. Fayoum University, Egypt
Abstract:
Background
Parotid gland is the largest salivary gland. About 80% of salivary gland tumors occur in parotid. Surgical resection is the recommended treatment for such cases. The facial nerve is the most important structure that pass through the parotid gland so identification and preservation of it is very crucial in parotid surgery. Several landmarks have been discovered and used like the posterior belly of digastric muscle, styloid process, tragal pointer, and trident landmark.
Aim of work
To evaluate the accuracy and safety of the trident landmark as an easy and accurate anatomical landmark for identification of the facial nerve trunk during superficial parotidectomy.
Methods
Between September 2016 and September 2018, 50 patients were eligible for superficial parotidectomy were admitted to the surgical departments at Fayoum University Hospitals. Facial nerve trunk is identified as the central prong of trident between the base of styloid process and origin of the posterior belly of digastric muscle.
Results
Facial nerve trunk was successfully identified in all the patients (100%). The mean operative time was 106.80±16.13 minutes. No intra-operative complications were reported. The mean amount of intraoperative blood loss was 98.20±13.38 ml. Temporary marginal mandibular nerve deficit was noted in 4%, surgical site infection in 2%.
Conclusion
The trident landmark method facilitates the identification of facial nerve trunk during superficial parotidectomy with relative ease, safety and accuracy. This can be a very useful method to minimize the facial nerve injury during parotid surgery.