Auricular Prostheses in Microtia Federspil, Philippe A
Facial plastic surgery clinics of North America
26, Številka:
1
Journal Article
Recenzirano
The progress made in the development of the silicones and percutaneous titanium implants allow for rehabilitation of patients with microtia with an inconspicuous auricular prosthesis. The art of ...making the prosthesis by the dedicated anaplastologist is the key for the success of this approach. Most patients with microtia desire camouflage. The greatest advantage of the auricular prosthesis is that it can be manufactured as a mirrored replica of the opposite side. The outcome is predictable. Computer science with virtual planning and rapid prototyping is about to revolutionize the process of prosthetic auricular rehabilitation.
Implant-retained craniofacial prostheses (or epitheses) made of silicone are state of the art for prosthetic rehabilitation of facial defects. With the modern extraoral implant systems, prostheses ...may be securely anchored to the bone regardless of size and location of the defect. Prerequisite for successful implantation is the classical atraumatic surgical technique with avoidance of any thermal trauma to the bone. The treatment intention may be a temporary measure, a rescue procedure after failed (re)construction, or a definitive treatment option. This article gives an overview of the strategies in various facial regions stratified according to the age of the patient and the etiology of the defect. Moreover, prosthetic rehabilitation offers additional options for septal perforations, distorted and leaky tracheostomies, and treatment-resistant tracheoesophageal fistula.
The aim of this study is to show differences between a modified facelift incision (MFI) for partial parotidectomy versus a bayonet-shaped incision (BSI). 24 patients presenting with a parotid tumor ...were surgically treated with a partial parotidectomy using a MFI. We generated a “matched pair control group” regarding age, tumor size and gender, who received a BSI. A questionnaire was sent to all patients and relevant data reviewed. The cosmetic satisfaction on a VAS with a MFI was 9.74 (±0.47) compared to BSI with 7.63 (±2.44,
p
= 0.004). The scoring in the two subgroups “visible scar” and “people noticed my surgery” was significantly better in the MFI group The postoperative skin numbness, skin depression, facial nerve function postoperatively showed no statistical differences. The MFI for parotid tumors has a better outcome than the BSI regarding cosmetic satisfaction and visible scarring.
Purpose
The study aimed to determine normative values for the Tonsillectomy Outcome Inventory 14 (TOI-14) in a healthy middle-European cohort. We also compared these generated values with TOI-14 ...scores from a patient population with recurrent tonsillitis (RT) and explored the factorial structure of the TOI-14.
Methods
We systematically studied the responses of healthy individuals (reference cohort) and patients with RT (clinical cohort) to the TOI-14 survey. The reference cohort contained 1000 participants, who were recruited using the Respondi panel for market and social science research. This subsample was quoted to the population distribution of the German Microcensus and selected from a non-probability panel. Tonsillitis patients were assessed before and 6 and 12 months after tonsillectomy.
Data were analysed using principal component and exploratory factor analyses.
Results
The PCA revealed three TOI-14 domains (physiological, psychological and socio-economic), which explained 73% of the total variance. The reference cohort perceived a good quality of life (QOL) with a TOI-14 total score of 11.8 (physiological: 8.0, psychological: 5.8, and socio-economic subscale score: 13.9). TOI-14 scores were higher in the patient cohort, indicating that the TOI-14 discriminates between patients with RT and healthy individuals with no RT. Age and female gender significantly influenced the total TOI-14 score, especially in the psychological (age) and socio-economic (gender) subscales.
Conclusion
We have developed a set of normative values that, together with the TOI-14, can determine the disease burden indicating tonsillectomy.
The artwork of making the epithesis by the dedicated anaplastologist is the prerequisite of acceptance by the patient and the key for success of this approach. However, computer science is helping ...with virtual planning and rapid prototyping, and it is likely to revolutionize this process in the near future. One of the advantages of the auricular prostheses is that it can be manufactured as a mirrored replica of the opposite side (if normal or near normal). Furthermore, the results are predictable, and may be shown to the patient before surgery. The developments of various implant systems allow secure retention even in unfavorable anatomic situations as in the ideally pneumatized mastoid process. The advantage of the plate systems is that they spread the loading forces to multiple smaller bone screws, rendering it thereby resistant to torque with abutment insertion or magnet change. Auricular prostheses fulfill three roles: (1) temporary measure, (2) rescue procedure in failed auricular (re)construction, and (3) definitive treatment option. Conventional retention by medical adhesives, sometimes helped by making use of the remnant, keeps its place in the use as a temporary measure or if the patient declines surgery. Today, implant-retained auricular prostheses made of silicone are state of the art for prosthetic rehabilitation of patients with auricular defects.
Abstract Purpose Locoregional control (LC) in malignant salivary gland tumors is dose-dependent, initial results with particle therapy were promising. We report our experience with raster-scanned, ...intensity-controlled carbon ion therapy (C12) and IMRT in 309 patients with pathologically confirmed adenoid cystic carcinoma (ACC) of the head and neck. Patients and methods Treatment records of patients treated with C12 between 08/1998 and 05/2013 were evaluated regarding tumor stage, treatment, toxicity (CTCAE v3), LC, progression-free survival (PFS) and overall survival (OS). Response assessment was carried out according to RECIST1.1. Results Tumor stages were mostly advanced (T4a/b: 60%, macroscopic disease: 71%), most common sites of origin were the paranasal sinus (37%). At a median follow-up at 33.9 months, LC, PFS, and OS at 3 and 5 year estimates are 83.7%/58.5%, 67.8%/56.1%, and 88.9%/74.6%. LC correlates with T-stage but neither nodal stage, age, relapse state, nor margin status. RECIST did not correlate with LC or survival rates. Conclusion IMRT plus C12 boost results in good control and survival rates at moderate toxicity. Margin status did not correlate with LC in T4 tumors, extensive and potentially mutilating surgical procedures may have to be re-evaluated. RECIST assessment did not correlate with either LC or survival rates; potentially more meaningful radiological parameters need to be developed.
Objectives
To evaluate the rate of surgical site infection (SSI) and associated risk factors after parotid gland surgery including the impact of antibiotic prophylaxis.
Design
Retrospective ...single‐centre clinical study.
Setting
Tertiary referral centre for head and neck surgery.
Participants
Seven hundred and fifty four patients who underwent parotid gland surgery at the University Hospital Heidelberg, Germany, between 2007 and 2014 were enrolled in this study. Data on patient age, American Society of Anesthesiologists (ASA) classification system, smoking status, diabetes mellitus, operation time, and antibiotic prophylaxis were collected. Additionally, the National Healthcare Safety Network (NHSN) risk index was calculated. Association of these factors with SSI was evaluated in univariate analyses and a multivariate logistic regression model.
Main outcome measures
Rate of SSI.
Results
Twenty four patients (3.2%) had an SSI according to the NHSN definition. In univariate analyses, only smokers (P = .048) and male patients (P = .01) had a significantly higher rate of SSI. Since the majority of smokers were men (62.3%), the effect of male gender, smoking, together with the NHSN risk index was further investigated as predictors of SSI within a logistic regression model. All three predictors showed a significant effect on SSI.
Conclusions
Parotid gland surgery has a low rate of SSI. In our cohort, male gender, smoking and high NHSN risk index scores were significantly associated with SSI, whereas antibiotic prophylaxis had no protective effect.
Genomic sequencing projects unraveled the mutational landscape of head and neck squamous cell carcinoma (HNSCC) and provided a comprehensive catalog of somatic mutations. However, the limited number ...of significant cancer‐related genes obtained so far only partially explains the biological complexity of HNSCC and hampers the development of novel diagnostic biomarkers and therapeutic targets. We pursued a multiscale omics approach based on whole‐exome sequencing, global DNA methylation and gene expression profiling data derived from tumor samples of the HIPO‐HNC cohort (n = 87), and confirmed new findings with datasets from The Cancer Genome Atlas (TCGA). Promoter methylation was confirmed by MassARRAY analysis and protein expression was assessed by immunohistochemistry and immunofluorescence staining. We discovered a set of cancer‐related genes with frequent somatic mutations and high frequency of promoter methylation. This included the ryanodine receptor 2 (RYR2), which showed variable promoter methylation and expression in both tumor samples and cell lines. Immunohistochemical staining of tissue sections unraveled a gradual loss of RYR2 expression from normal mucosa via dysplastic lesion to invasive cancer and indicated that reduced RYR2 expression in adjacent tissue and precancerous lesions might serve as risk factor for unfavorable prognosis and upcoming malignant conversion. In summary, our data indicate that impaired RYR2 function by either somatic mutation or epigenetic silencing is a common event in HNSCC pathogenesis. Detection of RYR2 expression and/or promoter methylation might enable risk assessment for malignant conversion of dysplastic lesions.
What's new?
Multi‐scale omics approaches provide a powerful tool to unravel cancer‐related genes with the potential to serve as prognostic biomarkers and putative drug targets. This study shows that somatic mutations and epigenetic silencing of the ryanodine receptor 2 (RYR2) are frequent in head and neck cancer. Loss of RYR2 expression was found during transition from dysplastic lesions to invasive tumors. Detection of somatic mutations or promoter methylation might thus improve risk assessment of malignant conversion, which could enable timely and adequate treatment of premalignant lesions.
•Patients with clivus chordomas had a 5-year PFS of 44.7 %.•The sixth nerve palsy could significantly be improved by surgery.•Vast and infiltrative tumor extension constitute major limitations of ...surgical resection.•Irradiation with carbon ions after chordoma surgery is recommended.
Clivus chordomas are semi-malignant, but infiltratively growing tumors. Currently, a widely-accepted treatment concept encompasses maximal, but safe, surgical resection and radiotherapy. Caused by the size and the tumor extension, different surgical approaches, especially in recurrent cases, might be necessary.
Retrospective review of 50 patients on whom 70 surgeries were performed: 29 in primary and 41 in recurrent cases. Based on MRI images, all cases were asserted according to the size and the extension of the tumor. Used surgical approaches were evaluated. Postoperative complications, neurological function prior to and after the surgery, the extent of tumor resection on postoperative MR images were assessed and progression-free survival was calculated.
Tumor size was estimated as small (< 5 cm3) in 8, as medium (5−20 cm3) in 21, as large (20−100 cm3) in 17, and as giant (> 100 cm3) in 4 patients. Most frequently used surgical approaches in primary cases were the transsphenoidal one and midfacial degloving (51.7 % and 17.2 %, respectively). In recurrent cases, dependent on the tumor extension, transsphenoidal (21.9 %), retrosigmoidal (29.3 %), and pterional (19.5 %) approaches, as well as midfacial degloving (17.1 %) were used. Due to the vast tumor extension and infiltration, gross total or near total resection could be achieved in 12 patients (24 %), only. There was no mortality and no major complications in primary cases. In recurrences, however, postoperative hemorrhages and strokes emerged in 4.9 % and 7.1 %. Minor complications occurred in 17.1 % and were dominated by CSF leaks (12.2 %), both in primary in recurrent cases. While most cranial nerve impairments were caused by tumor infiltration of the cavernous sinus, and hence have not improved by treatment, the sixth nerve palsy as a consequence of tumor mass compression, could significantly be improved by surgery. Following surgery, patients were subjected to radiotherapy (68.9 % for primary cases, and 36.6 % for recurrences) mainly with carbon ions. Overall, 5-year progression-free survival was 44.7 %.
Caused by the heterogenous pattern of growth of clivus chordomas, surgical approaches should be chosen individually. Vast and infiltrative tumor extension constitute major limitations of surgical resection, and hence result in poor progression-frees survival.
Purpose
The aim of this study was to determine whether there were differences in decannulation rates and time to decannulation in children depending on the indication for tracheostomy, age, and ...maturity at birth.
Study design
Retrospective chart review and prospective interview by questionnaire.
Methods
The medical records of 106 pediatric patients (age 0–18 years) tracheostomized between January 1 1999 and January 1 2019 were reviewed. Patients were divided into three different groups depending on the indication for tracheostomy: unsafe airway (37.7%), long-term respiratory dependence (50.9%), or bronchopulmonary toilet for aspirations (11.3%).
Results
40 patients were successfully decannulated. The time-dependent decannulation rate after 2 and 5 years was 28.3% and 40.5% for patients with an unsafe airway, 42.4% and 66.8% for patients with long-term respiratory dependence, and 41.7% and 70.8% for patients needing bronchopulmonary toilet, respectively. After 2 and 5 years, patients aged 0–12 months at the time of tracheostomy were decannulated in 13.1% and 50.2% of cases, 1–5-year-olds in 35.3% and 48.2% of cases, 6–10-year-olds in 70% and 70% of cases, and 11–18-year-olds in 66.6% and 66.6% of cases, respectively. However, in a multivariate analysis, prematurity was found to be the only significant unfavorable variable (
p
= 0.013). Maturely born patients had an odds ratio of 3.87 (95% CI 1.32–11.33) for successful decannulation. This effect was present only in the first 5 years of life.
Conclusion
Factors indicating problems with decannulation are an unsafe airway, a young age at the time of tracheostomy, and prematurity at birth.
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