Contemporary management of carotid blowout syndrome utilizing endovascular techniques.

OBJECTIVES/HYPOTHESIS: To illustrate complex interdisciplinary decision making and the utility of modern endovascular techniques in the management of patients with carotid blowout syndrome (CBS). STUDY DESIGNS: Retrospective chart review. METHODS: Patients treated with endovascular strategies and/or surgical modalities were included. Control of hemorrhage, neurological, and survival outcomes were studied. RESULTS: Between 2004 and 2014, 33 patients had 38 hemorrhagic events related to head and neck cancer that were managed with endovascular means. Of these, 23 were localized to the external carotid artery (ECA) branches and five localized to the ECA main trunk; nine were related to the common carotid artery (CCA) or internal carotid artery (ICA), and one event was related to the innominate artery. Seven events related to the CCA/ICA or innominate artery were managed with endovascular sacrifice, whereas three cases were managed with a flow-preserving approach (covered stent). Only one patient developed permanent hemiparesis. In two of the three cases where the flow-preserving approach was used, the covered stent eventually became exposed via the overlying soft tissue defect, and definitive management using carotid revascularization or resection was employed to prevent further hemorrhage. In cases of soft tissue necrosis, vascularized tissues were used to cover the great vessels as applicable. CONCLUSIONS: The use of modern endovascular approaches for management of acute CBS yields optimal results and should be employed in a coordinated manner by the head and neck surgeon and the neurointerventionalist. LEVEL OF EVIDENCE: 4. Laryngoscope, 2016 127:383-390, 2017.

Adenocarcinoma of the anterior tongue: a case report.

Adenocarcinoma of the minor salivary gland more commonly involves the palate and base of tongue but rarely presents in the anterior tongue. We report a rare case of adenocarcinoma of the minor salivary gland located in the anterior togue of a 74-year-old man. Furthermore, we discuss the histopathological features of this neoplasm, the treatment plan, and a literature review of the current standard of care.

Surgical treatment of the crooked nose.

One-stage septorhinoplasty has become a surgical standard of care because many surgeons in the mid-twentieth century recognized that septal surgery played an essential role in the management of the crooked nose and therefore combined septoplasty and rhinoplasty into a single operation. Definitive predictable correction of the crooked nose is one of the most exigent aspects of this operation. The surgeon should methodically analyze the anatomy and aesthetics of a patient's nose, as a unique structure and as part of the overall face, and must have an understanding of the interrelationships of the structural components of the nose and of the dynamics of change that result from altering these various structures. This article discusses the general principles and the surgical details of septorhinoplasty.

Head and neck cancer: an overview.

Ablative surgery for malignancies of the upper aerodigestive tract is the most common reason why the reconstructive surgeon is called upon to reconstruct adult head and neck defects. An understanding of the pathophysiology and treatment of head and neck malignancy is vital to the reconstructive surgeon so that restoration of both form and function can be achieved. It is important to understand the behavior of cancers of each head and neck subsite, as staging and ultimately the treatment of tumors from each subsite is different. Historically, the standard treatment of head and neck cancer was surgery and/or primary radiation therapy with surgical salvage for failure. Beginning in the 1980s, advances in chemotherapy and concurrent delivery with radiation offered new options to standard surgical therapy. Over the past two decades, the concept of organ preservation using chemotherapy together with radiation therapy has been definitively established. Yet, even with the strides made over these two decades with chemoradiation, surgical treatment of head and neck cancer and reconstruction thereof will be an important treatment option for the foreseeable future. Therefore, the relationship between the extirpative and reconstructive surgeon is vital, and a clear understanding of the biology and behavior of head and neck malignancy is crucial to successful patient outcomes.