Background
Perioperative management of advanced osteoradionecrosis of the head and neck requiring free flap (FF) reconstruction varies. Our objectives included assessment of practice patterns and ...outcomes.
Methods
Multi‐institutional, retrospective review of FF reconstruction for head and neck osteoradionecrosis (n = 260).
Results
Administration of preoperative antibiotics did not correlate with reduction in postoperative complications. Preoperative alcohol use correlated with higher rates of hardware exposure (p = 0.03) and 30‐day readmission (p = 0.04). Patients with FF compromise had higher TSH (p = 0.04) and lower albumin levels (p = 0.005). Prealbumin levels were lower in patients who required neck washouts (p = 0.02) or a second FF (p = 0.03). TSH levels were higher in patients undergoing postoperative debridement (p = 0.03) or local flap procedures (p = 0.04).
Conclusion
Malnutrition, hypothyroidism, and substance abuse correlated with a higher incidence of postoperative wound complications in patients undergoing FF reconstruction for advanced osteoradionecrosis. Preoperative antibiotics use did not correlate with a reduction in postoperative wound complications.
Endoscopic Inside-Out Mastoidectomy with the Ultrasonic Bone Aspirator Mehta, Rahul; Mankekar, Gauri; Mayland, Erica ...
OTO open : the official open access journal of the American Academy of Otolaryngology--Head and Neck Surgery Foundation,
January‐March 2019, Letnik:
3, Številka:
1
Journal Article
Recenzirano
Odprti dostop
We report our experience using the ultrasonic bone aspirator (UBA) for transcanal endoscopic “inside out” mastoidectomy. The UBA has irrigation, suction, and nonrotatory ultrasonic bone-removing ...technology in 1 handpiece, which makes it appropriate for bone removal during this procedure. The results of our study show that this technique is safe and effective for patients with cholesteatoma in a small sclerotic mastoid. We also discuss the nuances associated with using the UBA during endoscopic ear surgery.
Heterotopic ossification of a vascular pedicle is an uncommon, but established, phenomenon occasionally seen incidentally on post-operative imaging after fibular free flap reconstruction. Symptomatic ...cases of pedicle ossification, however, are much rarer, with very few cases requiring operative intervention. We present the largest case of pedicle ossification recorded to date, review the literature on symptomatic pedicle ossification, and describe our experience with the surgical management and outcomes of this complication in symptomatic patients.
A 60-year-old man with a 7 cm neck mass and neck pain presents six months after fibular free flap reconstruction of an osteonecrotic mandible. CT demonstrates heterotopic ossification of the free flap vascular pedicle. The patient underwent surgical resection of the ossification with preservation of the pedicle and had an uncomplicated post-operative course with resolution of symptoms.
While pedicle ossification following fibula free flap surgery appears to be a somewhat common occurrence in the literature, clinically significant and symptomatic cases are rare. Symptomatic pedicle ossification may require secondary surgical intervention if large, painful, or disfiguring. Although there are surgical techniques described which may decrease the incidence of postoperative ossification, the rarity of symptomatic cases may not justify the additional surgical risks created by subperiosteal dissection.
Here, we present what appears to be the largest case of pedicle ossification in the literature. We believe this case may aid in the understanding of pedicle ossification and contribute towards a standard treatment protocol in the prevention and treatment of clinically relevant pedicle ossification.
Single‐stage long‐segment tracheal transplantation Genden, Eric M.; Miles, Brett A.; Harkin, Timothy J. ...
American journal of transplantation,
October 2021, 2021-10-00, 20211001, Letnik:
21, Številka:
10
Journal Article
Recenzirano
Odprti dostop
Tracheal transplantation has been envisioned as a viable option for reconstruction of long‐segment tracheal defects. We report the first human single‐stage long‐segment tracheal transplantation. ...Narrow‐band imaging and bronchoscopic biopsies demonstrate allograft vascularization and viable epithelial lining. The recipient was immunosuppressed with Tacrolimus, Mycophenolate mofetil, and corticosteroids. Six months after transplantation, the trachea is both functional and the patient is breathing without the need of a tracheostomy or stent.
The authors present a case of single‐stage, vascularized, long‐segment tracheal transplantation to reconstruct an extensive tracheal airway defect. Randhawa and Patterson comment on page 3223.
Evaluation and diagnosis of salivary gland neoplasms Mayland, Erica Jackson; Pou, Anna M.
Operative techniques in otolaryngology--head and neck surgery,
September 2018, 2018-09-00, Letnik:
29, Številka:
3
Journal Article
Recenzirano
Salivary gland tumors are an uncommon heterogeneous group of neoplasms that vary in their anatomical site, histology, and biologic behavior. Pleomorphic adenoma is the most common benign tumor, and ...mucoepidermoid and adenoid cystic carcinoma are the most common malignant tumors. Evaluation and diagnosis of these tumors include not only a complete history and head and neck exam, but also biopsy and imaging of the tumors. Controversy remains regarding the necessity and type of biopsy to be performed and the usefulness of imaging. This manuscript describes the utility of different diagnostic procedures in evaluating salivary gland neoplasms.
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