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Objectives Osteoradionecrosis is one of the most severe complications in patients with head and neck cancer, which is characterized by persistent exposed and devitalized bone without proper healing after radiation. The extent to which mandibulotomy and marginal mandibulectomy influence the occurrence of osteoradionecrosis remains unclear. This study evaluated the incidence and risk factors for developing osteoradionecrosis of the mandible after oral cancer treatments. Methods A retrospective study was performed to analyze medical records of patients who underwent surgery and postoperative radiotherapy for oral cancers from 2009 to 2019 at a tertiary care hospital. Patient characteristics, incidence, and risk factors for developing osteoradionecrosis were reviewed. Comparisons between continuous and categorical data were performed using t-test and Chi-squared test. Cox regression analysis was used to assess the association between factors and the development of osteoradionecrosis. Results Among the 61 patients included in the study, osteoradionecrosis of the mandible occurred in 9 of 32 (28.1%) patients who underwent mandibular surgery during oral cancer resection (marginal mandibulectomy and/or mandibulotomy) and 2 of 29 (6.9%) patients without mandibular surgery. The development of osteoradionecrosis was significantly associated with performing mandibular surgery (hazard ratio 4.64, 95% confidence interval: 1.002, 21.5) and HIV infection (hazard ratio 8.53, 95% confidence interval: 2.2, 33.3). In the subgroup analysis of mandibular surgery, the development of osteoradionecrosis significantly increased in patients undergoing mandibulotomy (hazard ratio 6.62, 95% confidence interval: 1.3, 34.8) but not in patients undergoing marginal mandibulectomy (hazard ratio 3.56, 95% confidence interval: 0.6, 22.0). The analysis also showed that concurrent chemoradiation, radiation doses ≥ 60 Gy, and smoking were potential risk factors for the development of osteoradionecrosis, but none of these factors were statistically significant. Conclusion Our findings suggest that mandibular surgery is a significant risk factor for the development of osteoradionecrosis in patients with oral cancer. Further studies including larger population sizes are required to verify these findings.
RESUMO
Background and objective Pharyngocutaneous fistula is the most common complication after total laryngectomy. The aim of this study was to examine the incidence of fistula and the association between fistula and the shape of mucosal closure (T-shaped, vertical, or horizontal closure). Method A search of English language databases from 1979 to 2021 was undertaken for studies of total laryngectomy that commented on pharyngeal closure techniques and fistulas. Pooled estimates for fistula incidence and odds ratios were calculated. Results A total of 24 retrospective studies were included. The pooled fistula rates in primary total laryngectomy were 19.9% with T-shaped closure, 16.1% with vertical closure, and 16.4% with horizontal closure. In salvage total laryngectomy, the pooled fistula rates were 35.1%, 36.1%, and 17.9% with T-shaped, vertical, and horizontal closure, respectively. In the analysis of association, the risk of fistula formation in the T-shaped closure was not significantly different compared to that in the vertical closure, (odds ratio, 0.96; 95% confidence interval, 0.46-2.00). The horizontal closure, when compared to vertical closure, was significantly associated with lower risk of fistula formation (odds ratio, 0.31; 95% confidence interval, 0.12-0.78), but had nonsignificant lower risk of fistula formation when compared to the T-shaped closure (odds ratio, 0.46; 95% confidence interval, 0.19-1.12). Conclusion Horizontal closure seems to be the best closure shape for primary repair after total laryngectomy. However, analysis bias may have occurred because of the lack of well-controlled studies.
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Although deltopectoral flap failure is uncommon, its management can be difficult. This report presents a case of deltopectoral flap failure successfully rescued by a three-stage revision reconstruction using the postdebridement flap. A 59-year-old patient presented with a pharyngocutaneous fistula due to radionecrosis and subsequently underwent a medially based deltopectoral flap reconstruction for fistula closure. Unfortunately, this operation was unsuccessful because the flap developed necrosis at its distal tip, and the postdebridement flap could not be directly placed on the defect because of its shorter length. A subsequent revision operation successfully closed the fistula using a three-stage reconstruction with the postdebridement flap. Although this three-stage technique can avoid the morbidity associated with additional flap harvesting and can greatly extend the distance to the recipient, it also requires more time to heal and more operations than simply harvesting a new flap.
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OBJECTIVE: To review our experience with infrahyoid myocutaneous flap in reconstruction after oral cancer resection. METHODS: Chart reviews were completed for all patients who underwent oral reconstruction with an infrahyoid myocutaneous flap by a single surgeon in the Department of Otolaryngology at Chonburi Cancer Hospital from 2011 to 2017. Characteristics of the patients and postoperative complications were analyzed. RESULTS: Of the 34 patients in the study, 10 (29.4%) developed partial flap loss and 1 (2.9%) developed total flap loss. All cases of partial flap loss resolved with conservative treatment. Apparent cancer involvement of a cervical lymph node was significantly associated with flap failure (odds ratio: 5.0, 95% CI: 1.03-24.28). CONCLUSIONS: The infrahyoid myocutaneous flap is a fairly reliable reconstruction method. The flap should be performed with caution in cases with gross lymph node involvement.
