RESUMEN
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.
Asunto(s)
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
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.
Asunto(s)
Colgajos Tisulares Libres , Reconstrucción Mandibular , Procedimientos de Cirugía Plástica , Cirugía Asistida por Computador , Diseño Asistido por Computadora , Peroné/cirugía , Humanos , OsteotomíaRESUMEN
Rehabilitation post reconstruction in head and neck cancer surgery is a vital component to improving quality of life. In this paper we discuss the current approaches to reconstruction of the maxilla and mandible and how they pertain to rehabilitation. There is a detailed discussion of dental rehabilitative challenges with different composite flaps and ways to solve those challenges. We conclude with a discussion about future approaches to reconstruction and how they will impact on improving rehabilitative outcomes and ultimately improve the quality of life of our patients.
Asunto(s)
Mandíbula/cirugía , Reconstrucción Mandibular/rehabilitación , Maxilar/cirugía , Procedimientos de Cirugía Plástica/rehabilitación , HumanosRESUMEN
PURPOSE OF REVIEW: The vessel-depleted neck is the ultimate challenge for the head and neck reconstructive surgeon. In patients who have had previous neck dissections or radiotherapy, the arterial and venous options for future reconstruction can be very limited, and it is important for the surgeon to consider alternative options for vessels. RECENT FINDINGS: Appropriate preoperative planning is crucial in these patients with a thorough history including previous operation notes, details of previous treatments, and previously used vessels for reconstruction. Clinical examination and a dual phase CT angiogram/MR angiogram can identify vessels available for reconstruction. Arterial options are discussed including tips on using the common carotid artery and the use of Corlett loops for utilizing contralateral arteries. Venous options are also discussed including cephalic vein transposition and Corlett loops. Novel options, such as use of extracorporeal perfusion of flaps have been shown to be effective when all other options have been depleted. SUMMARY: Creative solutions are needed for these extreme circumstances, and reconstructive surgeons need to be aware of the options available to select the best one in each case. Careful planning and having multiple back-up choices is crucial to successful reconstruction in these cases.
Asunto(s)
Neoplasias de Cabeza y Cuello/cirugía , Microcirugia/métodos , Cuello/irrigación sanguínea , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos/irrigación sanguínea , Procedimientos Quirúrgicos Vasculares/métodos , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Humanos , Disección del CuelloAsunto(s)
Distinciones y Premios , Cirugía Bucal , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Reino UnidoRESUMEN
The use of circulating biochemical molecular markers in head and neck cancer holds the promise of improved diagnostics, treatment planning, and posttreatment surveillance. In this review, we provide an introduction for the head and neck surgeon of the basic science, current evidence, and future applications of circulating tumor DNA (ctDNA) as a biomarker and liquid biopsy to detect tumor genetic heterogeneity in patients with head and neck squamous cell carcinoma (HNSCC).
Asunto(s)
Biomarcadores de Tumor/sangre , Carcinoma de Células Escamosas/genética , ADN de Neoplasias/sangre , Neoplasias de Cabeza y Cuello/genética , Carcinoma de Células Escamosas/sangre , Carcinoma de Células Escamosas/diagnóstico , Neoplasias de Cabeza y Cuello/sangre , Neoplasias de Cabeza y Cuello/diagnóstico , Humanos , Biopsia LíquidaRESUMEN
PURPOSE OF REVIEW: To review recent literature on the subject of free tissue transfer options in paediatric head and neck surgery, with a particular emphasis on highlighting the advantages and disadvantages of different reconstructions in the paediatric patient. RECENT FINDINGS: Free tissue transfer in paediatric patients is predictable and applicable for a wide range of congenital and acquired defects in the head and neck. The free fibula flap is a mainstay of mandibular reconstruction and allows excellent implant-supported prosthodontic rehabilitation and growth potential at the recipient site with little or no donor site morbidity. Other less commonly explored options include the deep circumflex iliac artery flap, scapula flap and medial femoral condyle flap. The gracilis mucle remains the mainstay for facial reanimation with other options including pectoralis minor, rectus abdominis, extensor digitorum brevis and latissimus dorsi. There are compelling arguments for centralization of services and creative strategies in postoperative rehabilitation (e.g. play therapy). SUMMARY: Free flaps in paediatric patients are a viable option and may even have advantages relative to adults because of the absence of atherosclerosis, purported lower risk of vasospasm and proportionally larger vessel size. Transfer earlier in life maximizes functional potential and 'normalizes' treatment.
Asunto(s)
Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Colgajos Tisulares Libres/irrigación sanguínea , Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/cirugía , Procedimientos de Cirugía Plástica/métodos , Factores de Edad , Carcinoma de Células Escamosas/mortalidad , Niño , Preescolar , Medicina Basada en la Evidencia , Femenino , Colgajos Tisulares Libres/trasplante , Rechazo de Injerto , Supervivencia de Injerto , Neoplasias de Cabeza y Cuello/mortalidad , Humanos , Lactante , Recién Nacido , Masculino , Pediatría , Pronóstico , Resultado del TratamientoRESUMEN
BACKGROUND: Traditional approaches in oral squamous cell carcinoma (OSCC) management utilize biopsy tissue for diagnostic purposes only. Adverse prognostic features, such as the tumor depth, are usually determined from final resection specimens, but are seldom studied in biopsy tissue. METHODS: A preliminary study of 139 consecutive biopsies compared biopsy size with T classification, tumor site, and operator grade, and biopsy tumor depth with the true tumor depth. RESULTS: This study demonstrated that biopsy size is independent of T classification (p = .44), subsite (p = .86), and operator grade (p = .10). The biopsy tumor depth significantly underrepresented true tumor depth (2.5 mm, 95% confidence interval [CI] = 2.4-2.9 vs 8.2 mm, 95% CI = 6.5-9.9; p < .001), confirming the limited prognostic utility of biopsies in OSCC. CONCLUSION: A future clinical trial will compare the routine biopsy technique with standardized deeper biopsy techniques using punch biopsy to sample invasive fronts and investigate opportunities for up-front staging using a combination of histological features and epithelial and stromal molecular biomarkers in OSCC. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1857-E1862, 2016.
Asunto(s)
Biopsia , Carcinoma de Células Escamosas/diagnóstico , Neoplasias de la Boca/diagnóstico , Carcinoma de Células Escamosas/patología , Femenino , Humanos , Masculino , Neoplasias de la Boca/patología , Estadificación de Neoplasias , PronósticoRESUMEN
BACKGROUND: The aims of the study were 1) to evaluate the incidence and types of postoperative complications after ablative oral cancer surgery with primary free flap reconstruction and 2) identify prognostic variables for postoperative complications. MATERIAL AND METHODS: Desired data was retrieved from a computer database at the department of Oral and Maxillofacial Department, Queen Elisabeth hospital Birmingham, United Kingdom, between June 2007 and October 2012. Logistic regression was used to study relationships between preoperative variables and postoperative outcomes. RESULTS: The study population consisted 184 patients, comprising 189 composite resections with reconstruction. Complications developed in 40.2% of the patients. Three patients (1.6%) died, 11.1% returned to the operating room, 5.3% developed donor site complications and 6.9% flap complications of which 3.2% total flap failure. In the multivariable analysis systemic complications were associated with anaesthesia time and hospital stay with red cell transfusion. CONCLUSIONS: A significant proportion of the patients with primary free flap reconstructions after oral cancer surgery develops postoperative complications. Prolonged anaesthesia time and red cell transfusion are possible predictors for systemic complications and hospital stay respectively. Preoperative screening for risk factors is advocated for patient selection and to have realistic information and expectations
Asunto(s)
Femenino , Humanos , Masculino , Neoplasias de la Boca/epidemiología , Neoplasias de la Boca/prevención & control , Procedimientos Quirúrgicos Orales/métodos , Complicaciones Posoperatorias/epidemiología , Colgajos Tisulares Libres/cirugía , Colgajos Tisulares Libres , Neoplasias de la Boca/complicaciones , Neoplasias de la Boca/cirugía , Modelos Logísticos , Factores de Riesgo , Calidad de Vida , Comorbilidad , Anastomosis QuirúrgicaRESUMEN
BACKGROUND: The aims of the study were 1) to evaluate the incidence and types of postoperative complications after ablative oral cancer surgery with primary free flap reconstruction and 2) identify prognostic variables for postoperative complications. MATERIAL AND METHODS: Desired data was retrieved from a computer database at the department of Oral and Maxillofacial Department, Queen Elisabeth hospital Birmingham, United Kingdom, between June 2007 and October 2012. Logistic regression was used to study relationships between preoperative variables and postoperative outcomes. RESULTS: The study population consisted 184 patients, comprising 189 composite resections with reconstruction. Complications developed in 40.2% of the patients. Three patients (1.6%) died, 11.1% returned to the operating room, 5.3% developed donor site complications and 6.9% flap complications of which 3.2% total flap failure. In the multivariable analysis systemic complications were associated with anaesthesia time and hospital stay with red cell transfusion. CONCLUSIONS: A significant proportion of the patients with primary free flap reconstructions after oral cancer surgery develops postoperative complications. Prolonged anaesthesia time and red cell transfusion are possible predictors for systemic complications and hospital stay respectively. Preoperative screening for risk factors is advocated for patient selection and to have realistic information and expectations.
Asunto(s)
Colgajos Tisulares Libres , Neoplasias de la Boca/cirugía , Femenino , Colgajos Tisulares Libres/irrigación sanguínea , Humanos , Incidencia , Tiempo de Internación , Masculino , Microvasos , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Pronóstico , Estudios RetrospectivosRESUMEN
We retrospectively audited operative complications, success of flaps, and speech and swallowing outcomes in patients with head and neck cancer who had reconstruction with jejunal free tissue transfer to the pharynx. A total of 104 patients had jejunal free flaps between 1987 and 2009 at University Hospital, Birmingham. Management was by a multidisciplinary team, and the same vascular surgeon did all the anastomoses. We investigated the relations between patients, operative factors, and postoperative complications, and noted the ischaemic time of the flaps and coexisting conditions of the patients. Outcomes measured included initial and final survival rates of flaps, donor and recipient site complications, and speech and swallowing outcomes on discharge and up to 2 years postoperatively. Of the 104 patients, 14 (13%) had initial flap complications but overall flap survival was 97%. A total of 11 (11%) patients developed a fistula at a mean of 15 days postoperatively and 11 (11%) had minor donor site complications. A total of 95 (91%) were able to resume oral diet on discharge. Of the 44 who were followed up on discharge, 32 (73%) were able to maintain oral intake at 2 years and 31 (70%) could use their voice in everyday situations. The jejunal free flap enables the tumour to be removed, and reconstruction and restoration of function to be done in a single operation using tissue that is versatile. The operation is associated with low morbidity at the donor and recipient sites, and results in good speech and swallowing outcomes. The flap can also be used to reconstruct pharyngolaryngeal defects.
Asunto(s)
Colgajos Tisulares Libres/trasplante , Neoplasias de Cabeza y Cuello/cirugía , Yeyuno/trasplante , Faringe/cirugía , Procedimientos de Cirugía Plástica/métodos , Adulto , Anciano , Anciano de 80 o más Años , Anastomosis Quirúrgica/métodos , Carcinoma de Células Escamosas/cirugía , Fístula Cutánea/etiología , Deglución/fisiología , Femenino , Fístula/etiología , Estudios de Seguimiento , Supervivencia de Injerto , Humanos , Masculino , Auditoría Médica , Persona de Mediana Edad , Enfermedades Faríngeas/etiología , Complicaciones Posoperatorias , Estudios Retrospectivos , Habla/fisiología , Resultado del Tratamiento , Calidad de la Voz/fisiología , Isquemia TibiaRESUMEN
Recurrent oral ulceration due to underlying iron-deficiency anaemia is already recognized. However, this case report describes a 78-year-old lady who developed severe ulceration of the tongue and floor of the mouth as a result of the treatment of iron-deficiency anaemia with ferrous sulphate tablets. Withdrawal of the ferrous sulphate tablets and replacement with ferrous fumarate syrup led to resolution of the lesion.