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 Scott-Brown’s EIGHTH EDITION

Otorhinolaryngology
Head and Neck
Surgery

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 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

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 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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 CRC Press
Taylor & Francis Group
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© 2019 by Taylor & Francis Group, LLC

CRC Press is an imprint of Taylor & Francis Group, an Informa business

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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

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 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

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 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

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mebooksfree.com
 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

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 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.

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 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
Newcastle-upon-Tyne, UK.
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.

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 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.

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 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
Newcastle-upon-Tyne, UK.

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 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.

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 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.
Homi Bhabha National Institute
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
Homi Bhabha National Institute
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.
Newcastle-upon-Tyne, 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.

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 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.

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 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
Newcastle-upon-Tyne, UK.

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 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.

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 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

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mebooksfree.com
 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

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 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.

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 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

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 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.

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 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

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 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

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 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

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 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

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Other documents randomly have
different content
 162 MILITARY MEMOIRS his reconnoissance with
Longstreet. Had Sumner's movement, and the advance and easy
retreat of the Federal skirmishers, been planned as a ruse to decoy
us into a charge, its success would have been brilliant. That part of
our plan which had called for a tremendous preliminary cannonade
was forgotten. Lee believed that his enemy was retreating and about
to escape him, and he hastened to send a verbal order to Magruder
through Capt. Dickinson of Magruder's staff, who wrote the order as
follows : — " Gen. Lee expects you to advance rapidly. He says it is
reported the enemy is getting off. Press forward your whole line and
follow up Armistead's success." Under Magruder's orders the
advance was commenced by Wright's Ga. and La. brigade, followed
by Mahone's Va. brigade, both of Huger's division. These two
brigades formed our extreme right, and went into action only about
2500 strong, many stragglers having been lost from the ranks in the
marchings and skirmishes of the three previous days. To the left of
Wright was Armistead of Huger's division, followed by Cobb's and
Semmes's brigades. In support of these were all the rest of
Magruder's and Huger's 10 brigades. Ransom, of Holmes's division,
being also temporarily attached to Huger. Farther to the left came D.
H. Hill's five brigades. Magruder's brigades consumed a little time in
developing a full roar of musketry, but no sooner was it heard than
D. H. Hill's division was also put in. Fitz-John Porter, in Battles and
Leaders, thus describes the opening of the battle from the Federal
point of view : — "The spasmodic, though sometimes fonnidable,
attack of our antagonists, at different points along our whole front,
up to about four o'clock were, presumably, demonstrations or feelers
preparatory to their engaging in more serious work. An ominous
silence, similar to that which had preceded the attack in force at
Gaines' Mill, now intervened, until, at about 5.30 o'clock, the enemy
opened upon both Morell and Couch with artillery from nearly the
whole of his front, and soon after pressed forward in columns of
infantry, first on one, then on the other, or on both. "As if moved by
a reckless disregard of life equal to that displa3red at Gaines Mill,
with a determination to capture our army or destroy it by driving us
into the river, brigade after brigade rushed at our batteries;
 THE ESCAPE. BATTLE OF MALVERN HILL 163 but the
artillery of both Morell and Couch mowed them down with shrapnel,
grape, and canister, while our infantry, withholding their fire until the
enemy were in short range, scattered the remnants of their columns,
sometimes following them up and capturing prisoners and colors."
One can scarcely read the full story of this charge without believing
that, made early in the day with the aid of all our reserve artillery on
the flanks and of the 22 brigades of infantry who were spectators,
we might, by main force, have crushed the enemy's army as it
stood. Porter himself, who was practically in command of the field,
and the most accomplished of the Federal corps conmianders,
records that, at one period of the action, as he rode to bring up
reinforcements, he felt such apprehensions of soon becoming our
prisoner, that he took from his pocket and tore up his ''diary and
despatch book of the campaign." That the ground was less
unfavorable for an assault from our right flank appears from the
reports of Wright and Mahone, whose small force was not driven
back at all, but made a lodgment and held their ground all night.
Gen. Wright reports as follows : — "At 4.45 o'clock I received an
order from Gen. Magruder through Gapt. Henry Bryan, one of his
staff, to advance immediately and charge the enemy's batteries. No
other troops had yet come upon the field. I ordered my men
forward, and, springing before them, led my brigade, less than 1000
men, against a force I knew to be superior in the ratio of at least 20
to 1. Onward we pressed, warmly and strongly supported by Gen.
Mahone 's brigade, under a murderous fire of shot, shell, canister,
and musketry. At every step my brave men fell around me, but the
survivors pressed on until we had reached a hollow about 300 yards
from the enemy's batteries on the right. Here I perceived that a
strong force had been sent forward on our left, by the enemy, with a
view of flanking and cutting us off from our support, now more than
1000 yards in our rear. I immediately threw the left of the 3d Ga. a
little back along the upper margin of the hollow, and, suddenly
changing front of the regiment, poured a galling fire upon the
enemy, which he returned with spirit, aided by a fearful direct and
cross-fire from his batteries. Here the contest raged with varying
success for more than three-quarters of an hour; finally the line of
the enemy was broken, and he gave way in great disorder. "In the
meantime, my front, supported by Gen. Mahone, had been
subjected to a heavy fire of artiUery and musketry, and had begun
to waver, and I feared I would be compelled to fall back. Just at this
moment firing was heard far away to our left, and soon we saw our
columns advancing upon the enemy's centre. This diverted a portion
of the enemy's fire from us, and I succeeded in keeping my men
steady. We
 164 MILITARY MEMOIRS had now approached within a few
hundred yards of the enemy's advanced batteries, and I again gave
the order to charge, which was obeyed with promptness and alacrity.
''We rushed forward, up the side of the hill imder the brow of which
we had been for some time halted, and dashing over the hill,
reached another hollow or ravine inmiediately in front of, and, as it
were, under, the enemy's guns. This ravine was occupied by a line of
Yankee infantry posted there to protect their batteries. Upon this we
rushed with sudi impetuosity that the enemy broke in great disorder
and fled. . . . "The firing had now become general along the left and
centre of our line, and night setting in, it was difficult to distinguish
friend from foe. "Several of my command were killed by our own
friends, who had come up on our inmiediate left, and who
commenced firing long before they came within range of the enemy.
This firing upon us from oiir friends, together with the increasing
darkness, made our position peculiarly hazardous^ but I determined
to maintain it at all hazards, as long as a man should be left to fire a
gun. The fire was terrific now, beyond anything I had ever
witnessed, — indeed, the hideous shrieking of shells through the
dusky gloom of closing night, the loud and incessant roll of artillery
and small-arms, were enough to make the stoutest heart quail. Still
my shattered little command, now reduced to less than 300, with
about an equal number of Gen. Mahone's brigade, held our positions
under the very muzzles of the enemy's guns, and poured volley after
volley with murderous precision into their serried ranks. . . . "Just at
this time a portion of Col. Ramseur's 49th N.C. regiment, having got
lost upon the field, was hailed by me and ordered to fall in with my
brigade. A strong picket was advanced all around our isolated
position, and the wearied, hungry soldiers threw themselves upon
the earth to snatch a few hours' rest. Detachments were" ordered to
search for water and administer to our poor wounded men, whose
cries rent the air in every direction. Soon the enemy were seen with
lanterns, busily engaged in moving their killed and wounded, and
friend and foe freely mingled on that gloomy night in administering
to the wants of wounded and dying comrades. . . . "Early on the
morning of July 2, Gen. Ewell rode upon the field, and coming to the
position where my men lay, I reported to him and was relieved from
further watching on the field. . . . My loss in this engagement was
very severe, amounting to 55 killed, 243 wounded, and 64 missing ,
(total 362) . I have no means of determining the loss of the enemy,
though I am satisfied it was very heavy." Gen. Mahone reports that
his brigade carried into action 1226,and lost 39 killed, 164 wounded,
and 120 missing (total 323). Wright's report gives a clear idea of the
fighting upon our right flank. Next, on the left, Semmes and
Kershaw also made, per 
 THE ESCAPE. BATTLE OF MALVERN HILL 165 haps, the
farthest advance of the attack, actually getting among the enemy's
guns, where lay the body of a handsome young Louisiana officer,
next morning, the farthest jetsam of the red wave which had stained
all the green fields of our advance. Both of these brigades had been
forced to fall back, not so much from the fire of the enemy in their
front, as from that of their friends farther on the left, advancing on
converging lines in the dusk. There were more troops concentrated
in the forest in a small space than could be well handled, even in
daylight; and the plateau oyer which their charge was to be made,
when they got free of the wood, was so bare of shelter, and swept
by such fire of musketry and artillery, that not a single brigade faced
it long without being driven back. The official reports show that in
the storm and smoke around them dingle brigades often thought
themselves to be the only ones engaged. D. H. Hill, whose advance
was across the plateau, thus describes the attack by his division : —
"While conversing with my brigade commanders, shouting was heard
on our right, followed by the roar of musketry. We all agreed that
this was the signal agreed upon, and I ordered my division to
advance. This, as near as I could judge, was about an hour and a
half before sundown. . . . " The division fought heroically and well,
but fought in vain. Garland, in my immediate front, showed all his
wonted courage and enthusiasm, but he needed and asked for
reinforcements. I sent Lt.-Col. Newton, 6th Ga., to his support, and,
observing a brigade by a fence in our rear, I galloped back to it and
found it to be that of Gen. Toombs. I ordered it forward to support
Garland, and accompanied it. The brigade advanced handsomely to
the brow of the hill, but soon retreated in disorder. Gordon,
commanding Rodes's brigade, pushed gallantly forward and gained
considerable ground, but was forced back. The gallant and
accomplished Meares, 3d N.C., Ripley's brigade, had fallen at the
head of his regiment, and that brigade was streaming to the rear.
Colquitt's and Anderson's brigades had also fallen back. Ransom's
brigade had come up to my support from Gen. Huger. It moved too
far to the left and became mixed up with a mass of troops near the
parsonage on the Quaker road, suffering much and effecting little.
Gen. Winder was sent up by Gen. Jackson, but he came too late,
and also went to the same belt of woods near the parsonage,
already overcrowded with troops. Finally Gen. Ewell came up, but it
was after dark, and nothing could be accomplished. I advised him to
hold the ground he had gained and not to attempt a forward
movement."
 166 MILITARY MEMOIRS Gen. Toombs's account of the
advance of his brigade will give some idea of the confusion of
commands upon the field after the battle was in full tide : —
"Accordingly, I advanced rapidly in line of battle through the dense
woods, intersected by ravines, occasionally thick brier patches, and
other obstructions, guided only by the enemy's fire in keeping
direction, frequently retarded and sometimes broken, by troops in
front of me, until the command reached the open field on the
elevated plateau immediately in front of, and in short range of, the
enemy's guns. Here, coming up with a portion of the troops which I
was ordered to support, I halted my line for the purpose of
rectif3ring it and of allowing many of the troops whom I was to
support, to pass me and form. These objects were but imperfectly
accomplished by me, as well as by the rest of the troops within my
view, from the great confusion and disorder in the field — arising
much from the difficulties of the ground over which they had to
pass, and in part from the heavy fire of grape and canister and
shells, which the enemy's batteries were pouring in upon them. But,
having accomplished what could be done of this work, I ordered my
brigade to advance. It moved forward steadily and firmly until it
came up with the troops in advance, who had halted. I then ordered
it to halt, and ordered the men to lie down, which they did, and
received the enemy's fire for a considerable time, when an order was
repeated along my line, coming from the left, directing the line to
oblique to the left. This order I immediately and promptly
countermanded as soon as it reached the part
 THE ESCAPE. BATTLE OF MALVERN HILL 167 plateau in
front of the enemy's gpins. This is further evidenced by the fact that
at roll-call next morning over 800 of my command answered to their
names, leaving under 200 unaccounted for, many of whom soon
made their appearance.'' Tliere is no doubt that the entire force
which had been engaged was wrecked for the time being, and that,
had the enemy been in position for a counterstroke, the fragments
could have made but little opposition. But A. P. Hill and Longstreet
were dose in rear, and Whiting's, Jackson's, and Ewell's divisions
were on the left, and Holmes a few miles oflf on the right. The
enemy, moreover, having sent ahead all of their trains, were now
very low both in ammunition and provisions, and could scarcely have
ventured anything serious. Whiting's division had suffered 175
casualties in its two brigades, and 19 hi Hampton's brigade, from the
enemy's artillery fire, while lying in support of our artillery in
Poindexter's field. Including with these the losses in Jackson's and
Swell's divisions and Lawton's brigade, the casualties were 599. In
Magruder's division the casualties were 2014, and in Huger's,
including Ransom's brigade, 1609. In Rodes's, Colquitt's, and Ripley's
brigades of D. H. Hill's division, the casualties were making 889, a
total, so far, of 6111. The other two brigades, Anderson's and
Garland's, report only their total casualties for the campaign as 863
and 844, a total of 1707. A half, 854, is a moderate estimate for their
losses at Malvern. This would make oiu- total losses. 5965 or more;
those of the enemy could scarcely have reached 2000, but the
casualties of dijGferent battles are not separated. Of Jackson's part
in this action there is very little to be said. He took no initiative,
though compljdng promptly with orders or requests as received. But
had he been the Jackson of the Valley, being on the left flank that
morning, he would have turned Malvern Hill by his left, and taken
position commanding the road somewhere beyond Turkey Creek.
Malvern should not have been attacked; only the enemy observed
and held by Longstreet, while Jackson got a position which they
would be forced to assault. Lee's report sums up the subsequent
operations briefly, as follows : —
 168 MILITARY MEMOIRS "On July 2, it was discovered that
the enemy had withdrawn during the night, leaving the ground
covered with his dead and wounded, and his route exhibiting
abundant evidence of precipitate retreat. The pursuit was
commenced, Gen. Stuart with his cavalry in the advance, but a
violent storm which prevailed throughout the day greatly retarded
our progress. The enemy, harassed and followed closely by the
cavalry, succeeded in gaining Westover and the protection of his
gunboats. He immediately began to fortify his position, which was
one of great natural strength, flanked on each side by a creek, and
the approach to his front commanded by the heavy guns of his
shipping in addition to those mounted in his intrenchments. It was
deemed inexpedient to attack him, and in view of the condition of
our troops, who had been marching and fighting almost incessantly
for seven days, under the most trying circumstances, it was
determined to withdraw in order to afford them the repose of which
they stood so much in need.'' One episode of the pursuit, however,
is worthy of note. On July 2, but little progress was made by the
infantry, owing to the heavy rain-storm, but Stuart's eavahy (which
had recrossed the Chickahominy by fording at Forge Bridge on the
afternoon of July I) followed the enemy and endeavored to shell his
colunms wherever opportunity offered. About 5 p.m. the last of
these colunms had arrived at its destination on the James River,
Harrison's Landing, — a peninsula about four miles long by one and
a half wide, formed by Herring Creek on the northeast, running for
that distance nearly parallel to the James before emptying into it. At
its head a small inlet from the river on the southwest left but a
narrow front exposed to attack. But, across Herring Greek, an
extensive plateau called Evelington Heights dominates the upper
part of this peninsula so that, if held by artillery, the enemy would be
forced to attack at a disadvantage — the creek being impassable for
some distance above. Diuing Wednesday night, Stuart received a
report from Pelham, commanding his artillery, describing thb position
and reconmaending its being seized. He forwarded the report to Lee,
through Jackson, and early on the 3d, with a few eavahy and a
single howitzer, nearly out of ammunition, he ran off a Federal
squadron and took possession of the heights. It is a pity that there
was any anmiimition, for Stuart writes that — ** the howitzer was
brought in action in the river road to fire upon the enemy's camp
below. Judging from the great commotion and excitement below, it
must have had considerable effect."
 THE ESCAPE. BATTLE OF MALVERN HILL 169 It did have
considerable effect of a most unfortunate kind for us. It awaked the
enemy to instant appreciation of the fact that it was essential for him
to hold that ground, and that it behooved lum to take it before we
brought up any more force. A military lesson is to be learned from
the result, to wit, that dangers lurk . in excess of enterprise as well
as in its deficiency. In this campaign our cavalry affords two
instances. Stuart's zeal, without necessity, led him to make the
circuit of McClellan's army, Jime II-I5. The result was that McClellan
was prepared to change his base to the James as soon as he found
Lee threatening his conmiunications. Now, the temptation to shell a
camp and wagon trains loses to our army its laJst chance to take a
position which would compel the enemy to assume the offensive.
One howitzer could, of course, accomplish nothing but to alarm the
enemy, and precipitate their attack. When Stuart opened fire, he
thought that both Longstreet and Jackson were near. In fact, neither
was within miles. Jackson had been sent in direct pursuit, being
nearest the most direct roads, and his troops having been least
engaged during the Seven Days. Two of the four brigades of his own
division had been so little exposed as to have had together but two
killed and 26 wounded, in the whole campaign. His 3d brigade.
Winder's, had had but 75 casualties at Gaines Mill, and 104 at
Malvern. Lawton's brigade, and Swell's and Whiting's divisions, had
only been severely engaged at Gaines Mill. Longstreet, with A. P.
Hill's and his own divisions, was on the 2d moved aroimd the field of
battle to Poindexter's house, and on the 3d was sent by roads to the
left of Jackson. By mistake of the guides he was conducted too far to
the left, and only reached Evelington Heights about dark on the 3d ;
Jackson's troops came up at the same time by the direct road.
Jackson's official report says : — "On the morning of the 3d, my
command arrived near the landing and drove in the enemy's
skirmishers," but the date is shown by all other reports to be a
clerical error for the 4th. Had Stuart not opened fire, the enemy
would not have disturbed him that day. During it McClellan wrote to
the Secretary of War, as follows: —
 170 MILITARY MEMOIRS '' I am in hopes the enemy b as
completely worn out as we are. He was certainly very severely
punished in the last battle. The roads are now very bad. For these
reasons I hope we shall now have enough breathing space to
reorganize and rest the men, and get them into position before the
enemy can attack again. ... It is, of course, impossible to estimate,
as yet, our losses, but I doubt whether there are to-day more than
50,000 men with their colors." By the next morning 21 Confederate
brigades had arrived and would have been upon Evelington Heights
had Stuart not forced the enemy to come over and occupy them.
McClellan's 50,000 men would then have had the task of removing
them. Stuart thus describes his resistance : — "I held the ground
from 9 a.m. till 2 p.m., when the enemy had contrived to get one
battery into position on this side the creek. The fire was, however,
kept up until a body of infantry was found approaching by our right
flank. I had no apprehension, however, as I felt sure Longstreet was
near by, and, althou^ Pelham had but two rounds of ammunition
left, I held out, knowing how important it was to hold the ground till
Longstreet arrived. "The enemy's infantry advanced, and his battery
kept up its fire. I just then learned that Longstreet had taken the
wrong road and was then at Nance's shop, six or seven miles off.
Pelham fired his last round, and the sharp-shooters, strongly posted
in the skirt of woods bordering the plateau, exhausted every
cartridge, but had at last to retire. . . . The next day, July 4, Gen.
Jackson's command drove in the enemy's advanced pickets. I
pointed out the position of the enemy, now occup3ring, apparently
in force, the plateau from which I shelled their camp the day before,
and showed him the routes by which the plateau could be reached,
to the left, and submitted my plan for dispossessing the enemy and
attacking his camp. This was subsequently laid before the
commanding general." From the Federal reports it appears that the
enemy occupied the heights on the afternoon of July 3 with
Franklin's division. The next morning Longstreet was up with his own
and A. P. Hill's division and two brigades of Magruder's. Jackson was
also up with his own, Ewell's, Whiting's, and D. H. Hill's divisions.
Lee did not reach the field imtil noon, and, as Longstreet ranked
Jackson, he ordered the enemy's pickets driven in and preparation
made for an attack. A favorable opportunity was presented to regain
the Evelington Heights by main force. Tliey were occupied by but
one
 THE ESCAPE. BATTLE OF MALVERN HILL 171 division, and,
being across Herring Creek from the rest of the Federal army, it
coiiid not have been rapidly reenforced. There would have been very
small risk in making the effort so earnestly urged by Stuart, for
McClellan would never have dared a counterstroke, had we failed.
The enemy's gunboats could have rendered little assistance, as their
own camps and lines intervened. Briefly, the game seems to have
been worth the candle, and it should have been played. Jackson's
troops, however, were in front, and Jackson protested against the
attack, saying that the troops were not in proper condition, and
asking for delay imtil Lee should reach the field. To this Longstreet
consented, and when Lee arrived, Jackson's arguments prevailed
and the attack was given up. It was entirely unlike Lee, and he must
have reluctantly yielded to Jackson's persuasion. Evidently, Jackson
was still not the Jackson of the Valley. The next day the troops were
moved back toward Richmond, and the campaign was ended. The
total casualties of the two armies for the Seven Da3rs were: —
Confederate: killed 3286, wounded 15,909, missing 946, total
20,141 Federal: " 1734, " 8,062, " 6053, " 15,849 Including the
Federal woxmded, we took about 10,000 prisoners and captiu-ed 52
guns and about 35,000 muskets. We lost two guns in the stampede
in Holmes's division. For a week after McClellan had established
himself at Westover, he neglected, to occupy the opposite bank of
the James. As the fire of his gunboats commanded it, he could do so
at pleasure, but as long as he did not, it was much better for us that
he should not. Again, however, the temptation to shell a camp
proved irresistible, and Lee was persuaded to authorize an
expedition for the purpose under Pendleton's supervision. On July 12
some 47 rifled guns were collected, positions chosen, and ranges
marked for night firing. After midnight they opened fire upon the
Federal transports, wharves, and camps, and used up their small
supplies of ammunition in a random cannonade. Tlie enemy replied
in like fashion, both from the shore and from gunboats. Of course,
there was much commotion in the Fed 
 172 MILITARY MEMOIRS era! camps, but the actual
damage done was trifling. Some 40 casualties are reported among
the Federals, and two or three among the Confederate artillerists.
The next day the Federals established themselves on the South Side.
The strategic advantages of a position astraddle of the James River
have already been referred to (page 61, Cliap. III.)^ but they were
not yet generally appreciated. Fortimately for us, Lincoln and Halleck
recalled McClellan and his army to Washington without ever realizing
them; although McClellan had tried hard to impress them upon his
superiors. Fortunately, too, for us, Gen. S. G. French, in command at
Petersburg, saw and appreciated the threat of the position, and
immediately began the construction of a line of intrenchments about
that city. These intrenchments, in 1864, defeated some attempts at
surprise; and at last enabled Beauregard, with two divisions, to
withstand the attack of Grant's whole army, between Jime 15 and 18
of that year. My personal duties during the Seven Days were the
supervision and distribution of our ammunition supplies. Our
organized division supply trains and brigade wagons worked
smoothly, and no scarcity was felt anywhere. In addition to these
duties, I was placed in charge of a balloon which had been
manufactured in Savannah by Dr. Edward Cheves, and sent to Gen.
Lee for use in reconnoitring the enemy's lines. It was made from sUk
of many patterns, varnished with gutta-percha car-springs dissolved
in naphtha, and inflated at the Ridimond Gas Works with ordinary
city gas. I saw the battle of Gaines Mill from it, and signalled
informar tion of the movement of Slocum's division across the
Chicki^hominy to reenforce Porter. Ascensions were made daily, and
when the enemy reached Malvern Hill, the inflated balloon would be
carried down the river and ascensions made from the deck of a boat.
Unfortimately, on July 4, the boat — the Teaser, a small armed tug
— got agroimd below Malvern Hill on a falling tide, and a large
Federal gunboat, the MarUama, came up and captured both boat
and balloon, the crew escaping. We could never build another
balloon, but my experience with this gave me a high idea of the
possible efficiency of balloons
 THE ESCAPE. BATTLE OF MALVERN HILL 173 in active
campaigns. Especially did we find, too, that the baUoons of the
enemy forced upon us constant troublesome precautions in efforts to
conceal our marches. Malysxn Hill to Wsstoveb As affording a bird's-
eye view of our organization and of the forces engaged in the
different actions, and the severity of the conflicts, a table of
C!onfederate division casualties is attached, showing as accurately
as can be determined, the losses of each
 174 MILITARY MEMOIRS command for each action. The
total Federal losses in killed and wounded (excluding prisoners) is
also approximately divided for the principal actions as nearly as
records permit. DIVISION CASUALTIES. SEVEN DAYS BEFORE
RICHMOND Divisions a 1 1 > i 1 1 0 1 1 1 a 1 1 Whiting's Div. 2
1017 175 1192 Jackson's Div. 3 91 117 208 Lawton's Brig. 1 492 75
567 EweU's Div. 4 764 223 987 D. H. HiD's Div. 5 586 1423 1743 15
3767 1. D.R. Jones's Div. 2 424 455 879 is. |6 McLaws's Div. 2 357
315 672 Magnider's 2 84 874 9 967 Longstreet's Div. 6 1883 2555
4438 Huger's Div. 3 1137 394 1531 A. P. Hill's Div. 6 764 2688 750 8
4210 Holmes's Div. 3 499 178 677 Pendleton's Art. 2 2 Stuart's Cav.
71 71 Totals 10 Divisions 39 1350 8358 441 3306 5590 1124 20168
Federal Losses (killed and wounded only) 361 4001 400 2034 2000
1000 9796
 CHAPTER X Cedar Mountain Recuperation. Gen. Pope
Arrives. Gen. Halleck Arrives. McClellan Recalled. Lee Moves. Jackson
Moves. Cedar Mountain. The Night Action. Jackson's Ruse.
Casualties. The close of the Seven Days found both armies greatly in
need of rest. Lincoln called upon the governors of the Northern
States for 300,000 more men, and boimties, State and Federal, were
offered to secure them rapidly. They were easily obtained, but a
mistake was made in putting the recruits in the field. They were
organized into entirely new regiments, which were generally hurried
to the field after but little drilling and training. President Davis also
called for conscripts, — all that could be gotten. No great munber
were obtained, for those arriving at the age of conscription usually
volunteered in some selected raiment. Those who were conscripted
were also distributed among veteran regiments to repair the losses
of the campaign, and this was done as rapidly as the men could be
gotten to the front. Although this method allowed no time for drill or
training, yet it was far more effective in maintaining the strength of
the army than the method pursued by the Federals. During the short
intermission from active operations, something was accomplished,
too, to improve our organizations, though leaving us still greatly
behind the example long before set us by the enemy. Longstreet and
Jackson were still but majorgenerals commanding divisions, but each
now habitually commanded other divisions besides his own, called a
Wing, and the old divisions became known by the names of new
commanders. Thus, Jackson's old division now became Taliaferro's,
and Longstreet's division became Pickett's, while Longstreet and
Jackson each conunanded a Wing, so called. It was not until another
brief rest in October, after the battle 176
 176 MILITARY MEMOIRS of Sharpsburg, that Longstreet
and Jackson were made lieutenant-generals, and the whole army
was definitely organized into corps. Some improvement was also
made in om- armament by, the guns and rifled muskets captured
during the Seven Days, and my reserve ordnance train was
enlarged. Lines of light earthworks were constructed, protecting
Chaffin's Bluff batteries on the James River, and stretching across
the peninsula to connect with the lines already built from the
Chickahominy to the head of White Oak Swamp. Gen. D. H. Hill also
constructed lines on the south side of the James, protecting Drury's
Bluff and Richmond from an advance in that quarter; and Gen.
French at Petersburg, as already mentioned, threw lines aroimd that
city, from the river below to the river above. Just at the beginning of
the Seven Days' Battles, President Lincoln had called from the West
Maj.-Gen. John Pope, and placed him in command of the three
separate armies of Fremont and Banks, in the Valley of Virginia, and
McDowell near Fredericksburg. The union of the three into one was
a wise measure, but the selection of a commander was as eminently
imwise. One from the army in Virginia, other things being equal,
would have possessed many advantages, and there was no lack of
men of far sounder reputation than Pope had borne among his
comrades in the old U. S. Army. He had spent some years in Texas
boring for artesian water on the Staked Plains, and making
oversanguine reports of his prospects of success. An army song had
simuned up his reputation in a brief parody of some well-known
lines, "Hope told a flattering tale," as follows: — ''Pope told a
flattering tale, Which proved to be bravado, About the streams which
spout like ale . On the Llano Estacado." Pope arrived early in July
and began to concentrate and organize his army. A characteristic
"flattering tale" is told in an address to his troops, July 14, dated
"Headquarters in the Saddle": — "Let us understand each other. I
come to you from the West where we have always seen the backs of
our enemies ; from an army whose busi 
 CEDAR MOUNTAIN 177 ness it has been to seek the
adversary, and beat him when he was found ; whose policy has been
attack and not defence. ... I presume I have been called here to
pursue the same system, and to lead you against the enemy. . . .
Meantime, I desire you to dismiss from your minds certain phrases,
which I am sorry to find so much in vogue amongst you. I hear
constantly of 'taking strong positions and holding them'; of 'lines of
retreat,' and of 'bases of supplies.' Letusdiscard such ideas. . . .Let
us study the probable lines of retreat of our opponents and leave our
own to take care of themselves. . . . Success and glory are in the
advance. Disaster and shame lurk in the rear. . . ." The arrogance of
this address was not calculated to impress favorably officers of
greater experience in actual warfare, who were now overslaughed
by his promotion. McDowell would have been the fittest selection,
but he and Banks, both seniors to Pope, submitted without a word ;
as did also Simmer, Franklin, Porter, Heintzelman, and all the major-
generals of McClellan's army. But Fremont protested, asked to be
relieved, and practically retired from active service. Meanwhile, after
the discomfiture of McClellan, Mr. Lincoln felt the want of a military
advisor, and, on July 11, appointed Gen. Halleck commander-in-chief
of all the armies of the United States, and simmioned him to
Washington City. Pope's Story of the Civil War thus comments upon
this appointment : — "It is easy to see how this unfortunate
selection came to be made: Halleck was at that time the most
successful general in the Federal service ; it was perfectly natural
that he should be the choice of the President and Secretary of War,
to whom his serious defects as a military man could not have
become known. His appointment was also satisfactory to the public,
for, as so much had been effected under his command in the West,
he was generally credited with great strategic ability. . . . But both
the people and the President were before long to find out how
slender was Halleck 's intellectual capacity, how entirely unmilitary
was the cast of his mind, and how repugnant to his whole character
was the assumption of any personal and direct control of an army in
the field." Halleck arrived in Washington and took charge on July 22.
He found, awaiting for his decision, a grave problem. It was whether
McClellan's army, now intrenched at Westover on the James, should
be heavily reenforced and allowed to enter upon another active
campaign from that point as a base, or whether it should abandon
the James River entirely, and be brought
 178 MILITARY MEMOIRS back, by water, to unite with the
army now under Pope, in front of Washington. McClellan earnestly
begged for reenforcements, and confidently predicted success if they
were given him. He had begun to appreciate the strategic
advantages of his position, and he was even proposing as his first
movement the capture of Petersburg by a coup-de-main. This would
not have been, at that time, a difficult operation. McClellan had
90,000 men available, for he could have even abandoned his
position on the north side and used his whole force. As to its effect,
it would probably have finally compelled the evacuation of
Richmond, as it did in 1865. Had McClellan possessed enterprise and
audacity, he would have waited neither for permission nor
reenforcements, but have made the dash on his own responsibility
as soon as he found that there was serious thought of recalling his
army. All of this time, however, McClellan was still representing to his
government that Lee had 200,000 men. If he really believed this, it
is not strange that he kept closely within his intrenchments; but Mr.
Ropes, the most careful historian of the war, asserts that neither
McClellan nor Halleck believed this "preposterous story." McClellan
told it, and stuck to it, trying to scare the administration into giving
him unlimited reenforcements: but his real belief, Mr. Ropes thinks, is
apparent in his offer to undertake the new campaign with only
20,000 reenforcements, raising his force to only 110,000. Mr. Ropes
says that Halleck saw and appreciated McClellan's insincerity, but,
wishing to have the army brought back, he affected to believe in the
200,000 men, and easily confounded McClellan's arguments by
pointing out what such a force might do under such generals as Lee
and Jackson. Halleck had visited McClellan on the James soon after
his arrival in Washingkui, *uh] liic matter wai5 argued, pro and con,
in correifpondence afterward for some weeks, McClelJau ended with
a strong appeal^ pointing out that he could delivTT ■- *^^'- trithin
10 miles of Richmond, which was tha^iw^*^ (leracy, while a victory
70 miles off mig^ E^liUtcck answered that it was imsafe to kftt
^Uwe of Lee's force ; that the location I
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