Pedicled osteomyocutaneous pectoralis major flap with osseous rib harvest for salvage mandibular reconstruction: Case and technique.

In the era of free flap reconstruction, mandibular defects are routinely reconstructed with osseous free flaps, and non-free flap bony reconstruction options are limited. A patient with T4N0 mandibular squamous cell carcinoma underwent resection with fibula free flap reconstruction of a parasymphyseal to angle defect. After free flap failure due to venous congestion, the flap was explanted. He declined additional free flap reconstruction and elected to proceed with pedicled osteomyocutaneous pectoralis major with rib. In this case presentation, we discuss the technical details of harvest of this flap using the 6th rib. The pedicled osteomyocutaneous pectoralis major flap with osseous rib harvest, which is infrequently described in the literature, remains a viable option for bony reconstruction, particularly in the salvage setting.

Efficacy of melatonin for auditory brainstem response testing in children: A systematic review.

OBJECTIVE: To examine the literature on pre-treatment with melatonin for successful completion of Auditory Brainstem Response (ABR) testing in pediatric patients and evaluate melatonin dosing protocols. DATA SOURCES: The Cochrane Library, PubMed, Ovid MEDLINE, and Web of Science from inception through May 20th, 2019. In addition, a retrospective case series of pediatric patients (<18yr) who underwent melatonin assisted ABR testing between 2015 and 2018 was performed at our institution. REVIEW METHODS: Prospective and retrospective studies involving melatonin use in pediatric patients (<18yrs) for auditory brainstem response testing were evaluated. Studies meeting inclusion/exclusion criteria reported success rate of ABR testing using melatonin pre-treatment, dosage of melatonin used, duration of sleep, and whether adverse events occurred. RESULTS: 43 studies were identified, 8 studies were selected, and finally 5 studies were included in the review. A total of 480 pediatric patients underwent ABR testing with pre-treatment of melatonin with success rates ranging from 65% to 86.7%. Age across studies ranged from 1 month to 14 years, 6 months. Dosage of melatonin varied from 0.25 mg for patients <3 months of age to 20 mg for patients >6 years of age, with one study using a weight-based approach. No significant adverse events were reported by any of the included studies. CONCLUSION: Pre-medication with melatonin may be a useful option for obtaining successful results of non-sedated ABR testing in pediatric patients and may provide a useful alternative to sedation. Dosing patterns are highly variable. No adverse events were reported with any dosing strategy.