Postoperative chyle leak is a rare but serious complication of head and neck surgery. Chyle leak can lead to a systemic metabolic imbalance, a prolonged wound healing and longer hospital stay. Early ...identification and treatment are crucial for good surgical outcome. The diagnosis can be made intraoperatively or in the early postoperative period. Various treatment options described in the literature can be divided into conservative and surgical modalities. Currently, there is no evidence that any approach is superior to the other due to relatively small number of studies describing chyle leak management. There are no official guidelines for the treatment of postoperative chyle leak. The aim of this article is to present the therapeutic possibilities and to offer an algorithm for chyle leak management.
The aim of this study was to demonstrate the impact of COVID-19 pandemic on the number and characteristics of head and neck cancer patients in two consecutive periods, pre-pandemic and pandemic. For ...this purpose, we performed a retrospective analysis of patients with primary carcinomas of head and neck mucosal sites, salivary gland tumors, as well as neck metastases. Two pre-COVID-19 years (2018-2019) and two pandemic years (2020-2021) were compared. Demographic data, overall number of patients, TNM classification of the two most affected sites (oral cavity and larynx), time from symptom onset to first outpatient admission to our department, and time from first admission to treatment initiation were noted. Study results revealed a higher number of patients during the pandemic period and difference in the distribution of tumor sites (χ2=33.68, df=9, p<0.001). Oral cavity cancer prevailed over laryngeal cancer during the pandemic period. A statistically significant difference was observed in delay of initial presentation to head and neck surgeon for oral cavity cancer during the pandemic period (p=0.019). Furthermore, significant delay was found for both sites concerning time from initial presentation to the beginning of treatment (larynx: p=0.001 and oral cavity: p=0.006). Despite these facts, there were no differences in TNM stages comparing two observed periods. Study results indicated that there was a statistically significant delay of surgical treatment for both cancer sites observed (oral cavity and larynx) during the COVID-19 pandemic. A survival study is necessary in the future to definitely reveal the true consequences of COVID-19 pandemic on treatment outcomes.
Locking plates nowadays represent an important treatment in bone trauma and bone healing due to its strong biomechanical properties. The purpose of this study was to both computationally and ...experimentally validate a novel screw locking system by comparing it to another locking system from state-of-the-art and to apply it in an environment of a fractured mandible. FEA was used to test both systems prior to experimental tests. The systems were locked in the plate holes at 0°, 10°, 15°, and 20°. Cyclic bending tests and push-out tests were performed in order to determine the stiffness and push-out forces of both locking systems. Finally, newly designed locking system was implemented in mandibular angle fracture. Control locking system was biomechanically superior in push-out test, but with no greater significance. In contrast, the new locking system showed greater stiffness by 17.3% at the deflection angle of 20° in cyclic tests, with lower values for other deflection angles. Similar values were displayed in fractured mandible angle environment. Greater stiffness of the new locking system in cyclic loading tests, together with polyaxiallity of the new locking screw, could lead to easier application and improved biomechanical stability of the mandible angle fractures.
Graphical abstract
Background
Data from patients with post‐ablative dural defects reconstructed using a free temporalis muscle fascia graft (FTFG) after resection of anterior or central skull base tumors were ...retrospectively analyzed.
Methods
The primary predictor and outcome variables were the reconstructive methods for dural repair and postoperative cerebrospinal fluid (CSF) leakage rate, respectively.
Results
Eighty patients were included, and 94 postoperative dural reconstructions were performed using FTFG. The postoperative CSF leakage rate was 3.19%. The postoperative CSF leakage rates did not significantly differ between open and endonasal endoscopic surgeries (1.92% vs. 4.88%; p > 0.05). In cases completed using the endonasal endoscopic approach, the postoperative CSF leakage rate was significantly associated with the intraoperative CSF leak flow (p < 0.05).
Conclusions
Post‐ablative dural defect reconstruction using FTFG resulted in low postoperative CSF leakage and complication rates comparable to those of free fascia lata graft from available literature.
Postoperative chyle leak is a rare but serious complication of head and neck surgery. Chyle leak can lead to a systemic metabolic imbalance, a prolonged wound healing and longer hospital stay. Early ...identification and treatment are crucial for good surgical outcome. The diagnosis can be made intraoperatively or in the early postoperative period. Various treatment options described in the literature can be divided into conservative and surgical modalities. Currently, there is no evidence that any approach is superior to the other due to relatively small number of studies describing chyle leak management. There are no official guidelines for the treatment of postoperative chyle leak. The aim of this article is to present the therapeutic possibilities and to offer an algorithm for chyle leak management. Key words: Chyle; Neck dissection; Thoracic duct; Algorithm Postoperativna limforeja je rijetka, ali ozbiljna komplikacija operacija u podrucju glave i vrata. Limforeja mo?e dovesti do sistemskog metabolickog poremecaja, produ?enog cijeljenja rane i produljenog bolnickog lijecenja. Rano prepoznavanje i lijecenje temelj su dobrog kirur?kog ishoda. Dijagnoza se mo?e postaviti tijekom operacije ili u ranom postoperativnom periodu. Razlicite metode lijecenja opisane u literaturi mo?emo podijeliti u konzervativne i kirur?ke. Trenutno nema dokaza da je i jedan pristup bolji od drugog radi malog broja studija koje opisuju zbrinjavanje ove kirur?ke komplikacije. Ne postoje slu?bene smjernice za lijecenje limforeje nakon operacije. Cilj ovog rada je prikazati terapijske mogucnosti i predlo?iti algoritam za zbrinjavanje bolesnika s limforejom. Kljucne rijeci: Limfa; Disekcija vrata; Prsni duktus; Algoritam
Postoperativna limforeja je rijetka, ali ozbiljna komplikacija operacija u području glave i vrata. Limforeja može dovesti
do sistemskog metaboličkog poremećaja, produženog cijeljenja rane i ...produljenog bolničkog liječenja. Rano prepoznavanje
i liječenje temelj su dobrog kirurškog ishoda. Dijagnoza se može postaviti tijekom operacije ili u ranom postoperativnom
periodu. Različite metode liječenja opisane u literaturi možemo podijeliti u konzervativne i kirurške. Trenutno nema dokaza
da je i jedan pristup bolji od drugog radi malog broja studija koje opisuju zbrinjavanje ove kirurške komplikacije. Ne postoje
službene smjernice za liječenje limforeje nakon operacije. Cilj ovog rada je prikazati terapijske mogućnosti i predložiti algoritam
za zbrinjavanje bolesnika s limforejom.
The aim of this study was to demonstrate the impact of COVID-19 pandemic on the number and characteristics of head and neck cancer patients in two consecutive periods, pre-pandemic and pandemic. For ...this purpose, we performed a retrospective analysis of patients with primary carcinomas of head and neck mucosal sites, salivary gland tumors, as well as neck metastases. Two pre-COVID-19 years (2018-2019) and two pandemic years (2020-2021) were compared. Demographic data, overall number of patients, TNM classification of the two most affected sites (oral cavity and larynx), time from symptom onset to first outpatient admission to our department, and time from first admission to treatment initiation were noted. Study results revealed a higher number of patients during the pandemic period and difference in the distribution of tumor sites (x2=33.68, df=9, p<0.001). Oral cavity cancer prevailed over laryngeal cancer during the pandemic period. A statistically significant difference was observed in delay of initial presentation to head and neck surgeon for oral cavity cancer during the pandemic period (p=0.019). Furthermore, significant delay was found for both sites concerning time from initial presentation to the beginning of treatment (larynx: p=0.001 and oral cavity: p=0.006). Despite these facts, there were no differences in TNM stages comparing two observed periods. Study results indicated that there was a statistically significant delay of surgical treatment for both cancer sites observed (oral cavity and larynx) during the COVID-19 pandemic. A survival study is necessary in the future to definitely reveal the true consequences of COVID-19 pandemic on treatment outcomes. Keywords: COVID-19; Head and neck cancer; Pandemic; Delay in care Cilj ove studije bio je utvrditi utjecaj pandemije COVID-19 na broj bolesnika s karcinomima glave i vrata te njihove karakteristike u vremenu prije i za vrijeme pandemije. U tu svrhu provedena je retrospektivna studija kod bolesnika s primarnim sluznicnim karcinomima glave i vrata, ?lijezda slinovnica i onih s metastazama na vratu. Provedena je usporedba dviju godina prije pandemije COVID-19 (2018. i 2019.) i dviju pandemijskih godina (2020. i 2021.). Izracunati su i prikazani demografski podaci, ukupan broj bolesnika, TNM klasifikacija dvaju najucestalijih sijela (usna ?upljina i grkljan), vrijeme potrebno da se bolesnik od pojave prvih simptoma javi specijalistu na?eg Odjela (1. razdoblje) i vrijeme od prvog specijalistickog pregleda do pocetka terapije (2. razdoblje). Rezultati su pokazali veci broj bolesnika u razdoblju pandemije i razliku u distribuciji tumorskih sijela u odnosu na dvije godine prije pandemije (chi square=33,68, df=9, p<0,001). Za vrijeme pandemije karcinom usne ?upljine bio je ucestalilji od karcinoma grkljana. U pandemijskom razdoblju utvrdeno je statisticki znacajno produljenje vremena do prvog specijalistickog pregleda kod bolesnika s karcinomom usne ?upljine (p=0,019), kao i vremena od prvog pregleda specijalista do pocetka terapije za oba sijela (grkljan: p=0,001, usna ?upljina: p=0,006). Usprkos tomu nije bilo razlika u TNM stupnjevima bolesti izmedu dvaju promatranih razdoblja. Ovi rezultati pokazuju znacajno produljeno vrijeme do pocetka lijecenja tumora tijekom pandemije, i to za oba sijela, usnu ?upljinu i grkljan. U buducnosti je potrebno provesti studiju pre?ivljenja koja bi otkrila posljedice pandemije COVID-19 na ishode lijecenja ovih bolesnika. Kljucne rijeci: COVID-19; Karcinom glave i vrata; Pandemija; Odgodeno lijecenje
Cilj ove studije bio je utvrditi utjecaj pandemije COVID-19 na broj bolesnika s karcinomima glave i vrata te njihove
karakteristike u vremenu prije i za vrijeme pandemije. U tu svrhu provedena je ...retrospektivna studija kod bolesnika s primarnim
sluzničnim karcinomima glave i vrata, žlijezda slinovnica i onih s metastazama na vratu. Provedena je usporedba
dviju godina prije pandemije COVID-19 (2018. i 2019.) i dviju pandemijskih godina (2020. i 2021.). Izračunati su i prikazani
demografski podaci, ukupan broj bolesnika, TNM klasifikacija dvaju najučestalijih sijela (usna šupljina i grkljan), vrijeme
potrebno da se bolesnik od pojave prvih simptoma javi specijalistu našeg Odjela (1. razdoblje) i vrijeme od prvog specijalističkog
pregleda do početka terapije (2. razdoblje). Rezultati su pokazali veći broj bolesnika u razdoblju pandemije i razliku
u distribuciji tumorskih sijela u odnosu na dvije godine prije pandemije (χ2=33,68, df=9, p<0,001). Za vrijeme pandemije
karcinom usne šupljine bio je učestalilji od karcinoma grkljana. U pandemijskom razdoblju utvrđeno je statistički značajno
produljenje vremena do prvog specijalističkog pregleda kod bolesnika s karcinomom usne šupljine (p=0,019), kao i vremena
od prvog pregleda specijalista do početka terapije za oba sijela (grkljan: p=0,001, usna šupljina: p=0,006). Usprkos tomu nije
bilo razlika u TNM stupnjevima bolesti između dvaju promatranih razdoblja. Ovi rezultati pokazuju značajno produljeno
vrijeme do početka liječenja tumora tijekom pandemije, i to za oba sijela, usnu šupljinu i grkljan. U budućnosti je potrebno
provesti studiju preživljenja koja bi otkrila posljedice pandemije COVID-19 na ishode liječenja ovih bolesnika.
