Chronic Neck Pain After Oromandibular Reconstruction

xlomafota13 shared this article with you from Inoreader Message: Chronic Neck Pain After Oromandibular Reconstruction Lukas D. Dumberger, MD1; Leila J. Mady, MD, PhD, MPH1; Steven B. Cannady, MD1 Author Affiliations 1Department of Otolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia JAMA Otolaryngol Head Neck Surg. 2021;147(9):826-827. doi:10.1001/jamaoto.2021.1685 Full Text A 64-year-old woman with a history of hyperlipidemia, hypertension, HIV infection, coronary artery disease, and squamous cell carcinoma of the left mandible treated with composite resection, left neck dissection, and fibula free flap (FFF) reconstruction followed by postoperative radiotherapy presented with sharp, shooting left neck pain. Beginning 5 months after her reconstruction, the patient reported point tenderness on the left jaw, facial swelling, and electric pain with severity of 7 out of 10 in the left neck that occurred with talking or eating. Her postoperative course was complicated by osteoradionecrosis post-tracheostomy, plate removal, and left segmental mandibulectomy. She received regular physical therapy and lymphedema therapy and was seen by Physical Medicine and Rehabilitation, who treated her with onabotulinum toxin A injections; neither provided significant resolution of her symptoms. Review of a computed tomography scan of the head and neck (Figure 1) performed o n follow-up 5 years after initial reconstruction demonstrated a long, hyperdense structure in the left submental, submandibular region with accompanying soft-tissue thickening. On further review of prior imaging, this calcification appeared as a new finding in various scans dating back to 5 months after FFF reconstruction compared with preoperative imaging. There was no fluorodeoxyglucose avidity in the area of question on multiple positron emission tomography scans done during this follow-up window. Chronic Neck Pain After Oromandibular Reconstruction Via JAMA Otolaryngology–Head & Neck Surgery Current Issue A 64-year-old woman with a history of squamous cell carcinoma treated with resection, dissection, and flap reconstruction and radiotherapy presented with sharp left neck pain; imaging revealed a calcification. What is your diagnosis? View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Unilateral aberrant anatomy of the hypoglossal nerve

xlomafota13 shared this article with you from Inoreader Unilateral aberrant anatomy of the hypoglossal nerve Via radiol anat Surg Radiol Anat. 2021 Sep 9. doi: 10.1007/s00276-021-02828-0. Online ahead of print. ABSTRACT PURPOSE: Neck dissection is often performed in patients with oral cancer to both treat and reduce the risk of subsequent neck metastases. Injury to the hypoglossal nerve may result in dysarthria, dysphagia, and profound difficulty with upper airway control. Although surgical landmarks facilitate intra-operative identification of vital structures to be preserved, they should not be an absolute measure, due to anatomical variants. We present a rare case of unilateral aberrant anatomy of the hypoglossal nerve, passing superficial to the internal jugular vein. METHODS: A 70-year-old female presented to the emergency department with an indurated and ulcerated floor of mouth lesion, later confirmed to be a squamous cell carcinoma. She was treated with wide local excision, bilateral selective neck dissection of levels I to III, surgical tracheostomy, anterior mandibulectomy and reconstruction with a left composite radial forearm free flap. RESULTS: A nerve-like structure was identified crossing superficially and perpendicular to the internal jugular vein within the left neck, which was later determined to be an anatomical variant of the hypoglossal nerve. This was carefully dissected and preserved, and the remainder of the surgery completed uneventfully. On the right, the hypoglossal nerve followed its normal anatomical course. The patient made a good re covery and suffered no neurological complications. CONCLUSION: Identification, meticulous dissection and preservation of the hypoglossal nerve is essential in lymphadenectomy involving levels I and II. Detailed knowledge of both normal and variant anatomy is fundamental for surgeons, which will allow for identification and protection of important neurovascular structures, thereby minimising surgical morbidity. PMID:34498101 | DOI:10.1007/s00276-021-02828-0 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Gingival Ulceration

xlomafota13 shared this article with you from Inoreader Message: A 50-year-old man presented to the dental clinic with a 1-month history of fever, nasal congestion, and an enlarging ulcer between his front teeth. Biopsy revealed extranodal natural killer T-cell lymphoma. Xin Lyu, D.D.S. Xiaobing Guan, D.D.S. Beijing Stomatological Hospital, Beijing, China guanxbing2013@qq.com Gingival Ulceration Via The New England Journal of Medicine: Otolaryngology Figure 1. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Residual Tumor Volume and Tumor Progression after Subtotal Resection and Observation of WHO Grade I Skull Base Meningiomas

xlomafota13 shared this article with you from Inoreader Residual Tumor Volume and Tumor Progression after Subtotal Resection and Observation of WHO Grade I Skull Base Meningiomas Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1733974 Objective This study investigated the impact of residual tumor volume (RTV) on tumor progression after subtotal resection and observation of WHO grade I skull base meningiomas. Study Design This study is a retrospective volumetric analysis. Setting This study was conducted at a single institution. Participants Patients who underwent subtotal resection of a WHO grade I skull base meningioma and postsurgical observation (July 1, 2007–July 1, 2017). Main Outcome Measure The main outcome was radiographic tumor progression. Results Sixty patients with residual skull base meningiomas were analyzed. The median (interquartile range) RTV was 1.3 (5.3) cm3. Tumor progression occurred in 23 patients (38.3%) at a mean duration of 28.6 months postsurgery. The 1-, 3-, and 5-year actuarial progression-free survival (PFS) rates were 98.3, 58.6, and 48.7%, respectively. The Cox multivariate analysis identified increasing RTV (p = 0.01) and history of more than 1 previous surgery (p = 0.03) as independent predictors of tumor progression. In a Kaplan–Meier analysis for PFS, the RTV threshold of 3 cm3 maximized log-rank testing significance between groups of patients dichotomized at 0.5 cm3 thresholds (p < 0.01). The 3-year actuarial PFS rates for meningiomas with RTV ≤3 cm3 and >3 cm3 were 76.2 and 32.1%, respectively. When RTV >3 cm3 was entered as a covariate in the Cox model, it was the only factor independently associated with tumor progression (p < 0.01). Conclusion RTV was associated with tumor progression after subtotal resection of WHO grade I skull base meningioma in this cohort. An RTV threshold of 3 cm3 was identified that minimized progression of the residual tumor when gross total resection was not safe or feasible. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Quality improvement intervention to reduce time to postoperative radiation in head and neck free flap patients

xlomafota13 shared this article with you from Inoreader Quality improvement intervention to reduce time to postoperative radiation in head and neck free flap patients Via Head & Neck Abstract Background Best-practice guidelines for head and neck cancer patients advise postoperative radiation therapy (PORT) initiation within 6 weeks of surgery. We report our institutional experience improving timeliness of adjuvant radiation in free-flap patients. Methods Thirty-nine patients met inclusion criteria in the 2017–2019 study period. We divided into "Early" (n = 19) and "Late" (n = 20) time-period groups to compare performance over time. The primary endpoint was time to PORT initiation, with success defined as <6 weeks. Results The number of patients achieving timely PORT improved from 10.5% in the Early group to 50.0% in the Late group (p = 0.014). Patients undergoing concurrent adjuvant chemoradiation were more likely to meet the PORT target in the Late group (p = 0.012). Conclusions We ascribe this quality improvement in free-flap patients to increased communication among multidisciplinary care teams, proactive consultation referrals, and a targeted patient-navigator intervention. Though work is needed to further improve performance, insight gained from our experience may benefit other teams. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Stability and radioactive gaseous iodine-131 retention capacity of binderless UiO-66-NH(2) granules under severe nuclear accidental conditions

xlomafota13 shared this article with you from Inoreader Stability and radioactive gaseous iodine-131 retention capacity of binderless UiO-66-NH(2) granules under severe nuclear accidental conditions Via radioactive iodine J Hazard Mater. 2021 Aug 15;416:125890. doi: 10.1016/j.jhazmat.2021.125890. Epub 2021 Apr 15. ABSTRACT In the present work, we aim to investigate the ability of the zirconium-based MOF-type compound UiO-66-NH2, to immobilize molecular gaseous iodine under conditions analogous to those encountered in an operating Filtered Containment Venting System (FCVS) line. Typically, the UiO-66-NH2 particles were exposed to 131I (beta and gamma emitters) and sub mitted to air/steam at 120 °C, under gamma irradiation (1.9 kGy h-1). In parallel to this experiment under simulated accidental conditions, the stability of the binderless UiO-66-NH2 granules under steam and gamma irradiation was investigated. In order to fit with the specifications required by typical venting systems, and to compare the efficiency of the selected MOF to porous materials commonly used by the industry, scale-up syntheses and UiO-66-NH2 millimetric-size shaping were realized. For this task, we developed an original binderless method, in order to analyze solely the efficiency of the UiO-66-NH2 material. The shaped MOF particles were then submitted separately to gamma irradiation, steam and temperature, for confirming their viability in a venting process. Their structural, textural and mechanical behaviors were characterized by the means several techniques including gas sorption, powder X-ray diffraction, infrared spectroscop y and crushing tests. Promising results were obtained to trap gaseous molecular iodine in severe accidental conditions. PMID:34492828 | DOI:10.1016/j.jhazmat.2021.125890 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Need for Studies on Oral Corticosteroids After Sialendoscopy for Obstructive Salivary Gland Disease: Systematic Review

xlomafota13 shared this article with you from Inoreader The Need for Studies on Oral Corticosteroids After Sialendoscopy for Obstructive Salivary Gland Disease: Systematic Review Via otol rhinol Ann Otol Rhinol Laryngol. 2021 Sep 7:34894211045262. doi: 10.1177/00034894211045262. Online ahead of print. ABSTRACT OBJECTIVES: This qualitative systematic review evaluates the evidence in support of the use of oral corticosteroids in patients undergoing sialendoscopy for the treatment of obstructive sialadenitis. DESIGN: Qualitative systematic review. METHODS: A literature search was conducted from January 1985 and September 2020. Inclusion criteria embraced pe er-reviewed articles in which adult patients undergoing interventional sialendoscopy for obstructive salivary gland disease received oral corticosteroids. The results were initially screened based on title and abstract, and the remaining articles were reviewed for eligibility. RESULTS: About 218 papers were selected by title and abstract, 96 were selected for full-text review, and 9 met the inclusion criteria. Eight published reports were retrospective observational studies and 1 was a prospective comparative study. Overall, the heterogeneity of clinical data stood out in this systematic review. The pooled success rate in the studies was 873/979 (89%). Only 5 studies described a rationale for oral corticosteroid use as part of the post-operative management. In 4 studies, a prednisone total daily dose of 40 to 50 mg was used. One study clearly showed a lower recurrence rate in patients who received oral steroids for more than 7 days in addition to sialendoscopy for management o f ductal stenoses. CONCLUSION: This systematic review showed that most centers that prescribe oral corticosteroids after sialendoscopy are unaware of the specific results with this treatment. For ductal stenoses, only 1 paper clearly showed the benefits of oral corticosteroids after sialendoscopy but more high-quality evidence is required in the form of a comparative study or randomized controlled trial, with appropriate long-term follow up. PMID:34493105 | DOI:10.1177/00034894211045262 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.