Regional flaps are an important component of the reconstructive ladder and represent a versatile option in reconstructing various oral cavity defects. An axial buccal flap based on the facial artery, ...the facial artery musculomucosal flap, was first described by Pribaz et al. and has been shown to have good functional outcomes with minimal morbidity. Indeed, other surgeons have praised its favorable arc of rotation, reliability, and role as an alternative to free tissue transfer, with shorter duration of general anesthesia and allowance for earlier postoperative mobilization. The facial artery musculomucosal flap has significant versatility, as it can be superiorly or inferiorly based and can be performed in either single- or two-stage fashion. It is of particular advantage for reconstruction of the oral cavity (retromolar trigone, hard palate, alveolar ridge, lip, tongue, and floor of mouth), oropharynx (tongue base, lateral pharynx, and soft palate), and sinonasal structures. Despite its advantages, its widespread use has been limited by a lack of familiarity and difficulty in safely raising a reliable flap consistently. The senior author (S.C.D.) has successfully utilized a high volume of facial artery musculomucosal flaps with a low complication rate in a broad array of oral cavity and oropharyngeal defects. In this article, the authors share technical details on how to harvest and inset this flap by incorporating key landmarks in a reliable fashion.
To perform the first systematic review evaluating all established treatment modalities of head and neck lymphedema resulting from head and neck cancer therapy. Since craniofacial lymphedema treatment ...represents unique challenges not addressed by extremity lymphedema therapies, a systematic review and evaluation of treatment modalities specific to this area is needed to guide clinical management and further research.
Four electronic databases were searches from inception to September 2018. These included Scopus (Embase), PubMed (Medline), Clinicaltrials.gov, and Cochrane Databases.
A search string was developed, and all databases queried for keywords on three subjects: head and neck cancer, lymphedema, and therapy. Results were uploaded to an EndNote database where relevant items were identified by hand-searching all titles and abstracts. Subsequently results were combined, duplicates removed, and full papers screened according to eligibility criteria.
Of a total 492 search results, twenty-six items met eligibility criteria for this review. These included fourteen cohort studies, seven case reports, two randomized controlled trials, two systematic reviews, and one narrative review totaling 1018 study subjects. The manual lymph drainage group had the largest number of studies and participants, with fewer studies investigating selenium, liposuction, and lymphaticovenular anastomosis.
Evidence for the efficacy of all types of lymphedema therapy is limited by paucity of large randomized controlled trials. While manual lymph drainage is best studied, liposuction and surgical treatments have also been effective in a small number of patients.
Lower lid malposition is a common yet demanding problem that both functional and cosmetic eyelid surgeons will face. It encompasses a spectrum of lower eyelid conditions ranging from lower lid ...retraction to frank ectropion and entropion. The causes of lower lid malposition are numerous, and the problem can be challenging to correct even for experienced surgeons. Proper treatment of lower lid malpositioning requires a clear understanding of the lower eyelid anatomy, careful preoperative assessment, and appropriate selection of surgical and nonsurgical interventions to have a successful outcome.
Objective: To determine the safety, feasibility, and efficacy of coupling transoral robotic technology with the flexible carbon dioxide (CO2) laser for various tumors of the oropharynx and ...supraglottic larynx.
Study Design: Prospective, pilot trial.
Methods: Eight patients were enrolled in an IRB‐approved prospective trial for transoral robotic surgery with the aid of the flexible CO2 laser.
Results: Seven male patients with early carcinoma of the oropharynx or larynx successfully underwent tumor extirpation with the transoral robot and the flexible CO2 laser. We were unable to gain access to the supraglottic larynx in one female patient. The final pathology revealed seven patients with squamous cell carcinoma and one patient with adenoid cystic carcinoma. The flexible CO2 laser provided fine incisions with excellent hemostasis and minimal peripheral tissue injury. Additionally, the laser provided an excellent tool for raising pharyngeal flaps for reconstruction of the oropharynx.
Conclusion: The flexible CO2 laser offers a unique advantage of precise incisions and may provide a valuable tool for both tumor extirpation and the creation of flaps for transoral robotic reconstruction.
Head and neck surgical science has developed dramatically during the past 20 years with a major focus on organ preservation surgery. Among these organ preserving surgeries are the selective neck ...dissections, supracricoid partial laryngectomies, transoral laser surgeries, and now a newcomer, transoral robotic surgery utilizing the da Vinci surgical system. Transoral robotic surgery is in its infancy, but, indeed, there have been some questions raised about the role of these innovative robotic surgical techniques.
This article will review, point by point, the questions that have been raised concerning the feasibility; safety and efficacy; teachability; and cost effectiveness of transoral robotic surgery.
Although the present literature reports early findings, without long-term oncologic outcomes, the results are consistently encouraging. Training programs have already yielded successes. Indeed, multiple institutions have shown that transoral robotic surgery programs can be successfully established yielding excellent clinical outcomes. In addition, early studies of swallowing function following transoral robotic surgery show swallowing outcomes that are superior to some of the reported chemoradiation results for equivalent lesions.
Microvascular free flap reconstruction has now become the standard of care in the reconstruction of selected head and neck defects. Although uncommon, flap failure is a catastrophic event that ...results in significant patient morbidity, extended length of hospitalization, and increased cost. However, there is currently no gold standard for measuring the quality of a reconstructive center. Structure and process outcomes have recently been developed, but outcome measures are still lacking. Areas for future research include preoperative nutrition, preoperative flap planning, intraoperative fluid management, appropriate thromboembolism prophylaxis, consistent perioperative antibiotic regimens, skilled ancillary staff, and clear outcome measures for performance measurement.
Objectives:
Free tissue reconstruction of the head and neck must be initially overcorrected due to expected postoperative free flap volume loss, which can be accelerated by adjuvant radiation ...therapy. In this study, we aim to identify patient and treatment-specific factors that may significantly contribute to this phenomenon and translate these characteristics into a predictive model for expected percent free flap volume loss in a given patient.
Methods:
Patients with a history of oral cavity and/or oropharyngeal cancer who underwent nonosseous free flap reconstruction were reviewed between January 2009 and November 2018 at a tertiary care center. Demographics/characteristics, total radiation dose, radiation fractionation (RF), and pre/postradiation free flap volume as evaluated by computed tomography imaging were collected. Free flap volume was measured by a fellowship-trained neuroradiologist in all cases. Only patients receiving adjuvant radiotherapy with available pre/postradiation imaging were included. Multivariable linear regression modeling for prediction of free flap volume loss was performed with optimization via stepwise elimination.
Results:
Thirty patients were included for analysis. Mean flap volume loss was 42.7% ± 17.4%. The model predicted flap volume loss in a significant fashion (P = .004, R2 = 0.49) with a mean magnitude of error of 9.8% ± 7.5%. Age (β = 0.01, P = .003) and RF (β = −0.01, P = .009) were individual predictors of flap volume loss.
Conclusions:
Our model predicts percent free flap volume loss in a significant fashion. Age and RF are individual predictors of free flap volume loss, the latter being a novel finding that is also modifiable through hyperfractionation radiotherapy schedules.
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