Postoperative uvular necrosis: A case series and literature review.

OBJECTIVES/HYPOTHESIS: Postoperative uvular necrosis is rare, but can be distressing to the patient when it unexpectedly occurs. Little has been published regarding its predisposing factors and pathophysiology. The purpose of this comprehensive review was to compile cases of postoperative uvular necrosis and identify risk factors and potential causes for this complication. STUDY DESIGN: Retrospective case series. METHODS: The study was performed at an academic tertiary care referral center. Clinical records from four patients treated for postoperative uvular necrosis from 2008 to 2018 were reviewed. A comprehensive literature review was also performed. The MEDLINE, Embase, and Scopus databases were searched, as well as the grey literature. All case reports and literature reviews in the English literature from 1978 to 2018 were systematically identified for review. RESULTS: Four cases of postoperative uvular necrosis diagnosed clinically at our institution were included. The comprehensive literature review identified 26 reports and seven case series, totaling 53 cases of this complication. Use of suction was reported in 19 cases, and six cases reported no use of suction. Ninety-four percent of cases were treated conservatively, whereas 6% underwent excision. Ninety-one percent resolved within 14 days. CONCLUSIONS: Impingement with various devices and vascular trauma from suction each likely play a role in postoperative uvular necrosis. Male oropharyngeal anatomy may be a risk factor, but neither the type of instrumentation nor the type of procedure seem to predict this complication. Proper positioning of the patient and instruments and minimizing suction force help prevent uvular injury. LEVEL OF EVIDENCE: NA Laryngoscope, 130:880-885, 2020.

Use of the microdebrider in the surgical management of rhinophyma.

Rhinophyma is a disfiguring end-stage manifestation of acne rosacea. It is characterized by a painless hyperplasia of the sebaceous glands and connective tissues of the nose. Numerous surgical modalities-including scalpel surgery, dermabrasion, CO2 laser ablation, and electrocautery-have been reported with varying results. We describe our experience with using a microdebrider to treat 2 patients-a 65-year-old man and a 74-year-old man-who presented with rhinophyma. The instrument we used was the Medtronic Straightshot M4 Microdebrider. Using a low revolution speed, we easily excised the bulky superficial tissue. At higher revolution speeds with the use of a small shaver tip, we were able to achieve delicate contouring of the nasal tip and ala without causing scarring. Postoperatively, both patients exhibited an excellent cosmetic outcome and expressed a high degree of patient satisfaction. We conclude that the microdebrider is an excellent surgical tool for treating rhinophyma lesions. Its ease of use and its availability at most surgical centers makes it a favorable surgical option.

Trismus following treatment of head and neck cancer.

BACKGROUND: The aim of this preliminary study was to determine the prevalence of trismus in head and neck cancer patients treated with radiotherapy with or without concomitant chemotherapy and surgery. METHODS AND MATERIALS: Patients with malignant lesions in the head and neck treated with curative intent were comprehensively evaluated for trismus using subjective and objective measures. RESULTS: A large proportion of the 70 patients recruited demonstrated moderate to severe subjective trismus (45.7%). Similarly, the vast majority of patients showed slight to severe trismus (91.4%) according to objective secondary outcome measures. Of these patients, 21 (65.6%) were also treated with concurrent chemoradiotherapy. When the radiation field involved the pterygoid muscles, 30 (93.8%) patients reported subjective trismus. Similarly, bilateral pterygoid muscle inclusion resulted in 28 (87.5%) patients with trismus. CONCLUSIONS: Trismus is a significantly prevalent consequence of treatment for head and neck cancer. Predictive factors include treatment with concurrent chemoradiotherapy and bilateral inclusion of the structures of mastication in the high-dose radiotherapy volume.

Using photodynamic therapy as a neoadjuvant treatment in the surgical excision of nonmelanotic skin cancers: prospective study.

BACKGROUND: Topical photodynamic therapy (PDT) is a successful treatment for nonmelanotic skin cancers (NMSCs). Nevertheless, surgical excision continues to be the gold standard treatment. Cervicofacial excision often results in functional and aesthetic impairment. We hypothesize that topical PDT as a neoadjuvant therapy to surgical excision may reduce tumour size and subsequently decrease local morbidity. OBJECTIVE: To determine the utility of PDT in reducing the NMSC area for the purpose of surgical excision. METHOD: A prospective cohort study. RESULTS: Thirty-three basal cell carcinomas with a mean area of 523.11 ± 120.93 mm² and 26 squamous cell carcinomas with a mean area of 357.53 ± 61.96 mm² were included. Of these lesions, 22 demonstrated a complete curative response after an average of two PDT treatments, which were then confirmed with histologically negative biopsies. The remaining lesions demonstrated a partial response to topical PDT with a maximum reduction in lesion area following an average of three PDT treatments of at least 88% (p < .05). These lesions were then excised with clear histologic margins. Follow-up at 1 year for all lesions demonstrated no locoregional recurrence. CONCLUSIONS: This is the first study to investigate the efficacy of neoadjuvant topical PDT in the management of NMSC. The results suggest that for NMSC not demonstrating a complete curative response to PDT, neoadjuvant PDT can substantially reduce tumour burden, allowing for less morbid surgical excisions with histologically clear margins.

Revision rates after endoscopic sinus surgery: a recurrence analysis.

OBJECTIVES: Chronic rhinosinusitis with nasal polyposis is often refractory to medical and surgical management, especially in patients with asthma and aspirin intolerance. We used a contemporary database to investigate recurrence and revision surgery rates following endoscopic sinus surgery. METHODS: We performed a cohort study using a survival analysis technique. Records were reviewed of 549 patients with nasal polyposis who underwent endoscopic sinus surgery over a 10-year period. The main outcome measure was disease-free and surgery-free survival following endoscopic sinus surgery, investigated with Kaplan-Meier analyses. RESULTS: Patients with Samter's triad were significantly more likely to have a recurrence and undergo a second surgery following recurrence (risk-odds ratio, 2.7; 95% confidence interval, 1.5 to 3.2; p < 0.01) than were patients without asthma or with only asthma from the triad. The presence of initial frontal sinus disease also increased the likelihood of revision surgery (risk-odds ratio, 1.6; 95% confidence interval, 1.2 to 1.8; p < 0.05). CONCLUSIONS: This is the first study to use survival analysis to document revision surgery rates following endoscopic sinus surgery. Revision surgery occurs at a high rate, especially in patients with asthma, Samter's triad, or frontal sinus disease. Patients should routinely be informed during clinical consultations about the likelihood of recurrence. Early intervention for frontal sinus disease may be considered.

Neoadjuvant use of photodynamic therapy in Basal cell and squamous cell carcinomas of the face.

Background. This preliminary study sought to determine the success of photodynamic therapy (PDT) in reducing lesion size in an effort to assess the potential application of this treatment approach in a neoadjuvant role. Objectives. To quantify the effects of PDT on lesion area (mm(2)) for basal cell and squamous cell carcinomas of the face. Results. Eighteen participants (10 BCC lesions and 8 SCC lesions of the face) were assessed. Four lesions (all from the BCC group) showed a complete response to PDT. Of the remaining 14 lesions, 85.7% (n = 12) showed reductions in lesion area, while two lesions showed increase in lesion area. Proportional reductions for the 12 lesions that did not demonstrate complete response or an increase in area following-PDT were found to range from 13.2% to 85.1% (BCC) and 6.7% to 89.7% (SCC). Conclusions. PDT as a neoadjuvant treatment may provide a simple, efficient, and viable approach to reducing the area of malignant lesions of the face with the advantage of reduced cosmetic and aesthetic morbidities.

Wait times in the diagnosis and treatment of head and neck cancer: comparison between wait times in 1995 and 2005--a prospective study.

INTRODUCTION: There are limited studies documenting current wait times in the diagnosis and treatment of head and neck cancer. The objective of this study was to describe wait times along the health care pathway of head and neck cancer patients referred to an oncology centre in Ontario in 2005 and compare these times with those in a similar cohort of patients enrolled in 1995. METHODS: A cross-sectional study investigating wait times in newly diagnosed patients with squamous cell carcinoma of the head and neck was undertaken at the Princess Margaret Hospital, Toronto, Ontario. Data were collected prospectively in 2005 and 1995. Patient interviewing and health care provider corroboration were employed for a sample size of 45 patients in 2005 and 40 patients in 1995. RESULTS: Median wait times in 2005 were similar to those in 1995 for each time period, except for the time from consultation with the first tertiary specialist to treatment, which was statistically significantly shorter in 1995 (25 days) than in 2005 (37 days), p = .002. The median time from initial primary care practitioner seen to treatment (total professional delay) was not different from 1995 (126 days) to 2005 (115 days), p = .47. On univariate analysis, there were no statistically significant differences in wait times in each time period based on site (p = .226 and .321, respectively) and overall stage (p = .655 and .538, respectively). CONCLUSIONS: Wait times for head and neck cancer treatment from the time of initial consultation with an oncologist have increased from 1995 to 2005.