RESUMEN
BACKGROUND: ChatGPT is becoming very popular as an information source for the public. The adequacy of ChatGPT generated patient counseling material has not yet been extensively assessed. METHODS: ChatGPT was presented with perioperative counseling and complication questions regarding five different procedure, and accuracy of responses was assessed. The chat was then asked to present an explanation of each procedure, and quality of the responses were compared to online educational material. RESULTS: ChatGPT responses were comprehensive when discussing counseling points commonly discussed by a provider prior to a procedure. Responses to questions on surgical complications were less accurate and comprehensive. In comparison to online educational material, ChatGPT scored at or above the median SAM and PEMAT scores for all procedures. CONCLUSIONS: ChatGPT did well addressing basic counseling points during the perioperative period, although it did not perform as well when addressing surgical complications. Chat response quality was comparable to currently available online educational material.
Asunto(s)
Consejo , Educación del Paciente como Asunto , Humanos , Educación del Paciente como Asunto/métodos , Internet , Procedimientos Quirúrgicos Otorrinolaringológicos/educaciónRESUMEN
BACKGROUND: The safety of presurgical thromboprophylaxis using low molecular weight heparin (LMWH) has not been well described in head and neck oncologic surgery with free tissue transfer (HNS-FTT). METHODS: Retrospective chart review of HNS-FTT patients receiving versus not receiving presurgical subcutaneous enoxaparin (Px-LMWH) was performed. Outcomes included estimated blood loss (EBL), hematoma, flap compromise, DVT or pulmonary embolus (PE). Fisher's exact test and Wilcoxon Rank Sum test were performed to compare groups. Odds ratios and associated 95 % confidence intervals were provided as appropriate. RESULTS: 43 of 128 patients (34 %) received Px-LMWH. There was no significant difference in EBL, hematoma, or flap complications between groups. Patients without Px-LMWH had higher rates of DVT and PE, although the difference did not reach statistical significance (p = 1.00, 0.095, respectively). CONCLUSION: Presurgical Px-LMWH can be used in major head and neck reconstructive surgery without increased intraoperative blood loss or postoperative complications. Larger studies will need to be done to determine the impact of Px-LMWH on DVT and PE in this patient population.
Asunto(s)
Colgajos Tisulares Libres , Embolia Pulmonar , Tromboembolia Venosa , Humanos , Heparina de Bajo-Peso-Molecular/uso terapéutico , Anticoagulantes/uso terapéutico , Estudios Retrospectivos , Peso Molecular , Tromboembolia Venosa/etiología , Tromboembolia Venosa/prevención & control , Tromboembolia Venosa/tratamiento farmacológico , Embolia Pulmonar/etiología , Embolia Pulmonar/prevención & control , Embolia Pulmonar/tratamiento farmacológico , Hematoma , QuimioprevenciónRESUMEN
BACKGROUND: Metastases to the parotid nodal basin in patients with high-risk cutaneous squamous cell carcinoma (HRcSCC) impact disease specific survival (DSS) and overall survival (OS). METHODS: A writing group convened by the Salivary Section of the American Head and Neck Society (AHNS) developed contemporary, evidence-based recommendations regarding management of the parotid nodal basin in HRcSCC based on available literature, expert consultation, and collective experience. The statements and recommendations were then submitted and approved by the AHNS Salivary Committee. RESULTS: These recommendations were developed given the wide variation of practitioners who treat HRcSCC in order to streamline management of the parotid nodal basin including indications for imaging, surgery, radiation, and systemic treatment options as well. CONCLUSIONS: This clinical update represents contemporary optimal management of the parotid nodal basin in HRcSCC and is endorsed by the Salivary Section of the AHNS.
Asunto(s)
Carcinoma de Células Escamosas , Neoplasias de Cabeza y Cuello , Neoplasias de la Parótida , Neoplasias Cutáneas , Carcinoma de Células Escamosas/patología , Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/terapia , Humanos , Ganglios Linfáticos/patología , Estadificación de Neoplasias , Glándula Parótida/cirugía , Neoplasias de la Parótida/patología , Neoplasias de la Parótida/terapia , Estudios Retrospectivos , Neoplasias Cutáneas/patología , Estados UnidosRESUMEN
OBJECTIVE: This study aims to compare the composite outcome of progression to septic shock between 30 mL/kg/ideal body weight (IBW) versus 30 mL/kg/non-IBW fluid resuscitation dosing strategies in obese patients with severe sepsis. METHODS: We retrospectively evaluated obese patients admitted to an academic tertiary care center for the management of severe sepsis. Patients were included if they had a fluid bolus order placed using the sepsis order set between Oct 2018 and Sept 2019. The primary objective was the composite of progression to septic shock, defined as either persistent hypotension within 3 h after the conclusion of the 30 mL/kg fluid bolus administration or the initiation of vasopressor(s) within 6 h of the bolus administration. RESULTS: Of 72 included patients, 49 (68%) were resuscitated using an IBW-based and 23 (32%) using a non-IBW-based dosing strategy. There were similar rates of progression to septic shock in the IBW and non-IBW groups (18% vs. 26%; p = 0.54). Median ICU and hospital LOS in the IBW group versus non-IBW group were (0 [IQR 0] vs. 0 [IQR 0 to 4] days; p = 0.13) and (6 [IQR 3 to 10] vs. 8 [IQR 5 to 12] days; p = 0.07), respectively. In-hospital mortality rates were similar between the groups. CONCLUSIONS: Our study results suggest that in obese septic patients, fluid administration using an IBW-dosing strategy did not affect the progression to septic shock.
Asunto(s)
Relación Dosis-Respuesta a Droga , Fluidoterapia/normas , Obesidad/complicaciones , Sepsis/terapia , Anciano , Femenino , Fluidoterapia/métodos , Fluidoterapia/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Obesidad/fisiopatología , Resucitación/métodos , Resucitación/normas , Resucitación/estadística & datos numéricos , Estudios Retrospectivos , Sepsis/epidemiología , Sepsis/fisiopatologíaRESUMEN
INTRODUCTION: Historically, there were concerns vasopressors impair free flap outcomes, but recent studies suggest vasopressors are safe. Here we investigate this controversy by (1) evaluating vasopressors' effect on head and neck free-flap survival and surgical complications, and (2) performing soft tissue and bony subset analysis. PATIENTS AND METHODS: Post hoc analysis was performed of a single-blinded, prospective, randomized clinical trial at a tertiary care academic medical center involving patients ≥18 years old undergoing head and neck free flap reconstruction over a 16-month period. Patients were excluded if factors prevented accurate FloTrac™ use. Patients were randomized to traditional volume-based support, or goal-directed support including vasopressor use. Primary data was obtained by study personnel through intraoperative data recording and postoperative medical record review. RESULTS: Forty-one and 38 patients were randomized to traditional and pressor-based algorithms, respectively. Flap survival was 95% (75/79). There was no significant difference between the pressor-based and traditional protocols' flap failure (1/38 [3%] vs. 3/41 [7%], RR 0.36, 95% CI of RR 0.04-3.31, p = .63) or flap-related complications (12/38 [32%] vs. 18/41 [44%], RR 0.72, 95% CI 0.40-1.29, p = .36) Soft tissue flaps had surgical complication rates of 12/30 (40%) and 9/27 (33%) for traditional and pressor-based protocols, respectively. Bony flaps had surgical complication rates of 6/11 (55%), and 3/11 (27%) for traditional and pressor-based protocols, respectively. CONCLUSIONS: Intraoperative goal-directed vasopressor administration during head and neck free flap reconstruction does not appear to increase the rate of flap complications or failures.
Asunto(s)
Colgajos Tisulares Libres , Neoplasias de Cabeza y Cuello , Procedimientos de Cirugía Plástica , Adolescente , Adulto , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Complicaciones Posoperatorias , Estudios Prospectivos , Estudios RetrospectivosRESUMEN
OBJECTIVE: Hemoptysis in the pediatric population may be caused by foreign body aspiration, cystic fibrosis, bronchiectasis, or infection. Vascular causes are uncommon. We present a rare cause of hemoptysis related to a bronchial artery pseudoaneurysm. METHODS: We report the case of a child with a bronchial artery pseudoaneurysm causing hemoptysis and describe the clinical evaluation, treatment, and outcome. RESULTS: A 12-year-old girl presented to a tertiary children's hospital with a history of daily, intermittent, moderate-volume hemoptysis. Rigid bronchoscopy showed a fresh clot occluding the right bronchus intermedius. Computed tomography angiogram was concerning for mild external vascular compression of the right mainstem bronchus. A bronchial arteriogram showed a right mid-bronchial pseudoaneurysm, which was embolized without complication. On repeat bronchoscopy, thrombus was removed from the bronchus intermedius with no new active bleeding. The patient was discharged in stable condition and did not have any more episodes of hemoptysis. Additional medical work-up did not reveal another source of the patient's bleeding. CONCLUSION: Hemoptysis in the pediatric population can be inflammatory, infectious, or due to systemic disease. Although extremely rare, bronchial artery pseudoaneurysm should be considered in cases of moderate to severe intermittent hemoptysis without another identifiable cause. Bronchial angiography can be both diagnostic and therapeutic.
Asunto(s)
Aneurisma Falso/complicaciones , Arterias Bronquiales , Hemoptisis/etiología , Aneurisma Falso/diagnóstico , Aneurisma Falso/terapia , Arterias Bronquiales/diagnóstico por imagen , Broncoscopía , Niño , Embolización Terapéutica , Femenino , Humanos , RadiografíaRESUMEN
BACKGROUND: The availability of paid parental leave is an important factor for retention and wellness. The experiences of head and neck surgeons with parental leave have never been reported. METHODS: A survey was electronically distributed to head and neck subspecialty surgeons in the United States. Responses were collected and analyzed. RESULTS: Male surgeons had more children and took significantly less parental leave than women. Thirty percent of respondents reported that parental leave negatively impacted compensation, and 14% reported a delay in promotion due to leave, which impacted women more than men. The vast majority reported they are happy or neutral about covering those on leave. Most respondents utilized paid childcare, and approximately one quarter of respondents spending 11%-20% of their income on childcare. CONCLUSIONS: This study illuminates the current disparities regarding parental leave-taking within the subspecialty of head and neck surgery in the United States. Women surgeons are more likely to be impacted professionally and financially.
RESUMEN
Text-to-image artificial intelligence (AI) programs are popular public-facing tools that generate novel images based on user prompts. Given that they are trained from Internet data, they may reflect societal biases, as has been shown for text-to-text large language model programs. We sought to investigate whether 3 common text-to-image AI systems recapitulated stereotypes held about surgeons and other health care professionals. All platforms queried were able to reproduce common aspects of the profession including attire, equipment, and background settings, but there were differences between programs most notably regarding visible race and gender diversity. Thus, historical stereotypes of surgeons may be reinforced by the public's use of text-to-image AI systems, particularly those without procedures to regulate generated output. As AI systems become more ubiquitous, understanding the implications of their use in health care and for health care-adjacent purposes is critical to advocate for and preserve the core values and goals of our profession.
RESUMEN
OBJECTIVE: Letters of reference (LORs) play an important role in postgraduate residency applications. Human-written LORs have been shown to carry implicit gender bias, such as using more agentic versus communal words for men, and more frequent doubt-raisers and references to appearance and personal life for women. This can result in inequitable access to residency opportunities for women. Given the known gendered language often unconsciously inserted into human-written LORs, we sought to identify whether LORs generated by artificial intelligence exhibit gender bias. STUDY DESIGN: Observational study. SETTING: Multicenter academic collaboration. METHODS: Prompts describing identical men and women applying for Otolaryngology residency positions were created and provided to ChatGPT to generate LORs. These letters were analyzed using a gender-bias calculator which assesses the proportion of male- versus female-associated words. RESULTS: Regardless of the gender, school, research, or other activities, all LORs generated by ChatGPT showed a bias toward male-associated words. There was no significant difference between the percentage of male-biased words in letters written for women versus men (39.15 vs 37.85, P = .77). There were significant differences in gender bias found by each of the other discrete variables (school, research, and other activities) chosen. CONCLUSION: While ChatGPT-generated LORs all showed a male bias in the language used, there was no gender bias difference in letters produced using traditionally masculine versus feminine names and pronouns. Other variables did induce gendered language, however. ChatGPT is a promising tool for LOR drafting, but users must be aware of potential biases introduced or propagated through these technologies.
RESUMEN
Importance: Closure technique for optimization of postoperative and functional outcomes following salvage laryngectomy remains an area of debate among head and neck surgeons. Objective: To investigate the association of salvage laryngectomy closure technique with early postoperative and functional outcomes. Design, Setting, and Participants: This retrospective cohort study included patients from 17 academic, tertiary care centers who underwent total laryngectomy with no or limited pharyngectomy after completing a course of definitive radiotherapy or chemoradiotherapy with curative intent between January 2011 and December 2016. Patients with defects not amenable to primary closure were excluded. Data were analyzed from February 14, 2021, to January 29, 2024. Exposures: Total laryngectomy with and without limited pharyngectomy, reconstructed by primary mucosal closure (PC), regional closure (RC), or free tissue transfer (FTT). Main Outcomes and Measures: Patients were stratified on the basis of the pharyngeal closure technique. Perioperative and long-term functional outcomes were evaluated with bivariate analyses. A multivariable regression model adjusted for historical risk factors for pharyngocutaneous fistula (PCF) was used to assess risk associated with closure technique. Relative risks (RRs) with 95% CIs were determined. Results: The study included 309 patients (256 [82.8%] male; mean age, 64.7 [range, 58.0-72.0] years). Defects were reconstructed as follows: FTT (161 patients [52.1%]), RC (64 [20.7%]), and PC (84 [27.2%]). A PCF was noted in 36 of 161 patients in the FTT group (22.4%), 25 of 64 in the RC group (39.1%), and 29 of 84 in the PC group (34.5%). On multivariable analysis, patients undergoing PC or RC had a higher risk of PCF compared with those undergoing FTT (PC: RR, 2.2 [95% CI, 1.1-4.4]; RC: RR, 2.5 [95% CI, 1.3-4.8]). Undergoing FTT was associated with a clinically meaningful reduction in risk of PCF (RR, 0.6; 95% CI, 0.4-0.9; number needed to treat, 7). Subgroup analysis comparing inset techniques for the RC group showed a higher risk of PCF associated with PC (RR, 1.8; 95% CI, 1.1-3.0) and predominately pectoralis myofascial flap with onlay technique (RR, 1.9; 95% CI, 1.2-3.2), but there was no association of pectoralis myocutaneous flap with cutaneous paddle interposition with PCF (RR, 1.2; 95% CI, 0.5-2.8) compared with FTT with cutaneous inset. There were no clinically significant differences in functional outcomes between the groups. Conclusion and Relevance: In this study of patients with limited pharyngeal defects, interpositional fasciocutaneous closure technique was associated with reduced risk of PCF in the salvage setting, which is most commonly achieved by FTT in academic practices. Closure technique was not associated with functional outcomes at 1 and 2 years postoperatively.
Asunto(s)
Neoplasias Laríngeas , Laringectomía , Faringectomía , Terapia Recuperativa , Humanos , Laringectomía/métodos , Masculino , Femenino , Estudios Retrospectivos , Terapia Recuperativa/métodos , Persona de Mediana Edad , Neoplasias Laríngeas/cirugía , Anciano , Faringectomía/métodos , Procedimientos de Cirugía Plástica/métodos , Complicaciones Posoperatorias/epidemiología , Enfermedades Faríngeas/cirugía , Fístula CutáneaRESUMEN
OBJECTIVES: Microvascular free tissue transfer is routinely used for reconstructing midface defects in patients with malignancy, however, studies regarding reconstructive outcomes in invasive fungal sinusitis (IFS) are lacking. We aim to describe outcomes of free flap reconstruction for IFS defects, determine the optimal time to perform reconstruction, and if anti-fungal medications or other risk factors of an immunocompromised patient population affect reconstructive outcomes. METHODS: Retrospective review of reconstruction for IFS (2010-2022). Age, BMI, hemoglobin A1c, number of surgical debridements, and interval from the last debridement to reconstruction were compared between patients with delayed wound healing versus those without. Predictor variables for delayed wound healing and the effect of time on free flap reconstruction were analyzed. RESULTS: Twenty-seven patients underwent free flap reconstruction for IFS. Three patients were immunocompromised from leukemia and 21 had diabetes mellitus (DM). Patients underwent an average of four surgical debridements for treatment of IFS. The interval from the last IFS debridement to flap reconstruction was 5.58 months (±5.5). Seven flaps (25.9%) had delayed wound healing. A shorter interval of less than 2 months between the last debridement for IFS and reconstructive free flap procedure was associated with delayed wound healing (Fisher Exact Test p = 0.0062). Other factors including DM, BMI, HgA1c, and bone reconstruction were not associated with delayed wound healing. CONCLUSION: Patients with maxillectomy defects from IFS can undergo microvascular-free flap reconstruction with good outcomes while on anti-fungal medication. Early reconstruction in the first 2 months after the last IFS debridement is associated with delayed wound healing. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:1642-1647, 2024.
Asunto(s)
Colgajos Tisulares Libres , Infecciones Fúngicas Invasoras , Senos Paranasales , Procedimientos de Cirugía Plástica , Sinusitis , Humanos , Colgajos Tisulares Libres/irrigación sanguínea , Huesos Faciales , Sinusitis/cirugía , Sinusitis/microbiología , Estudios RetrospectivosRESUMEN
Although total laryngectomy continues to be important treatment of supraglottic laryngeal cancer, the management of early-stage disease has evolved from primary radiation/chemoradiation to consideration of partial laryngectomy surgery. Surgeon experience and careful patient selection can lead to excellent oncologic and functional outcomes for these techniques. However, advanced stage tumors and salvage situations are challenging and the ability to eradicate disease and preserve function should be carefully considered. Contraindications to supraglottic laryngectomy depend on surgical approach, as do complications. With adequate patient selection, high rates of cure and function can be achieved with both open and transoral supraglottic laryngectomy procedures.
Asunto(s)
Neoplasias Laríngeas , Laringe , Procedimientos Quirúrgicos Robotizados , Humanos , Neoplasias Laríngeas/cirugía , Neoplasias Laríngeas/patología , Laringe/patología , Laringectomía/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Quimioradioterapia , Resultado del TratamientoRESUMEN
BACKGROUND: Tumor-specific molecular imaging in head and neck squamous cell carcinoma (HNSCC) is not well established. Somatostatin receptors (SSTRs) are found in solid tumors, including HNSCC. 68 Ga-DOTATATE, a commercially available radionuclide that binds SSTRs, may have utility in imaging HNSCC. METHODS: Patients with HNSCC received pretreatment imaging with 18 F-FDG-PET/CT and 68 Ga-DOTATATE. Imaging was compared for concordance. When available, surgical resection specimens were compared to pretreatment imaging findings. Historic HNSCC tumor specimens were assessed for both SSTR and p16/human papilloma virus (HPV) expression. RESULTS: Twenty patients were imaged. Fifteen had oropharyngeal cancer. Primary tumor site was concordant between imaging modalities for all patients. One of 45 lymph nodes was discordant. Retrospective specimen review showed a significant correlation with SSTR expression and HPV/p16 expression. No adverse events occurred. CONCLUSIONS: 68 Ga-DOTATATE imaging is safe and effective in HNSCC. SSTR expression may be increased in HPV-mediated tumors. Targeted therapies to SSTR should be explored.
Asunto(s)
Neoplasias de Cabeza y Cuello , Compuestos Organometálicos , Infecciones por Papillomavirus , Humanos , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Fluorodesoxiglucosa F18 , Carcinoma de Células Escamosas de Cabeza y Cuello/diagnóstico por imagen , Estudios Retrospectivos , Electrones , Tomografía de Emisión de Positrones/métodos , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/terapia , RadiofármacosRESUMEN
PURPOSE: Radial forearm free tissue transfer (RFFF) has been an extremely reliable reconstructive option for head and neck oncologic defects for over 30âyears. With high reliability, interest has shifted in minimizing donor site morbidity, much of which results from closure techniques. RECENT FINDINGS: Portable negative pressure wound devices, newer dermal substitutes, and local flap techniques have improved donor site aesthetics and function. SUMMARY: Outcomes of the RFFF donor site may benefit from newer techniques in closure.
Asunto(s)
Colgajos Tisulares Libres , Procedimientos de Cirugía Plástica , Antebrazo , Humanos , Morbilidad , Reproducibilidad de los ResultadosRESUMEN
OBJECTIVE: To determine if anxiety, stress, depression, worry, and intolerance of uncertainty were related to pre-operative decisional conflict (DC), shared decision making (SDM), or demographic variables in adult otolaryngology surgical patients. METHODS: Consecutive adult patients meeting criteria for otolaryngological surgery were recruited and completed DC and SDM scales, Penn State Worry Questionnaire (PSWQ), Intolerance of Uncertainty Scale (IUS-12), and Depression, Anxiety and Stress Scale-21 (DASS-21). RESULTS: The cohort included 118 patients, 61 (51.7%) males and 57 (48.3%) females. Surgery was planned for a benign process in 90 (76.3%) and 46 (39.3%) had previous otolaryngologic surgery. SDM and DC scores did not significantly differ across gender, age, education level, previous otolaryngologic surgery or whether or not surgery was for malignancy. Patients with no malignancy had significantly higher DASS-21 Stress scores (mean 12.94 vs 8.15, P < .05) and total IUS-12 scores (mean 28.63 vs 25.56, P = .004). Women had lower PSWQ scores (41.56 vs 50.87 for men, P = .006). IUS-12 and PSWQ declined with age. DC scores correlated positively with DASS-21 Depression (r = .256, P = .008) and IUS-12 scores (r = .214, P = .024). SDM correlated negatively with DASS-21 Depression (r = -.208, P = .030). Linear regression model for DC scores revealed a significant relationship with DASS depression (B = 0.674, P = .048). CONCLUSION: Preoperative decisional conflict is associated with increased depression and intolerance of uncertainty in adults undergoing otolaryngologic surgery. Screening for and management of depression, anxiety, and related concerns may improve surgical outcomes in this group.
Asunto(s)
Ansiedad/epidemiología , Conflicto Psicológico , Toma de Decisiones Conjunta , Depresión/epidemiología , Procedimientos Quirúrgicos Otorrinolaringológicos/psicología , Incertidumbre , Adolescente , Adulto , Anciano , Ansiedad/diagnóstico , Estudios de Cohortes , Depresión/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: Burnout has been previously assessed in head and neck microvascular reconstructive surgeons (HNMVS), but not in the context of modifiable workplace factors. METHODS: Anonymous, cross-sectional survey. The Abbreviated Maslach Burnout Inventory - Human Services Survey for Medical Personnel (aMBI-HSS) was utilized to assess emotional exhaustion (EE), depersonalization (DP), and personal achievement (PA). Modifiable risk factors were also evaluated. RESULTS: High risk of burnout by EE, DP, and PA was demonstrated in 24%, 9%, and 27% of respondents, respectively. EE was associated with <10% dedicated research time, lack of autonomy over clinic schedule, inadequate inpatient support, and lack of supportive clinical partner. DP was associated with >3 operative days, difficulty balancing academic commitments, and lack of supportive clinical partner. Dedicated research time and two or fewer days of block time were protective. CONCLUSIONS: Burnout was associated with several modifiable workplace factors. Addressing these may prevent moderate to severe burnout in HNMVS.
Asunto(s)
Agotamiento Profesional , Otolaringología , Cirujanos , Agotamiento Profesional/epidemiología , Estudios Transversales , Humanos , Encuestas y Cuestionarios , Lugar de TrabajoRESUMEN
OBJECTIVE/HYPOTHESIS: Early and objective prediction of complications in head and neck reconstructive surgery could decrease morbidity and prolonged hospital stays but unfortunately most complications are not identified until their effect is fully realized. There are limited data regarding the association of platelet levels and post-operative complications. Post-operative thrombocytosis (POTCT) is proposed as a possible indicator for complications following free-flap reconstruction. STUDY DESIGN: Retrospective review. METHODS: A multisite retrospective chart review of patients undergoing free tissue transfer between 2013 and 2018 was undertaken. POTCT was recorded and data normalized between institutions. Data were compared between groups using t-tests and logistic regression (P < .05). A lag-1 difference was used to compare the rate of change in platelet values. RESULTS: A total of 398 patients were included. POTCT and a rate of change of 30 K between POD5 and POD6 was significantly associated with the presence of post-operative complication (P = .007). Additionally, lag-1 difference demonstrated a significant association of change in daily platelet counts and complication rates. CONCLUSIONS: Isolated POTCT may be an early predictor of complications in HNC patients undergoing free-flap reconstruction. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:1542-1547, 2021.
Asunto(s)
Colgajos Tisulares Libres/efectos adversos , Neoplasias de Cabeza y Cuello/cirugía , Microcirugia/efectos adversos , Infección de la Herida Quirúrgica/epidemiología , Trombocitosis/epidemiología , Femenino , Colgajos Tisulares Libres/trasplante , Neoplasias de Cabeza y Cuello/sangre , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Microcirugia/métodos , Proyectos Piloto , Recuento de Plaquetas , Periodo Posoperatorio , Valor Predictivo de las Pruebas , Curva ROC , Valores de Referencia , Reproducibilidad de los Resultados , Estudios Retrospectivos , Medición de Riesgo/métodos , Factores de Riesgo , Infección de la Herida Quirúrgica/etiología , Trombocitosis/sangre , Trombocitosis/diagnósticoRESUMEN
BACKGROUND: The SARS-CoV-2 (COVID-19) pandemic has caused rapid changes in head and neck cancer (HNC) care. "Real-time" methods to monitor practice patterns can optimize provider safety and patient care. METHODS: Head and neck surgeons from 14 institutions in the United States regularly contributed their practice patterns to a shared spreadsheet. Data from 27 March 2020 to 5 April 2020 was analyzed. RESULTS: All institutions had significantly restricted HNC clinic evaluations. Two institutions stopped free-flap surgery with the remaining scheduling surgery by committee review. Factors contributing to reduced clinical volume included lack of personal protective equipment (PPE) (35%) and lack of rapid COVID-19 testing (86%). CONCLUSIONS: The COVID-19 pandemic has caused a reduction in HNC care. Rapid COVID-19 testing and correlation with infectious potential remain paramount to resuming the care of patients with head and neck cancer. Cloud-based platforms to share practice patterns will be essential as the pandemic evolves.
Asunto(s)
Infecciones por Coronavirus/epidemiología , Neoplasias de Cabeza y Cuello/cirugía , Microcirugia/métodos , Pandemias/prevención & control , Neumonía Viral/epidemiología , Pautas de la Práctica en Medicina/organización & administración , Oncología Quirúrgica/organización & administración , COVID-19 , Prueba de COVID-19 , Técnicas de Laboratorio Clínico , Control de Enfermedades Transmisibles/organización & administración , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/prevención & control , Bases de Datos Factuales , Femenino , Neoplasias de Cabeza y Cuello/patología , Humanos , Masculino , Oncología Médica/organización & administración , Seguridad del Paciente/estadística & datos numéricos , Neumonía Viral/prevención & control , Evaluación de Programas y Proyectos de Salud , Estudios Retrospectivos , Sociedades Médicas , Encuestas y Cuestionarios , Estados UnidosRESUMEN
INTRODUCTION: Lingual thyroid cancer is a rare entity with a paucity of literature guiding methods of surgical treatment. Its location presents anatomic challenges with access and excision. OBJECTIVE: We present a case of T4aN1b classical variant papillary thyroid carcinoma of the lingual thyroid that was removed without pharyngeal entry. We also present a review of the literature of this rare entity and propose a treatment algorithm to provide safe and oncologic outcomes. FINDINGS: Our review of the literature found 28 case reports of lingual thyroid carcinoma that met search criteria. The trans-cervical/trans-hyoid approach was the most frequently used and provides safe oncologic outcomes. This was followed by the transoral approach and then lateral pharyngotomy. Complications reported across the series include 1 case of pharyngocutaneous fistula associated with mandibulotomy and postoperative respiratory distress requiring reintubation or emergent tracheostomy in 2 patients. CONCLUSION: The location of lingual thyroid carcinoma can be variable, and surgical management requires knowledge of adjacent involved structures to decrease the risk of dysphagia and airway compromise. In particular, for cases where there is extensive loss to swallowing mechanisms, laryngeal suspension can allow the patient to resume a normal diet after treatment.