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Background: Transoral Robotic Surgery (TORS) has been increasingly employed in head and neck surgery for the assessment and treatment of malignancies over the last two decades. PuraBond® is a self-assembling viscous solution that forms a transparent hydrogel 3-D matrix to promote local haemostasis. This study aimed to assess the utility of PuraBond® in patients undergoing TORS for Human Papilloma Virus (HPV) positive oropharyngeal squamous cell carcinoma (OPSCC). Methods: All patients who underwent TORS with PuraBond® between October 2021-May 2022 at a single tertiary university hospital in the United Kingdom were included. Primary outcome measures included post-operative haemorrhage rate (primary; within 24hrs of surgery, secondary; 1-30 days post-surgery). Secondary outcome measures included, Length Of hospital Stay (LOS), swallowing complications, hospital re-admission, and surgeon-reported ease of PuraBond® application. Results: Twelve patients were included (13 procedures due to one second look and re-resection case). No patients developed primary or secondary post-operative haemorrhage. There were no re-attendances within 30 days. Average LOS was 2.78 days (range: 1.54-4.31 days). No patient required feeding tube insertion or tracheostomy. In all procedures, the use of PuraBond® was reported as 'easy'. Conclusion: This is the first study to evaluate the role of PuraBond® in TORS. The wide range of favourable outcomes reported support its safety and efficacy. The current findings mandate the need for larger, prospective, controlled studies to better define whether the known haemostatic and regenerative properties of PuraBond® may translate into direct patient benefit in the expanding field of TORS for HPV-mediated OPSCC.
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BACKGROUND: Skeletal muscle mass (SMM) and chronic inflammation are associated with postoperative complications and survival. METHODS: Patients with head and neck cancer (HNC) undergoing microvascular free flap reconstruction were included. SMM and neutrophil-to-lymphocyte ratio (NLR) were measured and their association with treatment outcomes analyzed. RESULTS: Five hundred and fifty-four patients were included. Predictors for complications were elevated NLR in all flaps (OR 1.5), low SMM in radial forearm flap (OR 2.0), and elevated NLR combined with low SMM in fibula flap surgery (OR 4.3). Patients with solely elevated NLR were at risk for flap-related complications (OR 3.0), severe complications (OR 2.2), and when combined with low SMM for increased length of hospital stays (LOS) (+3.9 days). In early-stage HNC, low SMM (HR 2.3), and combined elevated NLR with low SMM (HR 2.6) were prognostics for decreased overall survival. CONCLUSIONS: SMM and NLR are predictive for poor outcomes in patients with HNC undergoing microvascular reconstruction.
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Colgajos Tisulares Libres , Neoplasias de Cabeza y Cuello , Procedimientos de Cirugía Plástica , Colgajos Tisulares Libres/irrigación sanguínea , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Inflamación , Músculo Esquelético , Complicaciones Posoperatorias/epidemiología , Procedimientos de Cirugía Plástica/efectos adversos , Estudios Retrospectivos , Colgajos QuirúrgicosRESUMEN
PURPOSE: This ambispective observational study aims to evaluate the local utility of peri-operative CRP testing and prophylactic antibiotics in relation to post-operative complications in patients who have undergone major head and neck oncological reconstructive surgery. RESULTS: A total of 79 patients were identified for inclusion; CRP testing was undertaken within the first 3 days postoperatively in 78/79 cases. Results demonstrated no benefit of extended prophylactic antibiotic use in reducing post-operative infection. Forty-two post-operative complications arose. In the prospective arm, CRP did not influence the decision to commence antibiotic therapy for any of the surgical site infections. Age, diabetes, smoking, or high body mass index (BMI) did not appear to affect the incidence of postoperative infection (p > 0.05). There is no evidence that more than 24 h of antibiotic prophylaxis is indicated for patients undergoing head and neck reconstructive surgery. CONCLUSION: Everyone who is involved in peri-operative patient care should be educated regarding the appropriate use of CRP testing, with the implementation of protocols required to standardize CRP testing and prophylactic antibiotic prescription.
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Neoplasias de Cabeza y Cuello , Procedimientos de Cirugía Plástica , Antibacterianos/uso terapéutico , Profilaxis Antibiótica , Proteína C-Reactiva , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Evaluación de Resultado en la Atención de Salud , Estudios Prospectivos , Procedimientos de Cirugía Plástica/métodos , Infección de la Herida Quirúrgica/prevención & controlRESUMEN
Malignant mesotheliomas (MMs) are malignancies of the mesothelium, with primary deposits originating in the pleura, peritoneum, pericardium and the tunica vaginalis (ie, testicular). Metastatic spread is commonly reported to affect the liver, adrenal glands, kidney and contralateral lung (in cases of malignant pleural mesothelioma). Metastases to distant sites are uncommon. Spread to the oral cavity in particular is very rare. A total of 23 cases of metastatic spread to the oral cavity have been reported in the literature to date; of those, 9 cases have been to the tongue. Given the rarity of the site of metastasis, the management remains challenging. This case highlights a rare site of metastasis in MM, discusses treatment options available and briefly talks about technical limitations in treating a mobile structure such as the tongue. Good palliative and supportive care is crucial in managing cases where no curative treatment is possible.
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Mesotelioma Maligno , Mesotelioma , Humanos , Masculino , Mesotelioma/diagnóstico por imagen , Pleura , Testículo , LenguaRESUMEN
The use of in-house 3D planning and manufacture has become more common in high-volume head and neck reconstructive centers worldwide. Various fibula cutting guides have been designed to allow for accurate and predictable head and neck reconstruction. In this paper, we describe the design, manufacture, and operative technique for use of a novel fibula cutting guide with detachable connecting arms. This straightforward design produces a guide that is less bulky, provides better access for safe osteotomies, and is versatile and adjustable to minimize bone removal between segments.
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Colgajos Tisulares Libres , Reconstrucción Mandibular , Procedimientos de Cirugía Plástica , Cirugía Asistida por Computador , Diseño Asistido por Computadora , Peroné/cirugía , Humanos , OsteotomíaRESUMEN
The term oral potentially malignant disorders, proposed at the World Health Organization workshop in 2005, has now been renamed potentially premalignant oral epithelial lesions (PPOELs). It is important to differentiate among PPOELs, which is a broad term to define a wide variety of clinical lesions, and oral epithelial dysplasia, which should be reserved specifically for lesions with biopsy-proven foci of dysplasia. PPOELs encompass lesions that include leukoplakia, erythroplakia, erythroleukoplakia, lichen planus, and oral submucous fibrosis. The primary goal of management of dysplasia includes prevention, early detection, and treatment before malignant transformation. The aim of this article is to inform the clinician about management of PPOELs.
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Transformación Celular Neoplásica/patología , Eritroplasia/patología , Eritroplasia/terapia , Leucoplasia Bucal/patología , Leucoplasia Bucal/terapia , Neoplasias de la Boca/prevención & control , Lesiones Precancerosas/patología , Lesiones Precancerosas/terapia , Diagnóstico Bucal , Progresión de la Enfermedad , Diagnóstico Precoz , Humanos , Liquen Plano Oral/patología , Liquen Plano Oral/terapia , Neoplasias de la Boca/patología , Fibrosis de la Submucosa Bucal/patología , Fibrosis de la Submucosa Bucal/terapia , Factores de RiesgoRESUMEN
Solitary bone cysts are uncommon. They have a reported incidence of 0.6% and are commonest in the mandible. The case of a 16-year-old patient who attended Accident and Emergency with a fractured mandible and the incidental finding of a solitary bone cyst is presented. Solitary bone cysts are usually asymptomatic and generally heal fully following surgical exploration. CPD/Clinical Relevance: This case report aims to increase awareness of the general dental practitioner of solitary bone cysts as a possible finding in patients with pathological jaw fractures and radiolucencies of the jaws. It outlines the surgical management that is carried out on patients with solitary bone cysts.
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Quistes Maxilomandibulares/diagnóstico por imagen , Enfermedades Mandibulares/diagnóstico por imagen , Fracturas Mandibulares/diagnóstico por imagen , Adolescente , Enfermedades Asintomáticas , Fracturas Espontáneas/diagnóstico por imagen , Humanos , Hallazgos Incidentales , Masculino , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/lesiones , RadiografíaRESUMEN
Our goal is to establish the long-term collection of data on temporomandibular joint replacement from all centres in the UK where this is done. Currently, 16 surgeons have been identified, and 13 of them had entered data when this paper was being prepared. Data are entered online through the Snap Survey and then analysed annually. We report on 402 patients (332 (83%) female and 70 (17%) male) who had 577 joints inserted between 1994 and 2012. The main diagnoses that resulted in total joint replacement were osteoarthritis, failed operation, ankylosis, and seronegative arthritis. Preoperatively, the median (IQR) maximal incisal opening was 20 (15-26)mm (mean 20) and the median pain scores on the visual analogue scale (VAS 0-10) were 8 for both joints. The median (IQR) baseline dietary score (liquid 0 - solid 10) was 4 (3-6). A total of 173 (43%) patients had had one or more open procedure(s) before total replacement, 177 (44%) had not had open operation, and 52 (13%) had no data entered. The 3 primary systems used were the TMJ Concepts System (Ventura, USA), the Biomet System (Biomet/Lorenz Microfixation, Jacksonville, USA), and the Christensen System (TMJ Implants, Golden, USA). The median (IQR) duration of inpatient stay was 3 (2-4) days (mean 3). Follow-up data will be collected to assess patient recorded outcome measures (PROM) and objective measurements of total joint replacements in the UK from 1994 onwards.
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Artroplastia de Reemplazo/estadística & datos numéricos , Articulación Temporomandibular/cirugía , Adolescente , Adulto , Anciano , Anquilosis/cirugía , Artritis Reactiva/cirugía , Bases de Datos como Asunto , Dieta , Femenino , Estudios de Seguimiento , Hospitalización/estadística & datos numéricos , Humanos , Prótesis Articulares/clasificación , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Sistemas en Línea , Osteoartritis/cirugía , Dimensión del Dolor/métodos , Rango del Movimiento Articular/fisiología , Reoperación , Trastornos de la Articulación Temporomandibular/cirugía , Resultado del Tratamiento , Reino Unido , Escala Visual Analógica , Adulto JovenRESUMEN
Cyanoacrylate tissue glue has many uses. We describe a case involving a 27-year-old man with a low-flow venous malformation that affected the right side of his face including the mandible. After extraction of the lower right eight, torrential haemorrhage was successfully arrested using N-butyl-2-cyanoacrylate (NBCA) glue. We think that it may be of use not only in the management of patients with vascular malformations, but also in the treatment of recalcitrant haemorrhage after dentoalveolar surgery.