Chemoradiotherapy has emerged as a gold standard in advanced squamous cell carcinoma of the head and neck (SCCHN). Because 50% of advanced stage patients relapse after nonsurgical primary treatment, the role of salvage surgery (SS) is critical because surgery is generally regarded as the best treatment option in patients with recurrent resectable SCCHN. Surgeons are increasingly confronted with considering operation among patients with significant effects of failed non-surgical primary treatment. Wide local excision to achieve clear margins must be balanced with the morbidity of the procedure, the functional consequences of organ mutilation, and the likelihood of success. Accurate selection of patients suitable for surgery is a major issue. It is essential to establish objective criteria based on functional and oncologic outcomes to select the best candidates for SS. The authors propose first to understand preoperative prognostic factors influencing survival. Predictive modeling based on preoperative information is now available to better select patients having a good chance to be successfully treated with surgery. Patients with a high comorbidity index, advanced oropharyngeal or hypopharyngeal primary tumors, and both local and regional recurrence have a very limited likelihood of success with salvage surgery and should be strongly considered for other treatments. Following SS, identifying patients with postoperative prognostic factors predicting high risk of recurrence is essential because those patients could benefit of adjuvant treatment or be included in clinical trials. Finally, defining HPV tumor status is needed in future studies including recurrent oropharyngeal SCC patients.

An overview of best evidence-based current practice in the use of prophylactic antibiotics in elective oncological head and neck surgery is presented. Patients undergoing head and neck oncological surgery are at great risk of developing complications following surgery. The incidence of wound infection has been reported to be as high as 87%, often with devastating effects. Prophylactic antibiotics have helped to reduce significantly the risk of infection; however, clinicians managing these patients should also have a thorough understanding of the risk factors leading to postoperative infections and should apply the most basic surgical principles at all times, to minimize infection rates. Prophylactic antibiotics usage in clean-contaminated major oncological head and neck surgery is mandatory to reduce the risk of infection. In clean major oncological head and neck surgery their use is also advisable but there is no evidence that in clean surgery for benign disease it offers any advantage. Short antibiotic regimes of four doses per 24 h are as effective as prolonged courses regardless of the complexity of the procedure. A combination of antibiotic agents covering aerobic, anaerobic and Gram-negative bacteria is superior to single agents. High-risk patients should be also given short regimes, as there is no evidence that prolonged courses are of more benefit in these patients. Methicillin-resistant Staphylococcus aureus infection can have devastating consequences for patients undergoing major head and neck surgery. Protocols of prevention and treatment should be in place in all institutions treating patients with head and neck cancer. Close collaboration between surgical, microbiology and infection-control teams is essential.

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. In the absence of high-level evidence base for follow-up practices, the duration and frequency are often at the discretion of local centres. By reviewing the existing literature and collating experience from varying practices across the UK, this paper provides recommendations on the work up and management of lateral skull base cancer based on the existing evidence base for this rare condition.Recommendations: • Patients should be followed up to a minimum of five years with a prolonged follow-up for selected patients. (G)• Patients should be followed up at least two monthly in the first two years and three to six monthly in the subsequent years. (G)• Patients should be seen in dedicated multidisciplinary head and neck oncology clinics. (G)• Patients should be followed up by dedicated multidisciplinary clinical teams. (G)• The multidisciplinary follow-up team should include clinical nurse specialists, speech and language therapists, dietitians and other allied health professionals in the role of key workers. (G)• Clinical assessment should include adequate clinical examination including fibre-optic rigid or flexible nasopharyngolaryngoscopy. (R)• Magnetic resonance imaging and positron emission tomography combined with computed tomography imaging should be used when recurrence is suspected. (R)• Narrow band imaging can be used in the follow-up in selected sites. (R)• Second primary tumours should be part of rationale of follow-up and therefore adequate screening strategies should be used to detect them. (G)• Patients should be educated with regard to the appearance and detection of recurrences. (G)• Patients with persistent pain should be investigated to exclude recurrent disease. (R)• Patients should be offered support with tobacco and alcohol cessation services. (R)

Purpose: To review the current options in the management of Warthin tumors (WTs) and to propose a working management protocol. Methods: A systematic literature search was conducted using PubMed and ScienceDirect database. A total of 141 publications were selected and have been included in this review. Publications were selected based on relevance, scientific evidence, and actuality. Results: The importance of parotid WTs is increasing due to its rising incidence in many countries, becoming the most frequently encountered benign parotid tumor in certain parts of the world. In the past, all WTs were treated with surgery, but because of their slow growth rate, often minimal clinical symptoms, and the advanced age of many patients, active observation has gradually become more widely used. In order to decide on active surveillance, the diagnosis of WT must be reliable, and clinical, imaging, and cytological data should be concordant. There are four clear indications for upfront surgery: uncertain diagnosis; cosmetic problems; clinical complaints, such as pain, ulceration, or recurrent infection; and the patient’s wish to have the tumor removed. In the remaining cases, surgery can be elective. Active surveillance is often suggested as the first approach, with surgery being considered if the tumor progresses and/or causes clinical complaints. The extent of surgery is another controversial topic, and the current trend is to minimize the resection using partial parotidectomies and extracapsular dissections when possible. Recently, non-surgical options such as microwave ablation, radiofrequency ablation, and ultrasound-guided ethanol sclerotherapy have been proposed for selected cases. Conclusions: The management of WT is gradually shifting from superficial or total parotidectomy to more conservative approaches, with more limited resections, and to active surveillance in an increasing number of patients. Additionally, non-surgical treatments are emerging, but their role needs to be defined in future studies.

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. Although much commoner in the eastern hemisphere, with an age-standardised incidence rate of 0.39 per 100 000 population, cancers of the nasopharynx form one of the rarer subsites in the head and neck.¹ This paper provides recommendations on the work up and management of nasopharyngeal cancer based on the existing evidence base for this condition.Recommendations: • Patients with nasopharyngeal carcinoma (NPC) should be assessed with rigid and fibre-optic nasendoscopy. (R)• Nasopharyngeal biopsies should be preferably carried out endoscopically. (R)• Multislice computed tomographic (CT) scan of head, neck and chest should be carried out in all patients and magnetic resonance imaging (MRI) where appropriate to optimise staging. (R)• Radiotherapy (RT) is the mainstay for the radical treatment for NPC. (R)• Concurrent chemoradiotherapy offers significant improvement in overall survival in stage III and IV diseases. (R)• Surgery should only be used to obtain tissue for diagnosis and to deal with otitis media with effusion. (R)• Radiation therapy is the treatment of choice for stage I and II disease. (R)• Intensity modulated radiation therapy techniques should be employed. (R)• Concurrent chemotherapy with radiation therapy is the treatment of choice for stage III and IV disease. (R)• Patients with NPC should be followed-up and assessed with rigid and/or fibre-optic nasendoscopy. (G)• Positron emission tomography–computed tomography (PET–CT), CT or MRI scan should be carried out at three months from completion of treatment to assess response. (R)• Multislice CT scan of head, neck and chest should be carried out in all patients and MRI scan whenever possible and specially in advanced cases with suspected recurrence. (R)• Surgery in form of nasopharyngectomy should be considered as a first line treatment of residual or recurrent disease at the primary site. (R)• Neck dissection remains the treatment of choice for residual or metastatic neck disease whenever possible. (R)• Re-irradiation should be considered as a second line of treatment in recurrent disease. (R)