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Scott-Brown’s EIGHTH EDITION
Otorhinolaryngology
Head and Neck
Surgery
K17879_Volume III_Book.indb 1 5/25/18 8:57 PM

VOLUME 1
Basic Sciences, Head and Neck Endocrine Surgery,
Rhinology
VOLUME 2
Paediatrics, The Ear, Skull Base
VOLUME 3
Head and Neck Surgery, Plastic Surgery

Scott-Brown’s EIGHTH EDITION
Otorhinolaryngology
Head and Neck
Surgery
VOLUME 3
Editors
John C Watkinson MSc (Nuclear Medicine; London) MS (London) FRCS (General Surgery) FRCS(ENT) DLO
One-Time Honorary Senior Lecturer and Consultant ENT/Head and Neck and Thyroid Surgeon, Queen Elizabeth Hospital
University of Birmingham NHS Trust and latterly the Royal Marsden and Brompton Hospitals, London, UK
Currently Consultant Head and Neck and Thyroid Surgeon, University Hospital, Coventry and Warwick NHS Trust; and
Honorary Consultant ENT/Head and Neck and Thyroid Surgeon, Great Ormond Street Hospital (GOSH)
Honorary Senior Anatomy Demonstrator, University College London (UCL)
Business Director, Endocrine MDT, The BUPA Cromwell Hospital, London, UK.
Raymond W Clarke BA BSc DCH FRCS FRCS(ORL)
Consultant Paediatric Otolaryngologist, Royal Liverpool Children’s Hospital, Liverpool, UK
Senior Lecturer and Associate Dean, University of Liverpool, UK.
Section Editors
Terry M Jones BSc FRCSEd FRCS(ORL-HNS) MD SFHEA FASE(RCS) FAcadTM
Professor of Head and Neck Surgery, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, UK
Honorary Consultant Otolaryngologist / Head and Neck Surgeon, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK.
Vinidh Paleri MBBS MS(ENT) FRCS(Glas) FRCS(Eng) FRCS(ORL-HNS)
Consultant Head & Neck and Thyroid Surgeon, The Royal Marsden Hospital, London, UK
Professor of Robotic and Endoscopic Head and Neck Surgery, The Institute of Cancer Research, London, UK
Visiting Professor, Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, UK.
Nicholas White BSc(Hons) MD MPH(HTA) FRCS(Plast) FFFMLM
Consultant Plastic and Craniofacial Surgeon, Birmingham Children’s Hospital and Queen Elizabeth Hospital Birmingham, UK
National Clinical Lead, Medical Directorate, NHS Improvement, London, UK.
Tim Woolford MD FRCS(ORL-HNS)
Consultant Ear, Nose & Throat Surgeon, Manchester Royal Infirmary, UK Honorary Clinical Professor, Edge Hill University, UK.

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Library of Congress Cataloging‑in‑Publication Data
Names: Watkinson, John C., editor. | Clarke, Ray (Raymond), editor.

Title: Scott-Brown’s otorhinolaryngology and head and neck surgery : basic sciences, endocrine surgery, rhinology / John Watkinson, Ray Clarke.
Other titles: Scott-Brown’s otorhinolaryngology, head and neck surgery | Otorhinolaryngology and head and neck surgery.
Description: Eighth edition. | Boca Raton : CRC Press, [2018] | Preceded by Scott-Brown’s otorhinolaryngology, head and neck surgery.
7th ed. c2008. | Includes bibliographical references and index.
Identifiers: LCCN 2017032760 (print) | LCCN 2017033968 (ebook) | ISBN 9780203731031 (eBook General) | ISBN 9781351399067 (eBook PDF) |
ISBN 9781351399050 (eBook ePub3) | ISBN 9781351399043 (eBook Mobipocket) | ISBN 9781138094611 (hardback : alk. paper).
Subjects: | MESH: Otolaryngology--methods | Otorhinolaryngologic Diseases--surgery | Head--surgery | Neck--surgery | Otorhinolaryngologic
Surgical Procedures—methods.
Classification: LCC RF20 (ebook) | LCC RF20 (print) | NLM WV 100 | DDC 617.5/1--dc23
LC record available at https://lccn.loc.gov/2017032760
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Contents
Contributors ....................................................................... ix 15: Rehabilitation after total laryngectomy ...................... 263
Foreword .......................................................................... xix Yvonne Edels and Peter Clarke
Preface ............................................................................. xxi 16: Management of hypopharyngeal cancer ................... 273
A Tribute to Bill Scott-Brown ...........................................xxiii Prathamesh S. Pai, Deepa Nair, Sarbani Ghosh Laskar
Acknowledgements .........................................................xxiv and Kumar Prabhash
Volume 1 – Table of Contents.......................................... xxv 17: Neck metastases from an unknown primary ............. 295
Volume 2 – Table of Contents..........................................xxix Ricard Simo, Jean-Pierre Jeannon and Maria Teresa
Abbreviations.................................................................xxxiii Guerrero Urbano
18: Metastatic neck disease ............................................ 305

Section 1 Head and Neck Vinidh Paleri and James O’Hara
1: History.............................................................................. 3 19: Principles and practice of radiotherapy in head

Patrick J. Bradley and neck cancer ........................................................ 335
Sara Meade and Andrew Hartley
2: Aetiology of head and neck cancer ............................... 17
Pablo H. Montero, Snehal G. Patel and Ian Ganly 20: Quality of life and survivorship in head and
neck cancer ............................................................... 343
3: Epidemiology of head and neck carcinoma .................. 27 Simon Rogers and Steven Thomas
Kristen B. Pytynia, Kristina R. Dahlstrom and
Erich M. Sturgis 21: Palliative care for head and neck cancer ................... 361
Catriona R. Mayland and John E. Ellershaw
4: Staging of head and neck cancer .................................. 35
Nicholas J. Roland 22: Transoral laser microsurgery ...................................... 369
Mark Sayles, Stephanie L. Koonce, Michael L. Hinni
5: The changing face of cancer information ...................... 49 and David G. Grant
Richard Wight
23: Anatomy as applied to transoral surgery ................... 383
6: Introducing molecular biology of head and Mark Puvanendran and Andrew Harris
neck cancer ................................................................... 55
Nikolina Vlatković and Mark T. Boyd 24: Principles of chemotherapy ....................................... 393
Charles G. Kelly
7: Nasal cavity and paranasal sinus malignancy ............... 73
Cyrus Kerawala, Peter Clarke and Kate Newbold 25: Cysts and tumours of the bony facial skeleton ......... 399
Julia A. Woolgar and Gillian L. Hall
8: Nasopharyngeal carcinoma ........................................... 93
Raymond King-Yin Tsang and Dora Lai-Wan Kwong 26: Head and neck pathology.......................................... 423
Ram Moorthy, Adrian T. Warfield and Max Robinson
9: Benign salivary gland tumours .................................... 115
Jarrod Homer and Andrew Robson 27: Open conservation surgery for laryngeal cancer ....... 449
Volkert Wreesmann, Jatin Shah and Ian Ganly
10: Malignant tumours of the salivary glands .................. 131
Vincent Vander Poorten and Patrick J. Bradley 28: Measures of treatment outcomes .............................. 461
Helen Cocks, Raghav C. Dwivedi and
11: Tumours of the parapharyngeal space....................... 157 Aoife M.I. Waters
Suren Krishnan
29: Applications of robotics in head and neck practice .... 473
12: Oral cavity tumours including lip reconstruction........ 171 Chris Holsinger, Chafeek Tomeh and Eric M. Genden
Tim Martin and Omar A. Ahmed
30: Biologically targeted agents in head and
13: Oropharyngeal tumours ............................................. 207 neck cancers ............................................................. 483
Terry M. Jones and Mererid Evans Kevin J. Harrington and Magnus T. Dillon
14: Tumours of the larynx................................................. 237 31: Prosthetic management of surgically acquired oral
Vinidh Paleri, Stuart Winter, Hannah Fox and and facial defects ...................................................... 499
Nachi Palaniappan Chris Butterworth
v

vi Contents
32: Multidisciplinary team working .................................. 509 51: Pharyngitis ................................................................. 791
Andrew Davies, Nigel Beasley and David Hamilton Sharan Jayaram and Conor Marnane
33: Nutritional considerations .......................................... 517 52: Cricopharyngeal dysphagia ....................................... 811
Rachael Donnelly, Susannah E. Penney, Siân Lewis, Nimesh N. Patel and T. Singh
Lesley Freeman and Pippa Mather
53: Oesophageal diseases............................................... 829
34: Speech voice and swallow rehabilitation Shajahan Wahed and S. Michael Griffin
after chemoradiation .................................................. 531
Justin W.G. Roe and Katherine A. Hutcheson 54: Neurological disease of the pharynx ......................... 845
Kim Ah-See and Miles Bannister
35: Surgical anatomy of the neck .................................... 541
Laura Warner, Christopher Jennings and 55: Rehabilitation of swallowing disorders ..................... 851
John C. Watkinson Maggie-Lee Huckabee and Sebastian Doeltgen
36: Clinical examination of the neck ................................ 565 56: Chronic aspiration ..................................................... 859
James O’Hara Guri S. Sandhu and Khalid Ghufoor
37: Imaging of the neck ................................................... 569 57: Temporomandibular joint disorders .......................... 871
Ivan Zammit-Maempel Andrew J. Sidebottom
38: Neck trauma .............................................................. 597 58: Anatomy of the larynx and tracheobronchial tree ...... 883
Andrew J. Nicol and Johannes J. Fagan Nimesh N. Patel and Shane Lester
39: Benign neck disease .................................................. 607 59: Physiology of the larynx............................................. 897
Ricard Simo, Jean-Pierre Jeannon and Enyinnaya Ofo Lesley Mathieson and Paul Carding
40: Neck space infections................................................ 623 60: Voice and speech production .................................... 905
James W. Moor Paul Carding and Lesley Mathieson
41: Anatomy and embryology of the mouth 61: Assessment and examination of the larynx ............... 911
and dentition .............................................................. 633 Jean-Pierre Jeannon and Enyinnaya Ofo
Barry K.B. Berkovitz
62: Evaluation of the voice............................................... 925
Julian A. McGlashan
42: Benign oral and dental disease.................................. 657
Konrad S. Staines and Alexander Crighton
63: Structural disorders of the vocal cords...................... 943
Yakubu Gadzama Karagama and Julian A. McGlashan
43: Salivary gland anatomy .............................................. 677
Stuart Winter and Brian Fish
64: Functional disorders of the voice............................... 963
Paul Carding
44: Physiology of the salivary glands ............................... 683
Mriganke De and T. Singh 65: The professional voice ............................................... 969
Declan Costello and Meredydd Harries
45: Imaging of the salivary glands ................................... 691
Daren Gibson and Steve Colley 66: Speech and language therapy for voice disorders .... 973
Marianne E. Bos-Clark and Paul Carding
46: Non-neoplastic salivary gland diseases..................... 709
Stephen R. Porter, Stefano Fedele and 67: Phonosurgery............................................................. 981
Valeria Mercadante Abie Mendelsohn and Marc Remacle
47: Anatomy of the pharynx and oesophagus ................ 737 68: Movement disorders of the larynx ............................. 995
Joanna Matthan and Vinidh Paleri Declan Costello and John S. Rubin
48: Physiology of swallowing ........................................... 757 69: Acute infections of the larynx .................................. 1003
Joanne M. Patterson and Stephen McHanwell Sanjai Sood, Karan Kapoor and Richard Oakley
49: Causes and assessment of dysphagia 70: Chronic laryngitis ..................................................... 1011
and aspiration ............................................................ 769 Kenneth MacKenzie
Helen Cocks and Jemy Jose
71: Contemporary management of
50: Functional investigations of the upper laryngotracheal trauma ............................................ 1023
gastrointestinal tract .................................................. 781 Carsten E. Palme, Malcolm A. Buchanan, Shruti Jyothi,
Joanne M. Patterson and Jason Powell Faruque Riffat, Ralph W. Gilbert and Patrick Gullane

Contents vii
72: Upper airway obstruction and tracheostomy .......... 1037 85: Nasal reconstruction ................................................ 1177
Paul Pracy and Peter Conboy Ullas Raghavan
73: Physiology of sleep and sleep disorders ................ 1049 86: Pinnaplasty .............................................................. 1193
John O’Reilly Victoria Harries and Simon Watts
74: Obstructive sleep apnoea: Medical management ....... 1061 87: Blepharoplasty ......................................................... 1199
Dev Banerjee Brian Leatherbarrow
75: The surgical management of snoring and 88: Surgical rejuvenation of the ageing face .................. 1235
obstructive sleep apnoea......................................... 1071 Gregory S. Dibelius, John M. Hilinski and
Bhik Kotecha and Mohamed Reda Elbadawey Dean M. Toriumi
76: Laryngotracheal stenosis in adults .......................... 1081 89: Non-surgical rejuvenation of the ageing face .......... 1247
Guri S. Sandhu and Reza Nouraei Lydia Badia, Peter Andrews and Sajjad Rajpar
77: Reflux disease .......................................................... 1093 90: History of reconstructive surgery ............................. 1255
Mark G. Watson and Kim Ah-See Ralph W. Gilbert and John C. Watkinson
78: Paralysis of the larynx .............................................. 1101 91: Grafts and local flaps in head and neck cancer ...... 1261
Lucian Sulica and Babak Sadoughi Kenneth Kok and Nicholas White
79: Outpatient laryngeal procedures.............................. 1111 92: Pedicled flaps in head and neck reconstruction...... 1283
Matthew Stephen Broadhurst Ralph W. Gilbert and John C. Watkinson
93: Reconstructive microsurgery in head and

Section 2 Plastic Surgery neck surgery ............................................................ 1299
John C. Watkinson and Ralph W. Gilbert
80: Rhinoplasty following nasal trauma ......................... 1127
Charles East 94: Benign and malignant conditions of the skin........... 1321
Murtaza Khan and Agustin Martin-Clavijo
81: Pre-operative assessment for rhinoplasty ............... 1133
Hesham Saleh and Catherine Rennie 95: Facial reanimation surgery ....................................... 1337
Demetrius Evriviades and Nicholas White
82: External rhinoplasty ................................................. 1143
Santdeep Paun 96: Partial and total ear reconstruction.......................... 1345
Cher Bing Chuo
83: Revision rhinoplasty ................................................. 1161
Claudia Rudack and Gerhard Rettinger 97: A combined prosthetic and surgical approach ....... 1357
Hitesh Koria, M. Stephen Dover and Steve Worrollo
84: Aesthetic dorsal reduction rhinoplasty .................... 1169
Julian M. Rowe-Jones Index .............................................................................. 1373

Contributors
Kim W Ah-See MD FRCS FRCS(ORL–HNS) Mark T Boyd BSc PhD SFHEA FRSB
Professor and Consultant ENT Head and Neck Surgeon Professor of Molecular Oncology
Department of Otolaryngology Head and Neck Surgery Department of Molecular and Clinical Cancer Medicine
Aberdeen Royal Infirmary University of Liverpool
Aberdeen, UK. Liverpool, UK.
Omar A Ahmed FRCSEd(Plast) Patrick J Bradley MB BCh BAO DCH MBA FRCS(ed, Eng Ir)
Consultant Plastic, Reconstructive, and Head & FHKCORL FRCSLT(Hon) FRACS
Neck Surgeon Honorary Professor
Newcastle-upon-Tyne Hospitals NHS Trust Department of Otolaryngology–Head and Neck Surgery
Newcastle-upon-Tyne, UK. Nottingham University Hospitals
Queens Medical Centre
Peter Andrews FRCS(ORL–HNS) Nottingham, UK.
Consultant ENT Surgeon
Royal National Throat, Nose and Ear Hospital Matthew Stephen Broadhurst BMBS FRACS
London, UK. (Otorhinolaryngology) Laryngeal Surgery (Harvard Medical School)
Director, Queensland Voice Centre
Miles Bannister BSc(Hons) MBChB(Hons) DOHNS Director, Queensland Centre for Otolaryngology
FRCS(ORL-HNS) Spring Hill, Queensland, Australia.
Specialist Registrar
Aberdeen Royal Infirmary Malcolm A Buchanan BSc(Hons) MBChB PhD FRCS
Aberdeen, UK. (ORL–HNS)
Department of Otolaryngology Head Neck Surgery
Lydia Badia FRCS(ORL–HNS) Westmead Hospital
Consultant ENT Surgeon University of Sydney, Australia.
Harley Street
London, UK. Chris Butterworth BDS(Hons) MPhil FDSRCS(Eng)
FDS(Rest Dent) RCS(Eng)
Dev Banerjee MBChB BSc(Hons) MD FRCP FRACP Consultant in Oral Rehabilitation
Consultant Sleep Physician Merseyside Head and Neck Cancer Centre
Woolcock Institute of Medical Research Honorary Senior Lecturer in Maxillofacial Prosthodontics
University of Sydney; and School of Molecular & Clinical Cancer Medicine
Department of Thoracic and Sleep Medicine University of Liverpool, UK.
St Vincent’s Hospital
Sydney, Australia. Paul Carding FRCSLT2
Deputy Head of School and Professor of Speech Pathology
Nigel Beasley FRCS(ORL-HNS) MBBS BSc National Course Coordinator in Speech Pathology
Consultant ENT Surgeon (Brisbane, Sydney, Melbourne)
Deputy Medical Director School of Allied Health l Faculty of Health Sciences
Nottingham University Hospitals NHS Trust Brisbane Campus, Australia.
Nottingham, UK.
Cher Bing Chuo MB BCh BAO MRSC MSc FRCS (Plast)
Barry KB Berkovitz BDS MSc PhD FDS(Eng) Consultant Plastic and Reconstructive Surgeon
Emeritus Reader in Dental Anatomy Hull and East Yorkshire Hospitals NHS Trust, UK.
King’s College London, UK; and
Visiting Professor Peter Clarke BSc FRCS
Oman Dental College Consultant Head and Neck Surgeon
Muscat, Oman. The Royal Marsden Hospital and Imperial College
Healthcare Trust
Marianne E Bos-Clark MSc Honorary Senior Lecturer
Royal Devon and Exeter NHS Foundation Trust Imperial College
Exeter, UK. London, UK.
ix

x Contributors
Peter Conboy FRCS(ORL-HNS) Sebastian H Doeltgen PhD

Consultant Otolaryngologist Head & Neck Surgeon Senior Lecturer
University Hospitals of Leicester Head of Teaching Section (Speech Pathology)
Leicester UK. Head of Swallowing Neurorehabilitation Research
Laboratory
Helen Cocks MD FRCS(ORL-HNS) College of Nursing and Health Sciences,
Consultant Otorhinolaryngologist Head and Neck Surgeon Flinders Universiy
City Hospitals Sunderland NHS Foundation Trust Adelaide, Australia.
Sunderland, UK.
Rachael Donnelly MSc RD
Steve Colley FRCR Acting Head of Nutrition and Dietetics
Consultant Head & Neck Radiologist Guy’s and St Thomas’ NHS Foundation Trust
Queen Elizabeth Hospital London, UK.
University Hospitals
Birmigham, UK. Stephen M Dover FDSRCS FRCS
Consultant Oral and Maxillofacial Surgeon
Declan Costello MA MBBS FRCS(ORL-HNS) Department of Maxillofacial Surgery
Consultant ENT Surgeon specializing in voice disorders University Hospital Birmingham NHS Foundation Trust
Queen Elizabeth Hospital Birmingham, UK.
Birmingham, UK.
Raghav C Dwivedi MS(ENT) PhD FRCS(ORL-HNS)
Alexander Crighton BDS MB ChB(Edin) FDS(OM) RCSEd Senior Clinical Fellow in ENT & Head Neck Surgery
FDS RCPS Queen Alexandra Hospital
Consultant in Oral Medicine, NHS Greater Glasgow Portsmouth Hospital NHS Trust
and Clyde; and Portsmouth, UK.
Honorary Senior Lecturer in Medicine in Relation to
Dentistry, University of Glasgow Charles East FRCS
Glasgow Dental Hospital & School Consultant Surgeon
Glasgow, UK. University College London Hospitals NHS Trust; and
Honorary Senior Lecturer, University College London
Kristina R Dahlstrom PhD London, UK.
Instructor
Department of Head and Neck Surgery Yvonne Edels FRCSLT
University of Texas MD Anderson Cancer Center Macmillan Consultant Speech and Language Therapist
Houston, Texas, USA. Imperial College Healthcare Trust
Charing Cross Hospital
Andrew Davies MB BS MSc MD FRCP London, UK.
Consultant in Palliative Medicine
Royal Surrey County Hospital; and Mohamed Reda Elbadawey MBChB MSc FRCS(Ed) MD
Visiting Reader FRCS(ORL-HNS)
University of Surrey Consultant Otolaryngologist
Guildford, UK. Freeman Hospital, UK; and
Associate Clinical Lecturer
Mriganke De FRCS University of Newcastle, UK; and
Consultant Head & Neck Surgeon Associate Professor of Otorhinolaryngology–Head and
Department of ENT Surgery Neck Surgery
Royal Derby Hospital, UK. Tanta University, Egypt.
Magnus T Dillon MBBS MRCP PhD John E Ellershaw MA FRCP

Royal Marsden NHS Foundation Trust Honorary Professor Molecular and Clinical
London, UK. Cancer Medicine
Director of Marie Curie Palliative Care Institute
Gregory S Dibelius MD Liverpool, UK.
Facial Plastic & Reconstructive Surgeon
Department of Otolaryngology–Head & Neck Surgery Mererid Evans PhD MRCP FRCR
University of Illinois Honorary Professor of Clinical Oncology
Chicago, USA. University of Liverpool; and
Consultant Clinical Oncologist
Velindre Cancer Centre
Cardiff, Wales, UK.

Contributors xi
Demetrius Evriviades FRCS(Plast) PGDip Daren Gibson MRCS DLO FRCR FRANCR
Consultant Plastic and Reconstructive Surgeon Consultant Radiologist
University Hospitals Birmingham NHS Trust Fiona Stanley Hospital
Birmingham, UK. Perth, Western Australia.
Johannes J Fagan FCS(SA) MMed(Otol) Ralph W Gilbert MD FRCSC

Division of Otolaryngology Department of Otolaryngology Head Neck Surgery
University of Cape Town University of Toronto
Cape Town, South Africa. Toronto, Canada.
Stefano Fedele DDS PhD David G Grant MB ChB

Senior Lecturer in Oral Medicine Department of Otolaryngology – Head & Neck Surgery
UCL Eastman Dental Institute Queen’s Medical Centre
London, UK. Nottingham University Hospitals’ NHS Trust
Nottingham, UK.
Brian Fish FRCS(CSIG) FRCS(ORL-HNS)
Consultant ENT / Head and Neck / Thyroid Surgeon S Michael Griffin FRCS FRCS(Ed) FRCS(HK)(Hon)
Addenbrooke’s Hospital Professor of Gastrointestinal Surgery
Cambridge University Hospitals NHS Trust Consultant Oesophago-Gastric Surgeon
Cambridge, UK. Royal Victoria Infirmary
Newcastle-upon-Tyne, UK.
Hannah Fox MBBS BSc(Hons) FRCS(ORL-HNS) DOHNS PGC
Med Ed PGC Med Lead Patrick Gullane CM OOnt MB FRCSC FACS(Hon) FRACS(Hon)
Consultant Head and Neck Surgeon FRCS(Hon) FRCSI
Freeman Hospital Wharton Chair in Head & Neck Surgery
Newcastle-upon-Tyne, UK. Professor Department of Otolaryngology-Head & Neck
Surgery
Lesley Freeman SRD PG Dip Dietetics, PG Dip Cancer Care for Professor of Surgery
Allied Health Professionals University of Toronto, Canada.
Head and Neck Oncology Dietitian
Freeman Hospital Newcastle-upon-Tyne; and Gillian L Hall FRCPath FDS
Head and Neck Oncology Dietitian Consultant Histopathologist
Darlington Memorial Hospital Central Manchester University Hospitals NHS
Darlington, UK. Foundation Trust
Manchester Royal Infirmary
Ian Ganly MD PhD Manchester, UK.
Associate Attending Surgeon
Head and Neck Service David Hamilton FRCS(ORL-HNS)
Department of Surgery Consultant Otorhinolaryngologist, Head and
Memorial Sloan-Kettering Cancer Center Neck Surgeon
New York, USA. Freeman Hospital
Eric M Genden Sr MD MHA
Professor and Chairman Meredydd Harries FRCS MSc
Department of Otolaryngology–Head and Neck Surgery; Consultant Laryngologist
and Brighton NHS Trust
Professor of Neurosurgery Brighton, UK.
Professor of Immunology
Senior Associate Dean for Clinical Affairs Victoria Harries MBBS MRCS(ENT)
The Icahn School of Medicine at Mount Sinai Specialist ENT Registrar
New York, USA. Bristol Royal Infirmary
Severn Deanery
Khalid Ghufoor BSc(Hons) MBBS FRCS(CSiG) FRCS(ORL-HNS) Bristol, UK.
ENT-Head and Neck Consultant Surgeon
Associate Clinical Director & Network Lead Kevin J Harrington PhD FRCP FRCR
Department of ENT-Head and Neck Surgery Professor of Biological Cancer Therapies
St Bartholomews and The Royal London Hospital Team Leader, Targeted Therapy Team
University College London Hospital The Institute of Cancer Research
The Royal National Throat Nose and Ear Hospital London, UK.
London, UK.

xii Contributors
Andrew Harris PhD FRCS(ORL-HNS) Christopher Jennings FRCS

ENT / Head and Neck & Reconstructive Surgeon Consultant ENT Surgeon
Bradford Teaching Hospitals NHS Foundation Trust University Hospitals Birmingham
Bradford, UK. Birmingham, UK.
Andrew Hartley MRCP FRCR Terry M Jones BSc FRCS(Ed) FRCS(ORL-HNS) MD SFHEA
Consultant Clinical Oncologist FASE(RCS) FAcadTM
Queen Elizabeth Hospital Professor of Head and Neck Surgery
Birmingham, UK. Department of Molecular and Clinical Cancer Medicine,
University of Liverpool, UK; and
John M Hilinski MD Honorary Consultant Otolaryngologist / Head and
Consultant Facial Plastic Surgeon Neck Surgeon
San Diego, California, USA. Aintree University Hospitals NHS Foundation Trust
Liverpool, UK.
Michael L Hinni MD
Department of Otolaryngology–Head & Neck Surgery Jemy Jose MS FRCS(ORL-HNS)
Mayo Clinic Consultant Otolaryngologist Head and Neck Surgeon
Phoenix, Arizona, USA. Hull and East Yorkshire Hospitals NHS Trust
Hull, UK.
Chris Holsinger MD
Professor and Chief of Head and Neck Surgery Shruti Jyothi BSc MBBS
Stanford University Medical Center Specialist Registrar Otolaryngology
Stanford, USA. Royal North Shore Hospital
St Leonards
Jarrod Homer BMedSci(Hons) BMBS FRCS FRCS(ORL-HNS) MD New South Wales, Australia.
Consultant Head and Neck Surgeon / Otolaryngologist
Manchester Head and Neck Centre Yakubu Gadzama Karagama DLO MSc Voice Research
Manchester Royal Infirmary FRCS (ORL & HN) PGCertMed
Manchester University NHS Foundation Trust Consultant ENT Surgeon & Laryngologist; and
Manchester, UK. Honorary Senior Lecturer
University of Manchester; and
Maggie-Lee Huckabee PhD Honorary Senior Lecturer
Professor, Department of Communication Disorders Edge Hill University; and
The University of Canterbury; and Honorary Fellow
Director, the Rose Centre for Stroke Recovery Royal Northern College of Music Manchester
and Research at St Georges Medical Centre Department of Otolaryngology–Head & Neck Surgery
Christchurch, New Zealand. Manchester University Hospital NHS Foundation Trust
Manchester, UK.
Katherine A Hutcheson PhD
Associate Professor Karan Kapoor FRCS
Department of Head & Neck Surgery Head & Neck Fellow
Section of Speech Pathology and Audiology Guy’s and St Thomas’ Hospitals
The University of Texas MD Anderson Cancer Center London, UK.
Houston, Texas, USA.
Charles G Kelly MSc FRCP FRCR FBIR DMRT
Sharan Jayaram FRCS(ORL–HNS) MS DNB Consultant Clinical Oncologist
Consultant Otolaryngologist Head & Neck Surgeon Northern Centre for Cancer Care
North Manchester General Hospital Newcastle-upon-Tyne, UK.
Pennine Acute Hospitals NHS Trust; and
Honorary Senior Lecturer Cyrus Kerawala FDSRCS FRCS
Edge Hill University Consultant Maxillofacial / Head and Neck Surgeon
Lancashire, UK. Head and Neck Unit
The Royal Marsden Hospital
Jean-Pierre Jeannon FRCS(ORL-HNS) London, UK.
Consultant Otolaryngologist Head & Neck Surgeon
Clinical Director of Surgical Oncology Murtaza A Khan MBBS MRCP(UK) MRCP Dermatology
Guy’s & St Thomas NHS Hospital; and Consultant Dermatologist
Associate Professor / Reader Mediclinic Al Noor Hospital
Guy’s, King’s and St Thomas’ Medical and Dental School Abu Dhabi, UAE.
London, UK.

Contributors xiii
Raymond King-Yin Tsang MBChC FRCSEd FHKCORL FHKAM Brian Leatherbarrow FRCS FRCOphth
Clinical Assistant Professor Consultant Ophthalmic, Oculoplastic & Orbital Surgeon
Division of Otorhinolaryngology and Division of Head Manchester; and
and Neck Surgery Honorary Consultant
Department of Surgery Manchester Royal Eye Hospital
The University of Hong Kong; and Manchester, UK.
Queen Mary Hospital, Hong Kong
Chief of ENT Shane Lester FRCS(ORL-HNS) Dip Med Ed
University of Hong Kong-Shenzhen Consultant ENT Head and Neck Surgeon
People’s Republic of China. Department of Otolaryngology
James Cook University Hospital
Kenneth Kok MBChB MRCS MSc(Hons) FRCS(Plast) Middlesbrough, UK.
Consultant Plastic & Reconstructive Surgeon
Queen Elizabeth Medical Centre University Hospital Siân Lewis MSc RD
Birmingham NHS Trust Dietetic Operational Lead
Birmingham, UK. Cwm Taf University Health Board
Royal Glamorgan Hospital
Stephanie L Koonce MD Llantrisant, Wales.
Department of General Surgery
Mayo Clinic Kenneth MacKenzie MBChB FRCS(Ed)
Jacksonville, Florida, USA. Consultant Otolaryngologist Head and Neck Surgeon
Glasgow Royal Infirmary; and
Hitesh Koria BSc(Hons) PDip(Maxfac) PDip(Ortho) MIMPT Honorary Clinical Senior Lecturer
Principal Maxillofacial Prosthetist University of Glasgow; and
Department of Maxillofacial Surgery Visiting Professor
University Hospital Birmingham NHS Foundation Trust University of Strathclyde
Birmingham, UK. Glasgow, UK.
Bhik Kotecha MBBCh MPhil FRCS(Eng) FRCS(Ed) Conor Marnane BSc(Hons) MB BCh PG Cert Med Ed
FRCS(ORL-HNS) DLO FRCS(Eng) FRCS(Ed) FRCS ORL
Honorary Clinical Professor Department of Otolaryngology Head and Neck Surgery
The London School of Medicine and Dentistry; and Abertawe Bro Morgannwg University Health Board
Consultant ENT Surgeon Port Talbot, Wales.
Royal National Throat, Nose and Ear Hospital
Queens Hospital Agustin Martin-Clavijo PhD MRCP
Romford, UK. Consultant Dermatologist
Queen Elizabeth Hospital
Suren Krishnan OAM FRACS Birmingham, UK.
Chairman
Department of Otorhinolaryngology, Head and Tim J Martin MBChB BDS MSc FRSRCS FRCS FRCS(OMFS)
Neck Surgery Consultant Oral and Maxillofacial Surgeon
Royal Adelaide Hospital; and Department of Oral and Maxillofacial Surgery
Honorary Professor University Hospitals Birmingham NHS Foundation Trust
Deakin University; and Birmingham, UK.
Clinical Associate Professor University of Adelaide,
Adelaide, South Australia. Pippa Mather BSc RD
Principal Head and Neck Oncology Dietitian
Dora Lai-Wan Kwong MBBS MD FRCR FHKCR FHKAM Guy’s and St Thomas’ NHS Foundation Trust
Professor and Head of Department London, UK.
Department of Clinical Oncology
The University of Hong Kong Lesley Mathieson FRCSLT
Queen Mary Hospital, Hong Kong. Honorary Research Adviser
Speech and Language Therapy Department
Sarbani Ghosh Laskar MD(Radiation Oncology) Royal National Throat Nose and Ear Hospital
Professor and Consultant Radiation Oncologist London, UK.
Department of Radiation Oncology
Tata Memorial Hospital Joanna Matthan MA(Eng) MBBS PGDipClinEd FHEA
Homi Bhabha National Institute Lecturer in Anatomy
Mumbai, India. Newcastle University
Faculty of Medical Sciences
School of Medical Education

xiv Contributors
Catriona R Mayland MBChB MD FRCP Deepa Nair MS

Consultant and Honorary Senior Clinical Lecturer in Professor and Surgeon
Palliative Medicine Department of Head and Neck Surgical Oncology
Palliative Care Institute Advanced Centre for Treatment Research &
University of Liverpool Education in Cancer (ACTREC)
Liverpool, UK. Tata Memorial Centre
Homi Bhabha National Institute
Julian A McGlashan MBBS FRCS(ORL) Mumbai, India.
Special Lecturer and Consultant
Department of Otorhinolaryngology Kate Newbold MRCP FRCR MD
Queen’s Medical Centre Campus Consultant Clinical Oncologist
Nottingham University Hospitals Head and Neck Unit
Nottingham, UK. The Royal Marsden Hospital
London, UK.
Stephen McHanwell BSc PhD MI Biol CI Biol
Professor of Anatomical Sciences; and Andrew J Nicol MBChB FCS
Director of Unit for Educational Research Development Associate Professor, Trauma Surgeon and Head of
and Practice Trauma Centre
Newcastle University Groote Schuur Hospital
Newcastle-upon-Tyne, UK. University of Cape Town
Cape Town, South Africa.
Sara Meade MBChB MRCP MsC FRCR
Consultant Clinical Oncologist and Honorary Lecturer Reza Nouraei BChir PhD FRCS
The Cancer Centre Consultant Laryngologist & Tracheal Surgeon
University Hospitals Birmingham NHS Foundation Trust The Robert White Centre for Airway Voice and
Edgbaston, Birmingham, UK. Swallowing
Department of Ear Nose & Throat Surgery
Abie Mendelsohn MD FACS Poole Hospital NHS Foundation Trust
David Geffen School of Medicine at UCLA Poole, UK.
Department of Head & Neck Surgery
Los Angeles, USA. Richard Oakley FDSRCS FRCS
Consultant Otorhinolaryngologist–Head &
Valeria Mercadante BSc PhD Neck Surgeon
Postgraduate Researcher in Oral Medicine Guy’s and St Thomas’ Hospitals
UCL Eastman Dental Institute London, UK.
London, UK.
Enyinnaya Ofo FRCS(ORL–HNS) PhD
Pablo H Montero MD Consultant Otorhinolaryngologist–Head and
Head and Neck Fellow Neck Surgeon
Head and Neck Service St George’s University and Kingston Hospitals NHS
Department of Surgery Foundation Trusts; and
Memorial Sloan-Kettering Cancer Center Honorary Senior Lecturer
New York, USA. St George’s University of London Medical School
London, UK.
James W Moor FRCS(ORL–HNS)
Consultant ENT / Head and Neck Surgeon James O’Hara FRCS(ORL–HNS)
Leeds Teaching Hospitals NHS Trust Consultant Otorhinolaryngologist–Head and
Honorary Senior Lecturer Neck Surgeon
University of Leeds The Freeman Hospital
Leeds, UK. Newcastle-upon-Tyne; and
Honorary Senior Clinical Lecturer
Ram Moorthy FRCS(ORL–HNS) Newcastle University
Consultant ENT / Head & Neck Surgeon Newcastle-upon-Tyne, UK.
Wexham Park Hospital
Frimley Health NHS Foundation Trust John O’Reilly MA MB FRCP
Slough, UK. Consultant Physician
Liverpool Sleep and Ventilation Centre
Liverpool, UK.

Contributors xv
Prathamesh S Pai MS(ENT) DNB, DORL MNAMS Stephen R Porter MD PhD FDS RCS FDS RCSE
Professor and Consultant Surgeon Institute Director and Professor of Oral Medicine
Department of Head and Neck Surgical Oncology UCL Eastman Dental Institute
Tata Memorial Centre London, UK.
Mumbai, India. Jason Powell MClinRes PhD MRCS
NIHR Clinical Lecturer
Vinidh Paleri MBBS MS(ENT) FRCS(Glas) FRCS(Eng) Newcastle University
FRCS(ORL–HNS) Otolaryngology Head and Neck Surgery Speciality
Consultant Head & Neck and Thyroid Surgeon Registrar
The Royal Marsden Hospital, London; and Health Education North East
Professor of Robotic and Endoscopic Head and Newcastle-upon-Tyne, UK.
Neck Surgery
The Institute of Cancer Research, London; and Kumar Prabhash MD
Visiting Professor Professor and Consultant Medical Oncologist
Northern Institute for Cancer Research Department of Medical Oncology
Newcastle University, Newcastle-upon-Tyne, UK. Tata Memorial Centre
Nachi Palaniappan MD MRCP FRCR Mumbai, India.
Consultant Clinical Oncologist
Velindre Cancer Centre Paul Pracy FRCS(ORL–HNS)
Cardiff, UK. Consultant Otorhinolaryngologist–Head and
Neck Surgeon
Carsten E Palme MBBS FRACS University Hospitals Birmingham NHS Foundation Trust
Department of Otolaryngology Head Neck Surgery Queen Elizabeth Hospital
Westmead Hospital Birmingham, UK.
University of Sydney, Australia.
Mark Puvanendran FRCS(ORL-HNS)
Nimesh N Patel FRCS(ORL) MSc(Newc) MSc(Oxf) Consultant Otorhinolaryngologist, Head, Neck and
DIU de Chirurgie Robotique Thyroid Surgeon
Consultant Otorhinolaryngologist/Head, Neck and Broomfield Hospital
Thyroid Surgeon Essex, UK.
University Hospital Southampton
Southampton, UK. Kristen B Pytynia MD MPH
Associate Professor Head and Neck Surgery
Snehal G Patel MD MD Anderson Cancer Center
Associate Attending Surgeon Houston, USA.
Head and Neck Service
Department of Surgery Ullas Raghavan FRCS(ORL–HNS)
Memorial Sloan-Kettering Cancer Center Consultant ENT and Facial Plastic Surgeon
New York, USA. Doncaster and Bassetlaw Teaching Hospitals
Doncaster, UK.
Joanne M Patterson FRCSLT
Macmillan Speech and Language Therapist Sajjad Rajpar MRCP
Sunderland Royal Hospital Consultant Dermatologist
Honorary Senior Lecturer University Hospital Birmingham
Newcastle University Birmingham, UK.
Marc Remacle MD PhD
Santdeep Paun FRCS(ORL-HNS) David Geffen School of Medicine at UCLA
Consultant Facial Plastic Surgeon Department of Head & Neck Surgery
St Bartholomew’s Hospital & The Royal London Los Angeles, USA.
Hospitals
London, UK. Catherine Rennie FRCS(ORL-HNS)
Specialist Registrar
Susannah E Penney MBChB DOHNS FRCS(ORL-HNS) Otolaryngology Department
Consultant in Ear Nose and Throat Surgery Charing Cross Hospital
Manchester Royal Infirmary Manchester, UK. Imperial College Healthcare NHS Trust
London, UK.

xvi Contributors
Gerhard Rettinger Prof Dr Dr h c Babak Sadoughi MD FACS

Head ENT University Department Assistant Professor
Ulm, Germany. ENT Otolaryngologist
Department of Otorhinolaryngology
Faruque Riffat BSc(Med) MBBS(Hons 1) MS(ORL) FACS Weill Medical College of Cornell University
FRACS(ORL-HNS) New York, USA.
Department of Otolaryngology Head Neck Surgery
Westmead Hospital Hesham Saleh FRCS(ORL–HNS)
University of Sydney, Australia. Consultant Rhinologist / Facial Plastic Surgeon and
Honorary Senior Lecturer
Max Robinson PhD FRCPath Otolaryngology Department
Senior Lecturer in Oral Pathology Charing Cross Hospital
Newcastle University Imperial College Healthcare NHS Trust
Newcastle-upon-Tyne, UK. London, UK.
Andrew Robson FRCS(ORL) Guri S Sandhu MD FRCS(ORL-HNS) Hon FRAM

ENT Consultant Consultant Otorhinolaryngologist–Head and
Director of Education ENTUK Neck Surgeon
North Cumbria University Hospitals NHS Trust Imperial College London; and
Cumbria, UK. Honorary Senior Lecturer
University College Hospital
Justin WG Roe BA(Hons) PGDip MSc PhD Cert MRCSLT London, UK.
Joint Head-Department of Speech and Language Therapy
The Royal Marsden NHS Foundation Trust Mark Sayles MB BChir PhD
Clinical Service Lead - Speech and Language Therapy Department of Otolaryngology–Head & Neck Surgery
(Airways / ENT) Queen’s Medical Centre
Imperial College Healthcare NHS Trust; and Nottingham University Hospitals’ NHS Trust
Honorary Lecturer Nottingham, UK.
Department of Surgery and Cancer
Imperial College London Jatin Shah MD PhD
London, UK. Head and Neck Service
Department of Surgery
Simon Rogers BDS MBChB(Hons) FSD RCS(Eng) FRCS(Eng) Memorial Sloan-Kettering Cancer Centre
FRCS(Max) MD New York, USA.
Professor and Consultant Maxillofacial Surgeon
Aintree University Hospital Andrew J Sidebottom BDS(Hons) FDSRCS MBChB(Hons)
Liverpool, UK. FRCS FRCS(OMFS)
Consultant Oral and Maxillofacial Surgeon
Nicholas J Roland MD FRCS Nottingham University Hospitals NHS Trust; and
Consultant Head and Neck Surgeon Honorary Assistant Professor (Clinical)
Department of Otolaryngology-Head and Neck Surgery University of Nottingham, UK.
Aintree University Hospitals NHS Foundation Trust
Liverpool, UK. Ricard Simo FRCS(ORL–HNS)
Consultant Otorhinolaryngologist Head and Neck Surgeon
Julian M Rowe-Jones FRCS(ORL) Guy’s and St Thomas’ Hospitals NHS Foundation Trust;
Consultant ENT / Facial Plastic Surgeon and
The Nose Clinic Honorary Senior Lecturer
Guildford, UK. Guy’s, King’s and St Thomas’ Medical and Dental School
London, UK.
John S Rubin MD FRCS FACS
Consultant ENT Surgeon T Singh MBChB BSc(Hons) MMedSci MS MD PhD FRCS
University College London Hospitals NHS Trust; and Eng(GEN Surg) FRCS(Eng) (OTO) FRCS(Eng) (ORL-HNS)
Visiting Honorary Professor MRCGP DFFP FHEA PGCert
University of London School of Health Sciences ENT Surgeon
Honorary Senior Lecturer, UCL Southampton General Hospital
London, UK. Southampton, UK.
Claudia Rudack MD PhD Sanjai Sood FRCS(ORL-HNS)

Chair and Professor Consultant Otorhinolaryngologist-Head &
ENT Department Neck Surgeon
University Hospital Bradford Teaching Hospitals
Münster, Germany. Bradford, UK.

Contributors xvii
Konrad S Staines BChD FDSRCS(Eng) MOMed RCS(Edin) Adrian T Warfield FRCPATH

Consultant & Senior Lecturer in Oral Medicine Consultant Histo-Cytopathologist, University Hospital
University Hospital Bristol NHS Foundation Trust Birmingham NHS Foundation Trust; and
Bristol Dental School Honorary Senior Clinical Lecturer
Bristol, UK. University of Birmingham
Birmingham, UK.
Erich M Sturgis MD MPH FACS Head and Neck Surgery
Professor in Head and Neck Surgery Laura Warner FRCS(ORL-HNS)
University of Texas MD Anderson Cancer Center Training Interface Group Fellow, Head and Neck Surgery
Houston, Texas. Freeman Hospital
Newcastle-upon-Tyne Hospitals
Lucian Sulica MD Newcastle-upon-Tyne, UK.
Sean Parker Professor of Laryngology
Director, Sean Parker Institute for the Voice Aoife M I Waters MRCS DO-HNS
Department of Otolaryngology ENT Registrar
Weill Cornell Medical College Freeman Hospital
New York, USA. Newcastle-upon-Tyne, UK.
Steven Thomas PhD FRCS John C Watkinson MSc(Nuclear Medicine; London)

Professor / Consultant Maxillofacial Surgeon MS(London) FRCS(General Surgery) FRCS(ENT) DLO
University of Bristol One-Time Honorary Senior Lecturer and Consultant
University Hospitals Bristol NHS Foundation Trust ENT/Head and Neck and Thyroid Surgeon, Queen
Bristol, UK. Elizabeth Hospital
University of Birmingham NHS Trust and latterly the
Chafeek Tomeh MD MPH Royal Marsden and Brompton Hospitals, London, UK
Otolaryngology-Head and Neck Surgery Specialist Currently Consultant Head and Neck and Thyroid
Head and Neck Surgical Oncology Surgeon, University Hospital, Coventry and Warwick
Banner MD Anderson Cancer Center NHS Trust; and
Phoenix, Arizona, USA. Honorary Consultant ENT/Head and Neck and Thyroid
Surgeon, Great Ormond Street Hospital (GOSH)
Dean M Toriumi MD Honorary Senior Anatomy Demonstrator, University
Department of Otolaryngology – Head & Neck Surgery College London (UCL)
University of Illinois Business Director, Endocrine MDT, The BUPA Cromwell
Chicago, Illinois, USA. Hospital, London, UK.
Maria Teresa Guerrero Urbano PhD FRCR MRCPI LMS Mark G Watson FRCS
Consultant Clinical Oncologist and Honorary Consultant ENT / Head and Neck Surgeon
Senior Lecturer Doncaster Royal Infirmary
Guy’s and St Thomas’ Hospitals NHS Foundation Trust Doncaster; and
and King’s College London President-Elect
London, UK. British Laryngological Association
London, UK.
Vincent Vander Poorten MD PhD MSc
Associate Professor of Otorhinolaryngology Simon Watts FRCS
Head and Neck Surgery and Epidemiology Consultant ENT and Facial Plastic Surgeon
Section Head of Head and Neck Oncology Department Royal Sussex County Hospital NHS Trust
of Oncology Brighton, UK.
KU Leuven, Leuven, Belgium.
Nicholas White BSc(Hons) MD MPH(HTA) FRCS(Plast) FFFMLM
Nikolina Vlatković BSc PhD Consultant Plastic and Craniofacial Surgeon
Senior Lecturer Birmingham Children’s Hospital and Queen Elizabeth
Department of Molecular and Clinical Cancer Medicine Hospital
University of Liverpool Birmingham, UK; and
Liverpool, UK. National Clinical Lead
Medical Directorate
Shajahan Wahed FRCS MD NHS Improvement
Consultant Oesophagogastric Surgeon London, UK.
Northern Oesophagogastric Unit
Royal Victoria Infirmary; and
Associate Lecturer
Northern Institute for Cancer Research
Newcastle University

xviii Contributors
Richard Wight FRCS(ORL) Steve Worrollo FIMPT

Consultant Otorhinolaryngologist–Head and Consultant Maxillofacial Prosthetist
Neck Surgeon Department of Maxillofacial Surgery
James Cook University Hospital University Hospital Birmingham NHS Foundation Trust
South Tees Hospitals NHSFT Birmingham, UK.
Middlesbrough, UK.
Volkert Wreesmann MD PhD
Stuart Winter MD FRCS(ORL-HNS) Head and Neck Service
Consultant Otorhinolaryngologist–Head and Department of Surgery
Neck Surgeon Memorial Sloan-Kettering Cancer Centre
Oxford University NHS Foundation Trust New York, USA.
Honorary Senior Lecturer, University of Oxford
Oxford, UK. Ivan Zammit-Maempel MBChB(Hons) MRCP FRCR
Consultant Radiologist
Julia A Woolgar BDS FRCPath FDS RCS(Eng) PhD Newcastle-upon-Tyne Hospitals NHS Foundation Trust
Emeritus Senior Lecturer in Oral Pathology Newcastle-upon-Tyne, UK.
University of Liverpool
Liverpool, UK.

Foreword
The eighth edition of Scott-Brown signals the beginning of never have imagined. It lays the groundwork for the
a new and exciting era for ear, nose and throat surgeons, current generation to make their contribution that
and also the end of 10 years of very hard work undertaken will, no doubt, be prompted by technological develop-
by John Watkinson and Ray Clarke, the Editors-in-Chief, ments, an evidence base of what is wise and what is not,
their team of subeditors and, not least, the publishers. together with the experience gained by teamwork with
Whatever subspeciality the current generation of trainees other clinicians in today’s multidisciplinary approach
decides to follow, they will all have to read and refer to to patient care.
Scott-Brown in order to complete their education and gain Simply looking at the table of contents it is clear to see
accreditation. It will be a constant companion and guide that our role in endocrine surgery has increased dramati-
throughout their professional lives. cally over the last 10 years. The thyroid and parathyroids
When asked to write the foreword for this edition, I was now account for 30 chapters. How would Scott-Brown
immediately reminded that I had read John Ballantyne have viewed that when the tonsils and adenoids justify just
and John Groves’s third edition as a trainee, bought the one chapter each, and the sore throat has a mere passing
fourth edition as a senior registrar, written chapters for reference? Times have certainly changed and ENT surgery
Alan Kerr and Philip Stell in the fifth edition, edited the has grown up. We have reflected on our past practices,
Basic science volume of the fifth edition and was ultimately and the evidence base for our management protocols that
Editor-in-Chief of the seventh edition. As each edition takes was emphasized in the previous edition of Scott-Brown
about 10 years to produce, that makes me very old indeed. has been taken to heart.
John and Ray have one final task as Editors-in-Chief: to I hope that this edition will find its way into every medi-
recommend their successors to the publishers. That was cal library in the world and onto every ENT surgeon’s
made easy for me as both of them had proved themselves bookshelf. It will serve and guide surgeons throughout the
more than capable with the previous edition, and the English-speaking world, whether they live in high- or low-
eighth edition is now their masterpiece. They can enjoy the income countries. It is said that the tragedy of getting old
next 10 years as thousands of surgeons worldwide recog- is that we feel young. Reading these volumes makes me
nize and thank them for their industry. wish that I had my time all over again.
This edition reflects the continued expansion of our
speciality into fields that Scott-Brown himself could Michael Gleeson
xix

Preface
When we were asked to head up the editorial team for time zones with a few keystrokes. The bulky packages con-
this, the eighth edition of Scott-Brown, we were mindful taining grainy photographic prints and the reams of paper
of Michael Gleeson’s towering achievement in bringing the with closely-typed and heavily scored text that accumu-
seventh edition to fruition. Michael delivered a much-loved lated on authors’ and editors’ desks are a distant memory.
text – conceived in the early post-war years when antimi- References, guidelines and systematic reviews are all avail-
crobials, the operating microscope and the National Health able online; the editorial ‘red pen’ has been replaced by a
Service were all in their infancy – in an entirely new format cursor on the screen. This ‘new age’ has enabled us to look
that befitted modern surgical scholarship. Authors, editors ever further for expertise. We are proud to have enlisted the
and readers alike had become acutely conscious of the need support of authors from more than 20 countries for this
to quote high-quality evidence to guide clinical decisions; edition. Scott-Brown always enjoyed particular affection
the concept of grading clinical recommendations – and, by and respect in Asia, Australia, Africa and the Middle East.
implication, acknowledging gaps in the evidence base of our It has been a joy to welcome authors in increasing numbers
practice – was born. Recognizing the enormity of Michael’s from many of these parts of the world. We are now a truly
contribution led us into the trap that has befallen every editor global specialty and the eighth edition fully reflects this.
who has come before us; we grossly underestimated the task What has not changed is the huge time commitment authors
ahead. We had misjudged the pace of change. What began and editors need to make. That time now has to be fitted into
as an ‘update’ of some outdated chapters became a com- an increasingly pressurized work environment. Revalidation,
plete rewrite to reflect the advances that marked the decade mandatory training, more intense regulatory scrutiny, expand-
between editions, but we were determined to keep the text ing administrative burdens and ever-expanding clinical com-
to a manageable size. In the end, we have 330 chapters, but mitments leave little time for scholarship. Our section editors
with a slightly smaller page count than the seventh edition. are all busy clinicians. They have generously given their time,
The basic science knowledge that underpins our clinical first instructing authors, cajoling them and then editing their
practice is no longer focused just on anatomy and physiol- chapters, virtually all of which have been completely rewritten
ogy; genetics, molecular biology, new techniques for auditory since the last edition. Each author was chosen because of his or
implantation, information technology, new medical therapies her specific clinical and scientific expertise and none has disap-
for many old disorders together with seismic changes in endo- pointed. Authors and section editors receive no reward other
scopic technology and in medical imaging have transformed than the satisfaction of knowing that they have made a contri-
our specialty. Today’s head and neck surgery would have bution to teaching and learning in a specialty that has given us
been unrecognizable to the early authors and editors. Surgical all so much professional satisfaction. We are profoundly grate-
oncologists have recourse to completely different treatment ful to them and hope that their endeavours spur the next gen-
strategies than did their predecessors and now work as part eration of otolaryngologists to carry on this noble tradition.
of multidisciplinary teams. They deal with different disease Scott-Brown simply wouldn’t happen without this generous
patterns and vastly changed patient expectations. Thyroid and dedicated commitment, unstintingly and graciously given.
and parathyroid surgery has become almost exclusively the It is impossible to produce a book like Scott-Brown with-
domain of the otolaryngologist. Surgery of the pituitary fossa out the contribution of many individuals working behind
has come within our ambit, as has plastic and reconstructive the scenes. We would like to express our gratitude to our
surgery of the head and neck as well as aesthetic facial surgery. Publishers, Taylor and Francis, and to the staff who have
Neurotology, audio-vestibular medicine, rhinology and paedi- worked on this project from its early days in 2011 to publica-
atric otolaryngology are accepted subspecialties, each with its tion in 2018. In particular we would like to mention Cheryl
own corpus of knowledge and skills and each warranting a size- Brandt who with good humour and patience helped to reel in
able section of this text. Contemporary otolaryngology is now many of the 330 chapters. Miranda Bromage joined the team
a collection of subspecialty interests linked by common ‘stem’ in 2016 and her publishing experience and enthusiasm for
training and a shared passion for looking after patients with medical education have helped guide this new edition through
disorders of the upper respiratory tract and the head and neck. its final phases to publication. Finally, we are indebted to
There is a view that a single text – even a multivolume Nora Naughton who has dedicated so much more than just
tome of this size – cannot cover the entire knowledge base her extensive publishing skills to this project. Nora’s meticu-
of modern clinical practice. The subspecialist will, of course, lous attention to detail, combined with her warmth and wis-
need recourse to supplementary reading. The pace of change dom have encouraged us all at the end of this endeavour.
shows no sign of slowing down, but there is still a need for a We are truly ‘passing on the torch’ of a huge amount of
comprehensive working text embracing the whole spectrum accumulated knowledge and wisdom; it is this that gives
of our workload. That was the task we set our authors and us, the Editors-in-Chief, the greatest pleasure.
section editors; we think they have done our specialty proud. Read on and enjoy, our thoughts are yours.
In the new ‘digital’ editorial world authors create manu-
scripts on personal computers. They transmit chapters, RWC
figures, amendments and revisions across continents and JCW
xxi

I wish to acknowledge the love, happiness and inspiration that have been passed on to me by both my
parents and grandparents. I recognise and value the friendship of my dear friend Ray Clarke who has
been with me all the way on this rewarding and worthwhile endeavour. I would specifically like to thank
Esme, Helen and William, without whom none of this would have been achievable. Their love and support
has helped guide me through the years leading up to the publication of this tome, and my final thanks go to
Angela Roberts and Sally Holden for their typing and editing skills.
JCW 2018
Thanks to my wife Mary for her patience and support. My parents, Emmet and Doreen Clarke, both sadly
died during the preparation of this book. They would have been proud to have played a part in such a
scholarly enterprise.
RWC 2018
Black Hut on the River Test – Pastel by W G Scott-Brown – circa 1970. Reproduced by kind permission of Mr Neil Weir,
who was presented with the original by the artist.

A Tribute to Bill Scott-Brown
They were made available to young physicians to help them
travel to overseas centres specifically to study tuberculosis,
then rampant and one of the commonest causes of death in
young adults. The young Scott-Brown visited the leading
pioneers of the day in Berlin, Vienna, Budapest, Stockholm,
Copenhagen, Madrid and Venice. Here he developed his
considerable endoscopy skills. He reported that his first
bronchoscopies were done on a Venetian street entertainer
who, for a few coins, would inhale sundry objects that the
doctors would then dexterously retrieve from his main stem
and segmental bronchi – without of course any anaesthesia!
Times were lean on Scott-Brown’s return. Margaret
(‘Peggy’) was now a popular and well-established GP
who supported him as his private practice developed.
Eventually he secured appointments at East Grinstead, the
Royal National and Royal Free Hospitals. He had a thriv-
ing Harley Street practice and was the favoured otolaryn-
gologist of the aristocracy. His reputation was such that he
become laryngologist to the Royal family, was appointed
Commander of the Victorian Order and was a particu-
lar favourite of the then Princess Royal, HRH Mary the
Countess of Harewood.
Walter Graham (‘Bill’) Scott Brown. 1897–1987 By 1938 he was wealthy enough to purchase a farm
in Buckinghamshire where he bred prize-winning short-
Walter Graham (‘Bill’) Scott-Brown was twenty-three when horn cattle. Ironmongery and blacksmith work were hard
he arrived at Corpus Christi College Cambridge in 1919. to come by during the war years, so Scott-Brown prided
One of the generation of young men whose entry to univer- himself on his ability to make his own agricultural imple-
sity and the professions was delayed by their participation ments, cartwheels and farm wagons in a makeshift forge
in the First World War, he had joined the Gunners in 1915 he himself established on the farm. He would while away
as an 18-year-old. He considered himself blessed to have endless hours here at weekends following a busy week in
survived – although wounded – when so many of his con- London. An accomplished fly fisherman, he was part of
temporaries never returned from the Front. In those early the exclusive Houghton Club whose members fished the
post-WW1 years the medical school at St Bartholomew’s River Test in Hampshire, where he numbered aristocrats
(‘Barts’) in London was keen to attract ‘gentlemen’. To this including the Prince of Wales among his circle.
end a series of scholarships – ‘Shuter’s scholarships’ – was Scott-Brown’s celebrated textbook came about in the
established to lure those with humanities degrees from early 1950s, when he became ill with jaundice and heart
Oxford and Cambridge into medicine. It was via this scheme trouble. He was advised to rest, and took 6 months off
that the young Scott-Brown qualified MB, BCh in 1925. By work. Not satisfied with editing what has become the
now married to Margaret Bannerman, one of the very few standard UK textbook, he took up painting as well. He
women medical graduates of her generation, the two estab- became a celebrated artist whose work is still prized in
lished a general practice in Sevenoaks, Kent. His work here many private collections. One of his pastels is reproduced
involved looking after children with poliomyelitis, which on the preceding page.
was then commonplace, and his MD thesis was on polio- Bill Scott-Brown lived to be 90. He died in July 1987,
related bulbar palsy. It earned him the Copeman Medal for six weeks after his beloved Peggy and just as the fifth edi-
research from the University of Cambridge. While work- tion of the celebrated textbook that still bears his name
ing in general practice, Bill pursued his interest in the then was going to press. His legacy lives on in the pages of this
fledgling specialty of otolaryngology, securing fellowships book, and we are proud to continue the tradition of schol-
from London and Edinburgh. Postgraduate training was arship and learning which he established all those years
haphazard; there were no structured programmes or even ago.
junior posts, so the young Scott-Brown was fortunate to We would like to thank Martin Scott-Brown for his
be awarded a Dorothy Temple Cross Travelling Fellowship. help in compiling the biography above.
Mrs Florence Temple Cross had set up these awards (now
administered by the Medical Research Council) in mem- John C. Watkinson and Raymond W. Clarke
ory of her daughter, who died in 1927 aged thirty-two. London, 2018
xxiii

Acknowledgements
We acknowledge our debt of gratitude to the many authors who have contributed to previous editions of Scott-Brown’s
Otorhinolaryngology, and in particular to authors from the seventh edition, published in 2008. We are also grateful to
Neil Bateman who helped with the initial planning of the Paediatrics section.
Chapter 7, Nasal cavity and paranasal sinus malignancy, Chapter 58, Anatomy of the larynx and tracheobronchial
contains some material from ‘Nasal cavity and paranasal tree, contains some material from ‘Anatomy of the larynx
sinus malignancy’ by Brent A McMonagle and Michael and tracheobronchial tree’ by Nigel Beasley. The material
Gleeson. The material has been revised and updated by has been revised and updated by the current authors.
the current authors.
Chapter 61, Assessment and examination of the larynx,
Chapter 42, Benign oral and dental disease, contains some contains some material from ‘Assessment and examina-
material from ‘Benign oral and dental disease’ by Crispian tion of the upper respiratory tract’ by Jean-Pierre Jeannon
Scully and Jose-V Sebastian Bagan. The material has been and Marcelle Macnamara. The material has been revised
revised and updated by the current authors. and updated by the current authors.
Chapter 48, Physiology of swallowing, contains some Chapter 63, Structural disorders of the vocal chords, con-
material from ‘Physiology of swallowing’ by Paula Leslie tains some material from ‘Disorders of the voice’ Julian
and Stephen McHanwell. The material has been revised McGlashan. The material has been revised and updated
and updated by the current authors. by the current authors.
Chapter 50, Functional investigations of the upper gastro- Chapter 67, Phonosurgery, contains some material from
intestinal tract, contains some material from ‘Functional ‘Phonosurgery’ Meredydd Harries. The material has been
investigations of the upper gastrointestinal tract’ by Lisa revised and updated by the current authors.
J Hirst. The material has been revised and updated by the
current authors.
xxiv

Volume 1 – Table of Contents
Section 1 Basic Sciences 17: Human papillomavirus
Mustaffa Junaid and Hisham M. Mehanna
Cell biology
18: Connective tissue diseases: ENT complications
1: Molecular biology Eileen Baildam
Michael Kuo, Richard M. Irving and Eric K. Parkinson
Microbiology
2: Genetics in otology and neurotology
Mohammed-Iqbal Syed 19: Microorganisms
Ursula Altmeyer, Penelope Redding and Nitish Khanna
3: Gene therapy
Seiji B. Shibata and Scott M. Graham 20: Viruses and antiviral agents
4: Mechanisms of anticancer drugs Richard B. Townsley, Camille A. Huser and
Chris Hansell
Sarah Payne and David Miles
5: Radiotherapy and radiosensitizers 21: Fungal infections

Christopher D. Scrase, Stewart G. Martin and Emily Young, Yujay Ramakrishnan, Laura Jackson and
David A.L. Morgan Shahzada K. Ahmed
6: Apoptosis and cell death 22: Antimicrobial therapy

Angela Hague Ursula Altmeyer, Penelope Redding and Nitish Khanna
7: Stem cells 23: Human immunodeficiency virus

Navin Vig and Ian C. Mackenzie Neil Ritchie and Alasdair Robertson
8: Aetiology and pathogenesis of goitre Haematology

Neil Sharma and Kristien Boelaert
9: Genetics of endocrine tumours 24: Blood groups, blood components and

Waseem Ahmed, Prata Upasna and Dae Kim alternatives to transfusion
Samah Alimam, Kate Pendry and Michael F. Murphy
Wound healing
25: Haemato-oncology
Robert F. Wynn and Mark Williams
10: Soft and hard tissue repair
Sarah Al-Himdani and Ardeshir Bayat 26: Haemostasis: Normal physiology, disorders of
11: Skin flap physiology haemostasis and thrombosis
Colin MacIver and Stergios Doumas Elizabeth Jones and Russell David Keenan
12: Biomaterials, tissue engineering and their Pharmacotherapeutics

application in the oral and maxillofacial region
Kurt Busuttil Naudi and Ashraf Ayoub 27: Drug therapy in otology
Wendy Smith
Immunology
28: Drug therapy in rhinology
13: Defence mechanisms Wendy Smith
Ian Todd and Richard J. Powell
29: Drug therapy in laryngology and head and neck surgery
Wendy Smith and Rogan Corbridge
14: Allergy: Basic mechanisms and tests
Sai H.K. Murng
Perioperative management
15: Evaluation of the immune system
Moira Thomas, Elizabeth Drewe and Richard J. Powell 30: Preparation of the patient for surgery
Michael Murray and Urmila Ratnasabapathy
16: Cancer immunology
Osama Al Hamarneh and John Greenman 31: Recognition and management of the difficult airway
Valerie Cunningham and Alistair McNarry
xxv

xxvi Volume 1 – Table of Contents
32: Adult anaesthesia 48: Image-guided surgery, 3D planning and reconstruction

Daphne A. Varveris and Neil G. Smart Ghassan Alusi and Michael Gleeson
33: Adult critical care 49: Interventional techniques

Robert I. Docking and Andrew Mackay James V. Byrne
34: Paediatric intensive care 50: Laser principles in otolaryngology, head and
Louise Selby and Robert Ross Russell neck surgery
Brian J.G. Bingham
Safe and effective practice
51: Contact endoscopy of the upper aerodigestive tract
35: Training, accreditation and the maintenance of skills Mario Andrea and Oscar Dias
B. Nirmal Kumar, Andrew Robson, Omar Mirza and
Baskaran Ranganathan
Section 2 Head and Neck Endocrine Surgery
36: Communication and the medical consultation
Uttam Shiralkar Overview
37: Clinical governance and its role in patient safety 52: History of thyroid and parathyroid surgery
and quality improvement Waraporn Imruetaicharoenchoke, Ashok R. Shaha and
Samit Majumdar and S. Musheer Hussain Neil Sharma
38: Medical ethics 53: Developmental anatomy of the thyroid and

Paul Baines parathyroid glands
Julian A. McGlashan
39a: Medical jurisprudence in otorhinolaryngology
Maurice Hawthorne 54: Developmental anatomy of the pituitary fossa
John Hill and Sean Carrie
39b: Medical negligence in otorhinolaryngology
Maurice Hawthorne 55: Physiology of the thyroid and parathyroid glands
Martin O. Weickert
40: Non-technical skills for ENT surgeons
Simon Paterson-Brown and Stephen R. Ell 56: Physiology of the pituitary gland
Mária Hérincs, Karen Young and Márta Korbonits
Interpretation and management of data
57: Imaging in head and neck endocrine disease
41: Epidemiology Steve Colley and Sabena Fareedi
Jan H.P. van der Meulen, David A. Lowe and Jonathan
M. Fishman 58: Thyroid and parathyroid gland pathology
Ram Moorthy, Sonia Kumar and Adrian T. Warfield
42: Outcomes research
Iain R.C. Swan and William Whitmer Thyroid disease
43: Evidence-based medicine in medical education 59: Clinical evaluation of the thyroid patient
and clinical practice Andrew Coatesworth and Sebastian Wallis
Phillip Evans
60: Investigation of thyroid disease
44: Critical appraisal skills Anthony P. Weetman
Paul Nankivell and Christopher Coulson
61: Benign thyroid disease
Advances in technology Christopher M. Jones and Kristien Boelaert
45: Electrophysiology and monitoring 62: Management of differentiated thyroid cancer

Patrick R. Axon and Bruno M.R. Kenway Hisham M. Mehanna, Kristien Boelaert and Neil Sharma
46: Optical coherence tomography 63: Management of medullary thyroid cancer

Jameel Muzaffar and Jonathan M. Fishman Barney Harrison
47: Recent advances in technology 64: Management of anaplastic thyroid cancer/lymphoma

Wai Lup Wong and Bal Sanghera James D. Brierley and Richard W. Tsang

Volume 1 – Table of Contents xxvii
65: Management of locoregionally recurrent 81: Medicolegal aspects of head and neck
differentiated thyroid cancer endocrine surgery
Iain J. Nixon and Ashok R. Shaha Barney Harrison
66: Non-surgical management of thyroid cancer Pituitary disease

Laura Moss
82: Clinical evaluation of the pituitary patient
Thyroid surgery Sean Carrie, John Hill and Andrew James
67: Thyroidectomy 83: Investigation of pituitary disease

Ricard Simo, Iain J. Nixon and Ralph P. Tufano Thozhukat Sathyapalan and Stephen L. Atkin
68: Surgery for locally advanced and nodal disease 84: Primary pituitary disease
Joel Anthony Smith and John C. Watkinson Christopher M. Jones and John Ayuk
69: Minimally invasive and robotic thyroid surgery 85: Surgical management of recurrent pituitary tumours
Neil S. Tolley Mihir R. Patel, Leo F.S. Ditzel Filho, Daniel M.
Prevedello, Bradley A. Otto and Ricardo L. Carrau
70: Surgery for the enlarged thyroid
Neeraj Sethi, Josh Lodhia and R. James A. England 86: Adjuvant treatment of pituitary disease
Andy Levy
Parathyroid disease
71: Clinical evaluation of hypercalcaemia Section 3 Rhinology

Mo Aye and Thozhukat Sathyapalan
87: Anatomy of the nose and paranasal sinuses
72: Investigation of hyperparathyroidism Dustin M. Dalgorf and Richard J. Harvey
M. Shahed Quraishi
88: Outpatient assessment
73: Management of hyperparathyroidism Martyn L. Barnes and Paul S. White
Neil J.L. Gittoes and John Ayuk
89: Physiology of the nose and paranasal sinuses
74: Management of persistent and recurrent Tira Galm and Shahzada K. Ahmed
hyperparathyroidism
David M. Scott-Coombes 90: Measurement of the nasal airway
Ron Eccles
75: Management of parathyroid cancer
Pamela Howson and Mark Sywak 91: Allergic rhinitis
Quentin Gardiner
Parathyroid surgery
92: Non-allergic perennial rhinitis
Jameel Muzaffar and Shahzada K. Ahmed
76: Bilateral parathyroid exploration
R. James A. England and Nick McIvor
93: Occupational rhinitis
Hesham Saleh
77: Minimally invasive parathyroidectomy
Parameswaran Rajeev and Gregory P. Sadler
94: Rhinosinusitis: Definitions, classification and diagnosis
Carl Philpott
78: Surgical failure and reoperative surgery
Schelto Kruijff and Leigh Delbridge
95: Nasal polyposis
Louise Melia
Thyroid and parathyroid outcomes
96: Fungal rhinosinusitis
79: Complications of thyroid and parathyroid surgery Eng Cern Gan and Amin R. Javer
and how to avoid them
Erin A. Felger, Dipti Kamani and 97: Medical management for rhinosinusitis
Gregory W. Randolph Claire Hopkins
80: Thyroid and parathyroid surgery: Audit and outcomes 98: Surgical management of rhinosinusitis
David Chadwick A. Simon Carney and Raymond Sacks

xxviii Volume 1 – Table of Contents
99: The frontal sinus 109: Granulomatous conditions of the nose

Salil Nair Joanne Rimmer and Valerie J. Lund
100: Mucoceles of the paranasal sinuses 110: Abnormalities of smell

Darlene E. Lubbe Richard L. Doty and Steven M. Bromley
101: Complications of rhinosinusitis 111: Disorders of the orbit

Stephen Ball and Sean Carrie Nithin D. Adappa and James N. Palmer
102: The relationship between the upper and lower 112: Diagnosis and management of facial pain
respiratory tract Rajiv K. Bhalla and Timothy J. Woolford
Nigel K.F. Koo Ng and Gerald W. McGarry
113: Juvenile angiofibroma
103: Nasal septum and nasal valve Bernhard Schick
Shahram Anari and Ravinder Singh Natt
114: Endoscopic management of sinonasal tumours
104: Nasal septal perforations Alkis J. Psaltis and David K. Morrissey
Charles East and Kevin Kulendra
115: Surgical management of pituitary and parasellar
105: Management of enlarged turbinates diseases
Andrew C. Swift and Samuel C. Leong Philip G. Chen and Peter-John Wormald
106: Epistaxis 116: Extended anterior skull base approaches

Gerald W. McGarry Carl H. Snyderman, Paul A. Gardner,
Juan C. Fernandez-Miranda and Eric W. Wang
107: Nasal and facial fractures
Dae Kim and Simon Holmes 117: Imaging in rhinology
Gregory O’Neill
108: CSF leaks
Scott M. Graham

Another random document with
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in all his dealings; he was punctual in the performance of promises;
he was a man of prayer, and an observer of the Sabbath. And the
point here to be noticed by youth, is, that all these qualities which we
have been noticing appear to be the fruit of seed sown in his youth.
They appear all to have taken root in one great principle—
obedience—obedience to his mother, obedience to his teachers—
obedience to a sense of duty, formed into habit in early life. This is
the real source of Washington’s greatness. He was not made greater
or better than most others, but he adopted good habits, and under
their influence he became great.
Another thing to be observed is, that in adopting good habits,
Washington rejected bad ones. He was guilty of no profanity; no
rudeness or harshness of speech; he was not addicted to sprees; he
was no haunter of bar-rooms or taverns; he had no vulgar love of
eccentricity; he affected not that kind of smartness which displays
itself in irregularity or excess; he did not think it clever to disobey
teachers or parents; he was no lover of scandal, or of profane and
rude society.
The teaching, then, of Washington’s example is this: study
obedience, patience, industry, thoroughness, accuracy, neatness,
respect to the rights and feelings of others, and make these things
habitual—rail-tracks in the mind. The path of obedience is the path to
glory; the path of disobedience is the path of failure and
disappointment in the race of life.
The Poet and the Child.
There is a man in England by the name of Thomas Campbell. He

is a poet, and wrote two famous pieces, “The Pleasures of Hope,”
and “Gertrude of Wyoming,”—besides many other smaller poems,
which are among the most beautiful in our language. A short time
since he was passing through one of the parks of London, which are
extensive fields ornamented with fine trees, and he there saw a
beautiful girl, four years old, led along by a woman. Mr. Campbell
seems to be a lover of children, and so he wrote the following lines
about this little girl. They are very pleasing lines; and I introduce
them here that my fair young readers may see how kindly a famous
poet looks on the face of a child, which bespeaks goodness.
LINES ON HIS NEW CHILD-SWEETHEART.

I hold it a religious duty
To love and worship children’s beauty;
They’ve least the taint of earthly clod,—
They’re freshest from the hand of God.
With heavenly looks, they make us sure
The heaven that made them must be pure.
We love them not in earthly fashion,
But with a beatific passion.
I chanced to, yesterday, behold

A maiden child of beauty’s mould;
’Twas near (more sacred was the scene)
The palace of our patriot Queen.
The little charmer to my view
Was sculpture brought to life anew;
Her eyes had a poetic glow—
Her pouting mouth was Cupid’s bow,
And through her frock I could descry
Her neck and shoulders’ symmetry.
’Twas obvious, from her walk and gait,
Her limbs were beautifully straight.
I stopped th’ enchantress, and was told,
Though tall, she was but four years old.
Her guide so grave an aspect wore
I could not ask a question more—
But followed her. The little one
Threw backward ever and anon
Her lovely neck, as if to say,
I know you love me, Mister Grey.
For, by its instinct, childhood’s eye
Is shrewd in physiognomy;
They well distinguish fawning art
From sterling fondness of the heart.
And so she flirted, like a true

Good woman, till we bade adieu!
’Twas then I with regret grew wild—
Oh! beauteous, interesting child!
Why asked I not thy home and name?
My courage failed me—more’s the shame.
But where abides this jewel rare?

Oh! ye that own her, tell me, where?
For sad it makes my heart, and sore,
To think I ne’er may meet her more.
The Ostrich.
Every one who looks at an ostrich can see that, having very long
legs, he can run pretty fast if he tries. The ostrich is, in fact, swifter of
foot than any other animal. He will outstrip the fleetest dog, or horse,
or even the antelope.
Not only is he the fleetest of running animals, but he is the largest
of birds; but though he is a bird, he cannot fly. In running, he only lifts
his wings a little, flapping them slightly, but deriving no aid from them
in his progress. The ostrich, therefore, is a remarkable bird, and
seems to have been quite a puzzle to a great many wise heads.
Pliny, the old Roman, thought it was rather a beast than a bird, and
the Greeks and Asiatics esteemed it so like a quadruped in some of
its qualities, that they called it a camel-bird.
When a thing is wonderful, people always strive to make it more
wonderful; so they tell very large stories about ostriches eating iron
and brass with a right good appetite! Upon hearing some people talk
about this creature, you would fancy that a shovel and tongs, and a
pair of andirons, would be but a good breakfast for it! Now this is all
nonsense. Iron and brass can no more give nutriment to an ostrich
than a man; it may be that an ostrich, which, it must be confessed,
has a good appetite, sometimes swallows down a spike or a
tenpenny-nail to aid his digestion, just as other birds eat gravel; but
this is no doubt all that can be said about the matter.
The ostrich is a native of most parts of Africa, and of Arabia in
Asia. It is scarce now in all countries, but in the days of ancient
Rome it appears that they were abundant, for the brains of six
hundred were served up at one famous dinner! It is a bird that likes
the company of its own kind very well, and several are often seen
together; but it has not a good opinion of mankind. It seeks places
remote from the haunts of men, and seems to prefer the desert and
the solitude. When pursued, it does not run straight forward, but
wheels round in circles, keeping pretty near its enemy, and is thus
often killed by being shot, or struck with a kind of spear. The creature
is generally inoffensive, and seeks safety by flight; but
when attacked, he resorts to the ungenteel trick of kicking violently,
and he often exercises his skill in this way with serious effect.
In some parts of Africa, the ostrich is tamed, and generally
behaves like a quiet, well-bred bird; it is said, however, not to like
strangers, and to have a spite against ill-dressed people. This is in
bad taste, for the ostrich, having fine silky feathers itself, may seem
to show foolish vanity and pride by picking flaws in the dress of other
people.
There has been a good deal of discussion among learned authors
about the manner in which the female ostrich manages her eggs—
which, by the way, are large and heavy, one of them weighing as
much as a small baby. It is generally agreed, however, that several
ostriches lay in one nest, and that one undertakes to hatch them, but
often covers them up in the sand and leaves them during the day,
knowing that the heat of the sun will carry on the process of hatching
as well without her as with her. I need only add that the ostrich is
about as tall as the Belgian giant, it being between seven and eight
feet high!
What do we mean by Nature?
By Nature, we mean the laws by which God works. And what are
these? Have they power to plan, devise, or execute, of themselves?
Have the laws of God any energy independent of him? Have they,
indeed, any existence independent of him? The seed that is
imbedded in the soil, shoots up into a plant. Is not this God’s work?
Is there any being concerned in this but God? Certainly not. What,
then, has nature to do? Nothing—nothing whatever. The Creator
makes the soil, the seed, the moisture, the heat, and he gives them
their quickening impulse. The stem, the stalk, the unfolding leaf, the
fragrant flower, the blushing fruit, are his. He supplies and guides
every particle of earth, air, water, and heat, concerned in the process
of vegetation; without him, these would remain dead, inert and
motionless. The seed would remain but a seed, and the shapeless
elements would pause forever in their state of original chaos.
Nature, then, is not an efficient power; it is not a being; it contrives
nothing, it does nothing, it plans nothing, it produces nothing. It is
only a term, signifying the ways and means by which God chooses
to perform his various works. Nature is but a word, used to designate
the laws of the material universe. But what are laws without the
lawgiver? Even if enacted, where is their efficiency without the
executive power? What would be our book of statutes, if we had no
government to sustain and enforce them? Instead of creating plants
outright, God produces them by a certain process, in which earth, air,
water, and heat are employed. This process is uniform, and we call it
nature. So animals are produced by a certain established process,
and this, again, we call nature.
Nature, then, and the laws of nature, are nothing more than the
beaten path of the Creator; they show his footsteps, but they should
never be confounded with God himself. We should never permit his
works to become idols which stand between us and him, casting a
shadow over his Almighty image. We should never look upon God’s
works as God, nor abuse our minds by substituting the thing created
for the Creator. This is mere idolatry, and the worshipper of nature as
truly bows down before senseless images, as he who kneels to Baal
or Moloch. Nature may, indeed, declare the glory of God, and show
forth his handy-work; it may serve to raise our minds from earth to
heaven; it may be a ladder by which we should climb to the skies.
But he who goes not beyond nature, stays forever upon the ladder,
and reaches not his proper destination. And yet, are we not in the
habit of doing this? In referring the seasons to nature; in speaking of
the rain, the frost, and the snow—the spring-time, with its bursting
buds and flowers; the summer, with its harvest; the autumn, with its
fruits; the winter, with its white winding-sheet for the death-bed of the
leaves, as the works of nature—do we not lead our minds from their
true Author? Do we not wrap up in the mist of words the idea that all
these are the works of a being who designs, contrives, thinks, and
acts?
A Vision.
“On parent knees, a naked, new-born child,
Weeping thou sat’st, while all around thee smiled;
So live that, sinking in thy last long sleep,
Calm thou may’st smile while all around thee weep.”
The beautiful sentiment in the above stanza, translated from the

Persian by Sir William Jones, struck me so much the other day, while
I was reading the life of that excellent man, that I laid down the book
to meditate upon it. It was a rainy, dull afternoon—the fog hung
heavily on the mountains—the smoke rose drowsily from the
chimneys—the cat and dog had forgotten their feeds, and were
sleeping on the rug at my feet. I caught the sluggish spirit of the day,
and leaning my head back in my rocking-chair, the room and its
furniture gradually faded from my sight, and the following dream or
vision occupied my imagination.
A little girl appeared before me in her freshest childhood, and her
mind just opening to the outward world. She held in her hand a pure
white blank tablet, which had been given her at her birth, and from
which she was never to part, in this world or the world to come.
At first she ran recklessly and gaily forward without heeding the
tablet, which, nevertheless, received certain impressions from every
circumstance of her life. These impressions were, for the most part,
gradually effaced as she proceeded, though a portion of them were
deepened, and some became brighter and more precious. Among
these last were the marks made by the tender love of brothers and
sisters, and the watchings, and gentle rebukes, and prayers of
parents. These, at first, were scarcely perceived, and often quite
unheeded; but I saw afterwards, when the child had become a
woman, and had gone far on in her journey in life, she would gather
from them courage to go forward, and strength to resist temptation.
As she proceeded on her youthful course, I inferred her diligence
from the number and distinctness of the images on her tablet; and
their value, from the frequency with which she recurred to them,
through her whole progress, as to a well-filled store-house for
constant use.
As my eye followed her course, I perceived some figures,
scarcely visible, hovering around her. I looked long and intently
before they were quite defined to my sight; but, by degrees, they
became more and more distinct, till at last I saw every expression—
every movement—and even fancied I detected their purposes.
On one side was a female of thoughtful and tranquil aspect, who
evidently regulated all her steps in relation to far-distant objects, to
which her clear, penetrating glance extended. I at first thought, from
her expression of purity, and her simple robe of snowy whiteness,
that she must be Innocence; but I looked again, and saw her glossy
hair was wreathed with amaranths:
“Immortal amaranth—a flower which once
In Paradise, fast by the tree of life,
Began to bloom;”
and which has since ever been, among “the spirits elect,” the
emblem of Virtue. While the young maiden (for she who started a
child had now become a tall and slender girl) kept her eye fixed on
Virtue, and followed her footsteps, her tablet was being inscribed
with beautiful and ever-brightening characters; and though her way
sometimes lay through entangled paths, and clouds were over her
head, and darkness round about her, yet, when it was again light,
and I could see her tablet, I perceived that during these dark
passages of her course she had ineffaceable images. I wondered
that Virtue—since, after all, it was but Virtue in the human form—
never faltered, or was bewildered in these difficult passages, and
while I wondered, a new keenness was imparted to my vision, and I
saw the radiant form of Religion bending from Heaven and
communicating her holy energy to Virtue.
But there were other figures in the maiden’s train, and one in
particular, whom I knew at once, by the miraculous variety of alluring
forms which she assumed, to be Temptation. She was always full of
smiles, and promises, and winning ways, and she carried in her
hand a magic glass, by which she excluded the distance from the
maiden’s eyes, and gave false and beautiful aspects to whatever
was present or near; and often did she lure her from the side of
Virtue, and plunge her into troubles, from which she could only be
extricated by the intervention and struggles of her true friend.
Though sometimes, when the maiden yielded to Temptation, that
deceitful spirit led her through the flowery paths, yet she always left
her in the hands of Remorse, a withered hag, whose name was
written in letters of fire on her breast, and who held an iron pen, with
which she engraved black and frightful images on the tablet.
The maiden looked at them with affright and sorrow; and
Penitence, a tender and pitiful nymph, tried to wash them out with
her tears; but, though they became fainter, it was impossible to
efface them; and the maiden, grieving that these records of her
wandering with Temptation must forever and forever remain on her
tablet, appealed to Virtue for aid; and Virtue pointed her to Religion,
who, it seemed, could alone enable her to resist the wiles of
Temptation. And now I saw, that, as her communications with
Religion became more frequent, and their intercourse more intimate,
though often assailed by Temptation, the maiden was always
victorious in the contest, and at every step she gave more and more
attention to her tablet, and felt a more intense desire that it should be
impressed with beautiful and brightening images.
I know not how much farther I might have traced her course, had
not my little Helen come bounding in from school—the dog barked,
and I was waked. I told my dream to the little girl.
“And what did the tablet mean?” she asked.
“Oh, it was but a dream, Helen.”
“Yes, but all the rest had a meaning, and there ought to be one to
the tablet.”
“Well, then, my child, let it mean Memory; and, if you like my
dream, let it persuade you to store your memory with beautiful and
indelible images.”—Stories for the Young, by Miss Sedgwick.
The Sun and Wind.
a fable.
The Sun and Wind once fell into a dispute as to their relative
power. The Sun insisted, as he could thaw the iceberg, and melt the
snows of winter, and bid the plants spring out of the ground, and
send light and heat over the world, that he was the most powerful. “It
may be,” said he, “that you can make the loudest uproar; but I can
produce the greatest effect. It is not always the noisiest people that
achieve the greatest deeds.”
“This may seem very well,” said the Wind, “but it is not just. Don’t I
blow the ships across the sea, turn windmills, drive the clouds across
the heavens, get up squalls and thundergusts, and topple down
steeples and houses, with hurricanes?”
Thus the two disputed, when, at last, a traveller was seen coming
along; and they agreed each to give a specimen of what he could do,
and let the traveller decide between them. So the Wind began, and it
blew lustily. It nearly took away the traveller’s hat and cloak, and very
much impeded his progress; but he resisted stoutly. The Wind
having tried its best, then came the Sun’s turn. So he shone down
with his summer beams, and the traveller found himself so hot that
he took off his hat and cloak, and so decided that the Sun had more
power than the Wind.
Thus our fable shows that the gentle rays of the Sun were more
potent than the tempest; and we generally find in life that mild means
are more effective, in the accomplishment of any object, than
violence.
The Kamschatka Lily.

In Kamschatka there is a lily called the Sarana, which almost
covers the ground with blossoms; the roots of this lily are good to eat
when they are baked, and are sometimes made into bread.
There is a little mouse in Kamschatka, which lays these roots by
in its own store-house, and when the weather is fine, it brings them
out to dry in the sun; sometimes the people of that country look for
the store-house of the little mouse, and carry away the roots; but
they always take care to leave some behind for the poor mouse that
has had the trouble of collecting them.
Habits which concern ourselves.
From our first days we are much absorbed in the affairs of self. It
is necessary we should take food, and we do it for ourselves alone.
This leads a very little child to put everything he can reach into his
mouth. Now, here is a habit; and it becomes so easy for him to carry
his hand to his lips, that he does not know, at length, when and how
often he does it.
It is, likewise, a habit of a selfish tendency; for the hand goes to
the mouth merely to gratify a feeling he himself has. But he soon
comes to do many other things; and in all his little actions he thinks
of self. James will not give John a part of his apple, because he is in
the habit of eating apples, and whatever else he can get, always by
himself. This is wrong; and if he do not reform his selfish habit, he
will be a complete miser when he arrives at manhood.
Habit not only effects our impressions, but our active propensities.
Hardly any habit is the source of more faults than heedlessness. It
is especially so in children. Why is that boy sitting idle in his seat at
school? Because he is heedless. He has formed the habit of looking
off his book, and around the school-room, whenever the eyes of his
teacher are turned from him. He has done it so often, that he is not
sensible of being idle, until his teacher calls him to attend to his
studies. The want of attention not only makes us poor scholars, but
poor in purse, and poor as men.
I will tell you an allegory, to show you the sad consequences of
heedlessness.
“There is a hill called Experience. Many people are going up this
hill. On the top of it is a temple, called the Temple of Truth. On the
side of the hill are fruit-trees, bearing good fruits of all kinds; but if
the people are not careful, they make themselves sick by eating it,
and must take medicine, or they become more and more sick.
“Two men set out to ascend this hill. The name of one was
Observation, and that of the other Inattention. Observation looked at
everything near him as he went up the hill; and when he became
sick, he thought of the fruit which had made him so, and was careful
not to eat too much of it and make himself sick again. Inattention,
when sick, thought of nothing but of being well again; and when he
got well, he ate again; and when he had hurt himself, he got up
again and ran on, without minding what hurt him.
“As Observation was going up the hill, he fell in company with
Attention, and they walked on together, and soon became friends.
Inattention preferred to walk alone. As he was going on his way, he
came to a river by the way-side, and, although he did not know how
to swim, he jumped into it without thought, and was near being
drowned; when Observation and Attention, arriving at the place,
pulled him out, and saved his life. The three persons then went on
together.
“They soon came to another river, and Inattention, regardless of
the dangers which he had just escaped, and of the advice of his
fellow-travellers, would go into it, and was drowned, although they
tried to save him. So the friends went on without him; and after many
years’ travelling, they arrived at the Temple of Truth, on the top of the
hill, and were rewarded for their perseverance and care, while
Inattention was punished for his negligence and folly.”
We should form the habit of keeping our good resolutions. If we
wish to improve, we must see our errors, and resolve to correct
them; without such resolutions, we shall always do the same wrong
things which we do now. But one point we must never forget; which
is, that the oftener we break our good resolutions, the less likely are
we to keep any we may form. Samuel is very apt to be passionate.
He will, when he is angry, sometimes speak improperly to his father,
or strike his little sister. He knows this is wrong, and every night he is
sorry for it, and resolves not to get angry the next day. But he has
broken just such a resolution so often, that it is growing more and
more difficult for him to govern his temper. The only way he can
reform, is to form the habit of making resolutions very deliberately,
and always carrying them into full execution.
It is important that we acquire fortitude. We must bear many
disappointments and much pain so long as we live. If we began to
bear them firmly in childhood, we should all make brave, patient, and
submissive men. God does not send us troubles without intending to
make us better by the use of them. But without fortitude, affliction
only hardens our hearts.
We have seen very young children bear pain without a single
complaint. In sickness, some are so calm and patient, that you would
not know, except by their countenance, that they were sick. It is
essential to form the habit of keeping our little bodily afflictions to
ourselves. It is our duty to do it, for we only make others unhappy by
continually talking of our own troubles. And we make the suffering
appear the greater to ourselves, also, the more we dwell upon and
converse about it. So of extreme cold and heat—we should begin in
childhood to bear them without tears and complaints. It will give us
no relief to think of them, and magnify our sufferings by relating them
to others.
Troubles of mind should be borne habitually with fortitude. James
has broken one of his skates, but no one would know it from his
appearance; he does not cry, or fret, or complain to his companions,
or at home. His tears he knows will not mend it; he only determines
to be more careful in future, and, as soon as he is able, to purchase
a new pair of skates.
We should always consider, too, that our Father in Heaven
intends to teach us wisdom and submission to his will, by our
smaller, as well as greater troubles.
Anecdotes of Haydn.
The great musician, Haydn, was the son of a wheelwright. His

father used to play on the harp, and on holidays, his mother would
sing while he played; and whenever the little boy heard this music,
he would get two pieces of wood, like a violin and the bow that plays
on it, and he would seem to be playing to his mother’s singing; and
as long as he lived, Haydn loved to play the airs his mother then
sung.
It happened that a relation of his parents, who was a
schoolmaster, came to see them, and, thinking the child clever, he
offered to bring him up, and his parents accepted the offer. When
Haydn was at school, he found a tambourine, and played on it a tune
so surprising, that everybody in the house came to listen to it.
He was afterwards taught to sing; and a person who understood
good music well, coming to hear him, was so pleased with him, that
he emptied a plate of cherries into his pocket.
Such was the beginning of this famous man, who composed
many of the beautiful tunes with which we are all familiar.

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Scott Brown s otorhinolarnygology and

head and neck surgery basic sciences

Scott-Brown’s Otorhinolaryngology and Head and Neck

Scott-Brown’s Otorhinolaryngology and Head and Neck

Scott-Brown’s Otorhinolaryngology and Head and Neck

Head and Neck Surgery P. Ashley Wackym

Scott-Brown’s Otorhinolaryngology Head and Neck Surgery

Plastic Surgery-Craniofacial, Head and Neck Surgery-

Master Techniques in Otolaryngology Head and Neck

Head, Neck and Thyroid Surgery: An Introduction and

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© 2019 by Taylor & Francis Group, LLC

No claim to original U.S. Government works

Printed on acid-free paper

International Standard Book Number-13: 978-1-138-09461-1 (Hardback; Volume 1)

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Names: Watkinson, John C., editor. | Clarke, Ray (Raymond), editor.

Visit the Taylor & Francis Web site at

and the CRC Press Web site at

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18: Metastatic neck disease ............................................ 305

1: History.............................................................................. 3 19: Principles and practice of radiotherapy in head

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93: Reconstructive microsurgery in head and

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Peter Conboy FRCS(ORL-HNS) Sebastian H Doeltgen PhD

Magnus T Dillon MBBS MRCP PhD John E Ellershaw MA FRCP

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Johannes J Fagan FCS(SA) MMed(Otol) Ralph W Gilbert MD FRCSC

Stefano Fedele DDS PhD David G Grant MB ChB

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Andrew Harris PhD FRCS(ORL-HNS) Christopher Jennings FRCS

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Catriona R Mayland MBChB MD FRCP Deepa Nair MS

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Gerhard Rettinger Prof Dr Dr h c Babak Sadoughi MD FACS

Andrew Robson FRCS(ORL) Guri S Sandhu MD FRCS(ORL-HNS) Hon FRAM

Claudia Rudack MD PhD Sanjai Sood FRCS(ORL-HNS)

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Konrad S Staines BChD FDSRCS(Eng) MOMed RCS(Edin) Adrian T Warfield FRCPATH

Steven Thomas PhD FRCS John C Watkinson MSc(Nuclear Medicine; London)

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Richard Wight FRCS(ORL) Steve Worrollo FIMPT

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5: Radiotherapy and radiosensitizers 21: Fungal infections

6: Apoptosis and cell death 22: Antimicrobial therapy

7: Stem cells 23: Human immunodeficiency virus

8: Aetiology and pathogenesis of goitre Haematology

9: Genetics of endocrine tumours 24: Blood groups, blood components and

12: Biomaterials, tissue engineering and their Pharmacotherapeutics

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32: Adult anaesthesia 48: Image-guided surgery, 3D planning and reconstruction