Temporary obturator using high-density polyurethane foam following maxillectomy during the coronavirus disease 2019 pandemic.

BACKGROUND: Rhino-orbital mucormycosis was seen in epidemic proportions during the second wave of the coronavirus disease 2019 pandemic. Many of these post-coronavirus rhino-orbital mucormycosis patients underwent maxillectomy for disease clearance. Rehabilitating such a large number of patients with surgical obturators as an emergency in a low-income setting was challenging. METHODS: High-density polyurethane foam was used to make a temporary obturator for patients who underwent maxillectomy. These obturators helped alleviate functional problems like dysphagia and nasal regurgitation, improving nutritional outcomes and shortening the hospital stay. CONCLUSION: The coronavirus disease 2019 pandemic gave physicians time-sensitive challenges, for which immediate alternatives to established care were required. A maxillary obturator made of high-density polyurethane foam is an innovative solution to rehabilitate maxillectomy patients in the immediate post-operative period.

ERAS for Head and Neck Tissue Transfer Reduces Opioid Usage, Peak Pain Scores, and Blood Utilization.

OBJECTIVES: We implement a novel enhanced recovery after surgery (ERAS) protocol with pre-operative non-opioid loading, total intravenous anesthesia, multimodal peri-operative analgesia, and restricted red blood cell (pRBC) transfusions. 1) Compare differences in mean postoperative peak pain scores, opioid usage, and pRBC transfusions. 2) Examine changes in overall length of stay (LOS), intensive care unit LOS, complications, and 30-day readmissions. METHODS: Retrospective cohort study comparing 132 ERAS vs. 66 non-ERAS patients after HNC tissue transfer reconstruction. Data was collected in a double-blind fashion by two teams. RESULTS: Mean postoperative peak pain scores were lower in the ERAS group up to postoperative day (POD) 2. POD0: 4.6 ± 3.6 vs. 6.5 ± 3.5; P = .004) (POD1: 5.2 ± 3.5 vs. 7.3 ± 2.3; P = .002) (POD2: 4.1 ± 3.5 vs. 6.6 ± 2.8; P = .000). Opioid utilization, converted into morphine milligram equivalents, was decreased in the ERAS group (POD0: 6.0 ± 9.8 vs. 10.3 ± 10.8; P = .010) (POD1: 14.1 ± 22.1 vs. 34.2 ± 23.2; P = .000) (POD2: 11.4 ± 19.7 vs. 37.6 ± 31.7; P = .000) (POD3: 13.7 ± 20.5 vs. 37.9 ± 42.3; P = .000) (POD4: 11.7 ± 17.9 vs. 36.2 ± 39.2; P = .000) (POD5: 10.3 ± 17.9 vs. 35.4 ± 45.6; P = .000). Mean pRBC transfusion rate was lower in ERAS patients (2.1 vs. 3.1 units, P = .017). There were no differences between ERAS and non-ERAS patients in hospital LOS, ICU LOS, complication rates, and 30-day readmissions. CONCLUSION: Our ERAS pathway reduced postoperative pain, opioid usage, and pRBC transfusions after HNC reconstruction. These benefits were obtained without an increase in hospital or ICU LOS, complications, or readmission rates. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E792-E799, 2021.

Early Postoperative Oral Exercise Improves Swallowing Function Among Patients With Oral Cavity Cancer: A Randomized Controlled Trial.

Dysphagia remains an unsolved problem for patients with oral cavity cancer who have undergone surgery. This randomized controlled trial was conducted to determine the effect of oral exercise in addition to standard general care and diet counseling on the physiology of swallowing. Fifty patients (25 in each group) with oral and oropharyngeal cancer who underwent tumor resection, neck dissection, and reconstruction were enrolled in this study. The Rosenbek penetration-aspiration scale and modified barium swallow study were administered at 1 and 4 month(s) postoperatively. We observed significant improvements in the intervention group regarding the penetration-aspiration scale (P = .037), and oral and pharyngeal residue with thickened boluses (Nectar P < .001, Honey P < .001, and Pudding P < .001). In conclusion, oral exercise significantly improves the postoperative swallowing function of patients with oral cavity cancers.

Results of surgical treatment alone for primary subglottic carcinoma.

Primary subglottic carcinoma is rare and surgery is the most common therapeutic strategy for Chinese patients with this disease. To retrospectively evaluate surgically treated primary subglottic carcinoma treated with surgery. Patients with primary subglottic carcinoma who initially underwent surgery from 2005-2010 were grouped by surgical procedures with or without laryngeal function preservation and reviewed. Of 1815 patients with laryngeal cancer, 23 had a subglottic origin. Of these, 21 initially underwent surgery; 12 had 'early' (stage I/II) disease, and nine had 'advanced' (stage III/IV) disease. The actuarial 5-year OS was 73.9% [95% confidence interval (54.1% ∼ 93.7%)] for patients with squamous cell carcinoma. Among patients with early disease, the 5-year OS and DFS were 80% for partial laryngectomy and 71.4% for total laryngectomy. Patients with advanced disease underwent total laryngectomy, and the 5-year OS and DFS were 62.5%. Satisfactory oncologic outcomes can be achieved with initial surgery. Patients with early disease who underwent partial laryngectomy had a comparable prognosis to those who underwent total laryngectomy; deglutition and speech function were maintained.

Absolute or relative voice rest after phonosurgery: a blind randomized prospective clinical trial.

OBJECTIVES: The first aim, was to compare participant compliance with postoperative voice rest advice in two groups. The second aim was to compare vocal function and recovery in the short-term, seven days post-surgery and in the long-term, 3-6 months post-surgery. DESIGN: Preliminary randomized prospective blind clinical trial. METHODS: Twenty patients scheduled for surgery for benign vocal fold lesions were randomized into seven days of absolute or relative voice rest. Compliance with voice rest advice was monitored with a voice accumulator for seven days following surgery. Vocal recovery was tracked through (a) self-perceived vocal function, (b) perceptual assessments of voice recordings and (c) visual assessment of high resolution and high speed digital imaging (d) vocal stamina and reaction to vocal loading, explored with a vocal loading task. RESULTS: The absolute voice rest group phonated significantly less than the relative voice rest group during seven days post-surgery, but they were not silent. The absolute voice rest group self-reported more difficulty with compliance than the relative voice rest group. The relative voice rest group coped with significantly more vocal loading at long-term check-up. In the short-term the absolute voice rest group improved morphological recovery to a significant degree, however relative voice rest renders superior long-term recovery. CONCLUSIONS: Absolute voice rest is difficult to comply with. Neither short-term, nor long-term vocal recovery differed significantly between groups. Within-group comparisons showed significant improvements in vocal stamina, immediate recovery from vocal loading and self-assessments of voice problems only for the group with recommended relative voice rest.

Enhanced recovery programmes in head and neck surgery: systematic review.

OBJECTIVE: To review the literature on enhanced recovery programmes in head and neck surgery. METHOD: A systematic review was performed in May 2013. RESULTS: Thirteen articles discussing enhanced recovery after laryngectomy, neck dissection, major ablative surgery and microvascular reconstruction were identified. Articles on general pre-operative preparation and post-operative care were also reviewed. CONCLUSION: Considerable evidence is available supporting enhanced recovery in head and neck surgery that could be of benefit to patients and which surgeons should be aware of.

Treatment of base of tongue cancer, stage III and stage IV with primary surgery: survival and functional outcomes.

This study examines functional outcome (speech and swallowing), survival, and disease control in patients receiving an intensified treatment regimen with primary aggressive surgery, and postoperative radiotherapy or postoperative concomitant chemoradiotherapy, for previously untreated, resectable, stage III and IV squamous cell carcinoma (SCC) of the tongue base. Sixty-six consecutive patients treated from June 1997 to June 2006 were followed prospectively through the Multidisciplinary Head and Neck Surgery Reconstruction Clinic. Speech and swallowing data were gathered at four evaluation times during the first year. Speech assessment was conducted by PERCI, Nasometer, and C-AIDS and swallowing assessment by Modified barium swallow, Diet survey and G-tube. Also, the overall survival, disease-specific survival and loco regional control were measured. The average age of the patients was 56.8, 85 % male and 15 % female. All patients had primary surgical resection and 83 % received postoperative radiotherapy and 17 % chemoradiation therapy. Overall survival at 3 years was 80.3 % and 5 years 52.2 %. Disease-specific survival at 3 years was 86.7 % and 5 years was 77.5 %. Local control was 94 %. Distal metastasis and second primary were found to be 7.5 % each. Primary surgical treatment of advanced BOT cancer offers excellent functional outcome, local control and disease-specific survival.

Enhanced recovery after surgery (ERAS) strategies: possible advantages also for head and neck surgery patients?

Enhanced recovery after surgery (ERAS) programs have recently been developed in order to reduce morbidity, improve recovery, and shorten hospital stays of surgical patients. Since the 1990 s, ERAS programs have been successfully applied in many centres, especially in northern Europe and America, to perioperative management for colorectal surgery, vascular surgery, thoracic surgery, and then also to urological and gynaecologic surgery. Purpose of this paper is to evaluate and discuss the very recent introduction of ERAS programs also in head and neck surgery. Embase and Pubmed database searches were performed for relevant published studies. There are still no reports concerning the results of the application of ERAS protocols in the head and neck field. ERAS programs, however, could offer also to head and neck surgery patients an advantage in terms of fastening recovery, reducing hospital stay, and favouring early return to daily activities after hospital discharge. Therefore, the investigation of specific ERAS protocol in head and neck surgery patients should be encouraged.

[Application of the physiotherapeutic treatment in endonasal surgery].

The objective of this study was to enhance the effectiveness of the surgical treatment of the patients following septoplasty with the splinting of the nasal septum. An original septal stent with an integrated electron was developed that allows endonasal electrophoresis to be performed in a minimally traumatic manner. Thereby, this procedure permits to reduce the period of patients' rehabilitation after intranasal surgical intervention and to improve its effectiveness.

[Surgery for severe aspirations]. / Chirurgie de la déglutition dans le traitement d'aspirations récidivantes.

Severe dysphagia resulting in repeated aspirations and pneumonia are difficult to treat with swallowing therapy and surgical treatment is often required. Our study retrospectively reviews our experience with 19 such cases operated by laryngeal suspension and laryngotracheal separation. Restoration of oral nutrition was possible in 45% of laryngeal suspension cases and in 75% of laryngotracheal separation operations. These surgical techniques prevent severe aspirations while conserving phonation, contrarily to total laryngectomy. Tracheocutaneous fistulas were frequent, especially after radiation, implying that the surgical technique should be modified in the future.

Effect of primary, cross-over, zigzag neopharyngoplasty on acoustic characteristics of alaryngeal, tracheoesophageal voice.

OBJECTIVE: To evaluate the effect of primary, cross-over, zigzag neopharyngeal construction on tracheoesophageal voice, compared with pharyngoesophageal myotomy, following total laryngectomy with partial pharyngectomy. STUDY DESIGN: Prospective clinical trial. SETTING: Otolaryngology department, Tanta University Hospital (tertiary referral centre), Egypt. PATIENTS AND METHODS: Over five years, 30 patients underwent total laryngectomy with partial pharyngectomy to manage stage III or IV laryngeal cancer, followed by primary tracheoesophageal puncture for voice restoration. For neopharyngeal construction, 15 patients underwent pharyngoesophageal myotomy (group one) and 15 cross-over, zigzag neopharyngoplasty (group two). Acoustic parameters of tracheoesophageal voice were compared. RESULTS: Most acoustic parameters were almost equivalent for the two groups, although significant differences were seen for loud intensity, dynamic range, shimmer, loud fundamental frequency, loud jitter, fluency and speaking rate. One post-operative pharyngocutaneous fistula (6.6 per cent) occurred in each group, and resolved with conservative measures. CONCLUSION: The cross-over neopharyngoplasty modification of hypopharyngeal closure may help avoid pharyngoesophageal spasm and assist maintenance of effective voice amplitude, fundamental frequencies, temporal measures and perceptual values.

[Quality of life evolution in patients after surgical treatment of laryngeal, hypopharyngeal or oropharyngeal carcinoma]. / Evolución de la calidad de vida en pacientes intervenidos de carcinomas de orofaringe, laringe o hipofaringe.

INTRODUCTION: The assessment of quality of life in patients with head and neck cancer is dependent on many variables. OBJECTIVE: The aim of this study was to evaluate the differences in quality of life among patients treated with conservative or radical surgery for laryngeal, oropharyngeal or hypopharyngeal cancer, evaluated before and at 3 and 6 months after definitive therapy. MATERIAL AND METHOD: Prospective study between November 2008 and June 2009 on 53 patients diagnosed and treated for head and neck carcinoma with surgery: partial (n=32) and radical (n=21). Quality of life was evaluated using the European Organization of Research and Treatment of Cancer (EORTC) general questionnaire EORTC QLQ-C30 and its specific head and neck EORTC QLQ-H&N35 before treatment, and at 3 and 6 months afterwards. RESULTS: No significant differences were found in overall health. Patients experienced the greatest changes in functional scale. There were no changes in swallowing problems or feeling of disease, while evident phonation problems were present in both groups. DISCUSSION AND CONCLUSIONS: The routine application of quality of life questionnaires in cancer patients improves information regarding how and to what extent patients feel that treatment and its sequelae modify it, making it possible to adapt rehabilitation and support programs to their real needs. This data helps in choosing between different options depending on the results, delivering improved care to patients.

Quality of life following nasal surgery.

OBJECTIVES/HYPOTHESIS: This prospective study aimed to investigate changes in quality of life (QOL) after nasal surgery. STUDY DESIGN: Prospective study. METHODS: A total of 788 patients (492 men and 296 women; age range, 9-81 years; mean age, 41 years) were included in this prospective study. Three hundred thirty-six patients received sinus surgery, 358 received septum surgery, and 94 additional patients received sinus surgery involving the septum. QOL was assessed with a standardized questionnaire for general health and well-being (36-Item Short Form Health Survey [SF-36]). Additionally, subjective sinonasal impairment was collected using the Rhinosinusitis Disability Index (RSBI). QOL and subjective sinonasal impairment were retested 4 months after surgery (63-339 days after surgery; mean, 128 days) in 361 patients. RESULTS: In the RSBI severity scale, 29.5% of the patients rated their sinonasal problems presurgery to be of high severity, 61.2% rated them as medium, and 9.3% as minor. Postsurgery, 2.8% of the patients rated the severity of their sinonasal problems high, 35% medium, and 62.2% minor. Subjective improvement of symptoms was found in more than 80% of the patients. Presurgery, general QOL (SF-36) was impaired in sinus patients and improved significantly after surgery. For most septum patients we found relatively little impact of sinonasal disease on general QOL (SF-36) compared to the German normative sample. CONCLUSIONS: Functional endoscopic surgery seems to be a good technique for reducing sinonasal symptomatology in the majority of patients. It appears to enhance QOL in those patients who were severely affected beforehand. Long-term investigations are currently underway to further explore the patients' subjective QOL following nasal surgery.

Preservation of the nasolacrimal duct during endoscopic medial maxillectomy for sinonasal inverted papilloma.

BACKGROUND: To assess the efficacy of a new endonasal medial maxillectomy technique (EMM) for the treatment of inverted papilloma (IP). METHODOLOGIES: A prospective series of 55 consecutive patients diagnosed with IP between March 2002 and April 2009 were entered into this study. The new surgical technique was applied to tumors arising from the anterior part of the maxillary sinus. After conventional EMM, the entire nasolacrimal duct was separated from the bony component of the nasolacrimal canal and preserved. Schirmer`s test and a visual analog scale (VAS) score were used to assess the lacrimal duct function after surgery. RESULTS: Ten of the 55 patients underwent the new surgical procedure. All patients were categorized with stage T3 or T4 tumors. No patients suffered tumor recurrence. There was no difference in lacrimal duct function between the diseased side and healthy side of the nasolacrimal duct. The mean VAS score was 2.8/100. CONCLUSIONS: This new surgical technique preserves the whole length of the nasolacrimal unit. It also offers several advantages including good visualization, nasolacrimal function after surgery and fewer adverse effects such as facial numbness and epiphora.

Speech and swallowing impairment after treatment for oral and oropharyngeal cancer.

OBJECTIVES: To assess the prevalence of speech and swallowing impairment after radical surgery for oral and oropharyngeal cancer from the patient's viewpoint and to examine the association of these functional alterations with selected clinical characteristics regarding patients, tumors, and oncologic treatment. DESIGN: Cross-sectional, multicenter study using a self-administered questionnaire. SETTING: Forty-three hospitals in Germany, Switzerland, and Austria. PATIENTS: A total of 3894 questionnaires about rehabilitation problems after treatment for oral and oropharyngeal squamous cell carcinoma were sent to patients. Of these, 1652 were filled out and returned, and 1334 (80.8%) met the inclusion criteria. MAIN OUTCOME MEASURES: Morbidity associated with treatment of oral and oropharyngeal cancer. RESULTS: Speech problems were reported by 851 patients (63.8%), and swallowing problems were reported by 1006 patients (75.4%). The variables that presented a significant association with speech and swallowing impairment were sex, tumor location, pTNM stages, stage of tumor, treatment modality, and reconstruction type. CONCLUSIONS: This survey, based on patient perception, suggests that those who undergo radiotherapy associated with the surgical removal of a tumor, have late-stage tumors (III-IV), or have tumors located in the floor of the mouth should be informed of the greater risk of persistent severe speech and swallowing problems.