A head and neck oncology service serving the Islington and Haringey District was organized in 1985. It is based at the Whittington and Royal Northern Hospitals and is conducted in conjunction with the combined clinic of the Head and Neck Oncology Group at the Royal Ear Hospital (University College Hospital). This paper presents a surgery of the first year's experience during which 29 new cases of head and neck cancer were seem.

The physiological factors controlling mucociliary transport are largely unknown. Nasal mucociliary clearance was measuredusing the saccharin test in seven patients who had previously undergone vidian neurectomy for vasomotor rhinitis. Persistent denervation was suggested by impaired tear secretion. The control group consisted of thirty-four patients with vasomotor rhinitis who had not had surgery. There was no significant difference in clearance times between the two groups, suggesting that mucociliary transport is well preservedin the absence of neural control.

Serum immunoglobulin E levels were estimated in 50 patients with head and neck cancer and in 25 controls. Mean serum IgE value was significantly higher in patients with various sites of cancer in the head and neck region other than carcinoma of the tonsil. The levels increased with advancement in the stage of cancer. There was, however, no difference in mean serum IgE value with respect to the character of the lesion, to the histopathological type of growth or to radiotherapy.

In patients with carcinoma of the tonsil, the mean serum IgE concentration was significantly lowered.

It has been widely held that peritonsillar abscess is a strong, if not absolute, indication for tonsillectomy, performed either immediately or after an interval of some weeks. A retrospective study of 48 patients is presented. It appears that age and the incidence of previous throat infections can be related to the likelihood of further problems and the need for operation.

Near-total laryngectomy with myomucosal valved neoglottis is the most recent of the various surgical proceedures for speech rehabilitation. The electrolaryngographic wave form (Lx), which was recorded initially to explore the site and mechanism of phonatory function of the neoglottis, has been successfully used in speech rehabilitation of these patients. In a pilot study it was tried as a visual feedback. The results confirm its utility for speech rehabilitation of these laryngectomees.

Epithelial salivary gland tumours presenting in the first month of life (perinatal tumours) are exclusively of major salivary gland origin and predominantly of the parotid gland. Approximately 25 per cent of these rare tumors have been histologically and/or biologically malignant. Except for an occasional pleomorphic and monomorphic adenoma, the majority of the tumors are proliferations suggesting a tumorous arrest of maturation of the salivary gland anlage, hence their designation as embryomas. A case report of an embryoma of the parotid is presented, accompanied by a review of the literature.

A series of 87 salivary glands was examined using an immunogold-silver technique for salivary gland amylase (SGA) and epithelial membrane antigen (EMA) and an indirect immunoperoxidase technique for both antigens. The specimens comprised 21 pleomorphic adednomas, 3 monomorphic adenomas, 25 adenolymphomas, 5 mucoepidermoid carcinomas, 3 acinic cell tumours, 8 adenoid cystic carcinomas, 2 adenocarcinomas and 8 undifferentiated carcinomas. In addition 5 normal salivary glands and 6 salivary glands showing benign lymphoepithelial lesions were included.

Symptoms producing small front-ethmoidal encephalocoeles are generally identified radiologically. The examination of choice is coronal CT, eventually performed axially with coronal reconstructions, and best with intrathecal contrast material delineating the basal cisterns. Two case reports demonstrate the clinical and radiological problems in identifying and fronto-ethmoidal encephalocoleles.

Fifty patients with diabetes mellitus of varying duration were divided into two groups according to whether they were on treatment with insulin or not. Nasal mucosal blood flow was investigated and the results were compared with a reference material from healthy subjects, and were also related to the degree of retinopathy. Patients with diabetes mellitus had normal mucosal blood flow. There was no correlation between the duration of diabetes and nasal blood flow, nor was there any correlation between the degree of retinopathy and nasal blood flow. Diabetes mellitus does not seem to be accompanied by changes in blood flow in the nasal mucosa.

The pain-relieving efficacy of naproxen and acetylsalicylic acid (ASA) in tonsillectomized patients was compared in a double blind parallel clinical trial comprising 83 patients, among whom 42 were treated with naproxen and 41 with ASA. The patients were treated post-operatively for two days with either naproxen suppositories 500 mg. twice, or ASA effervescent tablets 1000 mg. three times, daily.

The therapeutic gain was evaluated by recording the intensity of pain, reduced ability to open the mouth (trismus), consumption of supplementary analgesic (parcetamol), and pain-related sleep disturbances.

The statistical analysis of the results revealed no differences in pain intensity, consumption of additional analgesics or pain-related sleep disturbances in the two treatment groups. A considerable degree of trismus was demonstrated in most of the tonsillectomized patients. This reduced ability to open the mouth was gradually overcome in the naproxen group while it remained unchanged in the ASA group, however, no statistical significant difference could be demonstrated. Additionally, no significant positive correlation between pain intensity and trismus was proven. The pain-relieving effect, however, was unsatisfactory in both the naproxen and the ASA group, and clinical controlled trial studies of alternative analgetics in tonsillectomized patients are still to be encouraged.

Local anaesthetic with vasoconstrictor combinations are often used to reduce bleeding and hence improve the operating field in septal surgery. Two commonly used combinations are lignocaine with adrenaline and prilocaine with felypressin (citanest with octapressin). Most surgeons prefer to use lignocaine with adrenaline but because of the risks of cardiac dysrhythmias when used with halothane anaesthetists prefer prilocaine with felypressin. In a trial with lignocaine 2 per cent and adrenaline 1 in 200,000 against prilocaine 3 per cent and felypressin 0.03 international units/ml in 18 patients undergoing septal surgery with local anaesthesia alone there was significantly less blood loss in the lignocaine with adrenaline group, p>0.01. The mean blood loss in the adrenaline group was 7.5 ml. and 32.7 ml. with felypressin. Both combinations were equally effective in producing adequate local anaesthesia. It is concluded that lignocaine with adrenaline is superior to prilocaine with felypressin in achieving a dry operating field in septal surgery under local anaesthesia.

This paper present 35 patient with carcinoma of the tongue who have been treated in Southampton using the Carbon laser. The treatment programme for each individual patient was determined by radiotherapists and surgeons in a combined head and neck/oncology clinic. T1 carcinomas were treated by primary laser excision biopsy whereas larger tumours were treated first by conventional radiotherapy unless there was a significant contraindication to this treatment modality.

Of 10 patients with T1 lesions nine are alive and well and disease free, but one patient died of other causes with no sign of recurrence. The minimum follow-up period has been two years. Of 25 patients with T2 and T3 lesions treated either before or after radiotherapy, nine are alive and disease-free, eleven died of disease and five patients died of other causes with no evidence of recurrence.