Necrotizing otitis externa: a systematic review.

OBJECTIVE: To carry out a systematic review of scientific evidence available about necrotizing otitis externa, emphasizing epidemiologic data, diagnosis criteria, treatment protocols, follow-up criteria, prognosis factors, and chronologic evolution. DATA SOURCES: PubMed/MEDLINE and the Cochrane Database of Systematic Reviews were searched for publications in English and French languages, between 1968 and October 1, 2011. STUDY SELECTION: We included publications of all types including at least 6 cases. We excluded publications focused on cranial base osteomyelitis not originating from the external ear and publications limited to a specific population. DATA EXTRACTION: We assessed publication quality according to international guidelines. DATA SYNTHESIS: For each publication, data were entered in a spreadsheet software for analysis. We excluded individual data already published in other studies or reviews. CONCLUSION: Our review revealed the absence of strong scientific evidence regarding diagnosis criteria, treatment protocols and follow-up criteria. This implies the use of highly empirical indexes of suspicion in clinical practice. Our review confirmed the existence of a typical but not exclusive population at risk (aged, male, and diabetic patient) and also revealed major issues: lack of primary prevention in population at risk, delays before referral and management, bacteriologic issues caused by antibiotic misuse (agent identification problems, rise of resistant strains), persistence of recurrent cases. A better diffusion of medical information should help improve the management of this severe disease.

Free-flap head and neck reconstruction and quality of life: a 2-year prospective study.

OBJECTIVES: This prospective study was designed to evaluate quality of life (QOL) after free-flap head and neck reconstruction. STUDY DESIGN: Prospective study. METHODS: : Between January 2004 and December 2005, a total of 95 patients underwent microvascular reconstruction of the head and neck at our Institution (Centre Antoine-Lacassagne, Nice, France) and were initially included in this study. The European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire and the EORTC Head and Neck Cancer Quality of Life Questionnaire were completed before surgery, and at 6 and 12 months thereafter. Sixty-five patients completed the questionnaires on at least two of the assessment dates. Predictive factors of Quality of Life (QOL) scores at 6 months were researched among the following: age, sex, comorbidity, radiotherapy, tumor recurrence, tumor stage, and type of surgery. RESULTS: Global QOL remained stable over time. Physical, social, and role functioning deteriorated significantly after treatment. Pain decreased markedly. Social eating, senses, and speech difficulties increased significantly at 6 months, but stabilized between 6 and 12 months. Problems concerning mouth opening and social contact augmented progressively until the 12th postoperative month. Sex, type of surgery, and radiotherapy were the main factors influencing QOL 6 months after treatment. CONCLUSIONS: Despite some functional impairments, global QOL was preserved after major head and neck ablative surgery and microvascular free-flap reconstruction.

Head and neck reconstruction with free flaps: a report on 213 cases.

The aim of this retrospective study is to review the experience of our institution in performing microvascular head and neck reconstruction between 2000 and 2004. During this period, 213 free flaps, including 146 radial forearm free flaps, 60 fibular flaps and 7 scapular flaps, were performed. Free flap success rate and complications were reported. The pre-treatment factors influencing these results were subsequently analyzed. Functional and aesthetic outcomes were evaluated by the same clinician. There were 14 free flap failures, giving an overall free flap success rate of 93.4%. Salvage surgery for recurrent cancer was the only factor correlated with a higher risk of free flap failure (P = 0.0004). The local complication rate was 20.9%. High level of comorbidity (P = 0.009), salvage surgery for recurrent cancer (P = 0.03) and hypopharyngeal surgery (P = 0.002) were associated with a higher risk of local complications. An unrestricted oral diet and an intelligible speech were recovered by respectively 76 and 88% of the patients. Microvascular free flaps represent an essential and reliable technique for head neck reconstruction and allow satisfactory functional results.