Tunneled infusion catheter breakage: frequency and repair kit outcomes.

PURPOSE: To determine the frequency of tunneled infusion catheter breakage and the durability of a repair kit used to repair damage to the external catheter segment, avoiding catheter replacement. MATERIALS AND METHODS: With use of a quality assurance database, 724 silicone tunneled infusion catheters placed between July 2002 and September 2005 were identified. The repair kit outcomes portion of the study focused on 10-F triple-lumen catheters (n = 433), the type placed most frequently in our practice and that with the most repairs available for analysis. To compare durability, nonrepaired catheters and those requiring repair were compared by using Cox proportion hazard regression. RESULTS: Breakage occurred in 53 of 443 (12%) 10-F triple-lumen catheters, three of 64 (5%) 10-F dual-lumen catheters, four of 159 (3%) 11-F triple-lumen catheters, four of 12 (33%) 9.6-F single-lumen catheters, and eight of 56 (14%) 9-F double-lumen catheters. In the 10-F subset, the mean time to catheter breakage was 60 days. The mean catheter days for the nonrepaired group (143 days) and the repaired group (145 days) were not significantly different (chi2, 0.071; hazard ratio, 1.07; P = .79). Mean catheter dwell after repair was 79 days. The failure rate for the repair kit was 14% (seven of 51 attempts). CONCLUSIONS: Tunneled infusion catheter breakage is common. Given the high breakage rates observed for many catheter designs, the development of more durable catheters should be a priority for catheter manufacturers. Until more durable catheters are developed, the catheter repair kit studied is an easy, effective, durable, and relatively inexpensive solution for the repair of external segment damage in tunneled infusion catheters.

Prosthetic intervention in the era of microvascular reconstruction of the mandible--a retrospective analysis of functional outcome.

PURPOSE: The purpose of this retrospective study was to compare the functional outcomes of patients who had mandibular resection and reconstruction with and without prosthetic intervention, and to identify predictive factors that may have an impact on functional outcomes. MATERIALS AND METHODS: Two hundred twenty head and neck cancer patients who had undergone mandibular resection and reconstruction with at least 6 months of postoperative convalescence formed the basis of this retrospective review. Patients who did not receive prosthetic intervention formed group I (n = 142); those who received prosthetic intervention formed group II (n = 78). Functional outcomes were measured using four individual assessments (nutritional status, swallowing, masticatory performance, and speech) and one that combined the information from these assessments, the global measure of functional outcome (GMFO). Statistical analyses were used to compare the baseline characteristics and functional outcome between groups I and II and to analyze independent predictors for GMFO. RESULTS: Of the 220 patients reviewed, 78 (35%) had prosthetic intervention; group II patients had better individual functional outcome measures and GMFO. Use of a prosthesis remained associated with GMFO after controlling for other significant predictors; other independent predictors were xerostomia, number of remaining mandibular teeth, number of tooth-to-tooth contacts, type of reconstruction, flap interference, and tongue defect. Patients who had fewer mandibular teeth and received a smaller prosthesis had better overall outcome than patients who received a larger prosthesis. CONCLUSION: Patients who had prosthetic intervention after mandibular reconstruction had significantly better functional outcomes than patients who did not receive prosthetic intervention, even after adjusting for confounding variables.

Efficacy of speech aid prostheses for acquired defects of the soft palate and velopharyngeal inadequacy--clinical assessments and cephalometric analysis: a Memorial Sloan-Kettering Study.

BACKGROUND: Restoration of speech after surgical resection for oropharyngeal cancer traditionally includes maxillofacial prosthetic intervention. Relatively few publications with objective speech outcomes exist. The purpose of this study was to evaluate speech outcome relative to the size of the surgical defect, the type of speech prosthesis, and the height and position of the speech bulb in relation to the posterior pharyngeal wall in the nasopharynx. METHODS: Fifty-five patients treated at the Memorial Sloan-Kettering Cancer Center Dental Service who underwent ablative cancer therapy were evaluated. All patients were 4 months or longer after surgery and were using a speech aid or obturator prosthesis at the time of the study. Speech samples for percent intelligibility and perceptual evaluation were collected and analyzed, in addition to aeromechanical measurements of palatopharyngeal function. Lateral cephalograms were taken while wearing the prosthesis using a radiopaque marker placed on the posterior aspect of the prosthesis for evaluating the height and position of the prosthesis obturator-speech bulb component. RESULTS: After adjustment for the differences between listeners, findings revealed that as the percentage of resection of palate or tongue increased, the intelligibility of speech decreased. Aeromechanical assessment of speech was the only outcome measure sensitive to the type of speech prosthesis. The position of the speech bulb component, as well as the angle measured, was correlated with the percent intelligibility. The amount of the prosthesis physically contacting the posterior pharyngeal wall was not significantly associated with any of the functional outcome measures. CONCLUSIONS: Speech aid and obturator prostheses contribute to a higher percentage of intelligible speech. A difference in intelligibility exists in relationship to the position of the prosthesis and the anterior tubercle of the atlas vertebrae (C1), both statistically and clinically. The position for optimal speech could not be specifically located mathematically (ie, 3 mm or 3 degrees inferior to the anterior tubercle of the atlas vertebrae) from the analysis. Subjective ratings of the efficacy of the obturator-speech bulbs by the clinicians did not correspond to the percent intelligibility. A strong statistical and clinical correlation exists supporting the efficacy of speech bulb-obturator intervention after velopharyngeal insufficiency for improved intelligibility of both words and sentences.