Atlas of Head and Neck Surgery

Review by L Flood and P Bradley
Middlesbrough, UK / Nottingham, UK

I have often expressed a reluctance to review e-books and try to hold out for a paper version. For a book of this length the latter is much easier on the eyes. However, this one is expensive (with little difference between the hard copy and the e-version actually) and times are hard for publishers, so I settled for a pdf. I did so as this is such a significant publication for a UK readership. I hesitated to ask one of my most reliable reviewers, Prof Pat Bradley to take on what could only be the e-version, so I worked on my own effort. But, bless him, he did agree and the result is a double act. There is some inevitable repetition but that reflects that we did reach our conclusions independently, and very favourable they are.

Liam Flood, Book Review Editor

This is a welcome publication aimed at trainees and early consultant surgeons who desire or have chosen to pursue a career as a Specialist Head and Neck Surgeon, whatever primary career path initially chosen, whether (in alphabetical order) general surgery, oral and maxillo-facial surgery, otorhinolaryngology, or plastic and reconstructive surgery. This reviewer has an issue with head and neck surgery being referred to as a “sub-specialty” as it involves working in a multidisciplinary manner and as Head and Neck Surgery is not recognised as a specialty of its own, then such a working pattern must be a “super-specialty”!

Over the decades there have been several publications of “Atlas of Head and Neck Surgery”. One of the first was in the 1960’s by Lore J, using line drawings. In the recent past, several new publications, mainly from the USA and India, amongst others, have included coloured clinical and operative illustrations with line diagrams, to compliment the text. At present there are many ways to access such an “Atlas of Head and Neck Surgery” via Open Access, e-book versions, as well as the traditional hard- and soft-covered versions. Springer has led the way recently with several publications related to head and neck surgery, including a number of editions of “Atlas of Head and Neck”. This publication deals with adult head and neck surgery, and has been edited by two UK Senior ORL-Head and Neck Surgeons and an American OMF Surgeon. The spectrum of the surgery is covered in 51 chapters, authored by an international panel of surgical specialists, of which the majority are from the UK, as well as North America, Europe, and Australasia, The publication is 582 pages long, with an index. It is divided into twenty parts, each containing chapters ranging from one to five. The volume contains copious figures, coloured clinical pictures, radiographs and drawings which is to be expected. The art work that accompanies many of the surgical/clinical pictures enhances the quality of the publication enormously.

This volume is titled as an “Atlas of Surgery” rather than a Textbook and should then concentrate on the processes established with performing surgery: indications, procedure, after-care, special techniques to aid in unexpected events, avoidance of complications, and rehabilitation/long-term outcomes. All of the chapters covered and met this challenge, in part or in-whole. There were however a number of chapters that exceeded the concept of an “Atlas” and submitted a textbook chapter (which did include surgery). One chapter cited some 50 references. Several of the chapter texts duplicated topics and these could be amalgamated, should a second edition be contemplated, such as “excision of salivary stones, surgery for a ranula, lip surgery, surgery of the maxilla/palate, and thyroid surgery (isthmusectomy). The citing of references in the text is to be encouraged, both up-to-date and relevant to surgery, however 5 chapters instead of references suggested “further reading”. The presentation of surgical tips and recommendations, both as technique and how to avoid complications, should be highlighted in “boxes” where relevant or as bullet points as part of the final summary.

This publication is to be admired and the Editors and Authors are to be congratulated on completing such a mammoth task, as should Springer for inviting and challenging a very competent Editorial Team to select suitable authors. Maybe next time, should the chapters be presented “on time and on deadline”, which seldom happens, editorial “clipping and pasting” might reduce duplication, highlight tips and suggestions, improving the educational experience for the reader! This publication, is highly recommended and should be purchased by each NHS multidisciplinary team in the UK and elsewhere and made available to be consulted by the surgical members prior to undertaking head and neck surgery. The purchase price sadly, both the hardcover and eBook, makes this publication unlikely to be bought by an individual trainee or Junior Head and Neck Consultant.

Professor Patrick J Bradley 
Nottingham, UK

This is an important new book. There is an international panel of authors, with many a name familiar to UK readers of this journal. Indeed some I do recall as seated across a viva table, as candidates for the Fellowship exam decades ago. Tempus Fugit.

The title, as an Atlas, led me to expect many a page filled with large operative photographs, a few diagrams and a paucity of text. This was a pleasant surprise. The illustrations, viewed on my PC monitor are of superb quality and I would imagine them looking as good when in print. I do like to see every mucosal vessel in focus and I have never seen endoscopic stapling of a pharyngeal pouch so well captured. The many colour diagrams represent excellent art work and they work particularly well when positioned next to an operative photograph, illustrating the content graphically. That is a feature throughout.

Again, as per the Title, the text concentrates on the surgical approaches to 15 sub-sites in the head and neck, but it includes benign and malignant tumours, neck space infection, non neoplastic disease such as pouches, ranula or thyroglossal cyst and even traditional tonsillectomy. A notable feature is the emphasis on practical tips in any procedure. A great example is the opening chapter on outpatient laryngeal fibreoptic endoscopy, for which a whole chapter seemed quite excessive, well at least initially. However, I learnt so much about the various tricks and manoeuvres to glimpse inaccessible areas and only wish I had read this a few decades ago. Some chapters carry boxed “tips” (e.g. submandibular gland excision or robotic surgery in the oropharynx) and I do like to see them highlighted that way. Pearls of wisdom often included suture placement, avoidance of nerve damage or use of retractors, again emphasising that this is a “hands on” surgery text.

Appropriately it steers clear of radiotherapy or chemotherapy, of otology, even temporal bone resection, or the pathology of cancers. There is a nice index and I sought out “Verrucous Carcinoma” or the answer to a favourite viva question “What do you understand by the term dysplasia?” with no success. That is entirely appropriate for a book, of this title which is indeed a superb achievement by the editors. The advantages of the e-book then became apparent with the excellent search facility of a pdf and 23 links to the term “dysplasia”. I also sought out “guidelines” and found many, even a mention of the coming of our latest UK National Multidisciplinary Guidelines, a supplement to this journal in April of 2024.¹

This will have great appeal to trainees, to experienced super-specialists (I long knew that Pat Bradley will not tolerate the term sub-specialists) in ENT, Plastic or Maxillofacial Surgery. I will grudgingly admit it actually works very well as an e-book too. But do not do what I did and read its 582 pages, beginning to end, off a screen.

Liam M Flood
Middlesbrough, UK

1. Homer JJ, Winter SC, Abbey EC, et al. Head and Neck Cancer: United Kingdom National Multidisciplinary Guidelines, Sixth Edition. The Journal of Laryngology & Otology. 2024;138(S1):S1-S224. doi:10.1017/S0022215123001615

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