Summary Between 2000 and 2007, 376 free-flap transfers were performed in 352 patients at the Department of Maxillofacial Surgery, University of Parma, Italy. They included 303 reconstructions after ...cancer surgery (80.6%), 28 secondary reconstructions (7.4%), 32 transfers for facial paralysis (8.5%) and 13 reconstructions for other pathology (3.5%) such as osteonecrosis and ameloblastoma. We determined the rates of major and minor flap, donor-site and systemic complications and analysed their relationships with factors such as aetiology, patient age, smoking history and the presence of comorbid conditions. For the free flaps examined in this study, the overall complication rate was 47%. Major complications occurred in 20.7% of the cases and minor complications in 26.3%. The major flap, donor-site and systemic complication rates were 11.9, 3.2 and 5.6%, respectively. Total flap loss occurred in 15 cases (4%). The minor flap, donor-site and systemic complication rates were 19.1, 4 and 3.2% respectively. Aetiology, patient age, smoking history and the presence of comorbid conditions were related to higher rates of major and minor complications, although these were not statistically significant.
Purpose The purpose of this article was to analyze the efficacy of facelift incision, sternocleidomastoid muscle flap, and superficial musculoaponeurotic system flap for improving the esthetic ...results in patients undergoing partial parotidectomy for benign parotid tumor resection. The usefulness of partial parotidectomy is discussed, and a statistical evaluation of the esthetic results was performed. Patient and Methods From January 1, 1996, to January 1, 2007, 274 patients treated for benign parotid tumors were studied. Of these, 172 underwent partial parotidectomy. The 172 patients were divided into 4 groups: partial parotidectomy with classic or modified Blair incision without reconstruction (group 1), partial parotidectomy with facelift incision and without reconstruction (group 2), partial parotidectomy with facelift incision associated with sternocleidomastoid muscle flap (group 3), and partial parotidectomy with facelift incision associated with superficial musculoaponeurotic system flap (group 4). Patients were considered, after a follow-up of at least 18 months, for functional and esthetic evaluation. The functional outcome was assessed considering the facial nerve function, Frey syndrome, and recurrence. The esthetic evaluation was performed by inviting the patients and a blind panel of 1 surgeon and 2 secretaries of the department to give a score of 1 to 10 to assess the final cosmetic outcome. The statistical analysis was finally performed using the Mann-Whitney U test for nonparametric data to compare the different group results. P less than .05 was considered significant. Results No recurrence developed in any of the 4 groups or in any of the 274 patients during the follow-up period. The statistical analysis, comparing group 1 and the other groups, revealed a highly significant statistical difference ( P < .0001) for all groups. Also, when group 2 was compared with groups 3 and 4, the difference was highly significantly different statistically ( P = .0018 for group 3 and P = .0005 for group 4). Finally, when groups 3 and 4 were compared, the difference was not statistically significant ( P = .3467). Conclusion Partial parotidectomy is the real key point for improving esthetic results in benign parotid surgery. The evaluation of functional complications and the recurrence rate in this series of patients has confirmed that this technique can be safely used for parotid benign tumor resection. The use of a facelift incision alone led to a high statistically significant improvement in the esthetic outcome. When the facelift incision was used with reconstructive techniques, such as the sternocleidomastoid muscle flap or the superficial musculoaponeurotic system flap, the esthetic results improved further. Finally, no statistically significant difference resulted comparing the use of the superficial musculoaponeurotic system and the sternocleidomastoid muscle flap.
Patients surviving head and neck cancer (HNC) suffer from high physical, psychological, and socioeconomic burdens. Achieving cancer-free survival with an optimal quality of life (QoL) is the primary ...goal for HNC patient management. So, maintaining lifelong surveillance is critical. An ambitious goal would be to carry this out through the advanced analysis of environmental, emotional, and behavioral data unobtrusively collected from mobile devices. The aim of this clinical trial is to reduce, with non-invasive tools (i.e., patients' mobile devices), the proportion of HNC survivors (i.e., having completed their curative treatment from 3 months to 10 years) experiencing a clinically relevant reduction in QoL during follow-up. The Big Data for Quality of Life (BD4QoL) study is an international, multicenter, randomized (2:1), open-label trial. The primary endpoint is a clinically relevant global health-related EORTC QLQ-C30 QoL deterioration (decrease ≥10 points) at any point during 24 months post-treatment follow-up. The target sample size is 420 patients. Patients will be randomized to be followed up using the BD4QoL platform or per standard clinical practice. The BD4QoL platform includes a set of services to allow patients monitoring and empowerment through two main tools: a mobile application installed on participants' smartphones, that includes a chatbot for e-coaching, and the Point of Care dashboard, to let the investigators manage patients data. In both arms, participants will be asked to complete QoL questionnaires at study entry and once every 6 months, and will undergo post-treatment follow up as per clinical practice. Patients randomized to the intervention arm (n=280) will receive access to the BD4QoL platform, those in the control arm (n=140) will not. Eligibility criteria include completing curative treatments for non-metastatic HNC and the use of an Android-based smartphone. Patients undergoing active treatments or with synchronous cancers are excluded. Clinical Trial Registration: ClinicalTrials.gov, identifier (NCT05315570).
Abstract
Objectives
To identify independent predictors of outcome in patients with adenoid cystic carcinoma (ACC) of the paranasal sinuses and skull base.
Design
Meta-analysis of the literature and ...data from the International ACC Study Group.
Setting
University-affiliated medical center.
Participants
The study group consisted of 520 patients, 99 of them from the international cohort. The median follow-up period was 60 months (range, 32 to 100 months).
Main Outcome Measures
Overall survival (OS) and disease-specific survival (DSS).
Results
The 5-year OS and DSS of the entire cohort were 62% and 67%, respectively. The local recurrence rate was 36.6%, and the regional recurrence rate was 7%. Distant metastasis, most commonly present in the lung, was recorded in 106 patients (29.1%). In the international cohort, positive margins and ACC of the sphenoid or ethmoidal sinuses were significant predictors of outcome (
p
< 0.001). Perineural invasion and adjuvant treatment (radiotherapy or chemoradiation) were not associated with prognosis.
Conclusion
Tumor margin status and tumor site are associated with prognosis in ACC of the paranasal sinuses, whereas perineural invasion is not. Adjuvant treatment apparently has no impact on outcome.
The reconstruction of midface skin defects represents a challenge for the head and neck surgeon due to the midface's significant role in defining important facial traits. Due to the high complexity ...of the midface region, there is no possibility to use one definitive flap for all purposes. For moderate defects, the most common reconstructive techniques are represented by regional flaps. These flaps can be defined as donor tissue with a pedunculated axial blood supply not necessarily adjacent to the defect. The aim of this study is to highlight the more common surgical techniques adopted for midface reconstruction, providing a focus on each technique with its description and indications.
A literature review was conducted using PubMed, an international database. The target of the research was to collect at least 10 different surgical techniques.
Twelve different techniques were selected and cataloged. The flaps included were the bilobed flap, rhomboid flap, facial-artery-based flaps (nasolabial flap, island composite nasal flap, retroangular flap), cervicofacial flap, paramedian forehead flap, frontal hairline island flap, keystone flap, Karapandzic flap, Abbè flap, and Mustardè flap.
The study of the facial subunits, the location and size of the defect, the choice of the appropriate flap, and respect for the vascular pedicles are the key elements for optimal outcomes.
Metastases from lung cancer to the oral cavity and to the head and neck generally are very infrequent and usually manifest in advanced stages of the disease. Even more rarely, they are the first sign ...of an unknown metastatic disease. Nevertheless, their occurrence always represents a challenging situation both for clinicians, in the management of very unusual lesions, and for pathologists, in the recognition of the primary site. We retrospectively studied 21 cases of metastases to the head and neck from lung cancer (sixteen males and five females, age range 43-80 years; eight cases localized to the gingiva two of these to the peri-implant gingiva, seven to the sub-mandibular lymph nodes, two to the mandible, three to the tongue, one case to the parotid gland; in eight patients, metastasis was the first clinical manifestation of an occult lung cancer) and proposed a wide immunohistochemical panel for a proper identification of the primary tumor histotype, including CK5/6, CK8/18, CK7, CK20, p40, p63, TTF-1, CDX2, Chromogranin A, Synaptophysin, GATA-3, Estrogen Receptors, PAX8, PSA. Furthermore, we collected data from previously published studies and narratively reviewed the relevant literature.
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