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Gao K, Guo W, Shang Y, Liu G, Zhai X, Li H, Shi M, Tong X. Surgical treatment of carotid blowout syndrome after radiotherapy for head and neck malignant tumors: a single-center experience. Neurosurg Rev 2023; 46:293. [PMID: 37924361 DOI: 10.1007/s10143-023-02193-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/10/2023] [Accepted: 10/18/2023] [Indexed: 11/06/2023]
Abstract
To explore the treatments for and manifestations of carotid blowout syndrome (CBS) and to further explore the critical role of high-flow bypass combined with parent artery isolation. The clinical data of nine patients with radiotherapy-related CBS who were admitted to our hospital from March 2020 to March 2023 were retrospectively analyzed. Relevant literature was reviewed. From March 2020 to March 2023, nine CBS patients were admitted to Tianjin Huanhu Hospital, including eight males and one female. Digital subtraction angiography was performed for all the patients; all the pseudoaneurysms were located at the petrous segment of the internal carotid artery. A balloon occlusion test was performed on four patients, which was tolerated by all patients. CT and MRI scans showed seven cases of osteonecrosis combined with infection and two cases of tumor recurrence. Emergency permanent parent artery occlusion was performed on six patients, aneurysm embolization was completed in one case, covered stent implantation was performed in one patient, and three cases were treated by cerebral bypass surgery (including two patients with failed interventional treatment). Rebleeding was found in two patients, and no rebleeding was found in the bypass group. Paralysis was found in three patients, and asymptomatic cerebral infarction without permanent neurologic impairment was found in three patients. Two patients died due to tumor progression. Emergency occlusion surgery is lifesaving in the acute phase of CBS. Endovascular therapy cannot prevent the progression of pseudoaneurysms or lower the recurrence rate of bleeding events. High-flow bypass combined with parent artery isolation is a safe and effective method that may facilitate further surgical treatment. Further research is warranted.
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Affiliation(s)
- Kaiming Gao
- Department of Neurosurgery, Tianjin Huanhu Hospital, 6 Jizhao Road, Jinnan District, Tianjin, 300350, China
- Department of Neurosurgery, Tianjin Central Hospital for Neurosurgery and Neurology, Tianjin, China
| | - Wenqiang Guo
- Department of Neurosurgery, Qilu Hospital of Shandong University (Qingdao), 758 Hefei Road, Shibei District, Qingdao, Shandong, 266035, China
| | - Yanguo Shang
- Department of Neurosurgery, Tianjin Huanhu Hospital, 6 Jizhao Road, Jinnan District, Tianjin, 300350, China
- Department of Neurosurgery, Tianjin Central Hospital for Neurosurgery and Neurology, Tianjin, China
| | - Gang Liu
- Department of Otorhinolaryngology, Tianjin Huanhu Hospital, Tianjin, China
- Department of Otorhinolaryngology, Tianjin Central Hospital for Neurosurgery and Neurology, Tianjin, China
| | - Xiang Zhai
- Department of Otorhinolaryngology, Tianjin Huanhu Hospital, Tianjin, China
- Department of Otorhinolaryngology, Tianjin Central Hospital for Neurosurgery and Neurology, Tianjin, China
| | - Haiyan Li
- Department of Otorhinolaryngology, Tianjin Huanhu Hospital, Tianjin, China
- Department of Otorhinolaryngology, Tianjin Central Hospital for Neurosurgery and Neurology, Tianjin, China
| | - Minggang Shi
- Department of Neurosurgery, Tianjin Huanhu Hospital, 6 Jizhao Road, Jinnan District, Tianjin, 300350, China.
- Department of Neurosurgery, Tianjin Central Hospital for Neurosurgery and Neurology, Tianjin, China.
| | - Xiaoguang Tong
- Department of Neurosurgery, Tianjin Huanhu Hospital, 6 Jizhao Road, Jinnan District, Tianjin, 300350, China.
- Department of Neurosurgery, Tianjin Central Hospital for Neurosurgery and Neurology, Tianjin, China.
- Laboratory of Microneurosurgery, Tianjin Neurosurgical Institute, Tianjin, China.
- Tianjin Key Laboratory of Cerebral Vascular and Neural Degenerative Diseases, Tianjin, China.
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Bozkurt G, Elhassan HA, Mahmutoğlu AS, Çelebi İ, Mcleod RWJ, Soytaş P, Erol ZN, Sözen E. Neck Muscle Mass Index as a Predictor of Post-Laryngectomy Wound Complications. Ann Otol Rhinol Laryngol 2018; 127:841-847. [PMID: 30198302 DOI: 10.1177/0003489418798660] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE We investigated the relationship between paravertebral muscle cross-sectional area (PVM CSA) at the third vertebra (C3) level using computerized tomography (CT) neck images and its relationship with complications after total laryngectomy. DESIGN Retrospective analysis of 60 advanced laryngeal cancer patients who underwent total laryngectomy was performed. The cross-sectional areas of paravertebral neck muscles using neck CT at C3 level images obtained preoperatively were analyzed. RESULTS A significant difference in PVM CSA between complication and no complication groups, F(1, 53 = 4.319, P = .043), was identified by ANCOVA. There were no significant differences in between-subject effects: T-stage ( F = 1.652, P = .204), body mass index ( F = 0.889, P = .35), albumin ( F = .359, P = .552), age ( F = 1.623 P = .208), and smoking ( F = 4.319, P = .41). CONCLUSION The PVM CSA measured at C3 level on pretreatment CT may help identify patients at higher risk of postoperative wound complications after total laryngectomy and who may particularly benefit from preoperative optimization of nutritional status.
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Affiliation(s)
- Gülpembe Bozkurt
- 1 Department of Otorhinolaryngology, Acıbadem University Hospital, Istanbul, Turkey
| | | | | | - İrfan Çelebi
- 4 Department of Radiology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Robert W J Mcleod
- 5 Department of Otolaryngology, University Hospital of Wales, Cardiff, UK
| | - Pınar Soytaş
- 6 Department of Otorhinolaryngology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Zeynep Nur Erol
- 7 Department of Otolaryngology, Hopa State Hospital, Artvin, Turkey
| | - Esra Sözen
- 8 Department of Otorhinolaryngology, Istanbul Aydın University, Istanbul, Turkey
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Jain U, Somerville J, Saha S, Ver Halen JP, Antony AK, Samant S, Kim JY. Predictors of adverse events after neck dissection: An analysis of the 2006-2011 National Surgical Quality Improvement Program (NSQIP) Database. EAR, NOSE & THROAT JOURNAL 2017; 96:E37-E45. [PMID: 28231375 DOI: 10.1177/014556131709600218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
While neck dissection is an important primary and adjunctive procedure in the treatment of head and neck cancer, there is a paucity of studies evaluating outcomes. A retrospective review of the National Surgical Quality Improvement Program (NSQIP) database was performed to identify factors associated with adverse events (AEs) in patients undergoing neck dissection. A total of 619 patients were identified, using CPT codes specific to neck dissection. Of the 619 patients undergoing neck dissection, 142 (22.9%) experienced an AE within 30 days of the surgical procedure. Risk factors on multivariate regression analysis associated with increased AEs included dyspnea (odds ratio [OR] 2.57; 95% confidence interval [CI] 1.06 to 6.22; p = 0.037), previous cardiac surgery (OR 3.38; 95% CI 1.08 to 10.52; p = 0.036), increasing anesthesia time (OR 1.005; 95% CI 1 to 1.009; p = 0.036), and increasing total work relative value units (OR 1.09; CI 1.04 to 1.13; p < 0.001). The current study is the largest, most robust analysis to identify specific risk factors associated with AEs after neck dissection. This information will assist with preoperative optimization, patient counseling, and appropriate risk stratification, and it can serve as benchmarking for institutions comparing surgical outcomes.
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Affiliation(s)
- Umang Jain
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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Hsueh WD, Hwang PH, Abuzeid WM. Perioperative Management of Antithrombotic Therapy in Common Otolaryngologic Surgical Procedures: State of the Art Review. Otolaryngol Head Neck Surg 2015; 153:493-503. [PMID: 26307580 DOI: 10.1177/0194599815600409] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 07/23/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The perioperative management of patients undergoing otolaryngologic procedures is increasingly complicated by the use of newer antithrombotic agents. Furthermore, with advances in anesthesia and surgical technique, otolaryngologists are presented with the challenge of operating on patients with advanced comorbid diseases. The objective of this review is to provide evidence-based recommendations on perioperative antithrombotic management for common otolaryngologic procedures. DATA SOURCES PubMed/MEDLINE. REVIEW METHODS Selected literature on patient-specific thromboembolic risk, rate of bleeding complications in otolaryngologic procedures, and the interruption of antithrombotic therapy is reviewed and interpreted by expert opinion. CONCLUSIONS By stratifying patients into either low thromboembolic risk (≤ 5%) or high thromboembolic risk (> 5%) and interpreting this in the context of procedural bleed risk and potential clinical consequences in the event of a bleed, otolaryngologists can make evidence-based decisions to determine the appropriate perioperative management of antithrombotic therapy. IMPLICATIONS FOR PRACTICE When the perioperative management of antithrombotic therapy is being decided, 3 critical factors must be considered systematically: the patient's inherent thromboembolic risk, the risk and potential consequences of bleeding related to the procedure, and the timing of interruption of thromboembolic therapy.
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Affiliation(s)
- Wayne D Hsueh
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Waleed M Abuzeid
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, USA
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Jain U, Somerville J, Saha S, Hackett NJ, Ver Halen JP, Antony AK, Samant S. Oropharyngeal Contamination Predisposes to Complications after Neck Dissection. Otolaryngol Head Neck Surg 2015; 153:71-8. [DOI: 10.1177/0194599815581808] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 03/24/2015] [Indexed: 12/13/2022]
Abstract
Objective While neck dissection is important in the treatment of head and neck cancer, there is a paucity of studies evaluating outcomes. We sought to compare preoperative variables and outcomes between clean and contaminated neck dissections, using the 2006-2011 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data sets. Study Design Retrospective review of prospectively maintained database. Setting Multicenter (university hospitals; tertiary referral centers). Subjects and Methods A retrospective review was performed of the NSQIP database to identify patients undergoing neck dissection in clean vs oropharyngeal contaminated cases. Clinical factors, comorbidities, epidemiologic factors, and procedural characteristics were analyzed to identify factors associated with 30-day postoperative adverse events, including medical and surgical complications, unplanned reoperation, and mortality. Bivariate and multivariable analyses were performed for the outcome of one or more adverse events. Results In total, 8890 patients had clean neck dissections, while 572 patients had neck wound contamination with oropharyngeal flora. On multivariable regression analysis, oropharyngeal contamination was a significant risk factor for surgical complications (odds ratio [OR], 3.42; 95% confidence interval [CI], 1.96-5.96; P < .001). However, medical complications and mortality were not significantly different between the 2 cohorts. This finding persisted after subgroup analysis, with removal of all thyroidectomy patients from analysis (OR, 2.33; 95% CI, 1.25-4.36; P = .008). Conclusion Using the ACS-NSQIP data set, this study found an increased risk of surgical complications in the setting of contaminated neck dissections. These data should be used for patient risk stratification, informed consent, and to guide further research.
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Affiliation(s)
- Umang Jain
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jessica Somerville
- Department of Otolaryngology–Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Sujata Saha
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Jon P. Ver Halen
- Department of Plastic, Reconstructive, and Hand Surgery, Baptist Cancer Center–Vanderbilt Ingram Cancer Center, Memphis, Tennessee, USA
| | - Anuja K. Antony
- Division of Plastic and Reconstructive Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sandeep Samant
- Department of Otolaryngology–Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Kim BD, Lim S, Wood J, Samant S, Ver Halen JP, Kim JYS. Predictors of Adverse Events After Parotidectomy. Ann Otol Rhinol Laryngol 2014; 124:35-44. [DOI: 10.1177/0003489414542089] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: There is a current paucity of large-scale, multi-institutional studies that explore the risk factors for major complications following parotidectomy. Methods: The American College of Surgeons National Surgical Quality Improvement Program participant use file was reviewed to identify all patients who had undergone parotidectomy between 2006 and 2011. Risk factors that predicted adverse events were estimated by using multivariate logistic regression. Results: Of 2919 included patients, 202 patients experienced adverse outcomes within the first 30 days of surgery. These included surgical complications in 76 (2.6%) patients; medical complications in 90 (3.1%) patients; death in 7 (0.2%) patients; and reoperation in 77 (2.6%) patients. Predictors of any complication included disseminated cancer (odds ratio [OR] = 2.28; 95% confidence interval [CI], 1.05-4.95; P = .036) and increasing total relative value units (OR = 1.01; 95% CI, 1.00-1.02; P = .027). Active smoking was a major risk factor for surgical complications (OR = 1.81; 95% CI, 1.08-3.05; P = .025). Dyspnea (OR = 2.93; 95% CI, 1.37-6.27; P = .006) significantly predicted medical complications. Conclusion: Although complication rates after parotidectomy are generally low, avoidance of specific and nonspecific postoperative complications still remains an area for improvement. Future outcomes databases should include procedure-specific complications, including facial nerve injury.
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Affiliation(s)
- Bobby D. Kim
- Rosalind Franklin University of Medicine and Science, Chicago Medical School, North Chicago, Illinois, USA
| | - Seokchun Lim
- Rosalind Franklin University of Medicine and Science, Chicago Medical School, North Chicago, Illinois, USA
| | - Josh Wood
- Department of Otolaryngology–Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Sandeep Samant
- Department of Otolaryngology–Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Jon P. Ver Halen
- Division of Plastic and Reconstructive Surgery, Baptist Cancer Center–Vanderbilt-Ingram Cancer Center, Memphis, Tennessee, USA
| | - John Y. S. Kim
- Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
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