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Cuperus IE, Mathijssen IMJ, van Veelen MLC, Bouzariouh A, Stubelius I, Kölby L, Lundborg C, Das S, Johnson D, Wall SA, Larysz DF, Dowgierd K, Koszowska M, Schulz M, Gratopp A, Thomale UW, Zafra Vallejo V, Redondo Alamillos M, Ferreras Vega R, Apolito M, Vergnaud E, Paternoster G, Khonsari RH. A European multicenter outcome study on the different perioperative airway management policies following midface surgery in syndromic craniosynostosis: a proposal for a Standard Operating Procedure. Plast Reconstr Surg 2024:00006534-990000000-02238. [PMID: 38289904 DOI: 10.1097/prs.0000000000011317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
BACKGROUND Perioperative airway management following midface advancements in children with Apert and Crouzon/Pfeiffer syndrome can be challenging, and protocols often differ. This study examined airway management following midface advancements and postoperative respiratory complications. METHODS A multicenter, retrospective cohort study was performed to obtain information about the timing of extubation, perioperative airway management, and respiratory complications after monobloc / le Fort III procedures. RESULTS Ultimately, 275 patients (129 monobloc and 146 Le Fort III) were included; 62 received immediate extubation and 162 delayed extubation; 42 had long-term tracheostomies and nine perioperative short-term tracheostomies. Short-term tracheostomies were in most centers reserved for selected cases. Patients with delayed extubation remained intubated for three days (IQR 2 - 5). The rate of no or only oxygen support after extubation was comparable between patients with immediate and delayed extubation, 58/62 (94%) and 137/162 (85%) patients, respectively. However, patients with immediate extubation developed less postoperative pneumonia than those with delayed, 0/62 (0%) versus 24/161 (15%) (P = 0.001), respectively. Immediate extubation also appeared safe in moderate/severe OSA since 19/20 (95%) required either no or only oxygen support after extubation. The odds of developing intubation-related complications increased by 21% with every extra day of intubation. CONCLUSIONS Immediate extubation following midface advancements was found to be a safe option, as it was not associated with respiratory insufficiency but did lead to fewer complications. Immediate extubation should be considered routine management in patients with no/mild OSA and should be the aim in moderate/severe OSA after careful assessment.
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Affiliation(s)
- Iris E Cuperus
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Irene M J Mathijssen
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Anouar Bouzariouh
- Department of Anaesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ingrid Stubelius
- Department of Anesthesiology and Intensive Care, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Kölby
- Department of Plastic Surgery, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christopher Lundborg
- Department of Anesthesiology and Intensive Care, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sumit Das
- Department of Paediatric Anaesthesia, John Radcliffe Hospital, Oxford, United Kingdom
| | - David Johnson
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Oxford, United Kingdom
| | - Steven A Wall
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Oxford, United Kingdom
| | - Dawid F Larysz
- Department of Head and Neck Surgery for Children and Adolescents, Regional Specialized Children's Hospital Popowski, Olsztyn, Poland
- Department of Head and Neck Surgery for Children and Adolescents, University of Warmia and Mazury, Olsztyn, Poland
| | - Krzysztof Dowgierd
- Department of Head and Neck Surgery for Children and Adolescents, Regional Specialized Children's Hospital Popowski, Olsztyn, Poland
- Department of Head and Neck Surgery for Children and Adolescents, University of Warmia and Mazury, Olsztyn, Poland
| | - Małgorzata Koszowska
- Department of Head and Neck Surgery for Children and Adolescents, Regional Specialized Children's Hospital Popowski, Olsztyn, Poland
- Department of Head and Neck Surgery for Children and Adolescents, University of Warmia and Mazury, Olsztyn, Poland
| | - Matthias Schulz
- Pediatric Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin Berlin, Germany
| | - Alexander Gratopp
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrich-Wilhelm Thomale
- Pediatric Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin Berlin, Germany
| | - Víctor Zafra Vallejo
- Department of Oral and Maxillofacial Surgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Marta Redondo Alamillos
- Department of Oral and Maxillofacial Surgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Rubén Ferreras Vega
- Department of Anaesthesiology, University Hospital 12 de Octubre, Madrid, Spain
| | - Michela Apolito
- Department of Maxillofacial Surgery and Plastic Surgery, Hôpital Necker-Enfants Malades, AP-HP; National Reference Center for Craniosynostosis and Craniofacial Malformations (CRANIOST); Faculty of Medicine, Paris Cité University, Paris, France
| | - Estelle Vergnaud
- Department of Pediatric and Obstetrical Anesthesiology and Reanimation, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Giovanna Paternoster
- Department of Pediatric Neurosurgery, Hôpital Necker-Enfants Malades, AP-HP; National Reference Center for Craniosynostosis and Craniofacial Malformations (CRANIOST), Paris, France
| | - Roman H Khonsari
- Department of Maxillofacial Surgery and Plastic Surgery, Hôpital Necker-Enfants Malades, AP-HP; National Reference Center for Craniosynostosis and Craniofacial Malformations (CRANIOST); Faculty of Medicine, Paris Cité University, Paris, France
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Salzano G, Maglitto F, Calvanese C, Apolito M, Buono S, Franco P, Perri F, Vaira LA, De Luca R, Salzano FA, Califano L, Ionna F. Pharyngocutaneous Fistula in Salvage Laryngectomy: Use of the Stapler Versus Manual Suturing Technique. Indian J Otolaryngol Head Neck Surg 2023; 75:1441-1446. [PMID: 37636788 PMCID: PMC10447661 DOI: 10.1007/s12070-023-03587-7] [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: 05/27/2022] [Accepted: 02/16/2023] [Indexed: 02/27/2023] Open
Abstract
A pharyngocutaneous fistula (PCF) is the most common complication after salvage total laryngectomy (STL) with an incidence ranging from 5 to 73%, causing an increase in morbidity and delaying the patient's recovery. A surgical technique to prevent PCF formation is the use of the stapler to suture the pharyngeal mucosa. We have reviewed the medical files of 91 patients who had undergone STL, dividing the patients into two groups (manual suture vs. stapler), based on the type of pharyngeal suture performed during the STL. We found 12/49 (24.5%) cases of a PCF in group A (manual) and 5/42 (11.9%) cases of a PCF in group B (stapler). There is a statistically significant difference between the two groups with the patients in group B presenting better results in terms of the reduction of the surgical time, the length of the hospital stay and also in the restarting of oral feeding. The advantages of mechanical suturing with the stapler are reduced surgical times, a lower PCF formation rate, which involves an early removal of the nasogastric tube, and reduced hospitalization times. Further studies with a larger case series will be necessary to confirm the results obtained and to standardize the surgical technique.
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Affiliation(s)
- Giovanni Salzano
- Maxillo-Facial and ENT Surgery Unit, INT- IRCCS “Fondazione G. Pascale”, Naples, Italy
| | - Fabio Maglitto
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Naples, Italy
| | - Carlo Calvanese
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Naples, Italy
| | - Michela Apolito
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Naples, Italy
| | - Sarah Buono
- Ear Nose and Throat Unit, Department of Neuroscience, Reproductive and Odontostomatological Science , University of Naples ‘Federico II’, Naples, Italy
| | - Pierluigi Franco
- Maxillo-Facial and ENT Surgery Unit, INT- IRCCS “Fondazione G. Pascale”, Naples, Italy
| | - Francesco Perri
- Medical and Experimental Head and Neck Oncology Unit, INT- IRCCS “Fondazione G. Pascale”, Naples, Italy
| | - Luigi Angelo Vaira
- Maxillofacial Surgery Operative Unit, University Hospital of Sassari, Sassari, Italy
| | - Rolando De Luca
- Division of Anesthesia and Pain Medicine, INT- IRCCS “Fondazione G. Pascale”, Naples, Italy
| | - Francesco Antonio Salzano
- Otolaryngology Operative Unit, Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, University of Salerno, Salerno, Italy
| | - Luigi Califano
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Naples, Italy
| | - Franco Ionna
- Maxillo-Facial and ENT Surgery Unit, INT- IRCCS “Fondazione G. Pascale”, Naples, Italy
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Salzano G, Perri F, Maglitto F, Togo G, De Fazio GR, Apolito M, Calabria F, Laface C, Vaira LA, Committeri U, Balia M, Pavone E, Aversa C, Salzano FA, Abbate V, Ottaiano A, Cascella M, Santorsola M, Fusco R, Califano L, Ionna F. Pre-Treatment Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios as Predictors of Occult Cervical Metastasis in Clinically Negative Neck Supraglottic and Glottic Cancer. J Pers Med 2021; 11:jpm11121252. [PMID: 34945723 PMCID: PMC8706672 DOI: 10.3390/jpm11121252] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 11/30/2022] Open
Abstract
Background. Among patients with diagnosis of Laryngeal Squamous Cell Carcinoma (LSCC), up to 37.5% of cases may have occult metastasis (OM), and this feature is linked to poor prognosis and high rate of local recurrence. The role of elective neck dissection (END) in clinically negative neck (cN0) LSCC remains controversial. It is of great value to search for low-cost and easily detectable indicators to predict the risk of OM in laryngeal cancer. Recent reports have shown that high values of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) represent a negative prognostic factor in head and neck cancers. The aim of our study has been to investigate the value of pre-treatment NLR and PLR with regard to predicting occult cervical metastasis in cN0 supraglottic and glottic LSCC. Materials and methods. Data of patients affected by LSCC, who had been surgically treated by means of laryngectomy (total, horizontal partial and supracricoid) and END between January 2006 and January 2021, were retrospectively reviewed, using information retrieved from a database dedicated to such procedures in a single tertiary care referral institute. Results. A total of 387 patients were treated for LSCC at our Institute from 2006 to 2021, but only 108 of them met the inclusion criteria. The median age at the time of diagnosis was 64 years (range, 39–89 years). All the tumors were treated with a laryngectomy and an END. A total of 27.7% of patients were found positive for neck node metastasis (the pN+ group), while 78/108 (72.3%) patients were found to be negative for the presence of neck metastasis (the pN0 group). High values of NLR, but not PLR, significantly correlated with the probability of OM, and according to the iterative algorithm of Newton–Raphson, an NLR value of 2.26 corresponds to a probability of OM of 20%. Conclusion. Our analysis revealed a statistical correlation between high NLR pre-treatment values and positive neck OM in patients with LSCC.
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Affiliation(s)
- Giovanni Salzano
- Maxillo-Facial and ENT Surgery Unit, INT-IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (G.S.); (U.C.); (E.P.); (C.A.); (F.I.)
| | - Francesco Perri
- Head and Neck Medical and Experimental Oncology Unit, INT IRCCS Fondazione Giovanni Pascale, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-815-903-1734
| | - Fabio Maglitto
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, 80131 Naples, Italy; (F.M.); (G.T.); (G.R.D.F.); (M.A.); (F.C.); (C.L.); (V.A.); (L.C.)
| | - Giulia Togo
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, 80131 Naples, Italy; (F.M.); (G.T.); (G.R.D.F.); (M.A.); (F.C.); (C.L.); (V.A.); (L.C.)
| | - Gianluca Renato De Fazio
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, 80131 Naples, Italy; (F.M.); (G.T.); (G.R.D.F.); (M.A.); (F.C.); (C.L.); (V.A.); (L.C.)
| | - Michela Apolito
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, 80131 Naples, Italy; (F.M.); (G.T.); (G.R.D.F.); (M.A.); (F.C.); (C.L.); (V.A.); (L.C.)
| | - Federica Calabria
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, 80131 Naples, Italy; (F.M.); (G.T.); (G.R.D.F.); (M.A.); (F.C.); (C.L.); (V.A.); (L.C.)
| | - Claudia Laface
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, 80131 Naples, Italy; (F.M.); (G.T.); (G.R.D.F.); (M.A.); (F.C.); (C.L.); (V.A.); (L.C.)
| | - Luigi Angelo Vaira
- Maxillofacial Surgery Unit, University Hospital of Sassari, 07100 Sassari, Italy;
| | - Umberto Committeri
- Maxillo-Facial and ENT Surgery Unit, INT-IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (G.S.); (U.C.); (E.P.); (C.A.); (F.I.)
| | - Mario Balia
- Maxillofacial Surgery Unit, University of Naples Federico II, Via Sergio Pansini 5, 80131 Naples, Italy;
| | - Ettore Pavone
- Maxillo-Facial and ENT Surgery Unit, INT-IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (G.S.); (U.C.); (E.P.); (C.A.); (F.I.)
| | - Corrado Aversa
- Maxillo-Facial and ENT Surgery Unit, INT-IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (G.S.); (U.C.); (E.P.); (C.A.); (F.I.)
| | - Francesco Antonio Salzano
- Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy;
| | - Vincenzo Abbate
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, 80131 Naples, Italy; (F.M.); (G.T.); (G.R.D.F.); (M.A.); (F.C.); (C.L.); (V.A.); (L.C.)
| | - Alessandro Ottaiano
- SSD Innovative Therapies for Abdominal Metastases, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Naples, Italy; (A.O.); (M.S.)
| | - Marco Cascella
- Division of Anesthesia, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, 80131 Naples, Italy;
| | - Mariachiara Santorsola
- SSD Innovative Therapies for Abdominal Metastases, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Naples, Italy; (A.O.); (M.S.)
| | - Roberta Fusco
- Oncology Medical Division, Igea SpA, 80127 Naples, Italy;
| | - Luigi Califano
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, 80131 Naples, Italy; (F.M.); (G.T.); (G.R.D.F.); (M.A.); (F.C.); (C.L.); (V.A.); (L.C.)
| | - Franco Ionna
- Maxillo-Facial and ENT Surgery Unit, INT-IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (G.S.); (U.C.); (E.P.); (C.A.); (F.I.)
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