Rate of Fat Graft Volume Loss After Parotidectomy.

BACKGROUND: Reconstruction after parotidectomy can include fat grafting, which allows for symmetry, but grafts have demonstrated volume loss over time. OBJECTIVES: To provide quantitative evidence for the rate of volume loss of fat grafts. METHODS: Patients who received parotidectomy with fat graft reconstruction at a single institution from August 2016 to October 2020 were identified. Relationships between clinical factors and the logarithmic rate of fat graft volume loss were analyzed. RESULTS: Twelve patients received parotidectomy, fat graft reconstruction, and underwent a postoperative magnetic resonance imaging (MRI) scan. Rate of fat graft volume loss was a mean of 1.8% per month (standard deviation [SD]: 2.1% per month). Total parotid fat graft volume loss was a mean of 57.4% (SD: 67.5%). The mean follow-up time was 35.5 months (range: 9-89.8 months). Correlations between body mass index (BMI), history of smoking, and history of alcohol consumption and logarithmic rates of fat graft volume loss were increased but not significantly. CONCLUSIONS: Fat grafts have the potential of 60% volume loss at approximately 1 year. If there is clinical suspicion that patients will require adjuvant radiation or have clinical factors such as a smoking or alcohol-use history, volume requirements may be even greater to maintain adequate parotid volume for aesthetic purposes.

Nerve monitoring and stimulation during endoscopic neck surgery in the pig.

OBJECTIVES: To determine the feasibility of recurrent laryngeal nerve monitoring and stimulation during endoscopic neck surgery in an animal model. STUDY DESIGN: Prospective, nonrandomized experimental investigation in a porcine model. METHODS: Bilateral recurrent laryngeal nerve monitoring and stimulation was accomplished during endoscopic neck surgery in five domestic pigs. Each pig was intubated with an electromyography endotracheal tube. Recurrent laryngeal nerve function was monitored throughout the endoscopic neck surgery with a nerve integrity monitor system. An endoscopic surgical pocket was created in the neck using blunt dissection followed by low-pressure carbon dioxide insufflation. Under direct endoscopic visualization, the trachea, thyroid gland, and associated vasculature were identified. The recurrent laryngeal nerve was identified on each side of the animal and was successfully stimulated with a monopolar stimulator probe. RESULTS: Ten of ten recurrent laryngeal nerves were successfully monitored and stimulated. No significant complications were encountered during the procedures. CONCLUSIONS: Recurrent laryngeal nerve monitoring and stimulation may be successfully accomplished during endoscopic neck surgery.

Color-specific enhancement of digital photographs for identification of the extent of cutaneous malignancy.

OBJECTIVES: To introduce the concept of active digital imaging to the literature and to support further investigation by showing the utility of photochromatography in the identification of cutaneous cancer margins METHODS: Digital color images of 10 cutaneous basal cell carcinomas were digitally enhanced to highlight color change in and around each lesion. After the most intense area of tumor coloration was located and sampled, the color was digitally changed to a sharply contrasting color across the entire region, thereby highlighting abnormal areas not readily seen by the unaided eye. The enhanced areas of predicted tumor extent were compared with digital images of the resulting defect after treatment with Mohs micrographic surgery. RESULTS: The extent of tumor was predicted with good accuracy in 5 cases and with fair accuracy in 2 cases and was not determinable in the remaining 2 cases. In no case did photochromatography overestimate the extent of the lesion. CONCLUSIONS: Digital highlighting of color change not readily seen by the unaided eye (photochromatography) can improve identification and localization of cutaneous tumor. Our findings justify further investigation into algorithms for photographic color detection and enhancement in the evaluation of tissue change.