Modified tie-over technique for lingual sulcoplasty (vestibuloplasty) (original) (raw)
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Surgical Incisions: Balancing Surgical and Cosmetic Outcomes in Head and Neck Oncosurgery
An International Journal Otorhinolaryngology Clinics
The oral and oropharyngeal cancer surgery is challenging due to presence of carotid arteries, internal jugular vein and cranial nerves in close proximity to the primary tumor or matastatic lymph node. So surgical incisions should be planned to improve oncologic resection without compromising functional and esthetic outcomes. Macfee and Crile's incision are commonly used in present day oncologic practice. Extension and probable modification of these incisions depending on case scenerio are discussed. How to cite this article Tubachi J, Jainkeri V, Gadagi V, Gunari P. Surgical Incisions: Balancing Surgical and Cosmetic Outcomes in Head and Neck Oncosurgery. Int J Otorhinolaryngol Clin 2013;5(2):47-50.
Barbed suture in oral cavity reconstruction: preliminary results
Acta Otorhinolaryngologica Italica, 2019
The purpose of this study is to evaluate the efficacy and safety of unidirectional barbed suture (V-Loc) compared to a standard monofilament stitch (Vicryl) in suturing of a free flap to local tissue after head and neck surgery for squamous cell carcinoma of the oral cavity. Complication rates, operative closure time, length of hospitalisation and costs were evaluated. The study cohort (group A) of 20 consecutive patients reconstructed using barbed stitches for suturing was prospectively compared to a control cohort (group B) of 20 consecutive patients reconstructed using conventional vicryl stitches. All patients were affected by squamous cell carcinoma of the tongue and underwent different types of glossectomy and reconstruction with free flaps. This analysis demonstrates the efficacy of the barbed suture compared with a standard monofilament stitch in terms of lower complication rate (15% group A, 30% group B), intra-operative closure times (486 minutes group A, 517 minutes group B), and length of hospitalisation (average length of hospitalisation 14.60 days group A, 16.85 days group B). These factors coupled with the use of a lower number of stitches compared with the standard stitches may compensate the increased cost of the barbed suture. In conclusion, this study demonstrates that the use of unidirectional barbed stitches for suturing of a free flap to the recipient site reduces the complication rate, principally in terms of dehiscence and fistula incidence, and reduces intra-operative time and length of hospitalisation. Based on these results and on the literature, the use of unidirectional barbed stitches can be considered as a safe and efficient alternative to conventional stitches for suturing of free flaps to local tissue. KEY WORDS: Barbed suture • Free flap • Head neck reconstruction • Oral cavity cancer RIASSUNTO Il presente studio ha lo scopo di analizzare le potenzialità e la sicurezza della sutura unidirezionale barbed (V-Loc) rispetto alla sutura convenzionale monofilamento (vicryl) nella chirurgia ricostruttiva del cavo orale con lembo libero. Sono stati valutati i seguenti parametri: percentuale di complicanze, tempi intra-operatori, tempi di ospedalizzazione e costi della procedura. La coorte di studio (gruppo A), costituita da 20 pazienti consecutivi in cui è stata utilizzata la sutura barbed per suturare il lembo libero alla mucosa del cavo orale, è stata confrontata con la coorte di controllo (gruppo B), costituita da 20 pazienti consecutivi, in cui è stata invece utilizzata la sutura convenzionale Vycril. Tutti i pazienti, affetti da carcinoma squamocellulare della lingua, sono stati sottoposti a chirurgia compartimentale della lingua e successiva ricostruzione con lembo libero radiale di avambraccio o antero-laterale di coscia. La nostra analisi dimostra l'efficacia della sutura barbed se confrontata con quella convenzionale, in termini di minore percentuale di complicanze post-operatorie (15% gruppo A, 30% gruppo B), tempi intraoperatori di chiusura (486 minuti gruppo A, 517 minuti gruppo B), e tempi di ospedalizzazione (tempo medio di ospedalizzazione: 14,60 giorni gruppo A, 16,85 gruppo B). Questi fattori, associati al minor numero di fili barbed utilizzati durante la sutura, potrebbero compensare il costo maggiore della sutura barbed rispetto a quella convenzionale. In conclusione, questo studio dimostra che l'utilizzo della sutura unidirezionale barbed nella sutura del lembo libero alla mucosa del cavo orale riduce la percentuale di complicanze post-operatorie, principalmente in termini di deiscenza e fistola, i tempi intra-operatori e la lunghezza dell'ospedalizzazione. Basandosi su questi risultati e sulla letteratura, si può concludere che l'utilizzo della sutura barbed rappresenta un'alternativa sicura ed efficace rispetto alla sutura convenzionale nella chirurgia ricostruttiva del cavo orale.
Soft Tissue Management and Prosthetic Rehabilitation in a Tongue Cancer Patient
Case Reports in Dentistry, 2013
One major challenge in treating head and neck oncologic patients is to achieve an acceptable recovery of physiologic functions compatible with the complete tumor excision. However, after tumor resection, some patients present a surgically altered anatomy incompatible with prosthetic rehabilitation, unless some soft tissue correction is carried out. The aim of the present study is to describe the overall mandibular prosthetic rehabilitation of a postoncologic patient focusing on the possibility of soft tissue correction as a part of the treatment. A 72-year-old woman, who undergone a hemiglossectomy for squamous cell carcinoma several years before, was referred to our department needing a new prosthesis. The patient presented partial mandibular edentulism, defects in tongue mobility, and a bridge of scar tissue connecting one side of the tongue to the alveolar ridge. A diode laser (980 nm) was used to remove the fibrous scar tissue. After reestablishing a proper vestibular depth and ...
Prevention of wound complications following salvage laryngectomy using free vascularized tissue
Head & Neck, 2007
Background. Total laryngectomy following radiation therapy or concurrent chemoradiation therapy is associated with unacceptably high complication rates because of wound healing difficulties. With an ever increasing reliance on organ preservation protocols as primary treatment for advanced laryngeal cancer, the surgeon must develop techniques to minimize postoperative complications in salvage laryngectomy surgery. We have developed an approach using free tissue transfer in an effort to improve tissue vascularity, reinforce the pharyngeal suture line, and minimize complications in this difficult patient population. The purpose of this study was to outline our technique and determine the effectiveness of this new approach.
Journal of Maxillofacial and Oral Surgery, 2015
Purpose To investigate the merits and demerits of stapled skin closure when compared to conventional sutures in head and neck cancer surgery. Materials and Methods A total of 80 patients (40 patients each in control and study group) were enrolled. The patients underwent closure of incision wounds following head and neck cancer surgical procedures. Skin incisions were closed with sutures using 3-0 silk in control group and with stainless steel staples in study group. Both the groups were compared for speed of closure, cost effectiveness, pain on removal, patient comfort, aesthetic outcome on day of removal, 15 and 30 days after day of removal and complications. Results The mean incision length in control group was 54 ± 16.3 cm while in study group was 53.7 ± 15.4 cm which was statistically not significant (P = 0.95). The mean time of closure in control group was 34.2 ± 12 min while in study group was 3.3 ± 1.2 min which was statistically highly significant (P \ 0.001). The mean cost of material for skin closure in control group was Rs. 270.0 ± 46.4 and in study group was Rs. 517.5 ± 135.7 which was also statistically highly significant (P \ 0.001). Conclusion It was concluded that skin staples are better alternatives to conventional sutures in head and neck cancer surgery as they offer ten times faster wound closure, cost effectiveness, and similar results to sutures in terms of patient comfort, aesthetic outcome and complication rate.
Postoperative Care and Monitoring of the Reconstructed Head and Neck Patient
Seminars in Plastic Surgery, 2010
Reconstruction of head and neck patients using free tissue transfer is perhaps the most challenging of areas in the human body. Although complications are inevitable in a percentage of patients, it is good postoperative care and monitoring that determines the success or failure of the reconstruction and also permits early salvage of a failing free flap. Teamwork and cooperation among members of the reconstructive team are critical. Here we review the significance of clinical care and monitoring of reconstructed head and neck patients in the intraoperative and postoperative periods. We also review different techniques and strategies for flap monitoring and anticoagulation used for free tissue transfers.
Pearls and Pitfalls in Head and Neck Surgery
2008
In this unique volume, leading international experts share their experiences in the management of head and neck tumors, providing a guidebook for all surgeons dealing with head and neck neoplasms. Each chapter offers a concise description of useful 'pearls' and dangerous 'pitfalls' which must be avoided. Contributions cover topics from thyroid glands, neck metastases, and oral tumors to laryngeal, pharyngeal, and nasopharyngeal tumors, as well as salivary gland tumors, skull base tumors, and reconstruction surgery. In addition to frequent diseases which are encountered in everyday practice, some new therapeutic topics such as video-assisted thyroidectomy, robotic surgery, and management of the neck after organ preservation treatment are discussed. The 2nd edition has been extended by topical chapters of major practical interest including the latest findings and techniques. The new chapters are clearly indicated and can be recognized easily. Head and neck surgeons, otolaryngologists, neurosurgeons, maxillofacial surgeons, plastic surgeons, radiation and clinical oncologists, and general surgeons, as well as students and residents interested in the management of head and neck tumors, will find this publication an indispensable manual.
Free-Flap Head and Neck Reconstruction and Quality of Life: A 2-Year Prospective Study
The Laryngoscope, 2008
a total of 95 patients underwent microvascular reconstruction of the head and neck at our Institution (Centre Antoine-Lacassagne, Nice, France) and were initially included in this study. The European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire and the EORTC Head and Neck Cancer Quality of Life Questionnaire were completed before surgery, and at 6 and 12 months thereafter. Sixty-five patients completed the questionnaires on at least two of the assessment dates. Predictive factors of Quality of Life (QOL) scores at 6 months were researched among the following: age, sex, comorbidity, radiotherapy, tumor recurrence, tumor stage, and type of surgery.
Predicting the outcome of modified tongue base suspension combined with uvulopalatopharyngoplasty
European Archives of Oto-Rhino-Laryngology, 2014
The purpose of this study was to investigate the relationship between various polysomnographic variables and the success of modified tongue base suspension combined with uvulopharyngopalatoplasty in patients with severe obstructive sleep apnea (OSA). A total of 90 patients who had apnea hypopnea index (AHI) [30 and had both oropharyngeal and hypopharyngeal obstruction were included in this prospective case series with planned data collection. All patients were assessed preoperatively and at the sixth postoperative month by polysomnography. The surgery was considered to be successful when a C50 % reduction in the mean AHI to a final AHI of \20/h was obtained. Multiple logistic regression analyses were performed to determine the impact of variables on the surgical success. A total of 67 patients (74.4 %) met the surgical success criteria. The univariate analysis revealed a relationship between success and AHI (P = 0.001), obstructive apnea duration (P = 0.001), sleep time with oxygen saturation below 90 % (ST 90) (P = 0.004), minimum O 2 saturation (P = 0.0001), mean O 2 saturation (P = 0.011), mean O 2 desaturation (P = 0.0001), and oxygen desaturation index (P = 0.001). However, ST 90 [OR (95 % CI) = 1.40 (1.04-1.89), P = 0.023] was the only independent parameter predicting the surgical success in multivariate analysis. The ROC analysis revealed that the ST 90 value of B36 min was the best cutoff value with 96.97 % sensitivity (CI 89.5-99.6), 95.83 % specificity (CI 78.9-99.9), 98.5 % PPV (CI 91.6-100.0), and 92.0 % NPV (CI 74.0-99.0). The stratification of patients with severe OSA according to the ST 90 may allow better identification of patients in whom surgical success is probable.