Christopher J Skilbeck

The Royal Marsden NHS Foundation Trust, Londinium, England, United Kingdom

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Publications (12)18.09 Total impact

  • Brian Bisase · Cyrus Kerawala · Christopher Skilbeck · Cheka Spencer
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    ABSTRACT: Patients whose necks respond completely to chemoradiation are unlikely to have residual viable tumour, which questions the need for planned neck dissection. Partial responders often need further assessment. Positron emission tomography/computed tomography (PET/CT) is becoming the standard method of assessing the response of both the primary site and neck to chemoradiation. There is debate, however, about the timing of assessment, the best imaging technique, and the extent of neck dissection, and emerging evidence supports more selective procedures with their attendant reductions in morbidity. Various trials have tried to settle these controversies, but we hypothesised that current practice varies across the United Kingdom (UK), so we set out to establish what it is. A total of 219 questionnaires were sent to head and neck surgeons of varying disciplines and their oncology counterparts, which outlined a clinical picture of a patient with persistent nodal disease after chemoradiotherapy, and requested information about the respondents' preferred choice and timing of investigations in addition to the type of neck dissection, if indicated. There were noticeable variations in practice, with a tendency towards personal choice rather than a multidisciplinary approach. Although there were some items of broad agreement, there was disparity about the timing of imaging and operation. There is inconsistency in the management of the neck in these patients in the UK, which may reflect an absence of guidelines and paucity of evidence-based information. We need to unify practice to improve the care of patients.
    British Journal of Oral and Maxillofacial Surgery 03/2012; 51(1). DOI:10.1016/j.bjoms.2012.02.017 · 1.13 Impact Factor
  • B. Bisase · C. Skilbeck · C. Kerawala · C. Spencer
    Oral Oncology 07/2011; 47. DOI:10.1016/j.oraloncology.2011.06.131 · 3.03 Impact Factor
  • B. Bisase · C. Skilbeck · C. Spencer · C. Kerawala
    British Journal of Oral and Maxillofacial Surgery 06/2011; 49. DOI:10.1016/j.bjoms.2011.03.034 · 1.13 Impact Factor
  • Source
    Owain R Hughes · Christopher J Skilbeck · Ivor Kwame · Kelvin Kwa · Dennis I Choa
    The Laryngoscope 05/2011; 121(5):997-8. DOI:10.1002/lary.21436 · 2.03 Impact Factor
  • Source
    Christopher J Skilbeck · Jean-Pierre Jeannon · Mary O'Connell · Peter R Morgan · Ricard Simo
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    ABSTRACT: Squamous cell carcinoma (SCC) of the tonsil is the most common malignant tumour of the oropharynx. Paediatric tonsillectomy is one of the most commonly performed procedures in Otorhinolaryngology. SCC of the tonsil remnant (SCCTR) in a previously tonsillectomised patient is rare. Retrospective review of patients with SCCTR presenting to the Otorhinolaryngology, Head and Neck Unit January 2000 to December 2007. Two hundred and fifty patients with tonsil SCC were identified. Ten (4%) of these had previously undergone tonsillectomy in childhood. Nine patients underwent radical treatment including surgery, radiotherapy and in four cases concomitant chemotherapy. Eight patients are alive with no signs of recurrence with follow-up of a minimum of 24 months. One has been lost from follow-up. Clinicians should be aware that SCC can arise from a tonsillar remnant. SCCTR has similar oncological outcomes as tonsillar tumours.
    Head & Neck Oncology 01/2011; 3:4. DOI:10.1186/1758-3284-3-4 · 3.14 Impact Factor
  • Kevin N Kulendra · Christopher J Skilbeck · John Blythe · Dennis I Choa
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    ABSTRACT: We report a unique case of a young patient who accidentally swallowed his partial denture and alarmingly only presented to our ear, nose and throat (ENT) department 4 weeks later despite several previous presentations to primary and secondary care. The partial denture was successfully removed under general anaesthetic using direct laryngoscopy following admission. He was discharged on a normal diet 6 days later after oesophageal perforation was excluded using a contrast swallow.
    Case Reports 02/2010; 2010. DOI:10.1136/bcr.10.2009.2401
  • Daniel J Tweedie · Christopher J Skilbeck · Michelle E Wyatt · Lesley A Cochrane
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    ABSTRACT: Adenoidectomy is indicated for the relief of paediatric nasal obstruction, sleep-disordered breathing and otitis media with effusion (OME). Velopharyngeal insufficiency (VPI) is a rare complication. The main risk factor is the presence of pre-existing velopharyngeal closure-impaired mechanisms, including submucosal or overt cleft palate. Despite possible benefits, adenoidectomy is frequently withheld in such children to avoid VPI. This study aims to demonstrate the efficacy and safety of partial adenoidectomy using suction diathermy in children who previously underwent overt cleft palate repair during infancy, to allow selective resection of tissue and symptom resolution without producing VPI. Since 1994, 18 patients with previously corrected overt cleft palate have undergone partial adenoidectomy at this centre, for the treatment of nasal obstruction or sleep-disordered breathing, with or without OME. Three had existing VPI following their cleft correction surgery. Selective resection of the adenoid was performed transorally under indirect vision, using a malleable suction coagulator. This allowed exposure of the posterior choanae, leaving the remaining adenoid bulk intact. Patients were followed up at 4 weeks, and subsequently at regular intervals (total follow up 30-180 months, median 92 months), including perceptual speech assessment in all cases. All demonstrated symptomatic improvement with respect to the original indications for surgery. None developed worsening hypernasal speech or other features of VPI, and there were no cases of symptomatic adenoidal re-growth. Partial adenoidectomy, employing a variety of methods, has been used successfully in children with submucosal cleft palate. This study demonstrates the safe and effective use of suction diathermy to enable partial adenoidectomy in children who have previously undergone surgical correction of overt cleft palate, allowing symptom resolution without producing VPI.
    International journal of pediatric otorhinolaryngology 10/2009; 73(11):1594-7. DOI:10.1016/j.ijporl.2009.08.014 · 1.32 Impact Factor
  • D J Tweedie · C J Skilbeck · L A Cochrane · J Cooke · M E Wyatt
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    ABSTRACT: A variety of paediatric tracheostomy tubes are available. This article reviews those in current use at Great Ormond Street Hospital. We outline our preferences and the particular indications for the different tubes, speaking valves and other attachments. Practice has changed significantly in recent years. One product has been re-sized by its manufacturer; others are no longer commonly used. An updated sizing chart is included for reference purposes, together with manufacturers' contact details. The choice of paediatric tracheostomy tube is driven by clinical requirements. A small range of tubes are suitable for the majority of children, but some will require other varieties in specific circumstances.
    The Journal of Laryngology & Otology 03/2008; 122(2):161-9. DOI:10.1017/S0022215107007190 · 0.70 Impact Factor
  • C Skilbeck · A Leslie · R Simo
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    ABSTRACT: Thyroid lobectomy with isthmusectomy is the standard surgical technique for removal of unilateral thyroid nodules, and it involves the exposure of the tracheoesophageal grooves. Thyroid isthmusectomy is a surgical procedure that excises only the thyroid isthmus. It allows excision of a lesion without the exposure of the tracheoesophageal grooves. We aimed to demonstrate that isthmusectomy could be a safe alternative to thyroid lobectomy with isthmusectomy in patients with nodules confined to the isthmus or the pyramidal lobe. This was a prospective study performed over a five year period from 1999 to 2004. Inclusion criteria for thyroid isthmusectomy were: patients with a single lesion located in the region of the thyroid isthmus or the pyramidal lobe; maximum lesion diameter of 30 mm; and cytological reports of non-diagnostic appearance, follicular cells or suspicion of malignancy. Nine patients were identified with these criteria. Histology included two colloid nodules, three benign follicular adenomas, two Hurthle cell adenomas and two papillary thyroid carcinomas. There were no recorded complications. Thyroid isthmusectomy is a safe alternative to thyroid lobectomy with isthmusectomy in patients who have nodules confined to the isthmus and pyramidal lobe. Leaving a cuff of normal thyroid tissue has the advantage of not exposing the tracheoesophageal grooves, thus minimising potential damage to the recurrent laryngeal nerves and parathyroids. Surgeons performing isthmusectomies should be experienced in more complex thyroid surgical procedures.
    The Journal of Laryngology & Otology 11/2007; 121(10):986-9. DOI:10.1017/S0022215106005238 · 0.70 Impact Factor
  • C J Skilbeck · D J Tweedie · A R Lloyd-Thomas · D M Albert
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    ABSTRACT: When introduced, suction coagulation was initially utilised for haemorrhage control following curettage of the adenoid pad. More recently the whole procedure has been performed using the technique. This study aims to report post-operative haemorrhage rates and risk of recurrence in adenoidectomy performed solely by suction diathermy in children. A retrospective study of 1411 consecutive paediatric patients. Surgery was performed using suction diathermy. No patients were excluded. All patients were followed up. There were no cases of post-operative haemorrhage. 1.7% of patients remained symptomatic and underwent revision adenoidectomy. None required a third procedure. Re-growth of adenoid tissue may occur despite visualisation of the nasopharynx at the time of surgery. The incidence of re-growth is similar to that reported in patients undergoing conventional adenoidectomy by curettage. Post-operative haemorrhage was not encountered in children having adenoidectomy by suction diathermy. The authors suggest suction diathermy as the most appropriate method for adenoidectomy in children.
    International Journal of Pediatric Otorhinolaryngology 06/2007; 71(6):917-20. DOI:10.1016/j.ijporl.2007.03.001 · 1.32 Impact Factor
  • D J Tweedie · C J Skilbeck · A R Lloyd-Thomas · D M Albert
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    ABSTRACT: Obstructive sleep apnoea is a common childhood disorder. Adenotonsillar enlargement is most commonly implicated, with adenotonsillectomy representing an effective treatment in the majority of cases. Such children may develop respiratory compromise post-operatively, sometimes necessitating admission to the intensive care unit. We describe insertion of a nasopharyngeal "prong" airway and evaluate its benefits after adenotonsillectomy for obstructive sleep apnoea and milder forms of sleep-disordered breathing. The prong is easily fashioned from a paediatric endotracheal tube. It is inserted once surgery is complete, remaining in situ overnight. We retrospectively examine its elective use over an 18-month period in selected children considered to be at high risk of post-operative respiratory compromise. Existing practice over the preceding 18-month period is also examined, by way of comparison. Forty-three children underwent adenotonsillectomy for sleep-disordered breathing/OSAS in the 18 months prior to introduction of the prong. Ten were considered "high risk" cases: post-operative intensive care beds were pre-booked for these, but none were eventually required. During the subsequent 18 months, 60 children underwent adenotonsillectomy for the same indication. Seventeen "high risk" cases received the prong post-operatively. No intensive care beds were pre-booked and all children were managed safely on the ENT ward, with minimal intervention. Use of a nasopharyngeal prong significantly improves the post-operative course of selected children who are at high risk of respiratory compromise after adenotonsillectomy. This largely avoids the need for medical intervention and intensive care admission.
    International Journal of Pediatric Otorhinolaryngology 05/2007; 71(4):563-9. DOI:10.1016/j.ijporl.2006.11.026 · 1.32 Impact Factor
  • R J Oakley · C Skilbeck · R Simo
    Clinical otolaryngology: official journal of ENT-UK; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery 01/2006; 30(6):568-9. DOI:10.1111/j.1749-4486.2005.01106.x · 2.27 Impact Factor

Publication Stats

40 Citations
18.09 Total Impact Points

Institutions

  • 2011–2012
    • The Royal Marsden NHS Foundation Trust
      • Head and Neck Unit
      Londinium, England, United Kingdom
    • University College London
      Londinium, England, United Kingdom
  • 2007–2008
    • Great Ormond Street Hospital for Children NHS Foundation Trust
      Londinium, England, United Kingdom