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Complications related to the Cook-Swartz implantable Doppler probe use in head and neck microvascular reconstruction: a systematic review. Eur Arch Otorhinolaryngol 2023; 280:23-37. [PMID: 35941283 DOI: 10.1007/s00405-022-07577-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/26/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Vascular perfusion research has been dedicated to identify inexpensive, effective, and easy to use methods to assess free flap perfusion for both buried and non-buried flaps. METHODS Systematic review of complications in patients underwent Head and Neck microsurgical reconstruction and vascular implantable Doppler monitoring. RESULTS Sixteen articles were included for qualitative analysis. 2535 (92.2%) patients received IDP monitorization. Venous thrombosis was the most common vascular complication effecting 28 (1.1%). Regarding complications potentially related to the use of the IDP, just one study described the presence of granuloma formation along the suture line in 2 (0.07%) patients. CONCLUSIONS Our findings indicated that Cook-Swartz IDP will represents a safe and effective device for FF monitoring in HN reconstructive micro-surgery. A detailed prospective registration of the results and complications related to the use of IDP remains mandatory to precisely estimate results, cost, and complications.
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Bruin LL, Hundepool CA, Duraku LS, Mureau MAM, Zuidam JM. Higher incidences of neuropathic pain and altered sensation following radial forearm free flap: A systematic review. J Plast Reconstr Aesthet Surg 2021; 75:1-9. [PMID: 34736849 DOI: 10.1016/j.bjps.2021.09.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/28/2021] [Accepted: 09/19/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The radial forearm free flap (RFFF) has been used extensively for complex tissue defect reconstructions; however, the potential for significant donor-site morbidity remains a major drawback. Despite an abundance of literature on donor-site morbidities, no consensus has been reached on exact incidences of sensory morbidities that vary largely between 0% and 46%. Incidences of neuropathic pain in the donor site following RFFF still lack, even though clinical experience shows it often occurs. Therefore, the purpose of this systematic review was to identify the incidence of neuropathic pain and altered sensation in the hand following harvesting of a RFFF. METHODS A systematic search was performed in multiple databases (Embase, Medline, Cochrane, Web of Science, and Google Scholar). Studies from 1990 onwards that reported donor-site morbidities following harvest of the RFFF were included. Analyzed parameters included hand pain, hypoesthesia, cold intolerance, hyperesthesia, neuroma formation, paresthesia, sharp sensation loss, light sensation loss, and defect closure. RESULTS Of the 987 selected studies, 51 eligible articles were selected. The mean level of evidence was 3 (SD 0.6). Twenty articles reported pain as a donor-site morbidity, and the mean incidence of pain reported was 23% (SD 7.8). Hypoesthesia was reported by 37 articles and had a mean incidence of 34% (SD 25). Locations of pain and hypoesthesia included, amongst others, the area of the radial sensory nerve and the skin graft area. The mean incidences of cold intolerance and hyperesthesia were 13% (SD 13) and 16% (SD 15), respectively. CONCLUSION The results of this systematic review suggest that 23% of all patients are dealing with neuropathic pain in the donor-site following harvest of an RFFF. Future studies should therefore focus on the prognostic factors and preventive measures of neuropathic pain to further improve clinical outcomes of this widely used flap.
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Affiliation(s)
- L L Bruin
- The Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - C A Hundepool
- The Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - L S Duraku
- The Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M A M Mureau
- The Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J M Zuidam
- The Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Fernández-de-las-Peñas C, López-de-Celis C, Rodríguez-Sanz J, Hidalgo-García C, Donnelly JM, Cedeño-Bermúdez SA, Pérez-Bellmunt A. Is Dry Needling of the Supinator a Safe Procedure? A Potential Treatment for Lateral Epicondylalgia or Radial Tunnel Syndrome. A Cadaveric Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179162. [PMID: 34501752 PMCID: PMC8430708 DOI: 10.3390/ijerph18179162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/24/2021] [Accepted: 08/29/2021] [Indexed: 11/16/2022]
Abstract
The supinator muscle is involved in two pain conditions of the forearm and wrist: lateral epicondylalgia and radial tunnel syndrome. Its close anatomical relationship with the radial nerve at the arcade of Frohse encourages research on dry needling approaches. Our aim was to determine if a solid filiform needle safely penetrates the supinator muscle during the clinical application of dry needling. Needle insertion of the supinator muscle was conducted in ten cryopreserved forearm specimens with a 30 × 0.32 mm filiform needle. With the forearm pronated, the needle was inserted perpendicular into the skin at the dorsal aspect of the forearm at a point located 4cm distal to the lateral epicondyle. The needle was advanced to a depth judged to be in the supinator muscle. Safety was assessed by measuring the distance from the needle to the surrounding neurovascular bundles of the radial nerve. Accurate needle penetration of the supinator muscle was observed in 100% of the forearms (needle penetration:16.4 ± 2.7 mm 95% CI 14.5 mm to 18.3 mm). No neurovascular bundle of the radial nerve was pierced in any of the specimen’s forearms. The distances from the tip of the needle were 7.8 ± 2.9 mm (95% CI 5.7 mm to 9.8 mm) to the deep branch of the radial nerve and 8.6 ± 4.3 mm (95% CI 5.5 mm to 11.7 mm) to the superficial branch of the radial nerve. The results from this cadaveric study support the assumption that needling of the supinator muscle can be accurately and safely conducted by an experienced clinician.
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Affiliation(s)
- César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), 28922 Alcorcón, Spain
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
- Correspondence: ; Tel.: +34-91-488-88-84
| | - Carlos López-de-Celis
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya (UIC-Barcelona), C/Josep Trueta s/n, Sant Cugat del Vallès, 08017 Barcelona, Spain; (C.L.-d.-C.); (J.R.-S.); (S.A.C.-B.); (A.P.-B.)
- ACTIUM Functional Anatomy Group, 08195 Barcelona, Spain
| | - Jacobo Rodríguez-Sanz
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya (UIC-Barcelona), C/Josep Trueta s/n, Sant Cugat del Vallès, 08017 Barcelona, Spain; (C.L.-d.-C.); (J.R.-S.); (S.A.C.-B.); (A.P.-B.)
- ACTIUM Functional Anatomy Group, 08195 Barcelona, Spain
| | - César Hidalgo-García
- Unidad de Investigación en Fisioterapia, Universidad de Zaragoza, 50001 Zaragoza, Spain;
| | - Joseph M. Donnelly
- Department of Physical Therapy, Miami Campus, University of Saint Augustine for Health Sciences, Coral Gables, FL 33134, USA;
| | - Simón A Cedeño-Bermúdez
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya (UIC-Barcelona), C/Josep Trueta s/n, Sant Cugat del Vallès, 08017 Barcelona, Spain; (C.L.-d.-C.); (J.R.-S.); (S.A.C.-B.); (A.P.-B.)
- ACTIUM Functional Anatomy Group, 08195 Barcelona, Spain
| | - Albert Pérez-Bellmunt
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya (UIC-Barcelona), C/Josep Trueta s/n, Sant Cugat del Vallès, 08017 Barcelona, Spain; (C.L.-d.-C.); (J.R.-S.); (S.A.C.-B.); (A.P.-B.)
- ACTIUM Functional Anatomy Group, 08195 Barcelona, Spain
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Hand-sewn, coupler and Doppler-assisted venous anastomosis in free flap surgery: a systematic review and meta-analysis. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-021-01854-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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5
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Kaur K, Kakkar A, Manchanda S, Chatterjee P, Kaur H, Mishra D, Verma H, Kumar R, Sagar P, Jain D, Bhalla AS. Sinonasal IgG4-related disease: a rare and emerging entity broadening the differential diagnosis in the sinonasal universe. Eur Arch Otorhinolaryngol 2021; 278:2883-2890. [PMID: 33392765 DOI: 10.1007/s00405-020-06564-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 12/10/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND IgG4-related disease (IgG4-RD) is a multi-organ immune-mediated disorder characterized by fibroinflammatory mass-forming lesions, mimicking malignancy or infection. While well-documented in salivary glands, orbit and thyroid in the head and neck, sinonasal IgG4-RD is rare. METHODS Cases of sinonasal IgG4-RD were retrieved, and clinicopathological features reviewed. RESULTS Seven cases of sinonasal IgG4-RD were identified over a 2-year period, including three males and four females, with an age range of 13-48 years (median: 32 years). Patients presented with cheek swelling, pain and visual disturbances. Serum IgG4 levels were mildly elevated. Storiform fibrosis, obliterative phlebitis and plasma cell infiltration were seen in varying proportions. Destruction of bone and subepithelial mucoserous glands was present. ALK-1 negativity distinguished from inflammatory myofibroblastic tumor. CONCLUSION Sinonasal IgG4-RD expands the growing spectrum of IgG4-RD. A high degree of suspicion is required to include IgG4-RD in differential diagnosis of sinonasal masses, and perform detailed histological and immunohistochemical workup for accurate diagnosis.
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Affiliation(s)
- Kanwalpreet Kaur
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
| | - Smita Manchanda
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Puja Chatterjee
- Department of Otorhinolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Harpreet Kaur
- Department of Oral Pathology and Microbiology, Centre of Dental Education and Research, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Deepika Mishra
- Department of Oral Pathology and Microbiology, Centre of Dental Education and Research, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Hitesh Verma
- Department of Otorhinolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Rajeev Kumar
- Department of Otorhinolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Prem Sagar
- Department of Otorhinolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Ashu Seith Bhalla
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, 110029, India
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6
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Troob SH, Self Q, Gerecci D, Hodgson M, González-Castro J, Petrisor D, Wax MK. Venous Flow Coupler in Head and Neck Free Flap Reconstruction. Otolaryngol Head Neck Surg 2020; 164:574-579. [PMID: 32895011 DOI: 10.1177/0194599820953098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the utility of venous flow couplers in monitoring free tissue flaps in the immediate postoperative setting. STUDY DESIGN Retrospective case series. SETTING Otolaryngology department at a single tertiary care institution. METHODS A retrospective case series of free flap reconstructions in which venous flow couplers were employed to supplement flap monitoring. All free flap cases performed over the past 4 years were reviewed. Inclusion criteria were venous flow coupler and arterial flow Doppler monitored for 5 days postoperatively. RESULTS From July 2014 through May 2018, the venous flow coupler was used with the arterial flow Doppler and clinical monitoring in 228 cases. Eleven cases did not meet criteria for inclusion; thus, 217 cases were analyzed. Twenty cases (9.2%) returned to the operating room with concern for flap compromise, and 16 were salvaged. The combination of venous flow coupler and arterial flow Doppler identified 19 of these flaps. Venous flow couplers identified 5 compromised flaps before there was an arterial signal change, and all were salvaged. Additionally, there was a 24.1% false-positive rate when 2 venous flow couplers were used in parallel. For the venous flow coupler, the positive predictive value was 64.3% and the negative predictive value, 98.9%. The false-positive rate in the series was 5.1%. The sensitivity was 90% and the specificity, 94.9%. CONCLUSION The venous flow coupler is able to detect venous thrombosis in the absence of arterial thrombosis and may contribute to improved flap salvage rates.
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Affiliation(s)
- Scott H Troob
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Medical Center, New York, New York, USA
| | - Quinn Self
- University of Vermont Medical School, Burlington, Vermont, USA
| | - Deniz Gerecci
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University School of Medicine, Portland, Oregon, USA
| | - Macgregor Hodgson
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University School of Medicine, Portland, Oregon, USA
| | - Javier González-Castro
- Department of Otolaryngology-Head and Neck Surgery, University of Puerto Rico, San Juan, Puerto Rico, USA
| | - Daniel Petrisor
- Department of Oral and Maxillofacial Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Mark K Wax
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University School of Medicine, Portland, Oregon, USA
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7
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Calotta NA, Chandawarkar A, Desai SC, Dellon AL. An Algorithm for the Prevention and Treatment of Pain Complications of the Radial Forearm Free Flap Donor Site. J Reconstr Microsurg 2020; 36:680-685. [PMID: 32726818 DOI: 10.1055/s-0040-1714149] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The radial forearm free flap (RFFF) is a staple of microsurgical reconstruction. Significant attention has been paid to donor-site morbidity, particularly vascular and aesthetic consequences. Relatively few authors have discussed peripheral nerve morbidity such as persistent hypoesthesia, hyperesthesia, or allodynia in the hand and wrist or neuroma formation in the wrist and forearm. Here, we present a diagnostic and therapeutic algorithm for painful neurologic complications of the RFFF donor site. MATERIALS AND METHODS The peripheral nerves that can be involved with the RFFF are reviewed with respect to the manner in which they may be involved in postoperative pain manifestations. A method for prevention and for treatment of each of these possibilities is also presented. RESULTS Nerves from the forearm that can be harvested with the RFFF will have the most likelihood for injury and these include the lateral antebrachial cutaneous nerve, the radial sensory nerve, and the medial antebrachial cutaneous nerve. A nerve that may be injured at the distal juncture of the skin graft to the forearm is the palmar cutaneous branch of the median nerve. The "prevention" portion of the algorithm suggests that each nerve divided to become a recipient nerve should have its proximal end implanted into a muscle to prevent painful neuroma. The "treatment" portion of the algorithm suggests that if a neuroma does form, it should be resected, not neurolysed, and the proximal portion should be implanted into an adjacent muscle. The diagnostic role of nerve block is emphasized. CONCLUSION Neurological complications following RFFF can be prevented by an appropriate algorithm as described by devoting attention to the proximal end of recipient nerves. Neurological complications, once present, can be difficult to diagnose accurately. Nerve blocks are critical in this regard and are employed in the treatment algorithm presented.
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Affiliation(s)
- Nicholas A Calotta
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Akash Chandawarkar
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Shaun C Desai
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - A Lee Dellon
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.,Dellon Institutes for Peripheral Nerve Surgery, Baltimore, Maryland
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8
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Aberrant Superficial Branch of the Radial Nerve-Radial Forearm Free Flap Considerations. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2191. [PMID: 31624666 PMCID: PMC6635202 DOI: 10.1097/gox.0000000000002191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 01/30/2019] [Indexed: 11/25/2022]
Abstract
The superficial branch of the radial nerve (SBRN) is encountered and must be preserved during the harvest of a radial forearm free flap (RFFF). An abnormal course of the SBRN was encountered during the harvest of an RFFF. The nerve had an abnormal course with two branches—in the proximal forearm, one branch was anterior and the second branch was posterior to the brachioradialis muscle and in the distal forearm, both of these nerves merged together. A review of the literature was performed, with no such documented aberrant course of the SBRN being described previously. Knowledge of the SBRN anatomy and its variations is important to note during the RFFF harvest.
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9
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Haugen TW, Cannady SB, Chalian AA, Shanti RM. Anatomical Variations of the Superficial Radial Nerve Encountered during Radial Forearm Free Flap Elevation. ORL J Otorhinolaryngol Relat Spec 2019; 81:155-158. [PMID: 31035280 DOI: 10.1159/000496226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 12/11/2018] [Indexed: 11/19/2022]
Abstract
A frequently encountered anatomical structure in the elevation of a radial forearm free flap is the superficial branch of the radial nerve. This structure has a relatively consistent anatomic location, but variations do occur. We present a case where the superficial branch of the radial nerve was in an usual position but remained superficial to the brachioradialis throughout its course. Two previous reports also describe the superficial branch of the radial nerve remaining superficial to the brachioradialis, although, in these reports, the nerve was more medial than is typical. We postulate that one of the most common anatomic variations of the superficial branch of the radial nerve is for it to remain superficial to the brachioradialis. As this variation could potentially be confused with the medial or lateral antebrachial cutaneous nerves, it is important for the reconstructive surgeon to be aware of this to prevent inadvertent injury.
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Affiliation(s)
- Thorsen W Haugen
- Hospital of the University Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Steve B Cannady
- Hospital of the University Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ara A Chalian
- Hospital of the University Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rabie M Shanti
- Hospital of the University Pennsylvania, Philadelphia, Pennsylvania, USA,
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10
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Kumar P, John R, Sharma GK, Aggarwal S. Aberrant course of superficial radial nerve in the forearm: an anatomical variation and its clinical implications. BMJ Case Rep 2017; 2017:bcr-2017-220074. [PMID: 28611137 DOI: 10.1136/bcr-2017-220074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The superficial radial nerve (SRN) is the terminal pure sensory branch of the radial nerve supplying dorsal aspects of the proximal portion of the lateral three and a half digits including the lateral two-thirds of the dorsum of the hand. It transits from its submuscular position to a subcutaneous position by passing between the brachioradialis and extensor carpi radialis longus tendons around 7 to 9 cm proximal to the radial styloid. We present a case where this nerve instead of its normal forearm course, pierced the brachioradialis tendon to become subcutaneous.
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Affiliation(s)
- Prasoon Kumar
- Department of Orthopaedics, PGIMER, Chandigarh, India
| | - Rakesh John
- Department of Orthopaedics, PGIMER, Chandigarh, India
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11
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Implantable Doppler Probes for Postoperatively Monitoring Free Flaps: Efficacy. A Systematic Review and Meta-analysis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e1099. [PMID: 27975015 PMCID: PMC5142481 DOI: 10.1097/gox.0000000000001099] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 09/02/2016] [Indexed: 11/25/2022]
Abstract
Background: Although clinical assessment remains the gold standard for monitoring the circulation of free flaps, several adjunct techniques promote timely salvage by detecting circulation compromise early. The objective of this systematic review was to evaluate the efficacy of an implantable Doppler probe for postoperatively monitoring free flaps. Materials and Methods: English-language articles evaluating the efficacy of implantable Doppler probes compared with clinical assessment for postoperatively monitoring free flaps were analyzed. The outcome measures were total flap failure rates, salvage rates, sensitivity, false-positive rates, and positive likelihood ratios. Results: Of the 504 citations identified, 6 comparative studies were included for meta-analysis. An implantable Doppler probe significantly lowered the flap failure rate (risk ratio: 0.40; 95% confidence interval: 0.21–0.75) and raised the successful salvage rate (risk ratio: 1.73; 95% confidence interval: 1.16–2.59). Pooled sensitivity was higher (1.00 vs 0.98), the positive likelihood ratio was lower (72.16 vs 220.48), and the false-positive rate was higher (0.01 vs 0) in the implantable Doppler probe group than in the clinical assessment group. Conclusion: An implantable Doppler probe is significantly more efficacious than clinical assessment for postoperatively monitoring free flaps.
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12
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Vandjelovic ND, Humphreys IM. Immunoglobulin G4-related sclerosing disease of the paranasal sinuses: A case report and literature review. ALLERGY & RHINOLOGY 2016; 7:85-9. [PMID: 27658185 PMCID: PMC5010438 DOI: 10.2500/ar.2016.7.0154] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective: Immunoglobulin G4 (IgG4) related sclerosing disease (RSD) of the paranasal sinuses is a rare lesion of dense lymphoplasmacytic tissue, with a high proportion of IgG4+ plasma cells. We presented a rare case of IgG4-RSD with isolated involvement of the paranasal sinuses in the absence of multiorgan involvement. Methods: A case report and comprehensive literature review. Results: To our knowledge, only 11 cases of IgG4-RSD with paranasal sinus involvement have been reported. Patients with IgG4-RSD commonly present with epistaxis and symptoms that mimic chronic rhinosinusitis, e.g., rhinorrhea, nasal obstruction, and facial pressure. On imaging, an expansive and erosive process is described. Surgery provides tissue for immunohistologic evaluation; however, there is a paucity of evidence about the direct extent of surgical resection or medical therapies. Postoperative steroids were typically started, although the regimen was not standardized. Conclusion: Few cases of paranasal sinus IgG4-RSD have been reported in the literature. Evidence-based recommendations regarding treatment and surveillance of paranasal sinus IgG4-RSD are lacking; however, most reports describe systemic steroids as the mainstay of treatment. This single subject analysis, with a review of previously reported cases adds to the expanding body of data related to this rare disorder.
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Affiliation(s)
- Nathan D Vandjelovic
- 1Department of Otolaryngology-Head and Neck Surgery, Michigan State University, Detroit Medical Center, Detroit, Michigan, USA
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13
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Reiter M, Harréus U, Kisser U, Betz CS, Baumeister P. Buried free flaps in head and neck reconstruction: higher risk of free flap failure? Eur Arch Otorhinolaryngol 2016; 274:427-430. [DOI: 10.1007/s00405-016-4214-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 07/13/2016] [Indexed: 10/21/2022]
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14
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Song BH, Baiyee D, Liang J. A rare and emerging entity: Sinonasal IgG4-related sclerosing disease. ALLERGY & RHINOLOGY 2015; 6:151-7. [PMID: 26686205 PMCID: PMC5391482 DOI: 10.2500/ar.2015.6.0136] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Immunoglobulin G4 (IgG4) related sclerosing disease (rSD) is a new disease entity, first described in 2001, that involves autoimmune pancreatitis. Considered a systemic disease with lesions described in multiple organ systems, IgG4-rSD that affects the sinonasal region is rare. Our goal was to highlight the sinonasal presentation of this unique disease and to review previously reported adult cases from 2003 to 2014. METHODS Case report (a 72-year-old man who presented with left exophthalmos, periorbital pain, and epiphora) and review of the literature. RESULTS Radiographic workup with computed tomography and magnetic resonance imaging demonstrated a left sinonasal mass that involved the left maxillary and ethmoid sinuses, with surrounding bony destruction and orbital invasion. Nasal endoscopy demonstrated a fibrous lesion emanating in the middle meatus, with surrounding mucosal inflammation. The patient underwent an endoscopic biopsy, medial maxillectomy, and ethmoidectomy with tumor debulking. Pathology demonstrated inflamed respiratory mucosa with dense lymphoplasmacytic infiltrate and fibrosis; flow cytometry demonstrated no malignant cell populations; immunophenotyping demonstrated multiple foci of IgG4 cells. Plasma IgG4 was elevated in the setting of normal total IgG. The patient was treated with postoperative systemic and topical corticosteroids. Surveillance imaging studies and nasal endoscopy demonstrated disease resolution without recurrence. CONCLUSIONS Sinonasal IgG4-rSD is a rare disease that can present with bony and soft-tissue invasion. This was an exceptional case, with osseous involvement and orbital invasion. Immunohistologic workup is essential for diagnosis. It is important to differentiate this disease from sinonasal tumors. Treatment includes corticosteroids and surgical debulking. Sinonasal IgG4-rSD represents an emerging disease that may present challenges for future rhinologists.
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Affiliation(s)
- Brian H Song
- Department of Head and Neck Surgery, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
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15
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Takano K, Abe A, Yajima R, Kakuki T, Jitsukawa S, Nomura K, Himi T. Clinical Evaluation of Sinonasal Lesions in Patients With Immunoglobulin G4-Related Disease. Ann Otol Rhinol Laryngol 2015; 124:965-71. [DOI: 10.1177/0003489415593557] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objectives: Immunoglobulin G4-related disease (IgG4-RD) is a systemic disease entity characterized by elevated serum IgG4 and extensive IgG4-positive plasma cell infiltration of various organs. Patients with IgG4-RD show nasal manifestations with chronic rhinosinusitis. The objective of this study was to evaluate the clinical characteristics of sinonasal lesions in patients with IgG4-RD. Methods: We evaluated radiological findings of sinonasal lesions in 79 patients with IgG4-RD who were divided into 3 groups according to severity. We also compared serological findings, including serum IgG4 and IgE levels, and eosinophil counts. Results: Rhinosinusitis was found in 41 patients (51.9%). Although there were no significant differences in the serum IgG4 and IgE levels of the groups, there was a significant increase in eosinophil counts (445 ± 311.9/mm3) in Group C. Furthermore, 14 of the 41 patients with rhinosinusitis (34.1%) showed improvement after prednisolone administration. Patients with IgG4-RD and serum eosinophilia tend to also have sinonasal lesions. Conclusions: Rhinosinusitis is common in patients with IgG4-RD, and its pathogenesis can be similar to eosinophilic chronic rhinosinusitis.
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Affiliation(s)
- Kenichi Takano
- Department of Otolaryngology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Ayumi Abe
- Department of Otolaryngology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Ryoto Yajima
- Department of Otolaryngology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Takuya Kakuki
- Department of Otolaryngology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Sumito Jitsukawa
- Department of Otolaryngology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kazuaki Nomura
- Department of Otolaryngology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tetsuo Himi
- Department of Otolaryngology, Sapporo Medical University School of Medicine, Sapporo, Japan
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16
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Shankhdhar VK, Yadav PS, Dushyant J, Sakthipalan SSR. Anatomical variation of superficial radial nerve during free radial forearm flap harvest. Indian J Plast Surg 2015; 48:104-5. [PMID: 25991906 PMCID: PMC4413481 DOI: 10.4103/0970-0358.155289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Vinay K Shankhdhar
- Department of Plastic and Reconstructive Services, Homi Bhabha Block, TATA Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Prabha S Yadav
- Department of Plastic and Reconstructive Services, Homi Bhabha Block, TATA Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Jaiswal Dushyant
- Department of Plastic and Reconstructive Services, Homi Bhabha Block, TATA Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Selva S R Sakthipalan
- Department of Plastic and Reconstructive Services, Homi Bhabha Block, TATA Memorial Hospital, Parel, Mumbai, Maharashtra, India
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17
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Laco J, Kamarádová K, Mottl R, Mottlová A, Doležalová H, Tuček L, Žatečková K, Slezák R, Ryška A. Plasma cell granuloma of the oral cavity: a mucosal manifestation of immunoglobulin G4-related disease or a mimic? Virchows Arch 2014; 466:255-63. [PMID: 25522952 DOI: 10.1007/s00428-014-1711-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 11/23/2014] [Accepted: 12/09/2014] [Indexed: 12/23/2022]
Abstract
The aim of the study was to test the hypothesis that oral plasma cell granuloma may represent a mucosal manifestation of immunoglobulin (Ig)G4-related disease (IgG4-RD) in the oral cavity. The study sample comprised two males and four females, aged 54-79 years (median 62 years). The lesions were localized on gingival/alveolar mucosa (four cases), hard palate, and floor of the mouth, measuring 17-40 mm (median 31 mm). The duration of the lesions ranged from 3 months to several years. Information on IgG4 serum levels was available for two patients, and these were increased to 1.85 and 1.65 g/L, respectively. The follow-up period ranged 11-30 months (median 13 months). None of the lesions recurred, and none of the patients developed any manifestation of IgG4-RD. Microscopically, all cases presented as nodular lesions composed of numerous polyclonal plasma cells admixed with lymphocytes, histiocytes, mast cells, and eosinophils, set within collagenized stroma in variable proportions. Obliterative phlebitis was observed in two cases. The number of IgG4-positive plasma cells ranged between 51 and 142 per HPF (median 114), while the IgG4/IgG ratio values ranged between 0.16 and 0.72 (median 0.44) and were above 0.40 in three cases. Based on international criteria, two cases were diagnosed as definite and one as probable IgG4-RD. Oral plasma cell granuloma is a heterogeneous group of lesions, and a subset may represent a mucosal manifestation of IgG4-RD in the oral cavity.
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Affiliation(s)
- Jan Laco
- The Fingerland Department of Pathology, Charles University in Prague-Faculty of Medicine and University Hospital in Hradec Kralove, Sokolska 581, 500 05, Hradec Kralove, Czech Republic,
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