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Advanced Module in Head & Neck/Airway

Freeman Hospital

Contact:   Dr Linda Waddilove, Consultant Anaesthetist

The Freeman Hospital is a busy, major head and neck tertiary referral centre. The number, variety and complexity of cases ensures a wide range of clinical exposure during your time as airway fellow.  Rotas allowing, we aim for 75% of your lists to be ENT / Max Facs /Airway. You will partake in a standard on call rota, with a busy ENT component to emergency operating.

In the last year we undertook 180 major head and neck resections; total laryngectomies, laryngopharyngectomies, glossectomies , hemi-mandiblectomies and hemi-maxillectomies either for cancer or to manage complications of previous therapy – e.g.osteoradionecrosis. The majority of these cases will require one or more free flap. You would be encouraged to attend the MDT to observe discussion surrounding management options for these cases.

We have around 40 ENT / Max Facs sessions available to us per week.  In addition to the major resections, these lists are filled with a wide variety of surgeries including:

ENT /max facs lists are managed by a team of skilled anaesthetists who can teach you tubeless techniques such as STRIVE, THRIVE HI or Jet Ventilation using specialist equipment such as Hunsaker tubes. We are enthusiastic teachers, and keen for you to gain independence in managing the complex cases.

You will gain exposure to a variety of intubating techniques, including awake fibreoptic and, where possible, awake video-laryngoscopy. You will attend the nasendoscopy clinic with the fantastic Professor Wilson and have an opportunity to co-ordinate these sessions for your peers.  We have our own nasendoscope which you will be encouraged to use as you actively partake in complex airway decision making with your ENT colleagues.

As well as exceptional clinical experience we provide fantastic extra-clinical opportunities. We currently run 2 national courses per year, one of which is DAS approved, plus human factors teaching in the form of ENT ‘boot camp’. We are increasingly promoting combined ENT / Anaesthetics teaching, both didactically and in the form of workshops and simulation training. You would be welcome to be part of business case or guideline writing, and encouraged to initiate and execute your own research / audit / quality improvement projects.

Please get in touch if this sounds appealing to you – we’d love to have you!

Cumberland Infirmary

Contact:   Dr Sally Eason, College Tutor

There is one post for an advanced airway/head and neck module available every 6 months at the Cumberland Infirmary. Please feel free to contact Dr Sally Eason as college tutor for any information/availability through our anaesthetic department (01228 523 444 ext 4196).

We have a team of five ENT surgeons and three maxillofacial surgeons based at the Cumberland Infirmary in Carlisle. We work closely together with these surgeons as a team to provide a head and neck cancer service, reconstructive and orthognathic surgery as well as a heavy workload of general ENT/maxillofacial work in both adults and children down to 1 year old or 10kg. New appointments to this busy, enthusiastic department mean the breadth of surgery that is done here is expanding.

Our advanced anaesthetic trainee will have the opportunity to gain clinical experience in all of these areas with major head and neck cases happening every week. For example, we have busy lists with diagnostic laryngoscopies most days giving lots of opportunity to gain confidence in handling the difficult airway and learn specialised airway techniques such as fibreoptic intubation, videolaryngoscopy and venturi techniques. To give an idea of what happens here;  we performed 15 pharyngolaryngectomies last year,  8 free flap reconstructions, 30 neck dissections, 7 maxillectomies for head and neck cancer, 80 thyroidectomies, 30 mastoidectomies, complex transoral laser dissection/procedures every week and plenty of rhinology surgery including revisions. We have dedicated paediatric lists and in the region of 240 children came through the department last year.  Our trainee would spend their time becoming confident in anaesthetising for all these procedures in a supportive environment with very little competition from other trainees compared to other hospitals.

Non clinical opportunities would include opportunities to be involved in the planning and work up of patients for major surgery and accordingly attendance at weekly MDT meetings would be encouraged. The department participates in national audit such as the national head and neck cancer audit and the national tracheostomy safety audit etc. There is also opportunity for other audit, case presentations etc which may lead to national/international publication. We have an active and enthusiastic governance department so opportunity to develop new guidelines and be involved with incident management/root cause analysis etc is possible too. We run a number of courses, for example a twice yearly tracheostomy safety course for staff which our trainee would be welcome to teach on. Plenty to give you a competitive cv.

We intend this post to allow the trainee to make as much of the opportunities available here at Carlisle.  In the anaesthetic department, we work closely together as a group of consultants so would be able to accommodate working in different areas. For example, our ICU is well known for it’s early approach to tracheostomy giving an opportunity for our trainee to gain experience in performing percutaneous tracheostomies. We welcome new ideas for audit/research so feel free to come and see us if you’re interested.

Sunderland Royal Hospital

Contact:   Dr Keith Fordy, College Tutor

Sunderland Royal Hospital has a busy head and neck surgical department and has 11 ENT consultants and 7 maxillo-facial consultants. The case mix is varied, each year we perform approximately 30 major resections (hemi-mandibulectomy and glossectomy, pharyngo-laryngectomy) which require free-flaps, as well as regularly performing total laryngectomies, total thyroidectomies,  and neck dissections.

Previous airway fellows have accomplished their clinical objectives with ease, and should find themselves able to confidently manage the head and neck cancer lists which would include complex surgical procedures in a challenging patient population. They will also have the opportunity to anaesthetise patients on the dedicated paediatric ENT and dental lists. In total we have 35 theatre sessions each week for head and neck, and as such there are no issues with lack of exposure.

Given the range of surgical procedures they will become confident in performing fibre-optic intubations, both asleep and awake. On average we perform 45 such intubations each month. We also have the Clarus Shikani (similar to a Bonfils) which they will be taught how to use. In the past trainees have had the opportunity to join ENT clinics where they have had the opportunity to perform nasendoscopy to assess the airway.

The airway fellows have always had the opportunity in developing the non-clinical aspect of their training, This includes audit, teaching, business case writing, guideline writing and quality improvement projects.

Sunderland anaesthetic department takes part in all the national audit projects, as well as an expanding number of research projects which are on the national portfolio, including PQIP, which recruits the major head and neck cancer cases. We would support any future research and audit proposals.

We have always had good feedback from our previous airway fellows, and several have been tempted back to join us as consultants! Please feel free to get in touch to discuss the post further should you wish.