Perioperative mortality in oncologic head and neck surgery.

OBJECTIVE: The aim of this study was to establish the causes of perioperative mortality after head and neck oncologic surgery, to improve operative strategies and surgery procedures, and to reduce postoperative complications. SETTING: University Hospitals of Strasbourg, Head and Neck Department. PATIENTS AND METHODS: The medical files of patients who died within 30 days of presentation with epidermoid carcinoma of the head or neck were analyzed; criteria included age, sex, medical history, and the location and stage of development of the tumour. MEASUREMENT METHOD: The causes of death are discussed with reference to the pre- and postmortem observations. RESULTS: In this study, the perioperative mortality rate was 3.07%. It depended more on tumour stage and the medical history of the patient than on tumour location and the age of the patient. The responsibility of the medical team itself was involved in some cases. DISCUSSION AND CONCLUSION: The study shows the difficulty of establishing the cause of death of weakened patients who have undergone a heavy surgical operation. Although the majority of deaths recorded are considered to have been unavoidable, for a small number of them, the absence of vital function monitoring over the first days after the operation was a contributory cause. Perioperative mortality has greatly decreased over the last 30 years and is, at present, almost nonexistent during anesthesia in head and neck surgery.

Indications and results of cauterization by endoscopic approach of the sphenopalatine artery in severe posterior epistaxis.

OBJECTIVES: The authors present a retrospective study concerning cauterization by endoscopic approach of the sphenopalatine artery in the treatment of severe posterior epistaxis. The purpose is to evaluate the effectiveness of these therapeutics, their complications, to determine their indications and their contributions to the therapeutic arsenal of the treatment of severe epistaxis. PATIENTS AND METHOD: This study concerns 10 patients, which have been operated in the department of ORL head and neck surgery of Strasbourg and treated over a 23-month period (from January 2001 to November 2002), for clinically labelled posterior origin epistaxis. A preliminary treatment, by anterior and posterior tamponage, using a Brighton Epistaxis Balloon was carried out (n = 8); the use of an associated ligature of the ethmoidal arteries was sometimes necessary during operative time (n = 4). RESULTS: Hemorrhagic control with absence of recurrence was the rule (n = 9). A complementary interventional radiology embolization due to failure was necessary in one case. The average duration of post-surgical hospitalization was of 2.1 days. No post-surgical complications were noted. CONCLUSION: Cauterization by endonasal approach of the sphenopalatine artery in severe posterior epistaxis is a reliable intervention. Its role is clearly defined in our department, after failure of traditional treatments by packing methods.