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Biomedical subjects

N R McLean

Publications and source records attributed to N R McLean.

At least 19 recordsLinked to original sources
PubMed2006

Surgical treatment of chronic parotid sialadenitis.

OBJECTIVE: To review the results of surgical management of chronic parotid sialadenitis refractory to medical therapy, with particular respect to long-term symptom resolution and development of post-operative complications. METHODS: A retrospective review of parotidectomies performed for chronic intractable parotid sialadenitis. Information was collected about presentation, pre-operative investigations, surgical treatment, post-operative complications and outcome. RESULTS: 36 parotidectomies were performed for chronic sialadenitis between 1991 and 2002. Age at presentation was 56+/-9.6 years, with median symptom duration of 2.3 years. For patients with non-specific presentations, magnetic resonance imaging (MRI) was the most useful pre-operative investigation. Superficial parotidectomy with duct preservation was the main treatment with a 94 per cent success rate, and near-total parotidectomy was reserved for patients with extensive deep-lobe involvement. Duct ligation significantly increased the risk of transient facial palsy. There was a 56 per cent and 22 per cent incidence of temporary facial paresis and Frey's syndrome, respectively. CONCLUSIONS: Controversies exist regarding the optimal pre-operative investigation and surgical treatment of chronic parotid sialadenitis. We advocate magnetic resonance image (MRI) scanning for patients with non-specific symptoms of sialadenitis, and sialography in the presence of reasonable clinical suspicion. We propose superficial parotidectomy without parotid duct ligation as the standard of care, with near-total parotidectomy reserved for extensive deep-lobe disease.

Adolescent↗
PubMed2006

The conservative management of facial fractures: indications and outcomes.

BACKGROUND: With little in the published literature on the conservative management of facial fractures we set out to determine whether our current criteria for treatment are valid. METHOD: Two hundred and thirty adult patients with fractures of the facial skeleton were treated conservatively by our unit between February 1997 and January 2003. Their notes were reviewed retrospectively. RESULTS: Most patients were males (76%), the average age was 38 years, and drugs or alcohol were a significant aspect of the history in 30% of the cases. The most common mechanism of injury was assault (47%), followed by falls and sporting injuries. Fifty percent of the fractures involved the orbital or orbito-zygomatic complex, and 55% had associated injuries. Average follow-up was for six weeks (range 0-44 weeks). Most patients were managed conservatively based on our current criteria of un-displaced/minimally displaced fracture (57%); or minimal/no symptoms (24%). At final review, a number had residual symptoms, but only three required corrective surgery. The other reasons for conservative management included patient non-compliance (11%), and medical contraindications (8%). CONCLUSION: Our results support current indications for the conservative management of facial fractures, but emphasise the need for ongoing follow-up of these patients.

Adolescent↗
PubMed2004

Factors influencing the development of wound infection following free-flap reconstruction for intra-oral cancer.

Wound infection following tissue transfer in head and neck oncology is common. Factors known to be associated with infective complications include blood transfusion, pre-operative radiotherapy, duration of surgery, duration of pre-operative stay and a history of smoking. The present study specifically examined 100 consecutive patients on a standard antibiotic protocol undergoing free flap reconstruction following resection of cancers of the oral cavity or oropharynx. Despite prophylactic antibiotics, 21 patients developed a head and neck wound infection. No statistically significant association was found between infective wound complications and a history of smoking, pre-operative radiotherapy or chemotherapy, length of pre-operative hospital stay, duration of surgery, or number of units of blood transfused. We conclude that, in this group of patients, wound infection is a common and difficult problem, but with no statistically significant association with any of the variables studied.

Adult↗
PubMed2004

Malignant tumours of the minor salivary glands--a 20 year review.

The UK incidence of malignant disease of the minor salivary glands is only 0.6 per million per year. The tumours have a varied histology, can present in any age group and are frequently advanced if located in the sinonasal cavities. In a 20-year review of 21 patients treated for minor salivary gland malignancy in a single institution, it was found that mucoepidermoid tumours were more common in the oral cavity and adenoid cystic carcinomas in the sinonasal tract (p = 0.002). Outcome was variable with sinonasal and adenoid cystic carcinoma having a poorer outcome. Kaplan-Meier curves showed that oral tumours had a higher probability of long term survival. Radical surgery with reconstruction and post-operative adjuvant radiotherapy was effective in achieving loco-regional control. There were no local recurrences within 5 years and three after 5 years. Five patients developed metastatic disease within 10 years and a further two after 10 years. Late recurrences occurred and survival was mainly determined by the presence of systemic disease.

Adult↗
PubMed2004

Surgical education: neck dissection.

Neck dissection is a valuable procedure for treating metastatic cancers of the head and neck. Radical neck dissection remains the standard for cervical metastasis. Because of the morbidity associated with such a treatment, more conservative approaches are being adopted. The authors describe how they do a neck dissection and review the issues that currently surround the choice of treatment.

Head and Neck Neoplasms↗
PubMed2003

Incidence and significance of microscopic pathological lesions found in pedicle and recipient vessels used in microsurgical breast reconstruction.

The purpose of this study was to assess the incidence of abnormal vascular histology and to determine whether or not this was correlated with the incidence of postoperative microvascular problems. The microvascular histology of both donor and recipient vessels was studied in 38 patients (40 flaps) undergoing breast reconstruction with free TRAM flaps. Preoperative risk factors were assessed and correlated with histological changes in vessels, and both were tested against anastomotic complications. Thrombosis of either the artery or the vein of the flap was seen in 6 cases (15%), and of these, two flaps failed completely and one suffered partial necrosis. The occlusion affected the arterial anastomosis in 3 patients, and the venous anastomosis in 2 patients, while both the artery and the vein were thrombosed in one case. Preoperative risk factors such as smoking, obesity, radiotherapy, and chemotherapy were not associated with a significantly higher incidence of thrombosis or with significant histological abnormalities in vessels (P value varied between 0.3-0.06). Microvascular histology showed variable degrees of pathological changes in six flaps (15%); nevertheless, in this group, only one flap suffered a venous thrombosis, which ended in total flap loss. Among those with one or more risk factors (24 patients), only 2 had some evidence of histological abnormality of the blood vessels used for the microvascular anastomosis (P = 0.2).

Adult↗
PubMed2003

Microvascular histopathology in head and neck oncology.

A histological study of both recipient and flap vessels was performed in 30 patients with head and neck cancer, and relevant preoperative risk factors were assessed. A total of 35 free flaps were transferred in 30 patients; 16 patients had preoperative radiotherapy, 13 were smokers, eight had hypertension and six had peripheral vascular disease. No significant venous pathology was found in either the flap or the neck veins. However, over two-thirds of the neck arteries and one-half of the flap arteries were found to have microscopic arterial pathology. The only pre-existing factor significantly influencing vessel pathology was hypertension (P=0.007). All flaps survived, although in two there was some loss of the skin paddle. This study reveals that the majority of patients undergoing microsurgery in the head and neck region have pre-existing arterial damage in both the flap and the recipient arteries, but this does not have a significant effect on the overall patency of the microvascular anastomoses.

Adult↗
PubMed2003

Modified costochondral graft osteotomy in hemifacial microsomia.

Hemifacial microsomia is the second most common facial clefting condition after cleft lip and palate. The deformity affects the skeleton and soft tissues in the temporal region of the affected side, although the degree of involvement is markedly variable. We describe a modification of surgical technique in a skeletally mature case who had previously undergone mandibular reconstruction with a costochondral graft.

Facial Asymmetry↗
PubMed2003

Malignant peripheral nerve sheath tumour metastasising to the parotid gland.

Two rare cases of metastases from malignant peripheral nerve sheath tumours (MPNST) of the head and neck are described. The initial lesions were superficial, but despite early diagnosis and complete excision, they metastasised to the ipsilateral parotid gland. Both underwent further complete excision and neither metastatic lesion showed progression in grade. One patient is alive, however, the other died of widespread metastases. There are no other reported cases of these sarcomas in the head and neck metastasising to the parotid gland.

Adult↗
PubMed2003

Radiological imaging in primary parotid malignancy.

In a retrospective analysis of the preoperative imaging of patients presenting with primary malignant parotid disease, all relevant images were collected and reviewed by two experienced head and neck radiologists, blinded to the diagnosis. Forty-two patients (25 male, 17 female), median age 67.5 years (range 15-86), were included in the study of which 32 had undergone CT scanning, nine MR and three ultrasound. Forty tumours (93%) were correctly diagnosed as malignant when compared with histology. The two false negatives arose in a patient who had received an ultrasound scan only and in a patient with lymphoma, whose CT scan was reported as a pleomorphic adenoma. Neither had undergone prior radiotherapy. A poorly defined tumour boundary was the most consistent observation for both MR and CT images for the malignant tumours examined. Local infiltration was correctly correlated with pathological findings in eight of the nine MR scans, however, CT proved less reliable, correct in 14 of 24 cases (p=0.01). No correlation was identified between any of the imaging features examined and the final histological diagnosis. A poorly defined tumour boundary with evidence of local invasion was the best indicator of malignancy and was reported more frequently from MR scans than from CT. Imaging alone, however, proved unreliable in the prediction of final histological diagnosis or grade of tumour.

Adolescent↗
PubMed2002

The double-barrelled end-to-end microvascular anastomosis.

We describe a simple alternative method of microvascular anastomosis to the internal jugular vein, which is useful when part of the internal jugular vein has been sacrificed and the free flap has two draining venae commitantes. In our hands, this method has proven to be quick, efficient and successful.

Anastomosis, Surgical↗
PubMed2002

Prediction of the position of the intraparotid portion of the facial nerve on MRI and CT.

Despite developments in imaging technology, visualisation of the intraparotid portion of the facial nerve is not possible. Three separate radiological techniques have been described to predict the position of the facial nerve: Conn's arc; a plane extending posteriorly from the outer surface of the mandibular ramus; and soft-tissue structures, including the posterior belly of the digastric muscle, the retromandibular vein and the lateral border of the masseter muscle. We investigated the reliability of these techniques in predicting the relationship of tumours to the facial nerve. Cross-sectional imaging of the parotid glands was performed prior to the removal of a parotid mass in 26 patients. Twenty patients underwent MRI, and six had CT scans. We removed 14 malignant neoplasms, nine benign lesions and three non-neoplastic lesions. The relationship of the tumour to the facial nerve was assessed radiologically by each of the three techniques, and compared with the findings at surgery. In 18 patients the tumour involved the parotid gland deep to the facial nerve. The above techniques predicted the position of the facial nerve in 69%, 58% and 46% of cases, respectively. When planning parotid surgery, it is important that the surgeon understands the advantages and limitations of the radiological assessment of the position of parotid tumours in relation to the facial nerve.

Adult↗
PubMed2002

Head and neck oncology: the UK experience. Who is publishing what?

Using the MEDLINE database (OVID), a retrospective review of the UK literature on head and neck oncology was performed for the period 1994-2000, each publication being categorised by department and first author. Tumours almost exclusively managed by general surgeons, cardiothoracic surgeons and neurosurgeons were excluded. In the years 1994 to 2000, there were a total of 120 UK publications, 72% of which came from non-academic NHS units; 23% of the publications were from ENT units, 23% from oral and maxillofacial (OMF) surgery units and 18% from plastic surgery units. The majority of plastic surgery publications described reconstructive techniques, whereas a wider range of topics was observed in the publications by ENT and OMP surgeons. Several irregularities in the MEDLINE database were discovered and are discussed. The findings of this study may be relevant to the future planning of head and neck oncology services.

Bibliometrics↗
PubMed2002

Supercharged pedicled TRAM flap in breast reconstruction: is it a worthwhile procedure.

A clinical study of the incidence of vascular complications in free and supercharged pedicled transverse rectus abdominis musculocutaneous (TRAM) flaps was undertaken. The complications associated with each of these two TRAM flaps were assessed. The incidence of vascular complications in the supercharged pedicle was found to be twice that associated with the free TRAM flap (36% vs. 18%); however, these results did not reach significance ( = 0.2). Fat necrosis was the most common complication in each group, with the overall rate being 17%. The incidence in the supercharged TRAM flap (29%) was more than twice that in the free TRAM flap (13%; = 0.2). Partial flap loss was also greater in the charged flap than in the free flap (14% vs. 3%, = 0.1). The results, however, did not reach significance, and this may be related to the relatively small sample size (52 patients). Vein grafts were used more often in the supercharged pedicled TRAM flap ( = 0.02). Obesity was also associated more frequently with the supercharged pedicled TRAM flaps ( = 0.07). Other risk factors were nearly equally distributed between either type of the flap. The results of the study support the continued use of the free TRAM flap. There appears to be no additional advantage in charging the pedicled TRAM with a microvascular anastomosis because the results were found to be inferior to those of the free TRAM flap. Other clinical factors, however, may dictate the type of flap used. A larger series is required to assess the importance of each of the risk factors affecting flap survival.

Adult↗
PubMed2001

Do intraoral radial forearm free flaps re-mucosalise and is candida infection relevant?

Eleven patients, with a mean age of 57 years, who had undergone radial forearm flap reconstruction following the excision of intraoral carcinoma, underwent flap biopsy at a mean of 45 months postoperatively. Seven of the patients had received postoperative radiotherapy. In eight patients the clinical appearance of the flap was similar in colour to that of adjacent normal oral mucosa; the remaining flaps retained the appearance of normal volar forearm skin. Histological examination of the flaps showed varying degrees of telangiectasia and mild chronic inflammation. In only two patients was superficial infection by candida hyphae identified. Intraoral free flaps, although clinically resembling oral mucosa, retain histological features of skin, at least within the period under study. The erythematous clinical appearance was not correlated with the presence of chronic fungal infection, but reflected the presence of vascular repair tissue, telangiectasia and mild residual chronic inflammation.

Adult↗
PubMed2001

Adenoid cystic carcinoma of the head and neck.

Adenoid cystic carcinoma (ACC) is a rare malignant tumour believed to arise from the epithelial cells of mucous-secreting glands. It is a slow-growing but aggressive tumour with a propensity for perineural invasion. A 10 year review of 45 patients (19 males and 26 females with a median age of 56 years) treated for ACC at a single institution between 1989 and 1999 was performed to analyse factors involved in treatment failure, local control, treatment-related morbidity and mortality. The data collected were treated for survival curves according to the Kaplan-Meier method and the log-rank test was used to assess the statistical significance of the various groups. The overall survivals at 3 years and 5 years were 71% and 65%, respectively, while the disease-free survivals at 3 years and 5 years were 73% and 63% respectively. Out of the 45 patients, only six had local recurrences, yielding an 87% locoregional freedom from relapse; 16 patients (35.6%) developed distant metastases, with the lung (8/16) being the commonest site. Patients treated for tumours of the nose and paranasal sinuses experienced more morbidity than those with tumours at other sites. Positive margins, perineural invasion and solid histology of ACC were associated with increased morbidity and treatment failure. Patients treated with combined therapy did better than those who underwent a single treatment modality.

Adolescent↗