Publications by authors named "Raja Sawhney"

35 Publications

Unmet needs in breast cancer survivors are common, and multidisciplinary care is underutilised: the Survivorship Needs Assessment Project.

Breast Cancer 2021 Mar 14;28(2):289-297. Epub 2020 Sep 14.

Gold Coast Hospital and Health Service, 1 Hospital Blvd, Parklands Drive, Southport, QLD, 4215, Australia.

Purpose: The transition from a breast cancer patient to a survivor can be associated with significant physical, psychological, and social challenges. Development of multidisciplinary evidence-based care during the post-treatment period is a key area of cancer research. This study examined survivorship issues, unmet needs and perceptions about care among a cohort of breast cancer survivors.

Methods: Participants were 130 women diagnosed with breast cancer for at least one year, and attending a hospital breast or oncology outpatient clinic. They completed a series of self-report questionnaires assessing demographic and clinical characteristics, unmet needs, severity of survivorship issues, use of multidisciplinary services, clinical benchmarks, survivorship care satisfaction, and suggestions for service improvements.

Results: There was an average of 4.9 unmet survivorship needs, with 67% of participants reporting at least one unmet need. Fear of cancer recurrence, stress, coordination of medical care and negative iatrogenic impacts of hormonal treatments were key concerns. The cancer support team typically consisted of medical and nursing staff, and family/friends, and most were satisfied with their survivorship care. There was minimal use of other multidisciplinary clinicians and support groups. Provision of additional dietary and cancer recurrence education, and a written treatment plan were identified as key areas of service improvement.

Conclusion: Despite high satisfaction ratings, survivorship issues and unmet needs were relatively common, particularly among younger participants. Use of multidisciplinary care was inconsistent and overall underutilised.

Implications For Cancer Survivors: Ongoing specific evaluation and optimisation of existing models of multidisciplinary survivorship care are essential in meeting the complex needs of breast cancer survivors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12282-020-01156-2DOI Listing
March 2021

Osteoradionecrosis in osseous free flap reconstruction: Risk factors and treatment.

Head Neck 2020 08 5;42(8):1928-1938. Epub 2020 Mar 5.

Department of Otolaryngology, University of Florida, Gainesville, Florida.

Objective: To determine the rate and risk factors for osteoradionecrosis (ORN) in osseous free flaps after postoperative radiation therapy (PORT). To describe the treatment of free flap ORN.

Methods: Seventy-four patients undergoing osseous free flap reconstruction were analyzed. Thirty-eight completed PORT. Patients were followed for ≥6 months.

Results: The rate of ORN was 34% overall; 0% with 50 to 59.9 Gy; 8% with 60 Gy; 40% with 66 Gy; 56% with 70 to 74.4 Gy. Mean time to ORN was 13.1 months. 0/28 patients without PORT developed free flap osteonecrosis. Multivariate analysis found the only factor predicting ORN: PORT >60 Gy, which increased the risk 21-fold. Treatment included PENTACLO, hyperbaric oxygen, and surgical debridement with 75% within 2 years.

Conclusion: PORT >60 Gy is significantly associated with free flap ORN. As the dose of adjuvant RT increases beyond 60 Gy, the risk of ORN in free flaps rises. Consideration should be given to lower PORT doses or delaying free flap reconstruction when feasible.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/hed.26118DOI Listing
August 2020

Prophylactic antibiotics in head and neck free flap surgery: A novel protocol put to the test.

Am J Otolaryngol 2019 Nov - Dec;40(6):102276. Epub 2019 Aug 14.

Department of Otolaryngology, University of Florida, Gainesville, FL, USA; University of Florida Health Cancer Center, Gainesville, FL, USA. Electronic address:

Objective: Recent evidence supports the use of ampicillin-sulbactam as a favored choice for antibiotic prophylaxis following head and neck free flap reconstructive surgery. However, there is a paucity of evidence guiding the optimal duration of antibiotic prophylaxis. The aim of this study is to compare the infection rates of short courses of ampicillin-sulbactam versus extended courses of various antibiotics in head and neck free flap reconstructive surgery.

Methods: This is a retrospective cohort study conducted from 2012 to 2017 at a tertiary academic center on 266 consecutive patients undergoing head and neck surgery with free flap reconstruction. The primary outcome measure was the rate of any infection within 30 days of surgery.

Results: There were 149 patients who received antibiotic prophylaxis for an extended duration of at least seven days. 117 patients received a short course of antibiotics defined as 24 h for non-radiated patients and 72 h for radiated patients. Postoperative infections occurred in 45.9% of patients, of which 92.6% occurred at surgical sites. There was no significant difference in terms of postoperative infection rate between patients receiving an extended duration of antibiotics versus a short duration (p = 0.80). This held true for subgroups of surgical site infections (p = 0.38) and distant infections (p = 0.59 for pneumonia and p = 0.76 for UTI). Risk factors for infections were identified as hypothyroidism (p = 0.047) and clean contaminated wound classification (p = 0.0002).

Conclusion: Shorter duration of ampicillin-sulbactam prophylaxis in free flap reconstruction of head and neck defects does not negatively affect postoperative infection rates.

Level Of Evidence: Level 2b.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amjoto.2019.102276DOI Listing
April 2020

Tongue reconstruction: Rebuilding mobile three-dimensional structures from immobile two-dimensional substrates, a fresh cadaver study.

Head Neck 2019 10 26;41(10):3693-3699. Epub 2019 Jul 26.

Department of Otolaryngology, University of Florida, Gainesville, Florida.

Objective: To determine the two-dimensional (2D) characteristics of flaps necessary to create three-dimensional (3D) tongue anatomy.

Methods: Dissection of 11 fresh, nonpreserved human cadavers was performed. Six defects in each were created: total tongue, total oral tongue, hemiglossectomy, oral hemiglossectomy, total base of tongue, and hemi-base of tongue. The resections were debulked to create flat, 2D mucosal flaps. The dimensions and shapes of these flaps were determined.

Results: Each specimen showed consistent dimensions and geometry between cadavers. The total tongue was pear-shaped, the total oral tongue was egg-shaped, the oral hemi-tongue was bullet-shaped, the hemi-tongue resembled a dagger, the total base of tongue was rectangular, and the hemi-base of tongue was hour-glass shaped.

Conclusion: Typical dimensions and shapes of common tongue defects were determined. It is conceivable that customizing reconstructive flaps based on these data will increase the accuracy of neo-tongue reconstruction, and thus, improve functional outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/hed.25889DOI Listing
October 2019

Fellowship training in microvascular surgery and post-fellowship practice patterns: a cross sectional survey of microvascular surgeons from facial plastic and reconstructive surgery programs.

J Otolaryngol Head Neck Surg 2019 May 9;48(1):19. Epub 2019 May 9.

Department of Otolaryngology, College of Medicine, University of Florida, 1600 SW Archer Drive, PO BOX 100264, Gainesville, FL, 32610, USA.

Background: There is a lack of published literature on the training in microvascular reconstructive techniques in facial plastic and reconstructive surgery (FPRS) fellowships or of the extent these techniques are continued in practice. This cross-sectional web-based survey study was conducted to describe the volume, variety, and intended extent of practice of free tissue transfers during fellowship and the post-fellowship pattern of microsurgical practice among FPRS surgeons in various private and academic practice settings across the United States.

Methods: This survey was sent to recent graduates (n = 94) of a subset of U.S. Facial Plastic and Reconstructive Surgery fellowship programs that provide significant training in microvascular surgery.

Results: Among survey respondents (n = 21, 22% response rate), two-thirds completed 20-100 microvascular cases during fellowship using mainly radial forearm, fibula, anterior lateral thigh, latissimus and rectus free tissue transfers. In post-fellowship practice, those who continue practicing microvascular reconstruction (86%) complete an average of 33 cases annually. The choice of donor tissues for reconstruction mirrored their training. They are assisted primarily by residents (73%) and/or fellows (43%), while some worked with a micro-trained partner, surgical assistant, or performed solo procedures. Interestingly, among those who began in private practice (29%), only half remained with that practice, while those who joined academic practices (71%) largely remained at their initial post-fellowship location (87%).

Conclusions: These results provide the first formal description of the training and practice patterns of FPRS-trained microvascular surgeons. They describe a diverse fellowship training experience that often results in robust microvascular practice. The maintenance of substantial microsurgical caseloads after fellowship runs counter to the perception of high levels of burnout from free tissue transfers among microvascular surgeons.

Trial Registration: This study was approved as exempt by the University of Florida Institutional Review Board (#201601526).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s40463-019-0342-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6509799PMC
May 2019

Prosthetic Reconstruction of Orbital Defects.

Semin Plast Surg 2019 May 26;33(2):132-137. Epub 2019 Apr 26.

Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas.

Orbital and craniomaxillofacial defects, in general, are best approached preoperatively by a multidisciplinary team with a clear reconstructive plan in place. Orbital defects result from a myriad of underlying diseases and injuries, and reconstruction after orbital evisceration, enucleation, or exenteration can pose a challenge to the reconstructive team. Reconstruction of orbital injuries with orbital implants and prostheses can lead to acceptable aesthetic outcomes, and the reconstructive surgeon should be familiar with current orbital implants and prostheses. Herein, the authors review terminology and classifications of orbital defects, different types of orbital implants, advantages and disadvantages of different orbital implant reconstructive options, types of orbital prostheses, and pros and cons of different prosthetic options.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0039-1685479DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6486384PMC
May 2019

Pharyngeal Reconstruction with Microvascular Free Tissue Transfer.

Semin Plast Surg 2019 Feb 8;33(1):78-80. Epub 2019 Mar 8.

Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas.

Reconstruction of pharyngoesophageal defects after total laryngectomies and extirpation of hypopharyngeal and upper esophageal carcinomas presents a challenging task. Goals of reconstruction include adequate voice rehabilitation and restoration of normal swallowing. The reconstructive armamentarium contains many options for reconstruction and creation of a new upper digestive tract. This review article focuses on the most commonly used free tissue transfer options for the reconstruction of these defects, with an assessment of their advantages and disadvantages.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0039-1677877DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6408241PMC
February 2019

Perioperative Care of Free Flap Patients.

Semin Plast Surg 2019 Feb 8;33(1):5-12. Epub 2019 Mar 8.

Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas.

Microvascular free tissue transfer is an indispensable reconstructive option in head and neck reconstruction. Flap failure is relatively rare, but it is nonetheless very morbid and psychologically devastating to patients when it does occur. Further, complications after free tissue transfer to the head and neck remain common. There are numerous ongoing debates about various facets of preoperative, intraoperative, and postoperative care of patients undergoing free flap reconstruction of the head and neck, all ultimately searching for the optimal treatment algorithm to further improve flap success, minimize complications, and maximize patient outcomes. Herein, the authors review current literature surrounding optimal preoperative nutritional support, intraoperative vasopressor use, perioperative fluid management, use of antithrombotic agents, antibiotic use, and other facets of the care of head and neck free flap patients to provide a guide to surgeons.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0038-1676824DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6408252PMC
February 2019

Discharge Delay in Head and Neck Free Flap Surgery: Risk Factors and Strategies to Minimize Hospital Days.

Otolaryngol Head Neck Surg 2019 05 12;160(5):829-838. Epub 2019 Mar 12.

1 Department of Otolaryngology, University of Florida, Gainesville, Florida, USA.

Objective: Length of stay (LOS) includes time medically necessary in the hospital and time waiting for discharge (DC) afterward. This DC delay is determined in head and neck free flap patients. Reasons for and factors leading to DC delay, as well as associated adverse outcomes, are elucidated.

Methods: Retrospective chart review was performed for all head and neck free flap surgeries from 2012 to 2017. Data including demographics, comorbidities, and perioperative factors were collected. Regression analyses were performed to identify factors associated with DC delay.

Results: In total, 264 patients were included. Mean total LOS was 13.1 days. DC delay occurred in 65% of patients with a mean of 4.8 days. Factors associated with DC delay on univariate analysis included Medicaid/self-pay insurance, DC to a facility, and not having children ( P < .05). Multivariate analysis showed prolonged medically necessary LOS and surgery on a Monday/Friday ( P < .05) were associated with DC delay. Top reasons for DC delay included case management shortages, rejection by facility, and awaiting supplies. Eleven percent experienced complications during the DC delay.

Discussion: DC delay can add days and complications to the LOS. Prevention begins preoperatively with DC planning involving the patient's closest family. Understanding limitations of the patient's insurance may help plan DC destination. Optimizing hospital resources when available should be a focus.

Implications For Practice: Head and neck free flap patients require a team of teams unified in optimizing quality of care. DC delay is a novel quality metric reflecting the team's overall performance. Through strategic DC planning and capitalizing on available resources, DC delay can be minimized.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0194599819835545DOI Listing
May 2019

Prosthetics in Facial Reconstruction.

Craniomaxillofac Trauma Reconstr 2018 Mar 22;11(1):6-14. Epub 2017 May 22.

Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas.

Reconstruction of the head and neck can be a challenging undertaking owing to numerous considerations for successful rehabilitation. Although head and neck defects were once considered irretrievably morbid and associated with a poor quality of life, advances in surgical technique has immensely contributed to the well-being of these patients. However, all patients are not suitable surgical candidates and many have sought nonsurgical options for functional and cosmetic restoration. As such, the advent of prostheses has ameliorated those concerns and provided a viable alternative for select patient populations. Prosthetic reconstruction has evolved significantly over the past decade. Advances in biocompatible materials and imaging adjuncts have spurred further discovery and forward progress. A multidisciplinary approach to head and neck reconstruction focused on appropriate expectations and patient-centered goals is most successfully coordinated by a team of head and neck surgeons, maxillofacial surgeons, and prosthetic specialists. The aim of this article is to provide a comprehensive review of the current trends for prosthetic rehabilitation of head and neck defects, and further elaborate on the limitations and advancements in the field.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0037-1603459DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5790540PMC
March 2018

Predictors of returns to the emergency department after head and neck surgery.

Head Neck 2018 03 14;40(3):498-511. Epub 2017 Dec 14.

Department of Otolaryngology, University of Florida, Gainesville, Florida.

Background: Thirty-day hospital readmissions have become a measure of quality of care. Many readmissions enter through the emergency department. The purposes of this study were to determine the rate, risk factors, and costs of 30-day returns to the emergency department (30dEDRs) after head and neck surgery.

Methods: All adult patients undergoing head and neck surgery at the University of Florida from 2012 to 2014 were reviewed. Univariate and multivariate logistic regression analyses were performed to identify risk factors for 30dEDRs.

Results: We found 1065 patients who underwent 1173 procedures. There were 88 cases (7.5%) that resulted in 30dEDRs and 55 patients (4.7%) who had 30-day unplanned readmissions (30dURs). Significant predictors of 30dEDRs included: smoking; hypothyroidism; and intensive care unit (ICU) stays. Significant predictors of readmission from an emergency department visit were Charlson Comorbidity Index (CCI) and cancer stage. Total costs of 30dEDRs and any subsequent readmissions topped $500 000.

Conclusion: The rate of 30dEDRs after head and neck surgery is low; however, these visits increase the hospitals' financial burden as well as patient morbidity. Predictors of 30dEDRs may be utilized to formulate preventative measures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/hed.25019DOI Listing
March 2018

Modern Approaches to Skin Care.

Facial Plast Surg 2017 Dec 1;33(6):653-660. Epub 2017 Dec 1.

Department of Facial Plastics, Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0037-1607448DOI Listing
December 2017

Prophylactic Measures to Prevent Soft Tissue Abnormalities after Trauma.

Facial Plast Surg 2017 Dec 1;33(6):639-642. Epub 2017 Dec 1.

Department of Facial Plastics, Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0037-1608669DOI Listing
December 2017

Osseointegrated Implants and Prosthetic Reconstruction Following Skull Base Surgery.

Semin Plast Surg 2017 Nov 25;31(4):214-221. Epub 2017 Oct 25.

Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas.

Rehabilitation following ablative skull base surgery remains a challenging task, given the complexity of the anatomical region, despite the recent advances in reconstructive surgery. Remnant defects following resection of skull base tumors are often not amenable to primary closure. As such, numerous techniques have been described for reconstruction, including local rotational muscle flaps, pedicled flaps with skin paddle, or even free tissue transfer. However, not all patients are appropriate surgical candidates and therefore may instead benefit from nonsurgical options for functional and aesthetic restoration. Osseointegrated implants and biocompatible prostheses provide a viable alternative for such a patient population. The purpose of this review serves to highlight current options for prosthetic rehabilitation of skull base defects and describe their indications, advantages, and disadvantages.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0037-1607201DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5656447PMC
November 2017

Improving quality outcomes in head and neck free flap surgery with the use of a physician inpatient coordinator.

Laryngoscope 2018 02 12;128(2):336-342. Epub 2017 May 12.

Department of Otolaryngology, University of Florida, Gainesville, Florida, U.S.A.

Objectives/hypothesis: Head and neck free flap patients require complex postoperative care. The quality of care for these patients often depends on their management from the time they leave the operating room. The purpose of this study was to investigate the impact of a postoperative inpatient coordinator (IC) for head and free flap patients on quality outcomes: length of stay (LOS), 30-day unplanned return to the emergency department (30dRED), 30-day unplanned readmissions (30dUR), and complication rates.

Study Design: Retrospective cohort study.

Methods: One hundred eighty-eight consecutive patients who underwent head and neck free flap surgery between January 2012 and January 2016 were reviewed using a prospective database. Patients had an IC for their entire hospitalization (group 1) or for less than their entire hospitalization (group 2). Logistic regression analysis was performed to identify risk factors for quality outcomes.

Results: Mean LOS was 13.8 days and 17.3 days in groups 1 and 2, respectively (P = .002). The 30dRED rate was 12% and 22%, respectively (P = .04). Group 2 had an increased LOS by 4.1 days (P = .001) and a 2.4 fold increased 30dRED (P = .03). 30dUR and complications were not influenced by the IC (P > .05).

Conclusions: An IC may help decrease LOS and 30dRED in head and neck free flap patients.

Level Of Evidence: 4. Laryngoscope, 128:336-342, 2018.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/lary.26658DOI Listing
February 2018

Follicular thyroid carcinoma metastasis to the facial skeleton: a systematic review.

BMC Cancer 2017 03 28;17(1):225. Epub 2017 Mar 28.

Department of Otolaryngology (ENT), University of Florida, Gainesville, FL, 32610, USA.

Background: Follicular thyroid carcinoma (FTC) metastasis to the facial skeleton is exceedingly rare. A case of FTC metastasizing to the mandible is presented and a systematic review of the literature describing thyroid metastasis to the facial skeleton is performed.

Case Presentation: A 73-year-old female presented with metastatic FTC to the mandible and underwent total thyroidectomy, segmental mandibulectomy, bone impacted fibular free flap reconstruction, and adjuvant radioactive iodine treatment. The PubMed database was searched for literature describing thyroid cancer with facial skeleton metastasis using the key words "thyroid," "cancer," "carcinoma," "metastasis," and "malignancy" with "oral cavity," "maxilla," "mandible," "sinus," "paranasal," and "orbit." Reports that only involved the soft tissues were excluded. Systematic review revealed 59 cases of well-differentiated thyroid cancer with facial skeleton metastasis: 35 mandibular metastases (21 = FTC), 6 maxilla metastases (2 = FTC), 9 orbital metastases (4 = FTC), and 11 paranasal sinus metastases (7 = FTC). Treatment included surgery, RAI, external beam radiotherapy (XRT), or a combination of these modalities. The one, two, and five-year survival rates were 100%, 79%, and 16%, respectively.

Conclusion: Facial skeleton metastasis of FTC is a rare clinical challenge. Optimal treatment appears to include total thyroidectomy and resection of involved structures with or without adjuvant treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12885-017-3199-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5370488PMC
March 2017

Contemporary Issues in the Open Management of Subcondylar Fractures of the Mandible.

Facial Plast Surg 2016 Aug 5;32(4):424-30. Epub 2016 Aug 5.

Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas.

Subcondylar fractures encompass a large portion of mandible fractures. Owing to their proximity to the temporomandibular joint and difficulty achieving surgical exposure, treatment of these fractures has been challenging and highly debated throughout the literature. While no one modality is the accepted gold standard, there are multiple options for addressing these fractures that can yield satisfying results for both patient and surgeon alike. A thorough literature review was conducted using PubMed, analyzing articles in the past 15 years for relevance to the subject matter. Various search terms were used to glean information regarding closed treatment, open treatment, and the risks and benefits of the different surgical approaches involved. The articles were reviewed by all of the authors for applicability and quality of data provided. A total of 50 articles were selected for inclusion in the current study. The open management of subcondylar fractures encompasses a vast array of techniques. While some surgeons advocate closed treatment in some circumstances, open treatment affords numerous advantages with the advent of multiple access modalities. There is no single superior method, and as such, the craniofacial surgeon should have a comprehensive understanding of options so as to select the appropriate option that is individualized to the patient. A clear understanding of fracture biomechanics balanced with patient expectations and operative safety allows for the surgeon to make a sound decision for treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0036-1584554DOI Listing
August 2016

Use of Giant Bilobed Flap for Advanced Head and Neck Defects.

Facial Plast Surg 2016 Jun 1;32(3):320-4. Epub 2016 Jun 1.

Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas.

This article aims to review the use of giant bilobed flaps in the reconstruction of various large defects within the head and neck. A single case series study with chart review was performed. Various facial, neck, and mentum defects were documented, and closure was accomplished through a variety of medially and laterally based giant bilobed flaps. Preoperative and postoperative photography, as well as intraoperative planning, was performed. A total of 23 patients were able to achieve closure of facial, head, and neck defects with single-stage closure through the use of a giant bilobed flap. No tissue expanders, free tissue transfers, or skin grafts were required to achieve final closure, with acceptable cosmetic and functional results. Bilobed-shaped flaps allow for local tissue transfer in regions of otherwise limited tissue laxity and mobility, classically designed and utilized in the region of the nose. We describe its applicability to closure of large head and neck defects that may otherwise require free tissue transfer or the use of tissue expanders.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0036-1571808DOI Listing
June 2016

Update on mandibular condylar fracture management.

Curr Opin Otolaryngol Head Neck Surg 2016 Aug;24(4):273-8

Department of Otolaryngology - Head and Neck Surgery, University of Florida, Gainesville, Florida, USA.

Purpose Of Review: Fractures of the mandibular condyle have provided a lasting source of controversy in the field of facial trauma. Concerns regarding facial nerve injury as well as reasonable functional outcomes with closed management led to a reluctance to treat with an open operative intervention. This article reviews how incorporating new technologies and surgical methods have changed the treatment paradigm.

Recent Findings: Multiple large studies and meta-analyses continue to demonstrate superior outcomes for condylar fractures when managed surgically. Innovations, including endoscopic techniques, three-dimensional miniplates, and angled drills provide increased options in the treatment of condylar fractures. The literature on pediatric condylar fractures is limited and continues to favor a more conservative approach.

Summary: There continues to be mounting evidence in radiographic, quality of life, and functional outcome studies to support open reduction with internal fixation for the treatment of condylar fractures in patients with malocclusion, significant displacement, or dislocation of the temporomandibular joint. The utilization of three-dimensional trapezoidal miniplates has shown improved outcomes and theoretically enhanced biomechanical properties when compared with traditional fixation with single or double miniplates. Endoscopic-assisted techniques can decrease surgical morbidity, but are technically challenging, require skilled assistants, and utilize specialized equipment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MOO.0000000000000272DOI Listing
August 2016

Cutaneous squamous cell carcinoma of the scalp in the immunocompromised patient: review of 53 cases.

Oral Maxillofac Surg 2016 Jun 16;20(2):171-5. Epub 2016 Jan 16.

Otolaryngology and Facial Plastic Surgery Associates, 923 Pennsylvania Avenue Suite 100, Fort Worth, TX, 76104, USA.

Objective: We analyzed outcomes from immunocompromised patients with scalp squamous cell carcinoma (SCC) treated with surgical excision with and without radiation in order to explore 3-year disease-free survival and overall survival.

Study Design: The study design was a retrospective chart review.

Setting: This study was conducted in a private practice setting.

Subjects And Methods: The study included 53 immunocompromised patients with an average age of 63.2 years, with scalp squamous cell carcinoma. Pre-operative imaging dictated the extent of resection. Patients with bony involvement received wide local excision including full-thickness craniectomy and cranioplasty. Patients without bony involvement underwent wide local excision and outer-table calvarial resection. All patients were recommended to have post-operative radiation. Patients were followed for a minimum of 3 years.

Results: A total of 53 patients were included in the study. Six patients had pre-operative CT showing bone involvement and were treated with full-thickness craniectomy along with post-operative radiation. Fourteen patients without bone involvement on pre-operative CT were found to have positive bone involvement on final pathology. Forty-five patients underwent post-operative radiation. Patients treated with adjuvant radiation demonstrated a 3-year survival of 80 % and the overall survival was 62 %. In the surgery-only group, the 3-year survival was 62.5 % and the overall survival was 32.5 %.

Conclusions: Immunocompromised patients with scalp SCC have a poor prognosis. Early detection and treatment are crucial. Based on our results, we recommend wide local excision with at least outer-table calvarial resection, and post-operative radiation. Despite aggressive therapy, patients may still have distant, local, or regional recurrence.

Level Of Evidence: level 2b (retrospective cohort).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10006-016-0545-6DOI Listing
June 2016

The Real Cost of "Cosmetic Tourism" Cost Analysis Study of "Cosmetic Tourism" Complications Presenting to a Public Hospital.

Eplasty 2015 28;15:e34. Epub 2015 Jul 28.

Plastic & Reconstructive Surgery Gold Coast University Hospital, Queensland, Australia.

"Cosmetic Tourism," the process of traveling overseas for cosmetic procedures, is an expanding global phenomenon. The model of care by which these services are delivered can limit perioperative assessment and postoperative follow-up. Our aim was to establish the number and type of complications being treated by a secondary referral hospital resulting from "cosmetic tourism" and the cost that has been incurred by the hospital in a 1-year period. Retrospective cost analysis and chart review of patients admitted to the hospital between the financial year of 2012 and 2013 were performed. Twelve "cosmetic tourism" patients presented to the hospital, requiring admission during the study period. Breast augmentation was the most common procedure and infected prosthesis was the most common complication (n = 4). Complications ranged from infection, pulmonary embolism to penile necrosis. The average cost of treating these patients was $AUD 12 597.71. The overall financial burden of the complication to the hospital was AUD$151 172.52. The "cosmetic tourism" model of care appears to be, in some cases, suboptimal for patients and their regional hospitals. In the cases presented in this study, it appears that care falls on the patient local hospital and home country to deal with the complications from their surgery abroad. This incurs a financial cost to that hospital in addition to redirecting medical resources that would otherwise be utilized for treating noncosmetic complications, without any remuneration to the local provider.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4522144PMC
August 2015

Management of the thyroid gland during total laryngectomy in patients with laryngeal squamous cell carcinoma.

Laryngoscope 2015 Aug 8;125(8):1835-8. Epub 2015 Jun 8.

Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas.

Objectives/hypothesis: The goal of the study was to determine the role of routine total thyroidectomy and hemithyroidectomy in patients undergoing total laryngectomy for laryngeal squamous cell carcinoma.

Study Design: The study group consisted of 343 patients who underwent total laryngectomy (98 treated with surgery alone, 136 treated following radiation failure, and 109 following chemoradiation failure). Total thyroidectomy was performed in all obstructing and bilateral lesions or if there was suspicion of contralateral lobe involvement. Hemithyroidectomy was performed in all lateralized lesions. Retrospective histopathologic analysis of thyroid specimens was subsequently performed.

Results: In all, 262 patients underwent total thyroidectomy during total laryngectomy, six of which demonstrated squamous cell carcinoma evident within the thyroid gland (4 from transglottic lesions, 2 from subglottic lesions). Hemithyroidectomy was performed in 81 patients, with only one patient demonstrating evidence of squamous cell carcinoma within the thyroid gland. Hypothyroidism was observed in 88% (n = 61) of patients who underwent thyroid lobectomy alone, requiring hormone supplementation.

Conclusion: Routine surgical management of the thyroid gland should not be performed, except in cases of subglottic primary lesions, lesions with significant subglottic extension, or transglottic lesions. Despite efforts to preserve the contralateral thyroid lobe in cases of selective lobectomy, these patients often have a high rate of hypothyroidism, and a total thyroidectomy should be considered when involvement of the thyroid gland is suspected.

Level Of Evidence: N/A.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/lary.25263DOI Listing
August 2015

Mycobacterium Abscessus Abscess Post-thread Facial Rejuvenation Procedure.

Eplasty 2015 7;15:ic19. Epub 2015 Apr 7.

Department of Plastic Surgery, Gold Coast Hospital, Southport QLD, Australia.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4392889PMC
May 2015

Cutaneous chemical burns: assessment and early management.

Aust Fam Physician 2015 Mar;44(3):135-9

MBBS, BMedSci, Principal House Officer, Gold Coast University Hospital, Queensland Health, QLD.

Background: Chemical burns are common and may cause significant physical, psychological, social and economic burden. Despite a wide variety of potentially harmful chemicals, important general principals may be drawn in the assessment and initial management of such injuries. Early treatment of chemical burns is crucial and may reduce the period of resulting morbidity.

Objective: This article reviews the assessment and management of cutaneous chemical burns.

Discussion: Assessment of the patient should be rapid and occur in conjunction with early emergency management. Rapid history and pri-mary and secondary survey may be required to exclude systemic side effects of the injury. Depth of wound assessment is difficult given that necrosis caused by various chemicals can continue despite cessation of exposure. Early management should be conducted with consideration of clinician's safety, and appropriate precautions should be taken. Excluding specific situations and chemical exposure, copious irrigation with water remains the mainstay of early management. Referral to a centre of higher acuity may be required for expert evaluation.
View Article and Find Full Text PDF

Download full-text PDF

Source
March 2015

Laryngeal actinomycosis in an immunocompromised patient.

J Voice 2014 Nov 12;28(6):838-40. Epub 2014 Jun 12.

Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, University of Florida Health, Gainesville, Florida. Electronic address:

Actinomycosis of the larynx represents an unusual presentation for a common bacterium comprising the oral and oropharyngeal florae. There are few cases reported in the literature of laryngeal actinomycosis occurring primarily in the immunocompromised population. Here, we present a case in a 74-year-old man that occurred in the setting of neutropenia as a result of chemotherapy. Once the diagnosis was made with biopsy of the larynx, the infection was resolved after a prolonged course of penicillin-based therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jvoice.2014.02.011DOI Listing
November 2014

Condylar fractures.

Otolaryngol Clin North Am 2013 Oct 19;46(5):779-90. Epub 2013 Jul 19.

Department of Otolaryngology-Head and Neck Surgery, University of Florida, 200 Southwest 62nd Boulevard, Suite B, Gainesville, FL 32607, USA.

The purpose of this article is to review the basic indications for different treatments of condylar and subcondylar fractures. It also reviews the steps of different surgical approaches to access the surgical area and explains the pros and cons of each procedure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.otc.2013.06.003DOI Listing
October 2013

Miniplate fixation of fractures of the symphyseal and parasymphyseal regions of the mandible: a review of 218 patients.

JAMA Facial Plast Surg 2013 Mar;15(2):121-5

Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas, USA.

Objective: To review our experience with miniplate fixation of fractures of the symphyseal and parasymphyseal regions of the mandible.

Methods: A retrospective review of all mandible fractures treated from July 1, 1999, through July 31, 2011, by one of us (Y.D.) was performed. Intraoral, open rigid fixation of noncomminuted symphyseal and parasymphyseal fractures was performed using a combination of 2 miniplates that were either a 4-hole or a 6-hole miniplate using monocortical screws. The miniplates were 1-mm thick with a 2-mm screw diameter.

Results: A total of 218 patients with noncomminuted symphyseal and parasymphyseal mandible fractures were included in this study. Eighteen patients (8.3%) with concurrent panfacial fractures and other indications were left in postoperative maxillomandibular fixation (MMF), whereas 200 patients (91.7%) did not require postoperative MMF. All patients in this series achieved bony union. The following complications were noted: plate exposure, 2.3%; malocclusion, 1.4%; wound infection, 1.4%; and tooth root injury, 0.9%. The use of postoperative antibiotics and either a nonlocking or locking system was not associated with significant differences in the rates of complications.

Conclusions: For noncomminuted symphyseal and parasymphyseal mandible fractures, the application of 2 miniplates with monocortical screws offers good surgical outcomes in most patients with minimal complications. The advantages of using miniplates include easy plate adaptability, no need for MMF unless indicated, small screw diameter, and provision of adequate load-sharing rigid fixation for simple, noncomminuted symphyseal and parasymphyseal mandible fractures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamafacial.2013.307DOI Listing
March 2013

Management of pathologic fractures of the mandible secondary to osteoradionecrosis.

Otolaryngol Head Neck Surg 2013 Jan 3;148(1):54-8. Epub 2012 Oct 3.

Facial Plastics and Reconstructive Surgery, Otolaryngology/Head and Neck Surgery, University of Florida-Gainesville, Florida, USA.

Objective: To review our experience with late Marx stage III osteoradionecrosis (ORN) of the mandible in patients who present with pathologic fracture.

Study Design: Case series with chart review.

Setting: Tertiary care center.

Subjects And Methods: Thirty-seven patients were identified from June 1998 to August 2010 who underwent treatment of Marx grade III osteoradionecrosis with pathologic fracture of the mandible. All patients underwent reconstruction with osteocutaneous free tissue transfer and when possible underwent hyperbaric oxygen therapy Marx protocol.

Results: The average time between completion of radiation therapy and presentation of ORN-induced pathologic fracture was 3.2 years. Sixteen patients developed ORN following tooth extraction. Sixteen patients had no previous documented ORN prior to presenting with pathologic fracture. Follow-up after surgery averaged 4.5 years with no recurrence of disease. The overall complication rate was 24% with no total flap loss. Of the patients, 95% returned to prefracture dietary intake. Twenty-six patients underwent a staged protocol, in which after resection and plate reconstruction, they underwent 20 hyperbaric oxygen (HBO) dives. They then underwent free tissue transfer followed by a further 10 HBO dives. There were no flaps lost or nonbony unions. Eleven patients did not receive HBO therapy as part of their surgical treatment plan. Again, there was no total flap loss, but 2 skin paddles were lost and 4 bony nonunions occurred.

Conclusions: Pathologic fracture in conjunction with ORN has a relatively high treatment complication rate. Free tissue transfer and HBO are the treatment of choice for this population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0194599812463186DOI Listing
January 2013

Mylohyoid advancement flap for closure of composite oral cavity defects.

Laryngoscope 2011 Nov;121(11):2313-6

Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas, USA.

Objectives/hypothesis: To describe a new surgical procedure in the reconstruction of composite oral cavity resections.

Study Design: Retrospective chart review for all patients who received mylohyoid pull through muscle flap for reconstruction of oral composite resection with marginal mandibulectomy by the senior author between 1999 and 2008.

Methods: Data gathered from the chart review included demographics, pathologic diagnosis, tumor margins, use of reconstruction plate, exposure to radiotherapy, need for gastrostomy tube, flap viability, and flap complications.

Results: Twenty-nine patients received composite resection, marginal mandibulectomy, and reconstruction with the mylohyoid muscle flap between 1999 and 2008. Twenty-four of the 29 patients (82.7%) had a partial glossectomy as part of the resection. Flap success was 100%. Complications included partial skin graft loss (2 of 29) and partial flap dehiscence (2 of 29). Total complication rate was 13.8%. Twenty-five patients (86%) were exposed to external-beam radiotherapy. Two patients required supplemental alimentation with a gastrostomy tube. There were no cases of osteoradionecrosis.

Conclusions: The mylohyoid flap is a valuable addition to the armamentarium of anterior oral cavity closures. The procedure is intuitive, and surgical time is miniscule. This procedure can often be used in cases previously requiring free flap closure. It allows a quick return to oral alimentation and has minimal donor site morbidity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/lary.22332DOI Listing
November 2011

Risk factors and management approach for deep sternal wound infection after cardiac surgery at a tertiary medical centre.

Heart Lung Circ 2011 Nov 8;20(11):712-7. Epub 2011 Sep 8.

Department of Cardiothoracic Surgery, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD 4102, Australia. peter

Background: Deep sternal wound infection (DSWI) is a rare but severe complication following cardiac surgery. Our study investigated the risk factors and treatment options for patients who developed DSWI at our institution between May 1988 and April 2008.

Method: Data was collected prospectively in a database and information on demographics reviewed retrospectively on 5649 patients who underwent cardiac surgery during this period.

Results: The incidence of DSWI was 34/5649 (0.6%). These patients were older (mean age 66.1 vs. 64.5), more likely to die (in hospital mortality 11.8% vs. non DSWI group 1.8%) and had longer hospital stays (DSWI group mean stay 25 days vs. non DSWI group 9 days). Using Fisher's exact test the risk predictors for DSWI determined at our institution included diabetes managed with oral medications (p=0.021), previous cardiac surgery (p=0.038), BMI≥30 (p=0.041), LVEF≤30 (p=0.010), IABP usage (p=0.028) and homologous blood usage (p<0.001). Most commonly bilateral pectoralis major muscle flap (BPMMF) was used for treatment of DSWI (11/30, 36.7%).

Conclusion: Ultimately our data was comparable to published data in the literature on known risk predictors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.hlc.2011.08.001DOI Listing
November 2011
-->