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1.
Oral Oncol ; 116: 105195, 2021 05.
Article in English | MEDLINE | ID: mdl-33618103

ABSTRACT

INTRODUCTION: Current research is elucidating how the addition of depth of invasion (DOI) to the 8th edition of the American Joint Committee on Cancer (AJCC) TNM staging for oral cavity squamous cell carcinoma influences its prognostic accuracy. However, there is limited research on survival in pT3N0M0 oral tongue SCC (OTSCC) patients when stratifying by DOI. OBJECTIVES: Determine 5-year overall survival (OS), and cancer-specific survival (CSS) for patients with pT3N0M0 oral OTSCC based on shallow DOI (<10 mm) and deep DOI (10-20 mm). METHODS: Retrospective review involving three tertiary care cancer centers in North America. cT3N0M0 OTSCC patients receiving primary surgical treatment from 2004 to 2018 were identified. Inclusion: age > 18 years old and confirmation of pT3N0M0 OTSCC on surgical pathology. Exclusion: patients undergoing palliative treatment or previous head and neck surgery/radiotherapy. Analysis comprised two groups: shallow pT3 (tumor diameter > 4 cm, DOI < 10 mm) and deep pT3 (DOI 10 mm-20 mm). RESULTS: One hundred and four patients with pT3N0M0 OTSCC were included. Mean age was 59.1 years (range: 18-80.74). Age, gender, and Charlson Comorbidity Index were similar between the two groups (p > 0.05). Recurrence, LVI, PNI, and positive margins were more common in deep T3 tumors (P < 0.05). 5-year OS (50% vs 26%, p = 0.006) and CSS (72% vs 24%, p = 0.005) were worse in deep pT3 tumors. Deep pT3 disease was an independent predictor of OS (p = 0.004) and CSS (p = 0.01) on Cox-Regression analysis. CONCLUSION: DOI is an independent predictor of poor survival in pT3N0M0 OTSCC patients. Consideration should be given to escalating adjuvant therapy for deep pT3N0M0 OTSCC patients.


Subject(s)
Squamous Cell Carcinoma of Head and Neck , Tongue Neoplasms , Adult , Humans , Middle Aged , Neoplasm Invasiveness , Retrospective Studies , Survival Rate , Tongue Neoplasms/surgery
2.
Curr Oncol ; 21(5): e704-14, 2014 Oct.
Article in English | MEDLINE | ID: mdl-25302041

ABSTRACT

BACKGROUND: The treatment of head-and-neck cancer is complex and requires the involvement of various health care professionals with a wide range of expertise. We describe the process of developing a practice guideline with recommendations about the organization and delivery of health care services for head-and-neck cancer patients in Alberta. METHODS: Outcomes of interest included composition of the health care team, qualification requirements for team members, cancer centre and team member volumes, infrastructure needs, and wait times. A search for existing practice guidelines and a systematic review of the literature addressing the organization and delivery of health care services for head-and-neck cancer patients were conducted. The search included the Standards and Guidelines Evidence (sage) directory of cancer guidelines and PubMed. RESULTS: One practice guideline was identified for adaptation. Three additional practice guidelines provided supplementary evidence to inform guideline recommendations. Members of the Alberta Provincial Head and Neck Tumour Team (consisting of various health professionals from across the province) provided expert feedback on the adapted recommendations through an online and in-person review process. Selected experts in head-and-neck cancer from outside the province participated in an external online review. SUMMARY: The recommendations outlined in this practice guideline are based on existing guidelines that have been modified to fit the Alberta context. Although specific to Alberta, the recommendations lend credence to similar published guidelines and could be considered for use by groups lacking the resources of appointed guideline panels. The recommendations are meant to be a guide rather than a fixed protocol. The implementation of this practice guideline will depend on many factors, including but not limited to availability of trained personnel, adequate funding of infrastructure, and collaboration with other associations of health care professionals in the province.

3.
J Oral Rehabil ; 41(2): 133-40, 2014 Feb.
Article in English | MEDLINE | ID: mdl-24289234

ABSTRACT

Sensorimotor impairment of the tongue has the potential to affect speech and swallowing. The purpose of this study was to critically examine the effects of nerve preservation and reinnervation after reconstruction of the base of tongue on patient-perceived outcomes of quality of life (QoL) related to speech and swallowing through completion of the EORTC QLQ-H&N35 standardised questionnaire. Thirty participants with a diagnosis of base of tongue cancer underwent primary resection and reconstruction with a radial forearm free flap, which may or may not have included nerve repair to the lingual nerve, hypoglossal nerve or both. Eight QoL domains sensitive to changes in motor and sensory nerve function were included in the analysis. Transected lingual and hypoglossal nerves were associated with difficulty in swallowing, social eating, dry mouth and social contact. There were fewer problems reported when these nerves were either repaired or left intact. There were no significant differences between patient nerve status and QoL outcomes for speech, sticky saliva and use of feeding tubes. This study was the first to examine the impact of sensory or motor nerve transection and reconstruction on health-related QoL outcomes.


Subject(s)
Hypoglossal Nerve/surgery , Lingual Nerve/surgery , Quality of Life , Tongue Neoplasms/surgery , Tongue/innervation , Deglutition/physiology , Female , Humans , Male , Middle Aged , Plastic Surgery Procedures/adverse effects , Plastic Surgery Procedures/methods , Speech/physiology , Surgical Flaps , Surveys and Questionnaires , Tongue/physiopathology , Treatment Outcome
4.
J Oral Rehabil ; 39(3): 170-81, 2012 Mar.
Article in English | MEDLINE | ID: mdl-21923892

ABSTRACT

Primary treatment of oropharyngeal cancer often involves surgical resection and reconstruction of the affected area. However, during base of tongue reconstruction the lingual nerve is often severed on one or both sides, affecting sensation in the preserved tissue of the anterior tongue. The loss of specific tongue sensations could negatively affect a person's oral function and quality of life. The aim of this study was to explore the effects of different types of lingual nerve intervention on sensory function for patients with base of tongue cancer as compared to healthy, age-matched adults. Subjects included 30 patients who had undergone primary oropharyngeal reconstruction with a radial forearm free-flap and 30 matched controls. Sensations tested were temperature, two-point discrimination, light touch, taste, oral stereognosis and texture on the anterior two-thirds of the tongue. Results indicated that type of surgical nerve repair may not have a significant impact on overall sensory outcomes, providing mixed results for either nerve repair technique. Sensations for the nonoperated tongue side and operated side with lingual nerve intact were comparable to matched controls, with mixed outcomes for nerve repair. The poorest sensory outcomes were observed in patients with the lingual nerve severed, while all patients with lingual nerve intervention exhibited deteriorated taste sensation on the affected tongue side. Overall, patients in this study who had undergone oropharyngeal reconstruction with lingual nerve intervention exhibited decreased levels of sensation on the operated tongue side, with minimal differences between types of lingual nerve repair.


Subject(s)
Lingual Nerve Injuries/surgery , Lingual Nerve/surgery , Neurosurgical Procedures/adverse effects , Sensation/physiology , Tongue Neoplasms/surgery , Adult , Aged , Case-Control Studies , Female , Forearm/surgery , Humans , Male , Middle Aged , Neurosurgical Procedures/methods , Surgical Flaps , Treatment Outcome
5.
Arch Otolaryngol Head Neck Surg ; 127(9): 1086-8, 2001 Sep.
Article in English | MEDLINE | ID: mdl-11556857

ABSTRACT

BACKGROUND: The finite resources available for health care and the proliferation of managed care in the United States have forced the head and neck surgeon to critically evaluate the cost of tumor treatment. OBJECTIVE: To determine whether the cost of treating patients with head and neck tumors would be reduced if the patients were to spend a portion of what would otherwise be acute care hospital days in a hospital-based skilled nursing facility (HB/SNF). DESIGN: Retrospective cost-benefit analysis. SETTING: Tertiary referral center. PATIENTS: Twenty-four consecutive hospital admissions for definitive surgical treatment of head and neck tumors were retrospectively reviewed. The postoperative day on which the patient theoretically could have been transferred to the HB/SNF was determined. The charges and cost of each patient's actual hospital stay were compared with the theoretical counterparts had the patient been transferred to the HB/SNF on the determined day. MAIN OUTCOME MEASURE: Cost savings. RESULTS: The total hospital stay for the 24 patients was 524 days. One hundred eighty-two of those days could have been spent in the HB/SNF. The total charge and cost savings with the use of an HB/SNF were $201,045 and $84,238, respectively (15% of the total charge and cost). This represents an average charge and cost savings of $8377 and $3510, respectively, per patient. The difference was statistically significant (P<.005). CONCLUSION: An HB/SNF could reduce the cost of head and neck tumor treatment without compromising patient care.


Subject(s)
Head and Neck Neoplasms/economics , Head and Neck Neoplasms/surgery , Health Care Costs/statistics & numerical data , Hospitalization/economics , Skilled Nursing Facilities/economics , Cost-Benefit Analysis , Female , Hospital Costs/statistics & numerical data , Humans , Male , Patient Transfer/economics , Retrospective Studies , Subacute Care/economics , United States
6.
Laryngoscope ; 111(2): 347-52, 2001 Feb.
Article in English | MEDLINE | ID: mdl-11210886

ABSTRACT

OBJECTIVE: Radiation-induced xerostomia is a significant morbidity of radiation therapy in the management of patients with head and neck cancers. We have recently reported a method of transfer of one submandibular gland to the submental space in a small pilot series of eligible surgical patients. The submental space was shielded during postoperative radiation therapy. The transferred gland continued to function after the completion of radiation therapy and none of the patients developed xerostomia. The purpose of this article is to present the technique of submandibular gland transfer in detail and to evaluate the postoperative survival and function of the transferred submandibular glands. DESIGN: Prospective clinical trial. METHODS: The submandibular gland was transferred on eligible patients as part of their surgical intervention. The patients were followed clinically, with salivary flow and radioisotope studies. RESULTS: We performed the surgical transfer of the submandibular salivary gland in 24 of 25 patients placed on the protocol. All the glands survived transfer and functioned well postoperatively as demonstrated on the salivary flow and the radioisotope studies. The surgical transfer was relatively simple and added 45 minutes to the surgical procedure. There were no complications attributed to the submandibular gland transfer. CONCLUSIONS: We have successfully demonstrated that the submandibular gland can be surgically transferred to the submental space with its function preserved. The gland seems to continue functioning even after radiation therapy with the appropriate shielding. This surgical transfer procedure has the potential to change the way we currently manage patients with head and neck cancer.


Subject(s)
Carcinoma, Squamous Cell/surgery , Otorhinolaryngologic Neoplasms/radiotherapy , Radiation Injuries/prevention & control , Radiation Protection , Submandibular Gland/surgery , Xerostomia/prevention & control , Adult , Aged , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prospective Studies , Salivation/radiation effects , Submandibular Gland/radiation effects , Tissue Survival/radiation effects
7.
J Otolaryngol ; 30(2): 79-81, 2001 Apr.
Article in English | MEDLINE | ID: mdl-11770960

ABSTRACT

INTRODUCTION: Historically, squamous cells exfoliated from head and neck carcinoma resection have been implicated in locoregional recurrence, but there have been few studies demonstrating the presence of these cells. This study was designed to evaluate the presence of exfoliated malignant cells in surgical irrigation fluid collected during head and neck cancer resection. METHODS: Thirty patients undergoing surgery for biopsy-proven squamous cell carcinoma had their surgical sites irrigated with 1,000 cc of normal saline. Surgical gloves and instruments were also washed. These samples were prepared and stained using standard squamous cell cytologic stains. All cases were reviewed by one cytopathologist. RESULTS: Eighteen patients (60%) had positive or suspicious cytology detected in at least one of the surgical samples. In patients with T0 and T1 tumours, all surgical samples were negative. Positive or suspicious cytology was detected in the primary site and glove and instrument irrigation in 40% of patients with T2 tumours, 42% of patients with T3 tumours, and 50% of patients with T4 tumours. This was statistically significant (p < .05). Positive or suspicious cytology was detected in the neck and glove and instrument irrigation in 29% of patients with an N0 neck, 31% of patients with an N1 neck, 39% of patients with an N2 neck, and 100% of patients with an N3 neck. Five of seven patients (71%) with previous radiation therapy had positive or suspicious cytology in at least one of the surgical samples. CONCLUSIONS: Higher tumour and nodal staging and a previous history of radiation therapy are associated with an increased incidence of positive or suspicious cytology in surgical irrigation fluid. These findings have implications for surgical protocols.


Subject(s)
Carcinoma, Squamous Cell/surgery , Head and Neck Neoplasms/surgery , Adult , Aged , Carcinoma, Squamous Cell/pathology , Female , Gloves, Surgical , Head and Neck Neoplasms/pathology , Humans , Male , Middle Aged , Neoplasm Recurrence, Local , Surgical Instruments , Therapeutic Irrigation
8.
Head Neck ; 22(4): 435-8, 2000 Jul.
Article in English | MEDLINE | ID: mdl-10862028

ABSTRACT

BACKGROUND: Extramedullary hematopoiesis (EMH) is known to occur in myeloproliferative disorders and hemoglobinopathies and is usually seen in the spleen and liver. METHODS: We report the first case of EMH causing subglottic stenosis in a woman with postpolycythemia myeloid metaplasia (PPMM). A tracheotomy was performed to maintain the airway and local radiotherapy was given. RESULTS: Two months after the radiotherapy was completed laryngoscopy showed an unobstructed airway with no evidence of disease, and the patient was successfully decanulated. Magnetic resonance imaging 8 months after radiotherapy confirmed the absence of local disease. CONCLUSION: Consideration should be given to EMH as a possible cause of airway obstruction in the differential diagnosis of a patient with a history of PPMM.


Subject(s)
Hematopoiesis, Extramedullary , Polycythemia/complications , Primary Myelofibrosis/complications , Tracheal Stenosis/etiology , Tracheal Stenosis/radiotherapy , Aged , Female , Follow-Up Studies , Glottis/pathology , Glottis/radiation effects , Hematopoiesis, Extramedullary/radiation effects , Humans , Magnetic Resonance Imaging , Polycythemia/diagnosis , Primary Myelofibrosis/diagnosis , Tracheal Stenosis/diagnosis , Tracheostomy
9.
Int J Radiat Oncol Biol Phys ; 46(1): 7-11, 2000 Jan 01.
Article in English | MEDLINE | ID: mdl-10656365

ABSTRACT

BACKGROUND: Xerostomia is a significant morbidity of radiation therapy in the management of head and neck cancers. We hypothesized that the surgical transfer of one submandibular salivary gland to submental space, outside the proposed radiation field, prior to starting radiation treatment, would prevent xerostomia. METHODS: We are conducting a prospective clinical trial where the submandibular gland is transferred as part of the surgical intervention. The patients are followed clinically, with salivary flow studies and University of Washington quality of life questionnaire. RESULTS: We report early results of 16 patients who have undergone this procedure. Seven patients have finished and 2 patients are currently undergoing radiation treatment. In 2 patients, no postoperative radiation treatment was indicated. Two patients are waiting to start radiation treatment and 2 patients refused treatment after surgery. The surgical transfer was abandoned in 1 patient. All of the transferred salivary glands were positioned outside the proposed radiation fields and were functional. The patients did not complain of any xerostomia and developed only minimal oral mucositis. There were no surgical complications. CONCLUSIONS: Surgical transfer of a submandibular salivary gland to the submental space (outside the radiation field) preserves its function and prevents the development of radiation-induced xerostomia.


Subject(s)
Radiation Injuries/prevention & control , Radiation Protection/methods , Submandibular Gland/surgery , Xerostomia/prevention & control , Adult , Aged , Carcinoma, Squamous Cell/radiotherapy , Head and Neck Neoplasms/radiotherapy , Humans , Middle Aged , Prospective Studies , Quality of Life , Radiation Injuries/etiology , Submandibular Gland/radiation effects , Treatment Outcome , Xerostomia/etiology
10.
J Otolaryngol ; 28(3): 152-7, 1999 Jun.
Article in English | MEDLINE | ID: mdl-10410347

ABSTRACT

Interposition vein grafting is an important technique in microvascular free tissue transfer. Studies in rats have demonstrated that the patency rate of vessels is not affected by interposition grafting when the vein grafts and receipt vessels are of similar diameter. Size discrepancy between vein grafts and recipient vessels is frequently encountered in clinical practice and may potentially be an important factor in anastomotic patency. This study was, therefore, designed to assess the effect of vein graft diameter on the patency of arterial repair and survival of a groin free flap in the rat model. Forty-nine Sprague-Dawley rats were used. The inferior epigastric and femoral veins were used to reconstruct the femoral artery in situ (12 rats, 24 anastomoses) and in groin free flaps (30 rats). The vessel patency with inferior epigastric (1:1 size match) and femoral (2:1 size match) veins was 100% in the non free flap model. In the free flap model, flap survival was 30% in the femoral (2:1 size match) vein graft group. This was significantly less than both the free flap epigastric vein graft group (90% survival) and primary anastomoses group (100% survival). The results of this study suggest that size-matched interposition vein grafts can provide a high degree of reliability, but with size mismatch vein grafts are prone to thrombus formation and subsequent free flap failure.


Subject(s)
Arteriovenous Shunt, Surgical/methods , Disease Models, Animal , Femoral Artery/surgery , Femoral Vein/transplantation , Graft Occlusion, Vascular/prevention & control , Graft Survival , Mesenteric Veins/transplantation , Animals , Blood Vessel Prosthesis Implantation , Endothelium, Vascular/surgery , Microsurgery/methods , Prosthesis Design , Rats , Rats, Sprague-Dawley , Surgical Flaps , Thrombosis/prevention & control
12.
Otolaryngol Head Neck Surg ; 120(5): 689-92, 1999 May.
Article in English | MEDLINE | ID: mdl-10229594

ABSTRACT

OBJECTIVE: The presence of pulmonary metastases significantly alters the treatment of patients with head and neck cancers. Currently, a chest radiograph (CXR) is used as a screening examination, although a chest CT (CCT) can detect smaller lesions. The aim of this study was to evaluate the benefit of CCT as a screening tool in patients with newly diagnosed advanced head and neck cancers. METHOD: New patients with stage III and IV head and neck squamous cell carcinomas were enrolled in this prospective study from August 1994 to December 1995. Twenty-five patients underwent CXR ($71) and CCT ($597) within 2 weeks of diagnosis of the index cancer. RESULTS: In 20 patients neither the CXR nor the CCT showed any evidence of pulmonary malignancy. Two patients had normal CXRs but possible metastases on CCT. Both the pulmonary lesions resolved on follow-up evaluation. Two patients had suspicious lesions on CXR, 1 of whom had a normal CCT. The second patient underwent CT-guided biopsy which was negative for malignancy. Both the CXR and CCT of the final patient, who had a bronchogenic carcinoma, were suspicious. CONCLUSION: In 2 patients CCT detected suspicious lesions missed on CXR, although neither revealed malignancy. Three patients with suspicious CXRs would have had CCTs anyway. Thus 22 of 25 CCTs done at the additional cost of $13,314 did not add to the sensitivity of the screening for pulmonary metastasis or second lung primary.


Subject(s)
Head and Neck Neoplasms/pathology , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/secondary , Mass Chest X-Ray , Tomography, X-Ray Computed , Adult , Aged , Biopsy, Needle , Female , Health Care Costs , Humans , Male , Mass Chest X-Ray/economics , Mass Chest X-Ray/methods , Middle Aged , Neoplasm Staging , Prospective Studies , Reproducibility of Results , Sensitivity and Specificity , Tomography, X-Ray Computed/economics , Tomography, X-Ray Computed/methods
13.
Laryngoscope ; 109(4): 528-35, 1999 Apr.
Article in English | MEDLINE | ID: mdl-10201735

ABSTRACT

OBJECTIVES: No-reflow is failure of perfusion in free tissue transfer despite adequate arterial inflow. The objectives of this study were to construct a theory of interactive mechanisms of the no-reflow phenomenon and to determine whether preischemic vascular washout could increase flap ischemia tolerance. STUDY DESIGN: The evidence for the role of various mechanisms in the development of no-reflow is reviewed, and an integrated network proposed. A rat-groin free flap model is used to test preischemic vascular washout with normal saline, heparinized normal saline, lactated Ringer's solution, Tis-U-Sol, and Viaspan. METHODS: The mean ischemia tolerance of this flap without any therapeutic intervention was first determined, using 22 animals. An additional 50 animals were used to compare with the control group the ischemia tolerance of flaps washed out with the above fluids before their ischemic period. RESULTS: The critical ischemia time 50 (time after which half of the flaps are expected to survive and half, die) of the untreated flap is 23.4 hours in this model (P<.05). Flaps washed out with normal saline or lactated Ringer's solution have significantly worse ischemia tolerance (P<.0001). Flaps washed out with Tis-U-Sol or Viaspan behave similarly to the control group (P>.57). Flaps receiving preischemic washout with heparinized normal saline (4,000 units/L) had a significantly better outcome than the control group (P<.027). CONCLUSIONS: Preischemic washout with normal saline, lactated Ringer's solution, or heparinized Tis-U-Sol is detrimental for flap survival after ischemia, Tis-U-Sol- and Viaspan-treated flaps do have ischemia tolerance similar to the control group, and flaps washed out with heparinized normal saline have a survival advantage in this model.


Subject(s)
Disease Models, Animal , Ischemia/diagnosis , Models, Biological , Surgical Flaps/blood supply , Animals , Disease Progression , Graft Survival , Heparin/therapeutic use , Ischemia/drug therapy , Platelet Aggregation Inhibitors/therapeutic use , Rats , Time Factors
15.
Laryngoscope ; 108(3): 362-7, 1998 Mar.
Article in English | MEDLINE | ID: mdl-9504608

ABSTRACT

Epstein-Barr virus (EBV) has been shown to be a likely etiologic agent in nasopharyngeal carcinogenesis. Human papillomaviruses (HPVs) have previously been identified in numerous upper aerodigestive tract carcinomas. This pilot study was undertaken to investigate the prevalence of combined EBV and HPV infection in 17 patients with nasopharyngeal carcinoma (NPCA) using polymerase chain reaction (PCR). The primary goal was to determine if the presence of HPV could be correlated with molecular, histologic, or clinical parameters. There were seven patients with undifferentiated NPCA (World Health Organization [WHO] type III) and 10 patients with squamous cell carcinoma (WHO type I). All 17 patients had stage IV disease at presentation. EBV was identified in 15 patients (88.2%), and HPV subtypes were identified in samples from nine patients (52.9%). All HPV-positive cases were also EBV positive. Western blot analysis of six samples showed a high level of expression of c-myc and cdc2 kinase and a low level of p53 protein in NPCAs that contained both HPV and EBV (n = 3). Increased expression of c-myc and cdc2 kinase was seen in the cases that contained EBV only, but to a lesser extent (n = 2). These findings indicate an effect of the virus on cellular proliferation and differentiation. Similarly, an elevated level of Rb protein was found only in the HPV-containing NPCAs. Moderate differentiation (keratinization) occurred in four of eight HPV-negative and none of the nine HPV-positive NPCAs. (All HPV-positive cases were poorly differentiated or undifferentiated.) This difference is statistically significant for this sample size (P < 0.03). There was a trend for the group that was HPV positive to have WHO III histology and for the HPV-negative group to have WHO I. The presence of HPV could not be correlated with any clinical parameters in this small group of patients with advanced disease; however, these data suggest that coexistence of EBV and HPV infection may be a factor in the pathogenesis of NPCA and may have an effect on regulation of cellular proliferation and differentiation.


Subject(s)
Herpesviridae Infections/complications , Herpesvirus 4, Human/isolation & purification , Nasopharyngeal Neoplasms/virology , Papillomaviridae/isolation & purification , Papillomavirus Infections/complications , Tumor Virus Infections/complications , Adolescent , Adult , Aged , Carcinoma, Squamous Cell/genetics , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/virology , DNA, Viral/analysis , Gene Expression , Genes, Tumor Suppressor/genetics , Humans , Middle Aged , Nasopharyngeal Neoplasms/genetics , Nasopharyngeal Neoplasms/pathology , Oncogenes/genetics , Pilot Projects
17.
Arch Otolaryngol Head Neck Surg ; 124(1): 60-6, 1998 Jan.
Article in English | MEDLINE | ID: mdl-9440782

ABSTRACT

OBJECTIVE: To present a decision paradigm for facial defect reconstruction, and test the ability of this paradigm to improve resident performance. DESIGN: A decision paradigm for reconstruction of facial skin defects is proposed and explained, with patient examples. The paradigm's usefulness is then tested with residents. SETTING: Otolaryngology residency training program at a tertiary hospital. STUDY PARTICIPANTS: Otolaryngology residents. INTERVENTIONS: Twelve residents took a pretest wherein they were presented with drawings of skin defects and asked to choose the "best" (most aesthetically pleasing) type of reconstruction from a closed set. This paradigm was presented to these residents, and their posttest consisted of choosing again with the same defects and closed set of choices. MAIN OUTCOME MEASURES: Cosmetic outcomes of reconstructive decisions on the pretest and posttest were rated on a scale of 0 to 5 (with 0 indicating poor; 5, excellent). RESULTS: There was a significant improvement in reconstructive choices between the pretest and posttest (P<.001, Student t test). CONCLUSION: This paradigm can be easily modified to accommodate different surgical approaches preferred by individual surgeons and is thus useful in almost any reconstructive teaching situation.


Subject(s)
Face/surgery , Internship and Residency , Otolaryngology/education , Skin Abnormalities/surgery , Teaching , Algorithms , Cicatrix , Decision Making , Humans , Plastic Surgery Procedures/methods , Surgical Flaps
18.
Otolaryngol Head Neck Surg ; 117(5): 547-54, 1997 Nov.
Article in English | MEDLINE | ID: mdl-9374182

ABSTRACT

Microvascular free tissue transfer has revolutionized head and neck reconstruction and currently is considered the most successful and reliable method of primary oromandibular reconstruction. This study was designed to assess the feasibility of full thickness free vascularized transfer of the clavicle based on the clavicular branch of the thoracoacromial artery and the soft tissue component associated with the thoracoacromial axis. Forty dissections of the pectoral region were performed on 26 cadavers. The anatomic relations of the region and the thoracoacromial arterial and venous systems were documented in detail. Selective ink injections of the thoracoacromial arterial branches were also performed on fresh cadavers. The clavicle was supplied mainly by the clavicular artery (medial three quarters), with minor contribution from the deltoid artery (lateral quarter). An average of 16.1 cm (range of 12 to 20 cm) was obtained with total clavicular harvest and the clavicle had sufficient width and height to support dental implants. Two soft tissue donor sites were associated with the thoracoacromial artery: the sternocostal head of the pectoralis major muscle, with the overlying skin supplied by the pectoral artery, and the clavicular head of the pectoralis major muscle, with the overlying skin supplied by the deltoid and clavicular arteries. Sensory innervation of the upper chest was supplied through the supraclavicular nerves, whereas the lateral pectoral nerve supplied motor innervation to both heads of the pectoralis major muscle. The anatomy of the clavipectoral donor site and the first case of full thickness free clavicular transfer for mandibular reconstruction in the English literature are presented. The donor site is an excellent source of well vascularized, thin, pliable, hairless, potentially innervated (motor and sensory) soft tissue, along with up to 20 cm of clavicular bone. The surgical anatomy is familiar to the head and neck surgeon. The harvesting does not require repositioning of the patient and is amenable to a two-team, simultaneous approach. The functional and cosmetic donor site morbidity is minimal even with clavicular harvest. The major disadvantage of this flap is the relatively short pedicle. The authors conclude that the thoracoacromial system provides a free flap with osseous and soft tissue components that are well suited for oromandibular reconstruction.


Subject(s)
Bone Transplantation/methods , Pectoralis Muscles/transplantation , Skin Transplantation/methods , Surgical Flaps , Acromion/blood supply , Adult , Aged , Arteries/anatomy & histology , Bone Transplantation/pathology , Cadaver , Clavicle/blood supply , Clavicle/innervation , Coloring Agents , Dental Implantation, Endosseous , Feasibility Studies , Female , Head/surgery , Humans , Ink , Male , Mandible/surgery , Maxillofacial Injuries/surgery , Microsurgery , Motor Neurons/ultrastructure , Neck/surgery , Neurons, Afferent/ultrastructure , Pectoralis Muscles/blood supply , Pectoralis Muscles/innervation , Plastic Surgery Procedures , Reproducibility of Results , Skin Transplantation/pathology , Surgical Flaps/pathology , Treatment Outcome , Veins/anatomy & histology , Wounds, Gunshot/surgery
19.
Arch Otolaryngol Head Neck Surg ; 123(5): 493-6, 1997 May.
Article in English | MEDLINE | ID: mdl-9158395

ABSTRACT

OBJECTIVES: To determine the satisfaction of patients with their current method of alaryngeal communication. To focus primarily on the patients' perception of their own speech. DESIGN: A retrospective review of patients who underwent total laryngectomy for malignancy identified 4 groups of patients. A survey using a mailed questionnaire was used to compare groups. SETTING: Tertiary care university hospital, University of Texas Medical Branch at Galveston. PATIENTS: Forty-seven patients underwent total laryngectomy for cancer and survived. Thirty-one of the 47 patients responded to the survey. Patients were divided into 4 groups by their current method of communication: (1) tablet writers; (2) esophageal speech; (3) electrolarynx; and (4) tracheoesophageal speech. MAIN OUTCOME MEASURES: Satisfaction with communication, satisfaction with speech quality, ability to communicate over telephone, limitation of interaction with others, and satisfaction with quality of life. RESULTS: Patients in group 4 were significantly more satisfied with their speech (P < .001), perceived their speech to be of better quality (P < .001), had improved ability to communicate over the telephone (P < .001), and had less limitation of their interactions with others (P < .004). Patients in group 4 also rated their overall quality of life higher (P = .23). CONCLUSION: Although many studies in the past have demonstrated the objective superiority of tracheoesophageal speech compared with other methods of alaryngeal communication, most studies have focused on the intelligibility of speech judged by listeners. This study demonstrates that patients who use tracheoesophageal speech rate their own speech significantly higher than patients who use other methods and most likely have an overall superior quality of life.


Subject(s)
Communication , Laryngectomy/rehabilitation , Patient Satisfaction , Adult , Aged , Communication Aids for Disabled , Female , Humans , Laryngectomy/statistics & numerical data , Larynx, Artificial , Male , Middle Aged , Patient Satisfaction/statistics & numerical data , Quality of Life , Retrospective Studies , Speech, Esophageal , Surveys and Questionnaires , Texas
20.
Laryngoscope ; 107(1): 40-3, 1997 Jan.
Article in English | MEDLINE | ID: mdl-9001263

ABSTRACT

Use of sympathomimetic topical nasal decongestants to treat nasal obstruction is usually restricted to 3 to 5 days to avoid potential rebound swelling (rhinitis medicamentosa). In this study, 10 healthy volunteers used oxymetazoline (long-acting topical nasal decongestant) nightly for 4 weeks. Subjects who used antihistamines, oral or topical decongestants, or systemic steroids or who had active sinusitis were excluded from the study. Weekly history, physical examination, and anterior rhinomanometry revealed no adverse effects. Eight (80%) subjects developed nightly nasal obstruction a few hours before the evening dose; the obstruction resolved within 48 hours if no more decongestant was used. All subjects remained responsive to oxymetazoline 4 weeks and 8 weeks after the study began. This finding suggests that long-acting decongestants may be safely used for longer than the recommended 3 to 5 days without adverse effects if used once nightly.


Subject(s)
Nasal Decongestants/administration & dosage , Oxymetazoline/administration & dosage , Sympathomimetics/administration & dosage , Humans , Nasal Decongestants/adverse effects , Nasal Obstruction/chemically induced , Oxymetazoline/adverse effects , Rhinitis/chemically induced , Sympathomimetics/adverse effects
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