A very longstanding (I must not say ‘old’) friend, Prof Pat Bradley, recently corrected me for talking of sub-specialisation, insisting that it should be super-specialisation and, indeed, it does have a better ring to it. Decades ago, UK head and neck surgery was largely the province of the general surgeons, but pioneers in our field and, later, in maxillofacial surgery, developed the multi-disciplinary approach that was to transform outcomes. Until recently, there was still however an ‘understanding’ that the parotid belonged to us, but the thyroid and parathyroid glands went to general surgery. The subsequent shift in practice was reflected in our own John Watkinson becoming the first ENT surgeon to hold the office of President of the British Association of Endocrine and Thyroid Surgeons (2011–2013).
This is an important book for our specialty therefore, and it immediately impresses, with the quality we expect from this publisher. The Preface does highlight some very attractive and novel features, seen in each and every chapter. Bulleted key points and case reports we might expect, but I did like what are termed ‘points to ponder’ (often posing quite tricky questions to the reader). Chapters carry massive lists of very up-to-date references, but another novelty here was the use of an ‘Annotated Bibliography’, listing between three and five of the most valuable papers, for further reading on the topic.
The text opens with the ‘Basic Science of the Thyroid Gland’, with chapters on embryology, physiology, pathology, and then detailed and very topical coverage of the molecular characterisation of tumours and cytopathology. This is followed by three chapters on the medical management of thyroid dysfunction or neoplasia. Section II appealed, as it covered decision-making, pre-operative imaging, laryngology studies and evaluation of nodes. Anaesthetic considerations were particularly interesting, with the previously mentioned key points/pearls and ‘points to ponder’ as true highlights. I was struck by a coronal computed tomography scan of a massive goitre that it was felt ‘does not portend difficulties with direct laryngoscopy and intubation’. That image would have worried many an anaesthetist in my former practice!
Section III has 12 chapters on surgery of the various thyroid tumours, but also mediastinal goitre, lymphoma, paediatric cancer or locally invasive, aggressive malignancy. Section IV on ‘Special Considerations and Techniques’ is the longest. Chapters here are particularly well chosen, covering topics as diverse as minimally invasive video-assisted thyroidectomy, the risks to laryngeal innervation, various neck dissections, or differing approaches, whether transoral, face-lift or robotically assisted. The thyroid coverage closes with radiation therapy, including radio-iodine or external beam and targeted modalities. Final chapters on ethics and medicolegal issues, and on ‘Thyroid Cancer Survivorship’, were thought-provoking.
The last sections follow a similar format, now concentrating on the parathyroid glands, obviously dealing with the many biochemical challenges and the use of imaging for localisation. The very last chapter (of 62 chapters) ‘Unsuccessful and Revision Parathyroid Surgery’ was fascinating to this retired otologist.
The comprehensive text is illustrated throughout, and imaging is particularly well printed and sharply defined. In the appendices, I found attractive colour illustrations introducing me to the various anatomical triangles of Simon, of Joll and of Beahr, which I am sure are more familiar to John Watkinson than to me!
This is an important new publication that will appeal to many medical and surgical disciplines. I would recommend it as a surprisingly ‘easy read’ for what is a complex and massive field of practice. I frankly expected it to cost about twice the asking price for its massive content, the video access and the e-book too.
