An analysis of unplanned readmissions after head and neck microvascular reconstructive surgery

The 30-day readmission rate is a highly scrutinized metric of quality surgical care, because readmission is costly and perceived to be avoidable with planning and patient education. Head and neck surgery patients generally have multiple risk factors for readmission, as readmitted patients are generally older, with more co-morbidities, lower socio-economic status, and a history of multiple emergency department visits and readmissions. A retrospective cohort study was implemented to determine the incidence and etiology of 30-day readmission after microvascular head and neck reconstructive surgery, focusing on social risk factors. Data were analyzed by χ² test, analysis of variance, t-test, and logistic regression, with statistical significance set at P<0.05. Of 209 patients included in this study, 35 (16.7%) had a 30-day readmission. Increased needs at discharge were associated with increased readmission, while other social risk factors were less significant for a readmission in this study.

Myxofibrosarcoma in Head and Neck: Case Report of Unusually Aggressive Presentation

Myxofibrosarcoma (MFS) is a malignant fibroblastic tumor that primarily affects the lower and upper extremities. It is usually described as a slow-growing tumor with high recurrence rates but low metastatic potential. The reported incidence of head and neck MFS is 2 to 4% and rarely presents with distant metastases. This report describes a case of maxillary MFS in a 72-year-old woman whose disease progression followed an atypical course with an extremely rapid rate of growth and early pulmonary and central nervous system lesions. The pulmonary symptoms at initial presentation made a final diagnosis a challenge. Various diagnostic modalities and multidisciplinary collaboration were required. The disease course and management are outlined. To the authors' knowledge, this is the first case of MFS originating in the maxillary alveolus with multiple metastases, including the brain and lungs, in the early course of the disease.

The Cervicofacial Flap in Cheek Reconstruction: A Guide for Flap Design

PURPOSE

The cervicofacial (CF) flap is a random-pattern flap that provides an excellent match for cheek reconstruction. The design of the CF flap varies between different cheek subunits. In this report, the authors review their experience with this flap and present a guide for flap design for different cheek subunits.

MATERIALS AND METHODS

Patients who had cheek reconstruction were screened using the database of the surgical procedures from 2011 to 2016. Seventy-four patients were identified. Data on patient demographics, diagnosis, defect type, and outcome were retrospectively reviewed. Patients who did not have a clear description of the defect or flap design were excluded from the study. The authors divided the cheek into 3 zones and created a guide for flap design for each zone.

RESULTS

Twenty-eight patients with CF flap for cheek reconstruction met the inclusion criteria (21 male [75%] and 7 female [25%]; mean age, 57 yr; range, 8 to 88 yr). Fifty-seven percent had zone A defects, 18% had zone B1 defects, 14% had zone B2 defects, and 11% had multiple-zone defects. Mean follow-up was 4.6 months (0 to 17 months). Ninety-three percent had a successful outcome. Only 2 patients developed wound complications.

CONCLUSION

The CF flap is a versatile flap that provides excellent skin color, thickness, and texture match in cheek reconstruction. Planning the flap design is essential to achieve a good outcome. The present algorithm provides a straightforward method to reliably design the CF flap for cheek reconstruction.

Advanced predoctoral implant program at UIC: description and qualitative analysis

Dental implant education has increasingly become an integral part of predoctoral dental curricula. However, the majority of implant education emphasizes the restorative aspect as opposed to the surgical. The University of Illinois at Chicago College of Dentistry has developed an Advanced Predoctoral Implant Program (APIP) that provides a select group of students the opportunity to place implants for single-tooth restorations and mandibular overdentures. This article describes the rationale, logistics, experiences, and perspectives of an innovative approach to provide additional learning experiences in the care of patients with partial and complete edentulism using implant-supported therapies. Student and faculty perspectives on the APIP were ascertained via focus group discussions and a student survey. The qualitative analysis of this study suggests that the select predoctoral dental students highly benefited from this experience and intend to increase their knowledge and skills in implant dentistry through formal education following graduation. Furthermore, the survey indicates that the APIP has had a positive influence on the students' interest in surgically placing implants in their future dental practice and their confidence level in restoring and surgically placing implants.