Rates of osteoradionecrosis in resected oral cavity cancer reconstructed with free tissue transfer in the intensity-modulated radiotherapy era.

BACKGROUND: Resected oral cavity carcinoma defects are often reconstructed with osteocutaneous or soft-tissue free flaps, but risk of osteoradionecrosis (ORN) is unknown. METHODS: This retrospective study included oral cavity carcinoma treated with free-tissue reconstruction and postoperative IMRT between 2000 and 2019. Risk-regression assessed risk factors for grade ≥2 ORN. RESULTS: One hundred fifty-five patients (51% male, 28% current smokers, mean age 62 ± 11 years) were included. Median follow-up was 32.6 months (range, 1.0-190.6). Thirty-eight (25%) patients had fibular free flap for mandibular reconstruction, whereas 117 (76%) had soft-tissue reconstruction. Grade ≥2 ORN occurred in 14 (9.0%) patients, at a median 9.8 months (range, 2.4-61.5) after IMRT. Post-radiation teeth extraction was significantly associated with ORN. One-year and 10-year ORN rates were 5.2% and 10%, respectively. CONCLUSIONS: ORN risk was comparable between osteocutaneous and soft-tissue reconstruction for resected oral cavity carcinoma. Osteocutaneous flaps can be safely performed with no excess concern for mandibular ORN.

A case of Cheyne-Stokes breathing emerging in a patient with atrial fibrillation and an implanted hypoglossal nerve stimulator.

Treatment emergent central sleep apnea (TECSA) can occur with positive airway pressure (PAP) therapy, mandibular advancement devices, and now recent cases with hypoglossal nerve stimulator (HNS) therapy during treatment for obstructive sleep apnea (OSA). There have been few published reports of Cheyne-Stokes breathing (CSB) emerging after implantation of an HNS. We present a case of a 76-year-old male with chronic atrial fibrillation and OSA who developed significant CSB after implantation of an HNS device. As popularity increases for alternative treatments of OSA, there should be close monitoring for emergence of CSB, especially in those who may have a propensity for high loop gain abnormalities contributing to central sleep apneas, such as patients with chronic atrial fibrillation. Further research is needed on CSA in patients with HNS implantation and atrial fibrillation, the prevalence of TECSA in the growing HNS therapy population, and the development of future management strategies. CITATION: Hong H, Oster J, Grover A, Ismail K. A case of Cheyne-Stokes breathing emerging in a patient with atrial fibrillation and an implanted hypoglossal nerve stimulator. J Clin Sleep Med. 2021;17(8):1731-1735.