1
|
Di Maio P, De Virgilio A, Mincione A, Zocchi J, Boriani F, Spriano G, Deganello A, Iocca O. Infrahyoid myocutaneous flap in head and neck reconstruction: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2022; 51:1279-1288. [PMID: 35597668 DOI: 10.1016/j.ijom.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 11/27/2022]
Abstract
The aim of this systematic review and meta-analysis was to analyse the literature on the infrahyoid myocutaneous flap (IHMCF) and evaluate its clinical outcomes. The MEDLINE, Embase, Web of Science, Cochrane Library, and Scopus databases were searched (inception to December 31, 2021). Meta-analyses were then conducted to estimate the overall rates of partial flap loss, total flap loss, salivary fistula, and surgical revision. The 21 studies that met the inclusion criteria included 768 patients undergoing head and neck reconstruction with 773 IHMCF. The oral cavity (77.7%) and oropharynx (13.0%) were the most reconstructed sites. The meta-analyses estimated a pooled partial flap loss rate of 10.4% (99% confidence interval (CI) 5.4-16.7%), total loss rate of 1.8% (99% CI 0.8-3.2%), salivary fistula rate of 3.0% (99% CI 1.3-5.3%), and surgical revision rate of 1.9% (99% CI 0.7-3.7%). Fast flap harvesting and low donor site morbidity were other flap features. Previous thyroid surgery or neck dissection and advanced lymph nodal stage were considered contraindications to IHMCF reconstruction by most authors, while prior neck radiotherapy was reported as a relative contraindication. This pedicled cervical flap is a versatile and reliable reconstructive option for medium-sized head and neck defects. Careful preoperative assessment of the neck condition allows for its safe use.
Collapse
Affiliation(s)
- P Di Maio
- Department of Otolaryngology-Head and Neck Surgery, Giuseppe Fornaroli Hospital, ASST Ovest Milanese, Magenta, Milan, Italy.
| | - A De Virgilio
- Humanitas Clinical and Research Centre - IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - A Mincione
- Department of Otolaryngology-Head and Neck Surgery, Giuseppe Fornaroli Hospital, ASST Ovest Milanese, Magenta, Milan, Italy
| | - J Zocchi
- Department of Otolaryngology-Head and Neck Surgery, IRCCS National Cancer Institute "Regina Elena", Rome, Italy
| | - F Boriani
- Department of Plastic Surgery and Microsurgery, Teaching Hospital of Monserrato, University of Cagliari, Cagliari, Italy
| | - G Spriano
- Humanitas Clinical and Research Centre - IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - A Deganello
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - O Iocca
- Division of Maxillofacial Surgery, City of Health and Science of Turin Hospital, University of Turin, Turin, Italy
| |
Collapse
|
2
|
Cristalli G, Ferri E, Di Maio P, Spriano G, Mercante G, Ferreli F, Pellini R, Boscolo Nata F. Lateral conservative approach for recurrent/persistent hypopharyngeal carcinoma: a case series. Eur Arch Otorhinolaryngol 2020; 277:2375-2380. [PMID: 32367150 DOI: 10.1007/s00405-020-06009-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Early persistent/recurrent hypopharyngeal tumours represent a challenge for surgeons who have to balance the need for oncological radicality and the desire to maintain a functioning larynx with preservation of the patient's quality of life. The aim of this study was primarily to understand the technical feasibility, functional outcomes, and the possibility of obtaining oncological radicality using lateral hypopharyngectomy with laryngeal preservation in early recurrent post-radio/(chemo)therapy hypopharyngeal tumours. METHODS Patients with recurrent T1 hypopharyngeal squamous cell carcinoma were retrospectively selected from our institutional database. The external lateral approach according to Spriano and a modified lateral hypopharyngectomy with laryngeal preservation were used to resect tumours of the lateral pyriform sinus wall. Reconstruction was obtained by direct approximation of the posterior border of the sectioned thyroid cartilage to the posterior hypopharyngeal wall, and this was reinforced with a second layer of vascularised and non-irradiated tissue that was provided by a microvascular fascial anterobrachial flap. Swallowing was assessed 3 weeks after surgery using videoendoscopic evaluation. RESULTS The surgical procedure was technically feasible, and complete resection was obtained in all patients. None of the patients experienced major post-operative complications (salivary fistula, bleeding, aspiration pneumonia). Mild dysphagia was observed in one patient who underwent swallowing rehabilitation. Tracheostomy was closed in all patients. No recurrence was recorded after a median follow-up of 20 months. CONCLUSION The reported experience shows that, in selected cases, it is possible to radically remove lateral hypopharyngeal cancer with acceptable functional results.
Collapse
Affiliation(s)
- G Cristalli
- Ospedali Riuniti Padova Sud, Madre Teresa Di Calcutta, ENT Surgery, Via Albere 30, Monselice, 35043, Padua, Italy.
| | - E Ferri
- Ospedali Riuniti Padova Sud, Madre Teresa Di Calcutta, ENT Surgery, Via Albere 30, Monselice, 35043, Padua, Italy
| | - P Di Maio
- Department of Otolaryngology, Head and Neck Surgery (P.D., M.G.), Civil Hospital, Via Giovanni Borea, 56, Sanremo, 18038, Imperia, Italy
| | - G Spriano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
| | - G Mercante
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
| | - F Ferreli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
| | - R Pellini
- Department of Otolaryngology Head and Neck Surgery, National Cancer Institute "Regina Elena", Via Elio Chianesi 53, 00144, Roma, Italy
| | - F Boscolo Nata
- Ospedali Riuniti Padova Sud, Madre Teresa Di Calcutta, ENT Surgery, Via Albere 30, Monselice, 35043, Padua, Italy
| |
Collapse
|
3
|
De Virgilio A, Iocca O, Di Maio P, Mercante G, Mondello T, Yiu P, Malvezzi L, Pellini R, Ferreli F, Spriano G. Free flap microvascular anastomosis in head and neck reconstruction using a 4K three-dimensional exoscope system (VITOM 3D). Int J Oral Maxillofac Surg 2020; 49:1169-1173. [PMID: 32057512 DOI: 10.1016/j.ijom.2020.01.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/14/2019] [Accepted: 01/28/2020] [Indexed: 11/18/2022]
Abstract
The aim of this study was to evaluate the feasibility of microvascular anastomosis using a 4K three-dimensional exoscope system (VITOM 3D) in 10 consecutive cases of free flap head and neck reconstructive surgery. This was a clinical human study of free flap microvascular anastomosis using a VITOM 3D exoscope in 10 consecutive patients undergoing reconstruction after ablative surgery for head and neck carcinoma. Microvascular anastomoses were performed successfully using the exoscope in all patients, without any need for the conventional microscope. Arterial anastomoses were all end-to-end. Venous anastomoses were end-to-end in eight cases and end-to-side with the internal jugular vein in two cases. This study demonstrates the technical feasibility of microvascular anastomosis using a 4K three-dimensional exoscope system (VITOM 3D) in a series of 10 cases.
Collapse
Affiliation(s)
- A De Virgilio
- Otorhinolaryngology Unit, Humanitas University, Humanitas Clinical and Research Centre - IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
| | - O Iocca
- Otorhinolaryngology Unit, Humanitas University, Humanitas Clinical and Research Centre - IRCCS, Rozzano, Milan, Italy
| | - P Di Maio
- Giovanni Borea Civil Hospital, Department of Otolaryngology - Head and Neck Surgery, Sanremo, Italy
| | - G Mercante
- Otorhinolaryngology Unit, Humanitas University, Humanitas Clinical and Research Centre - IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - T Mondello
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - P Yiu
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - L Malvezzi
- Otorhinolaryngology Unit, Humanitas University, Humanitas Clinical and Research Centre - IRCCS, Rozzano, Milan, Italy
| | - R Pellini
- Department of Otolaryngology - Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - F Ferreli
- Otorhinolaryngology Unit, Humanitas University, Humanitas Clinical and Research Centre - IRCCS, Rozzano, Milan, Italy
| | - G Spriano
- Otorhinolaryngology Unit, Humanitas University, Humanitas Clinical and Research Centre - IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| |
Collapse
|