Modified genioglossus advancement with radiofrequency tongue base reduction for retroglossal collapse in Obstructive sleep apnea patients.

OBJECTIVE: To study the combined effect of modified genioglossus advancement (MGGA) and radiofrequency tongue base reduction (RFTBR) a long with anterolateral advancement (ALA) pharyngolplasty on OSA patients with retrolingual airway collapse. STUDY DESIGN: Prospective clinical study. SETTING: Zagazig and Benha Universities Medical Hospitals. PATIENTS AND METHODS: Twenty-one patients (21)with multilevel OSA underwent modified genioglossus advancement with radiofrequency tongue base reduction and anterolateral advancement pharyngolplasty. All patients were assessed before and 6 months after surgery by history talking, clinical examination, Epworth Sleepiness Scale evaluation fiberoptic examination during muller's maneuver, drug induced sleep endoscopy (DISE), panoramic X-ray, Cephalometry and polysomnography. RESULTS: Postoperative mean ± SD Epworth Sleepiness Scale (ESS) significantly decreased from 18.86 ± 2.03to 8.19 ± 1.86 (P-value was <0.001 95% (CI) 9.80 to 11.53).postoperative mean ± SD AHI decreased from 53.39 ± 14.10 to 26.66 ± 5.44 (P-value was <0.001 95% CI 22.37 to 32.81), postoperative mean ± SD LOS increased from 68.33 ± 9.12 to 86.0 ± 4.96 (P-value was <0.001 95% (CI) 15.24 to21.33).Based on cephalometric analysis postoperative mean ± SD PAS at mid retrolingual point in mm increased from 6.43 ± 1.25 to 11.98 ± 1.69 (P-value was <0.001 95% (CI) 4.78 to 6.32), also postoperative mean ± SD Distance between H-MP in mm decreased from 23.38 ± 1.14 to 15.17 ± 0.97 (P-value was 0.001 95% (CI) 7.66 to 8.76).The postoperative mean ± SD distance from hyoid to menton (H-me) in mm decreased from 39.47 ± 2.37to24.83 ± 2.43(P-value was 0.001 95% (CI) 7.31 to 8.41), the mean ± SD distance of genioglossus muscle advancement in mm was 14.45 ± 1.12.With a success rate defined as AHI < 20 and/or 50% reduction in AHI of the pre- operative value, the surgical success was 81%. CONCLUSION: MGGA with RFTBR along with anterolateral advancement pharyngoplasty in a single session is well tolerated and safe surgery in the treatment of multilevel OSA patients. It is effective in reducing respiratory parameters and subjective symptoms of OSA.

An update on the current management of head and neck mucosal melanoma.

Primary mucosal melanomas of the head and neck are rare and aggressive tumours that arise in the nasal cavity, paranasal sinuses and more rarely in the oral cavity. The current treatment options include radical surgical resection with adjuvant external beam radiotherapy being offered in high-risk patients. Although the latter can improve regional control, it does not reduce overall survival. Elective neck dissection is recommended for nodular oral mucosal melanoma, but its role in the clinically node negative neck is controversial. Systemic therapies including the use of tyrosine kinase inhibitors for tumours with c-KIT mutations are suitable for patients with advanced loco-regional and/or metastatic disease, but current results are variable. Patients with head and neck mucosal melanoma have a poor prognosis due to the high incidence of metastatic disease. This review assesses the latest evidence in the diagnosis and management of primary oral and head and neck mucosal melanoma including details of systemic therapies.

A cohort study of 30 day mortality after NON-EMERGENCY surgery in a COVID-19 cold site.

BACKGROUND: Two million non-emergency surgeries are being cancelled globally every week due to the COVID-19 pandemic, which will have a major impact on patients and healthcare systems. METHODS: During the peak of the pandemic in the United Kingdom, we set up a multicentre cancer network amongst 14 National Health Service institutions, performing urological, thoracic, gynaecological and general surgical urgent and cancer operations at a central COVID-19 cold site. This is a cohort study of 500 consecutive patients undergoing surgery in this network. The primary outcome was 30-day mortality from COVID-19. Secondary outcomes included all-cause mortality and post-operative complications at 30-days. RESULTS: 500 patients underwent surgery with median age 62.5 (IQR 51-71). 65% were male, 60% had a known diagnosis of cancer and 61% of surgeries were considered complex or major. No patient died from COVID-19 at 30-days. 30-day all-cause mortality was 3/500 (1%). 10 (2%) patients were diagnosed with COVID-19, 4 (1%) with confirmed laboratory diagnosis and 6 (1%) with probable COVID-19. 33/500 (7%) of patients developed Clavien-Dindo grade 3 or higher complications, with 1/33 (3%) occurring in a patient with COVID-19. CONCLUSION: It is safe to continue cancer and urgent surgery during the COVID-19 pandemic with appropriate service reconfiguration.