Long-term functional donor site morbidity of the free radial forearm flap in head and neck cancer survivors.

BACKGROUND: To assess the functional donor site morbidity of the forearm free flap in patients surviving at least 2 years after ablative head and neck cancer surgery in a tertiary care centre. METHODS: This study involved nine long-term survivors (2 year post-operative) who had forearm free flaps to reconstruct head and neck defects. All flaps were raised from the non-dominant arm. The non-donor side acted as a control for all patients. Objective measurements were as follows: grip, tip pinch and key pinch strength measured with dynamometers; flexion, extension, radial and ulnar deviation and pronation and supination range of motion at the wrist measured with goniometry; A timed manual dexterity task was performed with a grooved pegboard test, and sensation of the radial nerve was tested with Semmes Weinstein monofilaments. Subjective measurements included a validated patient questionnaire of hand function and opinions of scar appearance as well as a validated scar assessment from two different observers. RESULTS: Pronation at the wrist, manual dexterity and sensation were found to be significantly reduced in the donor side compared to the non-donor side. Inter-rater agreement between the two observers was found to be poor, except for an acceptable correlation between overall scar opinions. No correlations were found between any subjective or objective items or between the patient's and the observers' subjective evaluations. CONCLUSIONS: Donor site morbidity can be demonstrated with objective testing however this is accepted and well tolerated by head and neck cancer patients.

Pulmonary complications after major head and neck surgery: A retrospective cohort study.

OBJECTIVES/HYPOTHESIS: Postoperative pulmonary complications (PPCs) following head and neck surgery are common. Patients undergoing tracheostomy, free tissue transfer reconstruction, and postoperative ventilation in an intensive care unit (ICU) have a high incidence of PPCs. We sought to define the incidence of PPCs in this cohort and to determine what factors PPCs correlate with. STUDY DESIGN: Retrospective cohort study. METHODS: Following institutional research ethics board approval, a retrospective review of patients undergoing major head and neck surgery at a Canadian tertiary care center was conducted. The development of PPCs was the outcome of interest. Quality assurance parameters including ICU and hospital lengths of stay, and mortality were also recorded. RESULTS: There were 105 patients enrolled, of which 47 (44.8%) sustained one or more PPCs. The most frequent PPC was respiratory failure, accounting for 39 of 94 PPCs observed. Hypertension was the only comorbidity that correlated with development of a PPC (P = .031). Those who sustained PPCs were older than those who did not (median age, 65.6 vs. 58.7 years; P = .005). Development of PPCs correlated with longer ICU and hospital stays. There was increased mortality among patients with PPCs compared to those without (12.8% vs. 1.7%, P = .04). CONCLUSIONS: Patients undergoing major head and neck surgery are at high risk of PPCs. Advanced age and hypertension significantly correlated with PPCs. PPCs correlate with prolonged ICU and hospital stays, and increased mortality. Further research is needed to define risk factors, useful investigations, and effective optimization strategies to mitigate PPCs.

Complementary and alternative medicine use in the thyroid patients of a head and neck practice.

OBJECTIVE: To investigate the prevalence of complementary and alternative medicine (CAM) use among patients being investigated for thyroid nodules in a head and neck oncology practice. Subsequently, to determine whether the common therapies used were likely to interfere with the planned patient's care and whether the predominance was significant to warrant inclusion in routine history assessments. STUDY DESIGN: Cross-sectional survey. SETTING: Dalhousie University, Halifax, Nova Scotia, Canada. SUBJECTS AND METHODS: A survey regarding CAM use was completed by 100 patients being investigated for thyroid nodules upon their initial presentation to a head and neck oncology practice. RESULTS: Preliminary results showed that 79% of participants have a history of CAM use and 51% of participants were actively using oral supplements. Thirty-one percent of participants reported using supplements known to have hemostasis-affecting properties. CONCLUSION: Medical professionals should incorporate CAM questioning in any thyroid patient assessment to reduce patient risk and optimize medical and surgical outcomes.

Simple mass loading of the tympanic membrane to alleviate symptoms of patulous eustachian tube.

BACKGROUND: Patulous eustachian tube (PET) has a major impact on a patient's quality of life. The purpose of this study was to understand mechanisms behind the symptoms, develop treatments based on these, and develop and use a questionnaire to measure changes in PET symptoms with a novel intervention. Our hypothesis is that PET symptoms can be addressed at the level of the eardrum more easily than at the level of the eustachian tube. METHODS: In a population of 14 PET subjects and 6 fresh temporal bones, several investigations were performed. Nasal audiometry was used to measure frequencies preferentially transmitted to the ear in PET subjects. An intervention consisting of mass loading of the eardrum was devised in the temporal bones to damp these frequencies. This was then applied to subjects with PET. A questionnaire was developed and administered to measure the response to this intervention. This questionnaire included the more common symptoms associated with PET, such as echoing sounds, increased environmental sounds, and a plugging sensation in the ear. Mass loading of the eardrum was performed with Blu Tack, a clay-like, nontoxic substance. RESULTS/CONCLUSION: Low frequencies are preferentially transmitted in PET, and eardrum vibrations to these can be mitigated with mass loading. Mass loading in human subjects significantly reduced major symptoms of PET, although temporarily.

Do we measure up? Is an objective measuring device necessary for the accurate assessment of oral cavity and oropharyngeal lesions?

OBJECTIVES: The T stage of oral cavity and oropharyngeal squamous cell cancer lesions has a significant impact on patient treatment and overall outcome. Determining the presence and size of palpable lymph nodes also plays an important role in the complex staging of oral cancer. Oral cavity lesions and lymph nodes are often assessed by visual approximation and palpation. The focus of this study was to determine if the introduction of a measurement tool (a ruler) changes the T stage of oral cavity and oropharyngeal lesions and the N stage of lymph nodes. MATERIALS/METHODS: Various pieces of felt that represented oral cavity and oropharyngeal lesions were placed on the tongues of cadaver specimens. Several pieces of felt of different shapes were used to represent each T stage in the oral cavity and oropharyngeal tumour staging system (American Joint Committee on Cancer). Pieces of round clay, of differing sizes, were also placed in the neck of one of the cadavers once a subplatysmal flap was raised. These pieces of clay represented the various node sizes. The study participants were four head and neck surgeons, four senior residents, four junior residents, and five medical students. All subjects were asked to visually inspect the oral cavity and oropharynx of the cadaver and approximate, to the nearest 0.5 cm, the size of the lesion. The subjects were then asked to identify the lymph nodes in the same manner. Once the participants had recorded their answers, they were asked to repeat the process with the aid of a ruler and measure the same lesions and lymph node to the nearest 0.5 cm. RESULTS/CONCLUSIONS: In staging of oral cavity and oropharyngeal cancer, the use of a ruler is necessary to increase the accuracy of tumour staging. There was a statistically significant difference in the estimated size of tumours and nodes when using a ruler. The average absolute error using visual estimation of the tumour size was 5.6 mm. When using the ruler, the error was reduced to 1.7 mm. The node size showed the same trend, with average absolute error on visual estimation being reduced from 7.4 mm to 5.2 mm.

Informed consent in otologic surgery: prospective randomized study comparing risk recall with an illustrated handout and a nonillustrated handout.

OBJECTIVE: Following consent, do pictures in a handout improve patients' recall of otologic surgical risks? STUDY DESIGN: Prospective, randomized trial in a tertiary care centre. METHODS: Patients undergoing otologic surgery were consented with a standardized checklist of risks by two surgeons. They were randomized (stratified by educational level) to receive either a pure text or a text and pictures handout outlining the risks of surgery. A telephone interview tested recall at a mean of 19 days. Twenty-six patients were resampled at 1 year. MAIN OUTCOME MEASURES: Recall was analyzed with respect to type of handout, age, sex, and level of education. A subset of 31 patients was analyzed for the effects of which surgeon consented, previous otologic surgery, and actually reading the handout. RESULTS: Fifty-one patients completed the study. The overall risk recall was 43%, with 45% in the pictorial group and 42% in the pure text group (p = .84). The illustrated handout did not improve the recall of any individual surgical risk either. Higher education improved risk recall from 36 to 54% (p = .009). Age, consenting surgeon, previous otologic surgery, and even reading the handout did not improve risk recall. A subgroup of 26 patients was followed up 1 year later, and their recall fell from 41 to 35%. The illustrated handout did not improve long-term recall (p = .674). CONCLUSION: Pictorial cues do not improve recall of surgical risks, but education level does.