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Cohen Z, Zhang KK, Kim M, Haglich K, Woods J, Monge J, Matros E, Boyle JO, McCarthy C, Cracchiolo JR, Cohen MA, Shahzad F, Nelson JA, Allen RJ. A preliminary analysis of patient reported outcomes following posterolateral mandible reconstruction: The role of flap type. J Surg Oncol 2024; 129:617-628. [PMID: 37985365 DOI: 10.1002/jso.27520] [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: 10/26/2023] [Accepted: 10/29/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND The choice of tissue type for free flap reconstruction of posterolateral mandible resections is dependent on patient and defect characteristics. We compared clinical and patient-reported outcomes following reconstruction of these defects with a soft tissue or bony free flap. METHODS A retrospective review was performed on patients who underwent posterolateral segmental mandibulectomy with immediate free flap reconstruction at MSKCC from 2006 to 2021. Outcomes of interest were patient-reported outcome measures (PROMs) assessed by FACE-Q surveys and complications at the flap recipient site. RESULTS Ninety patients received a bony flap and 24 patients received a soft tissue flap. Patients reconstructed with soft tissue flaps had greater rates of composite soft tissue defects (p < 0.0001), condyle resection (p = 0.001), and peripheral vascular disease (p = 0.035). Complication rates were similar between the cohorts (p > 0.05). Bony flaps scored higher on multiple FACE-Q scales: Facial Appearance (p = 0.023) Eating/Drinking (p = 0.029), Smiling (p = 0.012), Speaking (p < 0.001), Swallowing (p = 0.012), Smiling Distress (p = 0.037), and Speaking Distress (p = 0.001). CONCLUSION Reconstruction of posterolateral mandibular defects has a similar complication profile when utilizing a bony or soft tissue free flap. Bony flaps may perform better with respect to PROMs. Reconstructive surgeons should consider using bony flap reconstruction to achieve higher patient satisfaction and quality of life.
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Affiliation(s)
- Zack Cohen
- Department of Surgery, Plastic and Reconstructive Surgery Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kevin K Zhang
- Department of Surgery, Plastic and Reconstructive Surgery Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Minji Kim
- Department of Surgery, Plastic and Reconstructive Surgery Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kathryn Haglich
- Department of Surgery, Plastic and Reconstructive Surgery Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jack Woods
- Department of Surgery, Plastic and Reconstructive Surgery Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jasmine Monge
- Department of Surgery, Plastic and Reconstructive Surgery Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Evan Matros
- Department of Surgery, Plastic and Reconstructive Surgery Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jay O Boyle
- Department of Surgery, Head and Neck Surgery Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Colleen McCarthy
- Department of Surgery, Plastic and Reconstructive Surgery Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jennifer R Cracchiolo
- Department of Surgery, Head and Neck Surgery Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Marc A Cohen
- Department of Surgery, Head and Neck Surgery Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Farooq Shahzad
- Department of Surgery, Plastic and Reconstructive Surgery Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jonas A Nelson
- Department of Surgery, Plastic and Reconstructive Surgery Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Robert J Allen
- Department of Surgery, Plastic and Reconstructive Surgery Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Muralidharan S, Acharya A, Mallaiah P, Babu BA. A systematic review on the guidelines for nutritional assessment for head and neck cancer patients managed by surgery. J Oral Maxillofac Pathol 2021; 25:370. [PMID: 34703139 PMCID: PMC8491340 DOI: 10.4103/0973-029x.325255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/10/2021] [Indexed: 11/04/2022] Open
Abstract
There are a number of guidelines to assess the nutrition status of cancer cases. None of these guidelines are specifically head and neck cancer related; except for the European guidelines. This article reviews the different guidelines in nutrition for cancer cases and also their drawbacks.
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Affiliation(s)
| | - Arunkumar Acharya
- Department of Public Health Dentistry, Navodaya Dental College and Hospital, Raichur, Karnataka, India
| | - Pramila Mallaiah
- Department of Public Health Dentistry, MR Ambedkar Dental College and Hospital, Karnataka, India
| | - B Anil Babu
- Department of Public Health Dentistry, Navodaya Dental College and Hospital, Raichur, Karnataka, India
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3
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Khaghaninejad MS, Khojastepour L, Ahmadi H, Tavanafar S, Ebrahimi A, Mahjoori-Ghasrodashti M. Analysis of hard tissue facial symmetry after unilateral mandibular reconstruction. Maxillofac Plast Reconstr Surg 2021; 43:15. [PMID: 34059964 PMCID: PMC8166985 DOI: 10.1186/s40902-021-00299-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/10/2021] [Indexed: 11/15/2022] Open
Abstract
Background This study aimed to determine how successful reconstruction of the mandible can recover the symmetry. Materials and methods All patients who underwent surgical treatment for unilateral mandibular reconstruction in 4 years were retrospectively examined. Bilateral differences of gonion (GO) positions were measured in 3 dimensions based on immediate postoperative computed tomography. The data collected was analyzed in 3 ways: First, the comparison of bilateral differences of GO in 3 dimensions. Second, the mean Asymmetry Index in control subjects was used to divide all cases into three groups: “Symmetry,” “Asymmetry,” and “Marked asymmetry.” Third, “maximum normal asymmetry” was calculated, and all cases were categorized as below and above maximum normal asymmetry. The difference between two gonial angles was used to determine the amount of asymmetry. Results Forty-seven patients and 47 normal adults were enrolled. The mean bilateral GO difference in the control group was higher than in the study group patients, but it was not statistically significant. The mean Asymmetry Index for the control group was not also significantly higher than the study cases. The study group was “Symmetric” in 78.7% of the cases whereas the control group in 91.4%, 19.1% of the study group and 8.5% of controls were “Asymmetric,” and 2.1% of study cases and 0% of controls were “Markedly Asymmetric.” Maximum normal asymmetry was 82.9% in the study group and 97.8% in the control group. The mean differences between the right and left gonial angles were higher in the study group, but it was not significant (P = 0.1). Conclusions Our study’s results showed that bilateral symmetry in mandibular reconstruction patients was satisfactory and similar to the normal individuals.
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Affiliation(s)
- Mohamad Saleh Khaghaninejad
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shiraz University of Medical Sciences, Ghasrodasht St, Shiraz, Iran
| | - Leila Khojastepour
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hanie Ahmadi
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeid Tavanafar
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shiraz University of Medical Sciences, Ghasrodasht St, Shiraz, Iran.
| | - Alireza Ebrahimi
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
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Assessment of facial symmetry by three-dimensional stereophotogrammetry after mandibular reconstruction: A comparison with subjective assessment. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 122:56-61. [DOI: 10.1016/j.jormas.2020.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/27/2020] [Accepted: 04/06/2020] [Indexed: 11/22/2022]
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5
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Suzuki H, Sasaki E, Nakamura R, Sawabe M, Hagiwara S, Hyodo I, Hanai N. Recurrent ameloblastoma with both hypercalcemia and BRAF mutation: A case report. Clin Case Rep 2020; 8:3463-3467. [PMID: 33363952 PMCID: PMC7752588 DOI: 10.1002/ccr3.3443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/16/2020] [Accepted: 10/03/2020] [Indexed: 11/10/2022] Open
Abstract
This case report describes a mandibular ameloblastoma with both BRAF V600E mutation and rare hypercalcemia. The patient without distant metastasis underwent subtotal mandibulectomy using double flaps of fibula and anterolateral thigh. A whole body computed tomography scan taken 69 months after surgery revealed neither recurrence nor metastasis.
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Affiliation(s)
- Hidenori Suzuki
- Department of Head and Neck SurgeryAichi Cancer Center HospitalNagoyaJapan
| | - Eiichi Sasaki
- Department of Pathology and Molecular DiagnosticsAichi Cancer Center HospitalNagoyaJapan
| | - Ryota Nakamura
- Department of Plastic and Reconstructive SurgeryAichi Cancer Center HospitalNagoyaJapan
| | - Michi Sawabe
- Department of Head and Neck SurgeryAichi Cancer Center HospitalNagoyaJapan
| | - Sumitaka Hagiwara
- Department of Head and Neck SurgeryAichi Cancer Center HospitalNagoyaJapan
| | - Ikuo Hyodo
- Department of Plastic and Reconstructive SurgeryUniversity of Occupational and Environmental HealthKitakyusyuJapan
| | - Nobuhiro Hanai
- Department of Head and Neck SurgeryAichi Cancer Center HospitalNagoyaJapan
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Kansara S, Wang T, Koochakzadeh S, Liou NE, Graboyes EM, Skoner JM, Hornig JD, Sandulache VC, Day TA, Huang AT. Prognostic factors associated with achieving total oral diet following osteocutaneous microvascular free tissue transfer reconstruction of the oral cavity. Oral Oncol 2019; 98:1-7. [PMID: 31521884 DOI: 10.1016/j.oraloncology.2019.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/14/2019] [Accepted: 09/06/2019] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Osteocutaneous microvascular free tissue transfer (OMFTT) is the current standard in reconstruction of large bony defects of the oral cavity. Although being able to swallow ranks as a top priority for patients undergoing OMFTT, factors associated with achieving an oral diet following surgery remain unclear. We sought to describe the rate of total oral diet achievement, and to identify possible pre-, intra-, and post-operative factors associated with achievement in patients undergoing OMFTT. METHODS Retrospective review between January 1, 2010 and March 31, 2018 at two tertiary academic centers. RESULTS 249 patients (67% male, mean age 58 years) met inclusion criteria, with a median follow up of 15 months. Overall, 142 (57%) of patients achieved a total PO diet post-operatively, with median time to achievement of 3.2 months. Multivariate analysis identified that lack of concurrent glossectomy (SHR 1.72 [1.09-2.70], p = 0.02), N0/1 disease (SHR 1.92 [1.16-3.13], p = 0.011), avoidance of post-operative fistula formation (SHR 1.96 [1.22-3.23], p = 0.005), pre-operative G-tube independence (SHR 3.33 [1.69-6.25], p < 0.001), and successful dental rehabilitation (SHR 2.08 [1.43-3.03], p < 0.001) are independently associated with total oral diet achievement. CONCLUSIONS Bony resections not requiring glossectomy, limited nodal disease burden, pre-operative gastrostomy-independence, avoidance of post-operative fistula, and dental rehabilitation are independently associated with achievement of total oral diet following OMFTT reconstruction of the oral cavity. Counseling patients on associated risk factors is important in guiding post-treatment expectations. Minimization of post-operative fistula, and maximization of dental rehabilitation may significantly improve total oral diet achievement in this patient population.
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Affiliation(s)
- Sagar Kansara
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Tao Wang
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, United States
| | - Sina Koochakzadeh
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Nelson E Liou
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Evan M Graboyes
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Judith M Skoner
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Joshua D Hornig
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Vlad C Sandulache
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Terry A Day
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Andrew T Huang
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, United States.
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Zhang Z, Zhang S, Li Z, Li S, Liu J, Zhang C. Osseointegration effect of biomimetic intrafibrillarly mineralized collagen applied simultaneously with titanium implant: A pilot in vivo study. Clin Oral Implants Res 2019; 30:637-648. [PMID: 31034662 DOI: 10.1111/clr.13449] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 04/18/2019] [Accepted: 04/21/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To investigate the promoting effects of biomimetic intrafibrillarly mineralized collagen (IMC) bone scaffold material on the osseointegration of a titanium implant simultaneously grafted into a critical-sized bone defect as well as the underlying mechanisms involved. MATERIALS AND METHODS A critical-sized bone defect was created in the rat femur, and a titanium (Ti) implant surrounded by IMC or extrafibrillarly mineralized collagen (EMC) bone scaffold material was placed in the defect. A blank group and a natural bone group were included as controls. Osseointegration was assessed by micro-computed tomographic, histological, and biochemical evaluations at 12 weeks postoperatively. Microarray technology was applied for transcriptional profile analysis at days 7 and 14 postoperatively. RESULTS Significant bone regeneration and osseointegration were observed in the IMC and EMC groups according to μ-CT and histological analyses. The bone volume (BV)/total volume (TV) fraction, bone-to-implant contact percentage, and bone area percentage as well as ultimate shear strength and maximal pull-out force were all significantly higher in the IMC group than in the EMC group (all p < 0.05). Transcriptional analysis revealed overexpression of genes mainly associated with cell proliferation, immuno-inflammatory response, skeletogenesis, angiogenesis, neurogenesis, and skeletogenesis-related pathways during the early process of osseointegration in the IMC group. CONCLUSION Our data suggest that IMC placed simultaneously with a Ti implant may be a promising strategy in jawbone defect reconstruction. Several candidate genes that were found to be differentially expressed in the IMC group may be responsible for the superior osseointegration effects in this model.
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Affiliation(s)
- Zhen Zhang
- Department of Oral & Maxillofacial-Head & Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - Shijian Zhang
- Department of Oral & Maxillofacial-Head & Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - Zheyi Li
- Department of Orthodontics, School of Stomatology, Capital Medical University, Beijing, China.,Institute for Clinical Research and Application of Sunny Dental, Beijing, China
| | - Song Li
- Department of Orthodontics, School of Stomatology, Capital Medical University, Beijing, China
| | - Jiannan Liu
- Department of Oral & Maxillofacial-Head & Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - Chenping Zhang
- Department of Oral & Maxillofacial-Head & Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
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Chen J, Yin P, Li N, Wu L, Jian X, Jiang C. Functional Mandibular Reconstruction With Double-Barrel Fibular Flap and Primary Osseointegrated Dental Implants Improve Facial Esthetic Outcome. J Oral Maxillofac Surg 2019; 77:218-225. [DOI: 10.1016/j.joms.2018.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/12/2018] [Accepted: 08/11/2018] [Indexed: 10/28/2022]
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9
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Zhang Z, Wang P, Li X, Wang Y, Qin Z, Zhang C, Li J. Reconstruction of mandibular bone defects using biphasic calcium phosphate bone substitutes with simultaneous implant placement in mini‐swine: A pilot
in vivo
study. J Biomed Mater Res B Appl Biomater 2018; 107:2071-2079. [PMID: 30576059 DOI: 10.1002/jbm.b.34299] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/25/2018] [Accepted: 12/01/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Zhen Zhang
- State Key Laboratory of Oral Diseases and Center of Orthognathic and TMJ SurgeryNational Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University Chengdu China
- Department of Oral & Maxillofacial‐Head & Neck OncologyShanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine Shanghai China
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of StomatologyNational Clinical Research Center of Stomatology Shanghai China
| | - Peng Wang
- State Key Laboratory of Oral Diseases and Center of Orthognathic and TMJ SurgeryNational Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University Chengdu China
| | - Xiang Li
- State Key Laboratory of Oral Diseases and Center of Orthognathic and TMJ SurgeryNational Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University Chengdu China
| | - Yu Wang
- State Key Laboratory of Oral Diseases and Center of Orthognathic and TMJ SurgeryNational Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University Chengdu China
| | - Zhifan Qin
- State Key Laboratory of Oral Diseases and Center of Orthognathic and TMJ SurgeryNational Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University Chengdu China
| | - Chenping Zhang
- Department of Oral & Maxillofacial‐Head & Neck OncologyShanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine Shanghai China
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of StomatologyNational Clinical Research Center of Stomatology Shanghai China
| | - Jihua Li
- State Key Laboratory of Oral Diseases and Center of Orthognathic and TMJ SurgeryNational Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University Chengdu China
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10
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Sugiura Y, Sarukawa S, Hayasaka J, Kamochi H, Noguchi T, Mori Y. Mandibular reconstruction with free fibula flaps in the elderly: a retrospective evaluation. Int J Oral Maxillofac Surg 2018; 47:983-989. [DOI: 10.1016/j.ijom.2018.02.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 11/16/2017] [Accepted: 02/21/2018] [Indexed: 10/17/2022]
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11
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Suzuki H, Hyodo I, Hasegawa Y. Prediction of decannulation, oral intake recovery, overall survival and lung metastasis following oral malignant tumor resection and reconstruction. Oncol Lett 2018; 15:2686-2694. [PMID: 29434993 DOI: 10.3892/ol.2017.7585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 06/21/2017] [Indexed: 11/05/2022] Open
Abstract
The present study investigated whether tongue base and mandibular bone defects were associated with the rate of decannulation and oral intake recovery, and survival time, including overall and lung metastasis-free survival time, in patients that underwent oral malignant tumor (OMT) resection with reconstruction. A total of 105 patients that underwent OMT resection with laryngeal preservation and reconstruction were recruited. The extent of defects was classified according to Urken's classification. The rates of decannulation and oral intake recovery were assessed with the Kaplan-Meier method. It was identified that 4-5 section segmental mandibulectomy (SM) and total glossectomy (TG) were significantly associated with a lower rate of decannulation and oral intake recovery by univariate and multivariate analysis using a Cox's proportional model. Patients in the high risk group (4-5 sections or TG) were significantly less likely to achieve decannulation and unaided oral intake. Patients in the high risk group exhibited a significantly shorter overall and lung metastasis-free survival time. Following multivariate analysis adjusted for the clinical stage (IV/I-III), past history of or postoperative radiotherapy (yes/no) and age (per year), the high risk group was associated with a significantly rate of decannulation and unaided oral intake. In conclusion, TG or wide SM is a prognostic parameter for functional and survival outcomes, including lung metastasis, in OMT.
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Affiliation(s)
- Hidenori Suzuki
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Ikuo Hyodo
- Plastic and Reconstructive Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Yasuhisa Hasegawa
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
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Barry CP, Brown J, Hanlon R, Shaw R. Tailored approach to oromandibular reconstruction in patients with compromised lower limb vessels. Head Neck 2017; 39:916-920. [DOI: 10.1002/hed.24709] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 11/01/2016] [Accepted: 12/09/2016] [Indexed: 11/07/2022] Open
Affiliation(s)
- Conor P. Barry
- Liverpool Head and Neck Cancer Unit; Aintree University Hospital; Liverpool United Kingdom
- National Maxillofacial Unit; St. James's Hospital; Dublin Ireland
- Dublin Dental University Hospital; Dublin Ireland
| | - James Brown
- Liverpool Head and Neck Cancer Unit; Aintree University Hospital; Liverpool United Kingdom
- Department of Molecular and Clinical Cancer Medicine; University of Liverpool; Liverpool United Kingdom
| | - Rebecca Hanlon
- Liverpool Head and Neck Cancer Unit; Aintree University Hospital; Liverpool United Kingdom
| | - Richard Shaw
- Liverpool Head and Neck Cancer Unit; Aintree University Hospital; Liverpool United Kingdom
- Department of Molecular and Clinical Cancer Medicine; University of Liverpool; Liverpool United Kingdom
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13
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Mandibular reconstruction with vascularised bone flaps: a systematic review over 25 years. Br J Oral Maxillofac Surg 2017; 55:113-126. [DOI: 10.1016/j.bjoms.2016.12.010] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 12/02/2016] [Indexed: 11/19/2022]
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Factors Influencing the Incidence of Severe Complications in Head and Neck Free Flap Reconstructions. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e1013. [PMID: 27826458 PMCID: PMC5096513 DOI: 10.1097/gox.0000000000001013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 07/05/2016] [Indexed: 12/15/2022]
Abstract
Background: Complications after head and neck free-flap reconstructions are detrimental and prolong hospital stay. In an effort to identify related variables in a tertiary regional head and neck unit, the microvascular reconstruction activity over the last 5 years was captured in a database along with patient-, provider-, and volume-outcome–related parameters. Methods: Retrospective cohort study (level of evidence 3), a modified Clavien-Dindo classification, was used to assess severe complications. Results: A database of 217 patients was created with consecutively reconstructed patients from 2009 to 2014. In the univariate analysis of severe complications, we found significant associations (P < 0.05) between type of flap used, American Society of Anesthesiologists classification, T-stage, microscope use, surgeon, flap frequency, and surgeon volume. Within a binomial logistic regression model, less frequently versus frequently performed flap (odds ratio [OR] = 3.2; confidence interval [CI] = 2.9–3.5; P = 0.000), high-volume versus low-volume surgeon (OR = 0.52; CI = −0.22 to 0.82; P = 0.007), and ASA classification (OR = 2.9; CI = 2.4–3.4; P = 0.033) were retained as independent predictors of severe complications. In a Cox-regression model, surgeon (P = 0.011), site of reconstruction (P = 0.000), T-stage (P = 0.001), and presence of severe complications (P = 0.015) correlated with a prolonged hospitalization. Conclusions: In this study, we identified a correlation of patient-related factors with severe complications (ASA score) and prolonged hospital stay (T-stage, site). More importantly, we identified several provider- (surgeon) and volume-related (frequency with which a flap was performed and high-volume surgeon) factors as predictors of severe complications. Our data indicate that provider- and volume-related parameters play an important role in the outcome of microvascular free-flap procedures in the head and neck region.
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