Role of the temporoparietal fascia free flap in salvage total laryngectomy

xlomafota13 shared this article with you from Inoreader Role of the temporoparietal fascia free flap in salvage total laryngectomy Via Head & Neck Abstract The procedure for salvage total laryngectomy (STL) is burdened by a high rate of postoperative complications as a result of delayed wound healing in previously irradiated tissue. Several observational studies have investigated the role of prophylactic vascularized flaps to aid pharyngeal closure after STL and prevent the development of PCF. The use of a temporoparietal fascia free flap (TFFF) as an overlay flap for STL has been described previously in two published studies and both sets of authors agreed that the most obvious benefit of the TFFF in STL is a reduced PCF rate with low site morbidity and good functional outcomes. The aim of this video is to illustrate the use of the temporoparietal fascia flap to provide an adjunctive reinforcement layer in the reconstruction of the pharynx. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Middle turbinate mucosal flap: A low‐morbidity option in the management of skull base defects

xlomafota13 shared this article with you from Inoreader Middle turbinate mucosal flap: A low‐morbidity option in the management of skull base defects Via Head & Neck Abstract Background To describe the low morbidity of middle turbinate mucosal flap (MTMF) to repair anterior skull base defects. Methods Skull base endonasal endoscopic surgeries performed at a tertiary hospital between 2015 and 2018 were analyzed. Patients were divided into two groups according the existence or not of a significant intraoperative cerebrospinal fluid (CSF) leak. In Group 1 (n = 28), gasket seal and a pedicled endonasal flap were used to repair the defect: 13 nasoseptal flaps (NSF), 8 inferolateral wall flaps (ILF), and 7 MTMF. In Group 2 only an endonasal flap was used: 9 NSF, 4 ILF, and 18 MTMF. Surgical and recovery time were analyzed (Student's t test). Our favorite surgical technique is described. Results Fifty‐nine patients were included. Average surgical time was 27.7, 41.6, and 11.3 min for NSF, ILF, and MTMF, respectively. MTMF showed a faster recovery. Conclusion MTMF is a safe reconstructive option for anterior skull base defects. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

What is the best method for prevention of postparotidectomy Frey syndrome?

xlomafota13 shared this article with you from Inoreader What is the best method for prevention of postparotidectomy Frey syndrome? Network meta‐analysis Via Head & Neck Abstract Background Prevention of Frey syndrome (FS) after parotidectomy using an interposition barrier has long been gaining a wide popularity; however, there is no clear evidence regarding which preventive technique is more effective. The aim of this network meta‐analysis (NMA) is to answer the question: What is the best method for prevention of FS after parotidectomy? Methods A comprehensive search of the PubMed, Embase, SCOPUS, and Cochrane library was conducted to identify the eligible studies. The outcome was the incidence of subjective Frey syndrome (SFS) and objective Frey syndrome (OFS). The Bayesian NMA accompanied with a random effects model and 95% credible intervals (CrIs) were calculated using GeMTC R package. Results Thirty‐four studies (n = 2987 patients) with five interventions, namely Alloderm (ADM), temporoparietal fascia (TPF), sternocleidomastoid muscle (SCM), superficial musculoaponeurotic system (SMAS), and free fat graft (FFG), were compared together and with no interposition barrier (NB). The results of NMA showed a statistically significant reduction in both SFS and OFS when ADM, TPF, SMAS, FFG, and SCM were compared with NB. No statistical differences were observed when comparing ADM, SCM, SMAS, FFG, and TPF. TPF ranked the best of all treatments (59.4%) and was associated with the least incidence of SFS; whereas ADM ranked the best of all treatments (61.1%) and was associated with the least incidence of OFS. Conclusions All interventions (TPF flap, ADM, FFG, SMAS, and SCM) were associated with a significant reduction in the incidence of FS when compared with NB. TPF and ADM showed the best outcome with the least incidence of SFS and OFS, respectively. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Laryngeal soft tissue sarcoma

xlomafota13 shared this article with you from Inoreader Laryngeal soft tissue sarcoma: A systematic review and individual patient data analysis of 300 cases Via Head & Neck Abstract Background Laryngeal sarcoma is rare. We performed a systematic review and individual patient analysis to evaluate the patterns of care, prognostic factors, and role of radiotherapy in laryngeal soft tissue sarcoma. Methods A systematic search on PubMed and Google scholar was done. An individual patient data analysis was done. Results Of the 300 cases of laryngeal sarcoma, 80% underwent surgery. 44% underwent larynx preservation surgery and 25% received radiotherapy with surgery. Median progression free survival (PFS) was 48 months and overall survival (OS) of 224 months for the entire cohort. Patients with large primary, cartilage invasion, and positive margins had numerically worse PFS. Cartilage invasion and primary tumor size >3 cm were the most common risk factors for adjuvant radiation therapy. Patients receiving radiotherapy were not associated with better survival. Conclusion Laryngeal sarcoma associated with a good survival. Larynx preservation surgery is feasible in nearly half patients. Adjuvant radiotherapy may be warranted in patients poor prognostic factors. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Dental radiation dosimetric maps from intensity‐modulated radiation therapy planning for head and neck cancers

xlomafota13 shared this article with you from Inoreader Dental radiation dosimetric maps from intensity‐modulated radiation therapy planning for head and neck cancers Via Head & Neck Abstract Background The purpose of this study was to create dental radiation maps to calculate the mean dose to individual teeth, maxilla and mandible using intensity‐modulated radiation therapy (IMRT). Methods Eighteen common clinical settings were chosen. Radiation plans were extracted, and each tooth was contoured at its junction with the gingiva and labeled based on the Universal/American numbering system. Results All patients were treated with prescribed doses of 50–70 Gy in 1.66–2 Gy/fraction. Patients receiving mean doses >50 Gy to the teeth, mandible, and maxilla included those with advanced tumors of the oral cavity and gross lymphadenopathy of level 1b. Conclusion We believe this to be the first study generating dosimetric maps of estimated doses to each tooth and each third of the mandible and the maxilla for common examples of head and neck cancer faced by radiation oncologists. Adoption of these dental maps may help improve clinical workflow efficiency. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Low‐ and high‐dose radioiodine ablation for low‐/intermediate‐risk differentiated thyroid cancer

xlomafota13 shared this article with you from Inoreader Low‐ and high‐dose radioiodine ablation for low‐/intermediate‐risk differentiated thyroid cancer in China: A large randomized clinical trial Via Head & Neck Abstract Background To determine whether 1.1 GBq radioiodine therapy is as effective as 3.7 GBq for ablation in Chinese patients with differentiated thyroid cancer (DTC). Methods In this single‐center randomized study, we compared the successful radioiodine ablation rates of 1.1 GBq and 3.7 GBq for patients with DTC. Results At 6–8 months after radioiodine ablation, there were 95 (39%) patients in the 1.1 GBq group and 79 (32%) patients in the 3.7 GBq group with thyroid hormone withdrawal (THW), and ablation success rates were 84% versus 80%, respectively; and 149 (61%) patients in the 1.1 GBq group and 169 (68%) patients in the 3.7 GBq group without THW, and ablation success rates were 89% versus 90%, respectively. In total, the ablation was successful in 412 (87%) of the 474 patients, and it was similar between the two groups. Conclusions Low‐dose radioiodine ablation was as effective as high dose in Chinese DTC patients. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Redefining risk of contralateral cervical nodal disease in early stage oropharyngeal cancer in the human papillomavirus era

xlomafota13 shared this article with you from Inoreader Redefining risk of contralateral cervical nodal disease in early stage oropharyngeal cancer in the human papillomavirus era Via Head & Neck Abstract Background The optimal extent of surgery and/or radiation to the contralateral lymph node region is unknown in early‐stage human papillomavirus (HPV)–related oropharyngeal squamous cell carcinoma (OPSCC). Methods To investigate the pathologic incidence of and risk factors for contralateral nodal disease (CND) in cT1‐T2 HPV‐related OPSCC treated with transoral robotic surgery (TORS) and bilateral neck dissection (BND), the records of 120 patients were reviewed. Results Eleven patients displayed pathologic contralateral nodal disease (pCND), including 7.1% of tonsil and 10.9% of base of tongue (BOT) cases. Medial hemistructure involvement and cN2 disease were significantly associated with pCND. Zero cN0 patients had pCND, and on multivariate analysis only cN classification remained significantly associated with pCND. Four percent of BOT patients and 2% of tonsil patients with a well‐lateralized primary and cN0/N1 neck demonstrated pCND. Conclusions HPV‐related OPSCC that are cN0‐N1 have exceedingly low rates of pCND. Well‐lateralized HPV‐related BOT primaries with limited clinical nodal disease may be candidates for ipsilateral only treatment. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Respiratory‐swallow coordination and swallowing impairment in head and neck cancer

xlomafota13 shared this article with you from Inoreader Respiratory‐swallow coordination and swallowing impairment in head and neck cancer Via Head & Neck Abstract Background The aim of the study was to determine the link between frequency of optimal respiratory‐swallow coordination, swallowing impairment, and airway invasion in head and neck cancer (HNC) patients. Method A cross‐sectional study of a heterogeneous group of HNC patients (49), precancer (N = 30) or postcancer treatment (N = 29), participated in a single Modified Barium Swallow Study (MBSS) with synchronized respiratory data. Results Spearman correlation coefficients revealed significant negative correlations between optimal respiratory‐swallow phase pattern and objective measures of swallowing impairment: penetration‐aspiration scale max, pharyngeal total, and oral total scores with Spearman correlation coefficients of −0.53 (z .001), −0.50 (P < .001), and −0.43 (P = .002), respectively. Optimal respiratory‐swallow pattern was significantly decreased (P = .03) in patients after cancer treatment compared with another patient group before cancer treatment. Conclusion These findings indicate that as the percentage of optimal respiratory‐swallow phase patterns increase, swallowing impairment decreases in the HNC patient population. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A new landmark for lingual artery identification during transoral surgery: Anatomic‐radiologic study

xlomafota13 shared this article with you from Inoreader A new landmark for lingual artery identification during transoral surgery: Anatomic‐radiologic study Via Head & Neck Abstract Background A landmark for the identification of the lingual artery (LA) through a transoral perspective can provide surgeons with an easy method to prevent and manage intraoperative bleeding during transoral approach to the base of tongue (BOT). Methods Thirteen tongue and five head and neck specimens were dissected to identify and assess the reliability of the lingual point (LP) as a new landmark for the LA at BOT. The pathway of 42 LAs was radiologically evaluated; axial depth and vertical offset were measured for each LA. Results Dissection study: a description of LP is provided; the LA was easily identified in all specimens (36/36 sides) using LP as a landmark. Radiologic study: the mean depth of the LA was 4.2 mm, the mean vertical offset was 1.3 mm. Conclusions LP is a simple and reliable landmark for identification of the LA, potentially helping surgeons to prevent and manage intraoperative bleeding. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Central auditory system responses from children while listening to speech in noise.

xlomafota13 shared this article with you from Inoreader Central auditory system responses from children while listening to speech in noise. Via cortical auditory Related Articles Central auditory system responses from children while listening to speech in noise. Hear Res. 2021 Jan 05;403:108165 Authors: Benítez-Barrera CR, Key AP, Ricketts TA, Tharpe AM Abstract Cortical auditory evoked potentials (CAEPs) have been successfully used to explore the effects of noise on speech processing at the cortical level in adults and children. The purpose of this study was to determine whether +15 dB signal-to-noise ratios (SNRs), often recommended for optimal speech perception in children, elicit higher amplitude CAEPs than more realistic SNRs encountered by children during their daily lives (+10 dB SNR). Moreover, we aimed to investigate whether cortical speech categorization is observable in children in quiet and in noise and whether CAEPs to speech in noise are related to behavioral speech perception in noise performance in children. CAEPs were measured during a passive speech-syllable task in 51 normal hearing children aged 8 to 11 years. The speech syllables /da/ and /ga/ were presented in quiet and in the presence of a 4-talker-babble noise at +15 dB and +10 dB SNR. N1 latencies and P2 amplitudes and latencies varied as a function of SNR, with poorer SNRs (+10 dB) eliciting significantly smaller P2 amplitudes and delayed N1 and P2 latencies relative to the higher SNR (+15 dB). Finally, speech categorization was present at the cortical level in this group of children in quiet and at both SNRs; however, N1 and P2 amplitudes and latencies were not related to behavioral speech-in-noise perception of children. PMID: 33485110 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

UK Guidelines on the Diagnosis and Treatment of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) on behalf of the Medicines and Healthcare products Regulatory Agency (MHRA) Plastic, Reconstructive and Aesthetic Surgery Expert Advisory Group (PRASEAG).

xlomafota13 shared this article with you from Inoreader UK Guidelines on the Diagnosis and Treatment of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) on behalf of the Medicines and Healthcare products Regulatory Agency (MHRA) Plastic, Reconstructive and Aesthetic Surgery Expert Advisory Group (PRASEAG). Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS Related Articles UK Guidelines on the Diagnosis and Treatment of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) on behalf of the Medicines and Healthcare products Regulatory Agency (MHRA) Plastic, Reconstructive and Aesthetic Surgery Expert Advisory Group (PRASEAG). J Plast Reconstr Aesthet Surg. 2021 Jan;74(1):13-29 Authors: Turton P, El-Sharkawi D, Lyburn I, Sharma B, Mahalingam P, Turner SD, MacNeill F, Johnson L, Hamilton S, Burton C, Mercer N Abstract Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon T cell Non-Hodgkin Lymphoma (NHL) associated with breast implants. Raising awareness of the possibility of BIA-ALCL in anyone with breast implants and new breast symptoms is crucial to early diagnosis. The tumour begins on the inner aspect of the peri-implant capsule causing an effusion, or less commonly a tissue mass to form within the capsule, which may spread locally or to more distant sites in the body. Diagnosis is usually made by cytological, immunohistochemical and immunophenotypic evaluation of the peri-implant fluid: pleomorphic lymphocytes are characteristically anaplastic lymphoma kinase (ALK) negative and strongly positive for CD30. BIA-ALCL is indolent in most patients but can progress rapidly. Surgical removal of the implant with the intact surrounding capsule (total en-bloc capsulectomy) is usually curative. Late diagnosis may require more radical surgery and systemic therapies a nd although these are usually successful, poor outcomes and deaths have been reported. By adopting a structured approach, as suggested in these guidelines, early diagnosis and successful treatment will minimize the need for systemic treatments, reduce morbidity and the risk of poor outcomes. These guidelines provide an evidence-based and systematic framework for the assessment and treatment of patients with suspected or proven BIA-ALCL and are aimed at all clinicians involved in the care of people with breast implants. PMID: 33483089 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The ban of the ipsilateral limb as a skin graft donor site after melanoma excision: A critical review.

xlomafota13 shared this article with you from Inoreader The ban of the ipsilateral limb as a skin graft donor site after melanoma excision: A critical review. Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS Related Articles The ban of the ipsilateral limb as a skin graft donor site after melanoma excision: A critical review. J Plast Reconstr Aesthet Surg. 2021 Jan 08;: Authors: Hage JJ, van Akkooi ACJ Abstract Split-thickness skin grafts are often applied in the management of primary cutaneous melanoma. It is routine surgical practice to use the contralateral limb because of the alleged risk of donor site metastases that may occur when the ipsilateral limb is used. The rationale and clinical evidence for this routine were assessed in light of current understanding of pathways of metastasis of melanoma. We found the preference for the contralateral limb to go back to Paget's ideas on melanoma spread from 1889, and the clinical observation of five cases of split-thickness skin graft donor site metastases in a series of 226 tumours, published in 1962. We traced ten additional reported cases of melanoma metastases occurring in the skin graft donor site. Contralateral donor sites were involved in seven of these cases. In light of current knowledge, the occurrence and the location of any split skin donor site metastasis are to be considered as mere indicators of an aggressive course of s ystemic disease. Any location of a split skin donor site, whether ipsilateral or contralateral in relation to the primary tumour, may become the location of metastases but chances that such metastases occur are extremely rare. Because of the lack of evidence in favour of the use of the contralateral limb and because of sound considerations in favour of using the ipsilateral limb, we conclude that there is no objective argument to sustain the dogmatic ban of the ipsilateral limb as a donor site for a split-thickness skin graft in melanoma surgery. PMID: 33483262 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.