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And Neck Surgery (and + neck_surgery)
Kinds of And Neck Surgery Selected AbstractsSmall Vestibular Schwannomas With No Hearing: Comparison of Functional Outcomes in Stereotactic Radiosurgery and MicrosurgeryTHE LARYNGOSCOPE, Issue 11 2008Daniel H. Coelho MD Abstract Objectives: To date, numerous studies have compared functional outcomes between stereotactic radiosurgery (SRS) and microsurgery (MS) in the treatment of vestibular schwannomas (VS). However, most of them involve tumors of difference sizes, radiation dosages, and surgical approaches. Few have systematically compared issues of dysequilibrium. By studying only patients with small tumors and no hearing, we sought to minimize confounding variables. Study Design: A retrospective chart review and telephone questionnaire. Methods: From 1998,2006, 31 patients with small (<1.5 cm) VS and nonserviceable hearing (American Academy of Otolaryngology,Head and Neck Surgery [AAO-HNS] Class C or D) were treated at our institution. Twenty-two were available for follow-up and telephone questionnaire, including the University of California Los Angeles Dizziness Questionnaire (UCLA-DQ). Twelve underwent SRS and 10 underwent MS. All MS patients underwent the translabyrinthine approach to their tumors. Outcomes measurements included tumor control, facial nerve function, tinnitus, trigeminal function, and imbalance. Results: Patients undergoing SRS had comparable rates of tumor control, facial nerve function, tinnitus, and trigeminal function to MS patients. However, SRS did result in statistically significantly worse long-term imbalance when compared with MS patients. Detailed comparisons of the two modalities are made. Conclusions: In our study population, patients with small tumors and no serviceable hearing, these data suggest that MS results in comparable minimal morbidity with SRS, though posttreatment dysequilibrium is significantly decreased. While the authors recommend translabyrinthine resection of small VS with no hearing in patients able to tolerate surgery, the need for further prospective investigation is clear. [source] Management and Outcome of Patients With Mucoepidermoid Carcinoma of Major Salivary Gland Origin: A Single Institution's 30-Year Experience,THE LARYNGOSCOPE, Issue 2 2008Katri Aro MD Abstract Background: Mucoepidermoid carcinoma (MEC) is one of the most frequent epithelial malignancies of the salivary glands. Prediction of clinical outcome of MEC is challenging. Material and Methods: We retrospectively reviewed 52 cases of MEC of major salivary gland origin diagnosed at the Department of Otolaryngology,Head and Neck Surgery, Helsinki University Central Hospital, Helsinki, Finland, during a 30-year period of 1976 to 2005. Criteria used for diagnosis were those of World Health Organization classifications valid at each time point, and criteria for grading were those recommended by Armed Forces Institute of Pathology fascicle (1996). Since 1993, the degree of cell proliferation was used at our institution as an adjunct tool when grading MEC. The majority of cases occurred in the parotid gland (n = 47, 90%) followed by the submandibular gland (n = 5, 10%). Results: We had 39% high-grade (HG), 14% intermediate-grade (IMG), and 44% low-grade (LG) MECs. T categories were T1, n = 18; T2, n = 16; T3, n = 9; T4, n = 9. Forty-nine (94%) patients were treated with curative intent. These patients underwent surgery, and 24 (49%) patients received postoperative radiotherapy. Follow-up time varied from 6 months to 9 years. Forty-five percent of HG-MEC patients and 67% of IMG-MEC patients developed locoregional failures or distant metastases during a 3-year follow-up as opposed to none of the LG-MEC patients. Of MEC patients with N0 neck, two HG-MEC patients and one IMG-MEC (8%) patient developed regional recurrence during follow-up. Conclusions: Patient outcome in the different grades of MEC suggests a need for overview of the treatment protocol, especially with regard to LG-MEC and IMG-MEC. The apparently unusual occurrence of locoregional failures and metastases in LG-MEC suggests a restrictive approach in surgical management. However, the frequent occurrence of such failures in IMG-MEC warrants an aggressive approach with these tumors. [source] Hypothermia During Head and Neck Surgery,THE LARYNGOSCOPE, Issue 8 2003Nishant Agrawal MD Abstract Objective To determine the predictors and incidence of hypothermia in patients undergoing head and neck surgery. Study Design Retrospective analysis. Methods Patients were either not warmed (n = 43) or actively warmed with forced-air warming (n = 25). Clinical variables that were assessed as predictors of core body temperature included age, body mass, duration of procedure, estimated blood loss, amount of intravenous fluids administered, and the use of forced-air warming. The incidence of severe intraoperative hypothermia and potential hypothermia-related complications was also examined. Results The study demonstrated that advanced age is a risk factor for hypothermia and decreased body mass is associated with lower final body temperatures in the groups of patients that was not warmed. After adjusting for differences in the ages and weights between the two groups, the mean core body temperature was found to be 0.4°C lower in the patients who were not warmed. Severe intraoperative hypothermia occurred in 5 of 38 patients (11.6%) who were not warmed and 2 of 23 patients (8.0%) who were warmed. The complications associated with hypothermia included delayed time to extubation, the development of neck seromas, and flap dehiscence. Conclusions Patients undergoing head and neck surgery are at risk for the development of intraoperative hypothermia and require careful temperature monitoring. Elderly patients and patients with low body mass are more prone to develop low intraoperative core body temperatures. Active warming with forced-air warmers should be considered for patients at risk for intraoperative hypothermia and for patients who develop hypothermia intraoperatively, to avoid hypothermia-related complications. [source] Sinonasal Undifferentiated Carcinoma: The Search for a Better Outcome,THE LARYNGOSCOPE, Issue 8 2002Pierre Y. Musy MD Abstract Objective To evaluate the clinical outcomes of a standardized treatment approach for sinonasal undifferentiated carcinoma (SNUC). Study Design Single-center, retrospective case series. Methods Fifteen patients with newly diagnosed SNUC were seen in the Department of Otolaryngology-Head and Neck Surgery at the University of Virginia from 1991 to 2000. Long-term follow-up on five additional patients diagnosed between 1986 and 1991 was also analyzed. Results Overall, 10 patients were treated with curative intent with neoadjuvant chemoradiotherapy followed by craniofacial resection (CFR). The majority of the remainder was treated with palliative radiotherapy or chemoradiotherapy alone. Four patients who underwent CFR are currently free of disease at 4, 36, 49, and 164 months postoperatively. The 2-year survival of all evaluable patients, regardless of treatment, was 47%. Two-year survival was 64% in the group treated by CFR and 25% in the group treated with chemo- and/or radiotherapy (P = .076). Conclusion For patients with good performance status and limited intracranial or intraorbital disease, we continue to advocate initial chemoradiotherapy followed by craniofacial resection. Patients who are deemed inoperable as a result of advanced disease may nevertheless experience significant palliation with chemoradiotherapy only. [source] Value of Fine-Needle Aspiration Cytology of Parotid Gland MassesTHE LARYNGOSCOPE, Issue 11 2001Peter Zbären MD Abstract Objective To evaluate the usefulness and accuracy of fine-needle aspiration cytology (FNAC) in the diagnosis of parotid gland masses. Study Design Retrospective chart review of patients undergoing FNAC. Methods Between January 1990 and December 1998, 410 parotid glands were resected at the Department of Otorhinolaryngology,Head and Neck Surgery at the University of Berne, Inselpital (Berne, Switzerland). Included in the study were 228 cases with preoperative FNAC. In a retrospective study the results of FNAC were analyzed and compared with the corresponding histopathological diagnosis. Results Histological evaluation revealed 65 malignant tumors and 163 benign lesions (150 neoplasms and 13 nonneoplastic lesions). The cytological findings were nondiagnostic in 13 (5.7%), true-negative in 146 (64%), true-positive in 39 (17%), false-negative in 22 (9.8%) and false-positive in 8 (4.5%) cases in detecting malignant tumors. Nineteen of 39 (49%) malignant tumors (true-positive) and 123 of 146 (84%) benign lesions (true-negative) were classified accurately. The accuracy, sensitivity, and specificity were 86%, 64%, and 95% respectively. Conclusions Fine-needle aspiration cytology is a valuable adjunct to preoperative assessment of parotid masses. Preoperative recognition of malignant tumors may help prepare both the surgeon and patient for an appropriate surgical procedure. [source] Learning Curve for Translaryngeal Tracheotomy in Head and Neck SurgeryTHE LARYNGOSCOPE, Issue 4 2001Gioacchino Giugliano MD Abstract Objectives Translaryngeal tracheotomy (TLT) is a widely accepted procedure in intensive-care units for its simplicity of execution, low morbidity, rapid wound closure after cannula removal, good esthetic results, and lack of long-term sequelae. The aim of this study was to evaluate the feasibility and use of adopting TLT in patients with cancer undergoing major head and neck surgery. Study Design Prospective analysis of learning curve and incidence of complications in 41 patients with cancer who underwent TLT at the Division of Head and Neck Surgery of the European Institute of Oncology from November 1997 to June 1999. Methods Patient characteristics, pathology, anatomic characteristics of the neck, and surgical short-term and long-term complications were noted. The patients were divided into consecutive groups of six or seven patients, and time trends in occurrence of complications and time to execute the procedure were assessed. Results TLT performance time decreased from 50 minutes in the first seven patients to 24 minutes in the last group. The technique was easy to perform and safe, with only two minor complications during surgery. However, minor complications occurred in three and major complications in 17 patients in the days immediately following surgery, almost entirely attributable to lack of counter-cannu1a and stylet. Conclusions In view of the high proportion of major complications, TLT using the presently available kit is unsuitable for major head and neck surgery. However, the considerable advantages of the technique would recommend it as a valid alternative to surgical tracheotomy if the kit included a counter-cannu1a and stylet. [source] Ear, Nose and Throat and Head and Neck Surgery, An Illustrated Colour TextTHE LARYNGOSCOPE, Issue 1 2001Christopher H. Rassekh MD No abstract is available for this article. [source] Avoiding Transfusion in Head and Neck Surgery: Feasibility Study of Erythropoietin,THE LARYNGOSCOPE, Issue 1 2000Erich M. Sturgis MD Abstract Objective: To determine the feasibility of perioperative erythropoietin to avoid blood transfusion in head and neck cancer surgery. Study Design: Retrospective chart review. Methods: Ninety-nine patients undergoing surgical resection of head and neck tumors at our institution were assessed for demographic data, nutritional parameters, tumor/surgical information, hematological/transfusion data, and contraindications to erythropoietin. Each transfusion was classified as to its appropriateness, and the potential benefit of erythropoietin was assessed in each patient. A cost analysis was also performed. Results: Most transfused patients (63%) received too many units. A subgroup at high risk of transfusion was identified who would benefit most from perioperative erythropoietin. Assuming that perioperative erythropoietin therapy is equivalent to the transfusion of 4 units, we estimate that the majority (74%) of transfused patients would not have required a transfusion if more stringent transfusion criteria were followed and those at high risk were given perioperative erythropoietin. Although the cost for transfusing 4 units is equivalent to that of a perioperative course of erythropoietin, the overall direct cost of erythropoietin treatment would actually have been more expensive. Conclusions: Perioperative erythropoietin therapy may be appropriate for a subgroup of head and neck cancer patients, but a prospective randomized controlled study in such a subgroup is needed to better define those most likely to benefit from it and to assess actual cost/benefit ratios. [source] Clinical outcome following total laryngectomy for cancerANZ JOURNAL OF SURGERY, Issue 5 2003Francis T. Hall Background: Patients with advanced cancers of the larynx and hypopharynx have been treated with total laryngectomy at the Department of Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney in the past. Increasingly, these patients are being managed with organ-sparing protocols using chemotherapy and radiotherapy. The aim of the present study was to review complication, recurrence and survival rates following total laryngectomy. Methods: Patients who had total laryngectomy for squamous carcinomas of the larynx or hypopharynx between 1987 and 1998 and whose clinicopathological data had been prospectively accessioned onto the computerized database of the Department of Head and Neck Surgery, Royal Prince Alfred Hospital, were reviewed. Patients whose laryngectomy was a salvage procedure for failed previous treatment were included. Results: A total of 147 patients met the inclusion criteria for the study, including 128 men and 19 women with a median age of 63 years. Primary cancers involved the larynx in 90 patients and hypopharynx in 57. There were 30 patients who had recurrent (n = 24) or persistent disease (n = 6) after previous treatment with radiotherapy (26 larynx cases and four hypopharynx cases). Pharyngo-cutaneous fistulas occurred in 26 cases (17.7%) and, using multivariate analysis, the incidence did not correlate with T stage, previous treatment or concomitant neck dissection. Local control rates were 86% for the larynx and 77% for the hypopharynx groups and neck control was 84% and 75%, respectively. Five-year survival for the larynx cancer group was 67% and this was significantly influenced by T stage and clinical and pathological N stage. Survival in the hypopharynx group was 37% at 5 years and this did not significantly correlate with T or N stage. There was a non-significant trend to improved survival among previously treated patients whose laryngectomy was a salvage procedure. Conclusion: Patients with cancer of the larynx had a significantly better survival following total laryngectomy than patients with hypopharyngeal cancer. Those whose laryngectomy was carried out as a salvage procedure following failed previous treatment did not have a worse outcome than previously untreated patients. [source] Oxford Handbook of ENT and Head and Neck Surgery.BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 6 20102nd Edn R. Corbridge, N. Steventon 180 × 100 mm. No abstract is available for this article. [source] Results of multimodality therapy for squamous cell carcinoma of maxillary sinusCANCER, Issue 5 2002Ken-ichi Nibu M.D., Ph.D. Abstract BACKGROUND A wide variety of modalities, including surgery, radiation therapy, and chemotherapy, alone or in combination, have been used for the treatment of squamous cell carcinoma (SCC) of the maxillary sinus to obtain better local control and maintain functions. However, there is still much controversy with regard to the optimum treatment. METHODS From 1987 to 1999, 33 patients with SCC of maxillary sinus were treated at the Department of Otolaryngology,Head and Neck Surgery, University of Tokyo Hospital. The treatment consisted of 30,40 grays (Gy) of preoperative radiotherapy with concomitant intraarterial infusion of 5-fluorouracil and cisplatin followed by surgery and 30,40 Gy of postoperative radiotherapy, for tumors without skull base invasion. For tumors invading the skull base, preoperative systemic chemotherapy with or without radiotherapy was performed, instead of intraarterial chemotherapy, then followed by skull base surgery. The surgical procedures varied according to the extent of tumor. Results were compared with those of the 108 patients treated in our hospital from 1976 to 1982. RESULTS Partial maxillectomy was performed in 2 T2 patients and 12 T3 patients. Total maxillectomy was performed in 1 T2 patient, 3 T2 patients, and 7 T4 patients. Skull base surgery was performed in eight T4 patients. Orbital content and hard palate were preserved in 22 patients and 18 patients, respectively. The overall 5-year survival rates were 86% in T 3 patients and 67 % in T4 patients, respectively. CONCLUSIONS Our multimodal treatment has provided favorable local control and survival outcome with good functional results. Cancer 2002;94:1476,82. © 2002 American Cancer Society. DOI 10.1002/cncr.10253 [source] Novel treatment of first bite syndrome using botulinum toxin type AHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 8 2009Byung-Joo Lee MD Abstract Background First bite syndrome is the development of pain in the parotid region after the first bite of each meal and can be seen after surgery of the parapharyngeal space. The purpose of this study is to evaluate the efficacy of intraglandular injection of botulinum toxin type A (BTA) in patients with first bite syndrome. Methods Five patients with first bite syndrome developed after head and neck surgery were treated by injection of BTA into parotid gland. All patients completed a 4-item quality-of-life survey with a 10-point response scale designed to measure outcome of intraglandular injection of BTA. Results The first bite syndrome without or with sialogogue and degree of interference with daily activity with or without eating or drinking improved significantly at 1 and 3 month after injection (p < .05). Conclusion The BTA injection into affected parotid gland produces a decrease in the severity of first bite syndrome and improves the patient's quality of life. © 2009 Wiley Periodicals, Inc. Head Neck, 2009 [source] Do pre-irradiation dental extractions reduce the risk of osteoradionecrosis of the mandible?HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 6 2007Daniel T. Chang MD Abstract Background. This study was done to determine if pre-radiotherapy (pre-RT) dental extractions reduce the risk of osteoradionecrosis (ORN). Methods. Between 1987 and 2004, 413 patients with oropharyngeal carcinomas were treated with definitive RT at the University of Florida. Dentate patients underwent pretreatment dental evaluation. Teeth in the RT field were usually extracted if thought to have poor long-term prognosis from dental disease. The endpoint was ,grade 2 ORN using a modified staging system. Patients were excluded for local recurrence, additional RT above the clavicles, or head and neck surgery besides neck dissection. Results. ORN rates were as follows: edentulous, <1%; teeth in-field with pre-RT extractions, 15%; and teeth in-field without pre-RT extractions, 9%. Patients with poor in-field teeth and pre-RT extractions had a higher 5-year incidence of ORN than those who did not have pre-RT extractions (16% vs 6%, p = .48). Likewise, for those with in-field teeth in good condition and pre-RT extractions, the 5-year ORN incidence was higher than for those who did not undergo extractions (15% vs 2%, p = .42). Multivariate analysis revealed increased ORN risk with doses of >70 Gy, once-daily fractionation, or brachytherapy. Conclusion. Pre-RT extractions do not appear to reduce the risk of ORN. © 2007 Wiley Periodicals, Inc. Head Neck, 2007 [source] Donor site morbidity after harvesting of proximal tibia boneHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 6 2006Yuan-Chien Chen DDS Abstract Background. Bone-grafting procedures are common in head and neck surgery. Donor site morbidity is an important factor in deciding the site for harvest of cancellous bone. The tibia has been recommended as a harvest site. Use of the proximal tibia as a donor site is associated with few complications. Our present study used proximal tibia bone grafts to reconstruct maxillofacial defects and augment bone volume for implantation. Methods. A retrospective study was undertaken to analyze 40 proximal tibia bone grafts in maxillofacial reconstruction. Minimal follow-up was 6 months. Results. There were no major complications during the follow-up period. Early minor complications (15%) included temporary sensory loss and ecchymosis. Late minor complication (2.5%) was gait disturbance for 2 months. Long-term minor complication (2.5%) was an unsightly scar. Conclusion. The procedure for proximal tibia bone graft is easy, has less operative risk, and results in a lower postoperative morbidity rate. Based on our findings, we believe the proximal tibia offers a reliable site for harvest of sufficient quantities of good-quality cancellous bone. © 2006 Wiley Periodicals, Inc. Head Neck 28:496,500, 2006 [source] Ballenger's otorhinolaryngology head and neck surgery, 16th edition by James B. Snow, Jr, and John Jacob Ballenger, BC Decker, Inc., Hamilton, Ontario, Canada, 2003, 1616 ppHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 11 2004M. Boyd Gillespie MD No abstract is available for this article. [source] Shoulder and neck morbidity in quality of life after surgery for head and neck cancerHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 10 2004C. P. van Wilgen PT Abstract Background. Quality of life has become a major issue in determining the outcome of treatment in head and neck surgery with curative intent. The aim of our study was to determine which factors in the postoperative care, especially shoulder and neck morbidity, are related to quality of life and how these outcomes compared between patients who had undergone surgery and a control group. Methods. We analyzed physical symptoms, psychological symptoms, and social and functional well-being at least 1 year after surgery and evaluated the differences in quality of life between patients who had undergone head and neck surgery and a control group. Results. Depression scores contributed significantly to all domains of quality of life. Reduced shoulder abduction, shoulder pain, and neck pain are related to several domains of quality of life. The patient group scored significantly worse for social functioning and limitations from physical problems but scored significantly better for bodily pain and health changes. Conclusion. Depression and shoulder and neck morbidity are important factors in quality of life for patients who have undergone surgery for head and neck cancer. © 2004 Wiley Periodicals, Inc. Head Neck26: 839,844, 2004 [source] An analysis of oral and maxillofacial pathology found in adults over a 30-year periodJOURNAL OF ORAL PATHOLOGY & MEDICINE, Issue 7 2006A. V. Jones Background:, The aim of this study was to determine the range of histologically diagnosed lesions in 44 000 oral and maxillofacial pathology specimens, from adults 17 years and older, submitted for diagnosis to our laboratory over a 30-year period (1973,2002). Materials:, All entries for specimens from the patients were retrieved and compiled into 12 diagnostic categories. Results:, During the period, 44 007 specimens comprised a male-to-female ratio of 0.9:1. The diagnostic category with the largest number of specimens was mucosal pathology (36.0%) followed by odontogenic cysts (13.8%). Malignant tumours accounted for 5.4% of all specimens and benign tumours 4.6%. Conclusion:, This survey showed that while the majority of diagnoses are benign, approximately one in 19 cases required major head and neck surgery for malignant disease. [source] Training in head and neck surgery and oncologyJOURNAL OF SURGICAL ONCOLOGY, Issue 8 2008*Article first published online: 20 MAY 200, Ashok R. Shaha MD, FACS Abstract Management of head and neck cancer truly represents the need for a multimodality approach. This manuscript discusses the history of head and neck surgery, head and neck fellowships and the current trends in the practice of head and neck surgery and oncology. Increasing emphasis is placed on organ preservation and non-operative treatment modalities. The head and neck surgeon (leader of the orchestra) must be familiar with appropriate indications of each treatment modality and outcome. The head and neck surgeon of today should be an all-rounder. J. Surg. Oncol. 2008;97:717,720. © 2008 Wiley-Liss, Inc. [source] Cartilage tissue engineering using resorbable scaffoldsJOURNAL OF TISSUE ENGINEERING AND REGENERATIVE MEDICINE, Issue 6 2007Nicole Rotter Abstract Cartilage tissue engineering holds considerable promise for orthopaedic and reconstructive head and neck surgery. With an increasingly ageing population, the number of patients affected by arthritis and recurrent joint pain is constantly growing, along with the associated socio-economic costs. In head and neck surgery reconstructive procedures gain increasing importance in multimodal tumour therapies. These procedures require the harvesting of large amounts of donor tissue, which causes significant donor site morbidity. Therefore, in vitro -engineered cartilage may provide for a cost-effective and clinically valuable medical need. This article presents an overview of the clinical background as well as considerations for engineered cartilage in the head and neck, and provides examples of cartilage tissue engineering based on various scaffolds. Copyright © 2007 John Wiley & Sons, Ltd. [source] Head and neck reconstruction using cephalic vein transposition in the vessel-depleted neckMICROSURGERY, Issue 8 2009M.B.B.S., Vasileios Vasilakis B.Sc. In microvascular reconstructive surgery the patency of the recipient vessels is the key to successful outcome. In head and neck surgery there is often a lack of adequate recipient vessels as a result of chemoradiation therapy and ablative surgery. To overcome this it is crucial to identify vessels of adequate length and diameter outside the field of injury. We report our experience with cephalic vein transposition for drainage of seven free flaps,six intestinal and one osteocutaneous,for head and neck reconstruction. In five cases the cephalic vein was used during the free flap transfer and in two cases in salvage re-exploration surgery. All flaps survived completely. The anatomical course and location of the cephalic vein allow good patency and straightforward harvesting. Its vascular properties are predictive of reduced incidence of complications such as flap congestion and failure. We suggest that the cephalic vein offers a high venous flow drainage system for large free flaps and advocate its use in free intestinal transfer in the vessel-depleted neck as well as in re-exploration surgery. © 2009 Wiley-Liss, Inc. Microsurgery 2009. [source] Hypothermia During Head and Neck Surgery,THE LARYNGOSCOPE, Issue 8 2003Nishant Agrawal MD Abstract Objective To determine the predictors and incidence of hypothermia in patients undergoing head and neck surgery. Study Design Retrospective analysis. Methods Patients were either not warmed (n = 43) or actively warmed with forced-air warming (n = 25). Clinical variables that were assessed as predictors of core body temperature included age, body mass, duration of procedure, estimated blood loss, amount of intravenous fluids administered, and the use of forced-air warming. The incidence of severe intraoperative hypothermia and potential hypothermia-related complications was also examined. Results The study demonstrated that advanced age is a risk factor for hypothermia and decreased body mass is associated with lower final body temperatures in the groups of patients that was not warmed. After adjusting for differences in the ages and weights between the two groups, the mean core body temperature was found to be 0.4°C lower in the patients who were not warmed. Severe intraoperative hypothermia occurred in 5 of 38 patients (11.6%) who were not warmed and 2 of 23 patients (8.0%) who were warmed. The complications associated with hypothermia included delayed time to extubation, the development of neck seromas, and flap dehiscence. Conclusions Patients undergoing head and neck surgery are at risk for the development of intraoperative hypothermia and require careful temperature monitoring. Elderly patients and patients with low body mass are more prone to develop low intraoperative core body temperatures. Active warming with forced-air warmers should be considered for patients at risk for intraoperative hypothermia and for patients who develop hypothermia intraoperatively, to avoid hypothermia-related complications. [source] Learning Curve for Translaryngeal Tracheotomy in Head and Neck SurgeryTHE LARYNGOSCOPE, Issue 4 2001Gioacchino Giugliano MD Abstract Objectives Translaryngeal tracheotomy (TLT) is a widely accepted procedure in intensive-care units for its simplicity of execution, low morbidity, rapid wound closure after cannula removal, good esthetic results, and lack of long-term sequelae. The aim of this study was to evaluate the feasibility and use of adopting TLT in patients with cancer undergoing major head and neck surgery. Study Design Prospective analysis of learning curve and incidence of complications in 41 patients with cancer who underwent TLT at the Division of Head and Neck Surgery of the European Institute of Oncology from November 1997 to June 1999. Methods Patient characteristics, pathology, anatomic characteristics of the neck, and surgical short-term and long-term complications were noted. The patients were divided into consecutive groups of six or seven patients, and time trends in occurrence of complications and time to execute the procedure were assessed. Results TLT performance time decreased from 50 minutes in the first seven patients to 24 minutes in the last group. The technique was easy to perform and safe, with only two minor complications during surgery. However, minor complications occurred in three and major complications in 17 patients in the days immediately following surgery, almost entirely attributable to lack of counter-cannu1a and stylet. Conclusions In view of the high proportion of major complications, TLT using the presently available kit is unsuitable for major head and neck surgery. However, the considerable advantages of the technique would recommend it as a valid alternative to surgical tracheotomy if the kit included a counter-cannu1a and stylet. [source] Clinical and cost effectiveness of an overnight Intensive Recovery (OIR) for patients undergoing complex airway and head and neck surgery in a regional unitANAESTHESIA, Issue 12 2008N. Sabir No abstract is available for this article. [source] Nasotracheal intubation for head and neck surgeryANAESTHESIA, Issue 11 2003R Williamson No abstract is available for this article. [source] Surgical anatomy of the external branch of the superior laryngeal nerve and its clinical significance in head and neck surgeryCLINICAL ANATOMY, Issue 2 2008Xenophon Kochilas Abstract Injury of the external branch of the superior laryngeal nerve (EBSLN) increases the morbidity following a variety of neck procedures and can have catastrophic consequences in people who use their voice professionally. Identification and preservation of the EBSLN are thus important in thyroidectomy, parathyroidectomy, carotid endarterectomy, and anterior cervical spine procedures, where the nerve is at risk. There are large variations in the anatomical course of the EBSLN, which makes the intraoperative identification of the nerve challenging. The topographic relationship of the EBSLN to the superior thyroid artery and the upper pole of the thyroid gland are considered by many authors to be the key point for identifying the nerve during surgery of the neck. The classifications by Cernea et al. ([1992a] Head Neck 14:380,383; [1992b] Am. J. Surg. 164:634,639) and by Kierner et al. ([1998] Arch. Otolaryngol. Head Neck Surg. 124:301,303), as well as clinically important connections are discussed in detail. Along with sound anatomical knowledge, neuromonitoring is helpful in identifying the EBSLN during neck procedures. The clinical signs of EBSLN injury include hoarseness, decreased voice projection, decreased pitch range, and fatigue after extensive voice use. Videostroboscopy, electromyography, voice analysis, and electroglottography can provide crucial information on the function of the EBSLN following neck surgery. Clin. Anat. 21:99,105, 2008. © 2008 Wiley-Liss, Inc. [source] Surgically important variations of the jugular veinsCLINICAL ANATOMY, Issue 6 2006B. Satheesha Nayak Abstract Knowledge of variations of veins of head and neck in relation to external jugular, anterior jugular, internal jugular, and facial veins is important to surgeons doing head and neck surgery as well as to radiologists doing catheterization and to clinicians in general. In the current case, multiple variations in the veins of the left side of neck are reported. The anterior division of retromandibular vein was absent. The facial vein continued as anterior jugular vein. The internal jugular vein was duplicated above the level of hyoid bone. There was a large communicating vein between the anterior jugular vein and anterior division of internal jugular vein. Lingual vein drained into the communicating vein. Jugular venous arch was abnormally large, doubled, and highly placed. The veins of the right side were normal. Clin. Anat. 19:544,546, 2006. © 2005 Wiley-Liss, Inc. [source] | ||||||||||||||||||||||