Sir Harold Gillies, born in New Zealand, is widely considered a British icon and the father of modern plastic surgery.

This article provides an overview of his life and the circumstances which led to him laying the foundations of plastic surgery in Britain in the early twentieth century.

A hand search and review of case notes from the Gillies Archives at Queen Mary's Hospital in Sidcup, UK, where he made history, was conducted.

Gillies' ongoing legacy was found to also include his influence on the development of his cousin Sir Archibald McIndoe's work. Gillies was a talented sportsman who engaged in charitable activities. Additionally, he was a gifted teacher, with his hospital attracting many young surgeons from around the world. He was found to have expressed genius in both the design and execution of the art and science of surgery. He incepted reconstructive techniques ranging from the world's first gender reassignment operation to facial reanimation procedures for the treatment of facial paralysis. His operative work on ex-servicemen in need of complex rhinoplasty and in particular the inception of the tubed pedicle flap are depicted.

Olfactory dysfunction is a common condition that may in some cases require imaging to investigate a potential underlying cause.

This review describes the anatomy of normal olfaction and illustrates the pathological substrates of olfactory dysfunction amenable to imaging.

This paper attempts to chart the history of head and neck cancers and their surgical treatment, starting from ancient Egypt and concluding with Galen.

The ancient Egyptians appear to have treated head and neck cancers with local applications. The ancient Greek corpus contains a reference to treating pharyngeal carcinoma with cautery, but the description is too vague to establish the diagnosis conclusively. The ancient Romans moved away from surgical treatments, with Galen establishing a prejudice against surgery that would last through the Middle Ages.

Animate foreign bodies in the ear are frequent occurrences in otology practice. Such foreign bodies may lead to hazardous complications.

This paper describes a retrospective study of six patients with a recent history of an insect in the ear who presented with various complications following intervention received elsewhere.

An insect was retrieved from the external auditory canal in four cases and from the antrum in two cases. The patients presented with progressive otological complications: two patients who presented with orbital apex syndrome and cavernous sinus thrombosis succumbed to the disease; three patients suffered sensorineural hearing loss; and two patients had persistent facial palsy. One patient with sigmoid sinus thrombosis, who presented early, experienced complete recovery.

Insects in the ear can lead to hazardous complications. Animate foreign bodies should preferably be managed by a trained otologist, even in an emergency setting. Patients with delayed presentation and complications have a guarded prognosis.

To determine the relationship between severe tinnitus and inflammation using the neutrophil-to-lymphocyte ratio as a marker of stress.

A total of 107 patients who had been suffering with severe tinnitus (tinnitus handicap inventory scale grades of 3–5) for at least 2 weeks were recruited. Patients underwent detailed ENT examinations and audiometric tests to exclude a relevant pathological cause of the tinnitus. Patients with systemic diseases, malignancy or inflammatory diseases that could alter neutrophil-to-lymphocyte ratio were excluded. A total of 107 age- and sex-matched healthy control participants were also recruited. Routine laboratory test results and neutrophil-to-lymphocyte ratio were compared between the patients and controls.

Lipid profile, liver function, white blood cell count, haemoglobin level, mean corpuscular volume, and vitamin B12 and folate levels were similar among the patients and controls. However, mean neutrophil-to-lymphocyte ratio was significantly higher among the patients than the controls (p < 0.05).

The findings of this novel study suggest that neutrophil-to-lymphocyte ratio should be considered during the evaluation of tinnitus patients as a potential clinical marker of tinnitus. Further studies are required to verify the findings.

This study aimed to assess the long-term outcome of functional endoscopic sinus surgery for Samter's triad patients using an objective visual analogue scale and nasal endoscopy.

Using a retrospective database, 33 Samter's triad patients who underwent functional endoscopic sinus surgery were evaluated pre- and post-operatively between 1987 and 2007 in Hospital of La Chaux-de-Fonds, Switzerland.

A total of 33 patients participated in the study, and the mean follow-up period was 11.6 years (range 1.2–20 years). Patients were divided into two groups based on visual analogue scale scores of the five parameters with the greatest difference in intensity of symptoms between the beginning and end of follow up. Group 1 included patients with a mean visual analogue scale score of 6 and below at the end of follow up and group 2 included patients with a mean visual analogue scale score of more than 6. The only statistically significant difference noted between the two groups was the endonasal findings: stage III–IV polyposis was present in 1 out of 24 patients (4 per cent) in group 1 and in 5 out of 9 patients (56 per cent) in group 2.

The results of our study indicate that functional endoscopic sinus surgery helps stabilise disease progression. Stage III–IV polyposis had a significant adverse effect on long-term outcome.

This study aimed to evaluate the impact of intra-operative neuromonitoring of the recurrent laryngeal nerve during total thyroidectomy for benign goitre.

A single-centre retrospective study using historical controls was conducted for a 10-year period, comprising a series of 767 patients treated by total thyroidectomy for benign goitre. Of these, 306 had intra-operative neuromonitoring of the recurrent laryngeal nerve and 461 did not. Post-operative laryngeal mobility was assessed in all patients by direct laryngoscopy before hospital discharge and at post-operative follow-up visits.

In all, 6 out of 461 patients (1.30 per cent) in the control group and 6 out of 306 patients (1.96 per cent) in the intra-operative neuromonitoring group developed permanent recurrent laryngeal nerve palsy. No statistically significant difference was observed between the two patient groups.

Intra-operative neuromonitoring does not appear to affect the post-operative recurrent laryngeal nerve palsy rate or to reliably predict post-operative recurrent laryngeal nerve palsy. However, it can accurately predict good nerve function after thyroidectomy.

To conduct a meta-analysis to compare the short-term outcomes of robotic thyroidectomy and conventional open thyroidectomy for differentiated thyroid cancer.

Medline, Embase, Science Citation Index Expanded and the Cochrane Library databases were searched for relevant literature. The evaluated endpoints were intra-operative and post-operative outcomes.

Twelve eligible, non-randomised comparative studies involving 2513 patients were included, with 923 patients in the robotic thyroidectomy group and 1590 patients in the conventional open thyroidectomy group. Meta-analysis results revealed that robotic thyroidectomy was associated with significantly longer operative time and a lower number of retrieved central lymph nodes, as compared with conventional open thyroidectomy. No significant differences were found between robotic thyroidectomy and conventional open thyroidectomy in terms of post-operative outcomes.

Robotic thyroidectomy appears to be a feasible and safe surgical procedure for patients with differentiated thyroid cancer. However, more high-quality randomised clinical trials should be undertaken to confirm these findings.

Anaplastic thyroid carcinoma is rare but carries a poor prognosis. Anaplastic thyroid carcinoma leads to tracheal compression, airway compromise and eventually death. Airway compromise, a particularly distressing symptom, can be palliated with tracheal stenting.

A retrospective case note analysis was conducted of patients diagnosed with anaplastic thyroid carcinoma between July 2003 and July 2013.

Twelve patients with anaplastic thyroid carcinoma were identified. Four patients underwent palliative tracheal stenting. Three patients had no dyspnoea at the time of stenting. Two stented patients subsequently developed dyspnoea secondary to stent migration; this was managed successfully with stent exchange. The other stented patient remained asymptomatic with regards to dyspnoea. All non-stented patients died with or from airway compromise.

Tracheal stenting is a relatively safe and effective method for palliation of distressing airway symptoms in patients with anaplastic thyroid carcinoma. Early prophylactic tracheal stenting in anaplastic thyroid carcinoma may be an effective option to prevent development of airway compromise as the disease progresses.

This study aimed to investigate pepsin as a marker of extra-oesophageal reflux disease by examining its presence in tracheal aspirates and correlating it with macroscopic changes on laryngobronchoscopy, along with the results of standard tests for gastro-oesophageal reflux disease and clinical features.

A retrospective review was undertaken of a cohort of 188 paediatric patients who underwent laryngobronchoscopy at a tertiary children's hospital and for whom pepsin assay results of tracheal aspirates were available. An association analysis was performed.

The mean patient age was 3.99 (3.40–4.58) years, with a male preponderance (55 per cent). Positive changes on laryngobronchoscopy were significantly associated with positive tracheal pepsin findings (p < 0.0001) but not with positive standard gastro-oesophageal reflux disease investigations. A positive pepsin assay was significantly associated with a history of recurrent croup (p = 0.0385) and a diagnosis of cystic fibrosis (p = 0.0232).

Macroscopic changes on laryngobronchoscopy were significantly associated with positive tracheal pepsin findings in this paediatric population, suggesting that extra-oesophageal reflux disease may be a contributing aetiology.

This study aimed to link expression patterns of AQP1, AQP5, Bcl-2 and p16 to clinicopathological characteristics of oro-hypopharyngeal squamous cell carcinomas.

Immunohistochemical expression of AQP1, AQP5, Bcl-2 and p16 was investigated in 107 consecutive oro-hypopharyngeal squamous cell carcinoma cases. Molecular interrelationship and correlations with clinicopathological parameters and survival were computed.

AQP1 was expressed exclusively by a subgroup of basaloid-like squamous cell carcinomas. AQP5 was detected in 25.2 per cent of the samples, showing significant association with the absence of p16 and Bcl-2 (p = 0.018; p = 0.010). In multivariate analysis, overexpression of p16 was significantly correlated with favourable overall survival (p = 0.014).

AQP5 defined a subset of patients with Bcl-2-negative and p16-negative tumours with a poor clinical outcome. AQP1 was found to be a marker of a subgroup of aggressive basaloid-like squamous cell carcinomas. These findings suggest that AQP1 and AQP5 are interesting candidates for further studies on risk group classification and personalised treatment of oro-hypopharyngeal squamous cell carcinomas.

This paper reports the authors' technique of manubrio-stapedioplasty using glass ionomer cement for malleus and incus fixation due to tympanosclerosis.

A retrospective case review was conducted of five patients with conductive hearing loss (mean pre-operative air–bone gap of 42.75 dB) treated in a tertiary referral centre. The hearing results of a manubrio-stapedial bone cement ossiculoplasty technique, utilised on the five patients, were analysed. All cases were Wielinga and Kerr tympanosclerosis classification type 2 (attic fixation of the malleus-incus complex with a mobile stapes). The incus and head of the malleus were removed in all patients, and the manubrium was directly connected to the head of the mobile stapes using glass ionomer cement. Patients were evaluated in terms of pre- and post-operative audiometric results; hearing gain and post-operative air–bone gap were the main outcome measures.

Mean post-operative air–bone gap was 5.25 dB. Four patients had an air–bone gap of less than 10 dB; the remaining patient had an air–bone of 12.50 dB.

Manubrio-stapedioplasty is an effective method for ossicular reconstruction in cases of malleus and incus fixation due to tympanosclerosis.

To present the utility of the recently introduced Maniceps septum stitch device for suturing of the nasal septum.

This paper describes nasal septum suturing techniques using the Maniceps septum stitch device following septoplasty to prevent post-operative complications such as haematoma and nasal septum perforation.

Nasal septum suturing using the Maniceps septum stitch device appears to be a safe and easy surgical procedure to help prevent post-operative complications and may reduce the incidence of nasal septum perforation following septoplasty.

An intraoral approach combined with tonsillectomy has been used to access the parapharyngeal space. However, the utility of this technique for parapharyngeal abscesses in paediatric patients has not been investigated. This paper describes an intraoral drainage technique combined with tonsillectomy for treating children with a parapharyngeal abscess that obviates the need for skin incision.

Clinical case records are presented, along with a description of the surgical procedure accompanied by a video clip.

Both cases encountered involved paediatric parapharyngeal space abscesses that extended to the skull base. The patients underwent an intraoral approach combined with tonsillectomy performed under surgical microscopy; this resulted in a good post-operative course without complications.

To our knowledge, no previous reports have addressed the use of surgical microscopy to help access the parapharyngeal space. The procedure described herein, performed under surgical microscopy, was specifically helpful in enabling access to these challenging spaces; it also meant that surgical procedures could be recorded clearly and findings shared with other medical staff.

Laryngeal dysplasia is an important pre-malignant lesion. In 2010, a consensus statement by ENT surgeons and pathologists was published outlining the management and follow up of patients with laryngeal dysplasia.

After reviewing these guidelines, we noted the need for a flowchart for laryngologists to improve efficiency in managing dysplasia and encourage adherence to evidence-based protocols.

A diagram has been produced to aid other ENT units around the country.

Necrotising (malignant) otitis externa is a severe infection causing temporal bone osteomyelitis. Although rare, our experience (reported herein) shows local doubling of cases in 2013. Hospital Episodes Statistics data for England over 14 years also indicate increased incidence nationally. Specific learning points in management are also discussed.

A retrospective review was conducted of patients admitted in 2013 to Wexham Park Hospital, Slough, UK (catchment population, 450 000). In addition, the UK Government Hospital Episodes Statistics data were interrogated.

There were five cases of necrotising (malignant) otitis externa in 2013, representing a local doubling on previous years. The mean age of patients was 82 years. All cultures grew Pseudomonas aeruginosa; no isolates were antibiotic resistant. All patients responded to systemic anti-pseudomonals on clinical, biochemical and radiological parameters. Hospital Episodes Statistics data showed a six-fold increase in the number of cases from 1999 (n = 67) to 2013 (n = 421).

Our experience suggests increasing necrotising (malignant) otitis externa incidence, and retrospective analysis of Hospital Episodes Statistics data supports this observation. Necrotising (malignant) otitis externa poses challenges in management, as exemplified in our cases, requiring a high index of suspicion and early aggressive treatment to achieve cure.

The bone-anchored hearing aid implantation technique is associated with post-operative skin reactions, which require conservative therapy and, in some cases, replacement of the abutment. Z-plasty is a technique that allows resection of the granulation tissue, thus ensuring that disease-free skin will be in contact with the abutment.

Use of the Z-plasty technique for resection of the peri-abutment granulation tissue is described. In the case presented herein, the episodes of skin reaction became very frequent and the patient was unable to use his bone-anchored hearing aid for 2 to 3 days a week. We opted for surgical treatment with Z-plasty for management of the skin complications.

Use of the Z-plasty technique is recommended for the management of skin reactions associated with bone-anchored hearing aid implantation.

Pregnancy-associated pyogenic granuloma (pregnancy tumour) is not uncommon. However, control of severe bleeding associated with the lesion by transarterial embolisation has never been reported.

We report the case of a 33-year-old pregnant woman (34 weeks gestation) who presented with a pregnancy-associated pyogenic granuloma of the mandibular gingiva with a life-threatening haemorrhage. The bleeding stopped soon after transarterial micro-embolisation and regressed after one month; thus, no further surgical excision was needed. The patient was free of post-operative wound pain and infection, and there was no recurrence after one year of follow up.

In general, surgical excision is the first treatment choice for pregnancy tumours. However, it is limited by the risk of marked deformity or incomplete excision when large lesions or difficult surgical areas are encountered. For large tumours, transarterial embolisation may be a safer alternative.

To report the occurrence of a concurrent oropharyngeal papilloma and branchial cleft cyst linked by p16INK4A and human papillomavirus immunohistochemistry.

A 42-year-old woman presented with a 1-month history of a left lateral neck mass. Contrast enhanced computed tomography showed a hypodense lesion 20 mm in diameter anteromedial to the left sternocleidomastoid muscle. Ultrasound-guided fine needle aspiration suggested a branchial cleft cyst. Panendoscopy was performed at the time of neck mass removal, and a papillomatous lesion was removed from the left hypopharynx. Histopathological analysis showed the neck lesion to be a branchial cyst containing lymphoid tissue, and the oral lesion to be a squamous papilloma. Immunohistochemical analysis showed both the branchial cleft cyst and papilloma to be positive for p16INK4A expression and human papillomavirus DNA.

Histological and immunohistochemical analyses support the cystic transformation of lymph nodes, or the ‘Inclusion Theory’, as the aetiology of branchial apparatus anomalies, and raise the possibility that human papillomavirus infection may play a much larger role in disease of the head and neck than previously supposed.