Update on orbital decompression as emergency treatment of traumatic blindness.

INTRODUCTION: Blindness is a rare and severe complication of craniofacial trauma. The management of acute orbital compartment syndrome (AOCS) is not well defined and there is no standard treatment. Our objective was to find indications for orbital decompression, the best time for treatment, and the appropriate techniques. MATERIALS AND METHODS: A literature review was made from articles published between 1994 and 2014 in the PubMed database, on the emergency treatment of AOCS. RESULTS: 59 of the 89 patients treated surgically for AOCS presented with significant improvement of visual acuity (VA) after orbital decompression. The delay between trauma and surgery was short. A lateral canthotomy with inferior cantholysis (LCIC) was the most frequently used technique. DISCUSSION: AOCS with a risk of visual impairment must be decompressed in emergency, at best in the 2 hours following trauma, most often by LCIC to have the best chance of recovering VA. Adjuvant medical treatment (acetazolamide, mannitol, corticosteroids) should not delay surgery. Postoperative corticosteroid therapy is not indicated, especially in patients with severe head trauma.

Salvage circular laryngopharyngectomy and radial forearm free flap for recurrent hypopharyngeal cancer.

OBJECTIVES/HYPOTHESIS: To evaluate surgical and long-term oncologic outcomes in a series of patients who underwent circular total laryngopharyngectomy with tubed radial forearm free flap as salvage surgery. STUDY DESIGN: Retrospective study in two tertiary referral centers. METHODS: Twenty-one patients who underwent surgery between 2001 and 2010 were included in the study. All patients underwent surgery for recurrence of advanced hypopharyngeal squamous cell carcinoma previously treated by chemoradiotherapy (CRT) or surgery followed by postoperative radiotherapy or CRT. Overall survival (OS) and disease-free survival (DFS) were determined by Kaplan-Meier analysis. The search for parameters that could influence long-term oncologic outcomes was carried out by univariate and multivariate analysis using log-rank test and Cox regression models. RESULTS: Median follow-up was 30 months. The 1, 2, and 5-year OS rates were 46%, 40%, and 16%, and the DFS rates were 42%, 30%, and 15%, respectively. Free flap failure (P [log rank] = .014 and P [Cox] = .016) and positive margins (P [log rank] = .001 and P [Cox] = .001) were found to have a significant negative impact on both OS and DFS in both univariate and multivariate analysis. CONCLUSIONS: Salvage surgery remains the only curative option as treatment of recurrent hypopharyngeal squamous cell carcinoma and should be offered to patients when possible. However, selection of patients eligible for this type of surgery and the choice of reconstructive procedure are crucial since long-term survival is clearly correlated with the presence of clear margins and the absence of free flap failure.