Publications by authors named "Sameep Kadakia"

79 Publications

Common Carotid-to-Internal Jugular Arteriovenous Loop for Single-Stage Microsurgical Reconstruction in the Radiated Vessel-Depleted Neck.

J Craniofac Surg 2021 Mar-Apr 01;32(2):711-715

Division of Plastic Surgery, Wright State University Boonshoft School of Medicine, Dayton.

Abstract: Management of head and neck defects in a radiated field can be quite challenging owing to the dearth of vasculature and significant degree of post-radiation fibrosis. In this setting, arteriovenous (AV) loop vascular grafts can bypass nonviable local vessels to provide viable and reliable inflow and outflow vessels for free tissue transfer in an otherwise hostile environment. Prior reports of the Corlett loop utilizing a cephalic vein transposition has been described however a common carotid-to-internal jugular AV loop has not been recently reported. Three patients underwent carotid artery to internal jugular vein AV loop creation to facilitate free-flap reconstruction secondary to radiation-induced vessel depletion. The specific technique described utilizes the saphenous vein as a donor and spares the cephalic vein for the possibility of flap complication. All three cases resulted in successful reconstruction, maintaining healthy tissue, vascular flow, and flap viability at all follow-up intervals. In our experience, vascular augmentation via AV loop formation provides reliable vascular inflow and outflow in the vessel-depleted neck to facilitate microvascular reconstruction. Sparing the cephalic vein yields an additional salvage mechanism in the event of venous congestion.
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http://dx.doi.org/10.1097/SCS.0000000000006953DOI Listing
March 2021

Transfacial transmandibular approach to the masticator space: Excision of odontogenic myxoma arising from the mandibular condyle.

Am J Otolaryngol 2021 Feb 2;42(4):102944. Epub 2021 Feb 2.

Department of Plastic and Reconstructive Surgery, Boonshoft School of Medicine at Wright State University, Premier Health Comprehensive Head and Neck Oncology and Reconstruction Program, 30 E Apple St, Suite 2200, Dayton, OH 45409, United States of America. Electronic address:

Odontogenic myxomas are an uncommon benign odontogenic tumor that can present with a wide variety of symptomatology depending on location and potentially be locally destructive. The present case describes a 66-year-old female who presented with left lower facial paresthesia, left aural fullness and hearing loss. She was found to have an odontogenic myxoma that involved the condylar head and extended into the masticator space. In this report we detail our surgical approach utilizing a preauricular transfacial transmandibular approach to the masticator space. In addition, we will discuss various approaches to the masticator space and infratemporal fossa along with considerations on how to manage facial nerve paralysis, facial contour deformities, and post-operative rehabilitation for permanent unilateral condylar head disarticulation.
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http://dx.doi.org/10.1016/j.amjoto.2021.102944DOI Listing
February 2021

Potential Complications With Cryopreserved Cadaveric Veins in Arteriovenous Loop Formation for Head and Neck Microvascular Reconstruction.

J Craniofac Surg 2021 Jan 7;Publish Ahead of Print. Epub 2021 Jan 7.

Department of Orthopedic and Plastic Surgery, Division of Plastic Surgery, Wright State University, Boonshoft School of Medicine. Dayton, OH.

Abstract: Vessel depletion in the head and neck from radiation or previous surgical intervention adds to the operative complexity by limiting reconstructive options. Arteriovenous (AV) loop vascular grafts provide a conduit to bypass these nonviable local vessels to provide adequate blood flow. In certain situations, autologous donor vascular options are deficient or not readily available for creation of the AV loop. Cadaveric vein grafts provide an alternative option in these circumstances, but the efficacy and safety has not yet been delineated. In this study we discuss our experience utilizing cryopreserved cadaveric vein grafts for AV loop creation in head and neck reconstruction. In our initial cohort we aim to elucidate potential challenges and complications associated with the use of cadaveric vein grafts.
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http://dx.doi.org/10.1097/SCS.0000000000007413DOI Listing
January 2021

Technologic Advancements in Head and Neck Reconstruction.

Facial Plast Surg 2020 Dec 24;36(6):679-680. Epub 2020 Dec 24.

Department of Plastic and Reconstructive Surgery, Boonshoft School of Medicine, Wright State University, Dayton, Ohio.

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http://dx.doi.org/10.1055/s-0040-1717094DOI Listing
December 2020

Repairing Nasal Defect and Lower Eyelid Defect With a Tube Flap: Comment.

J Craniofac Surg 2020 Nov/Dec;31(8):2377

Department of Plastic and Reconstructive Surgery, Wright State University, Middletown, OH.

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http://dx.doi.org/10.1097/SCS.0000000000006816DOI Listing
November 2020

Prophylactic Use of the Pectoralis Major Flap to Prevent Anastomotic Leak in the Reconstruction of a Total Laryngopharyngoesophagectomy Defect Combined With Gastric Pull-Up After Chemoradiotherapy.

J Craniofac Surg 2020 Sep;31(6):1833-1835

Department of Plastic and Reconstructive Surgery, Boonshoft School of Medicine at Wright State University, Dayton, OH.

Total laryngopharyngoesophagectomy defects after surgical ablation for laryngopharyngeal carcinoma with involvement of the cervical esophagus represents a challenge to the reconstructive surgeon. Complicating an already challenging operation is when surgical ablation occurs after failure of primary chemoradiation requiring the surgeon to operate and reconstruct in an irradiated field limiting potential reconstructive options. Due to the advanced stage at diagnosis, some studies have shown that while traditional management with radiotherapy may be considered as an initial treatment modality, often times this has failed to provide sustainable improvement in survival with reported high local recurrence rates. With relatively high local recurrence rates following radiotherapy, movement towards aggressive surgical resection is favored in some institutions. Despite this movement, primary treatment with chemoradiation is still commonly used as a primary modality opening up the opportunity for residual or recurrent disease leading the surgeon to perform salvage surgery to eradicate disease after primary treatment failure. With advanced ablative surgery comes the challenge to find an ideal reconstructive option that will optimize functional outcomes which has shown to be particularly challenging when operating in a post-radiated field with a higher risk for pharyngocutaneous fistulas. The authors present a case where reconstruction of such a defect after local failure with primary chemoradiation was successful using a single stage reconstruction with the gastric pull up technique in combination with a pectoralis major myocutaneous flap. As the risk of anastomotic leak is significantly higher in patients following radiation, this method showed utilizing a prophylactic muscle flap at the time of reconstruction may further bolster the repair and prevent anastomotic leak.
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http://dx.doi.org/10.1097/SCS.0000000000006519DOI Listing
September 2020

Prosthetic Reconstruction of the Maxilla and Palate.

Semin Plast Surg 2020 May 6;34(2):114-119. Epub 2020 May 6.

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

Maxillary defects commonly present following surgical resection of oncologic processes. The use of rotational and free flaps has largely replaced the use of prosthetic options for hard palate and maxillary reconstruction, but prostheses remain a useful tool. Prosthetic devices may be invaluable in patients considered poor candidates for surgical reconstruction secondary to poor vascularity, need for postoperative radiation, or medical comorbidities that place them at high risk for healing following reconstruction. Obturators may also be considered over soft tissue options if oncologic surveillance via direct visualization of the surgical site is warranted.
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http://dx.doi.org/10.1055/s-0040-1709143DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202916PMC
May 2020

Osteoradionecrosis of the Maxilla: Conservative Management and Reconstructive Considerations.

Semin Plast Surg 2020 May 6;34(2):106-113. Epub 2020 May 6.

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

The implementation of radiotherapy in the multimodal treatment of advanced head and neck cancer has greatly improved survival rates. In some patients, however, this benefit comes at the potential expense of the tissue surrounding the primary site of malignancy. Osteoradionecrosis (ORN) of the facial bones, in particular the maxilla, is a debilitating complication of radiation therapy. Exposure to ionizing radiation results in devitalization of underlying bone with necrosis of adjacent soft tissue. Controversy surrounding appropriate early intervention in ORN persists and no consensus for clinical treatment has been established. In the present article, we review the pathophysiology of maxillary ORN and discuss the role of both conservative medical therapy and reconstruction.
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http://dx.doi.org/10.1055/s-0040-1709144DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202910PMC
May 2020

Premaxillary Deficiency: Techniques in Augmentation and Reconstruction.

Semin Plast Surg 2020 May 6;34(2):92-98. Epub 2020 May 6.

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

Progressive premaxillary retrusion is a common sequela of the facial aging process. In most cases, this manifests with central maxillary recession. Central maxillary insufficiency is also commonly encountered within certain ethnic communities, or in cleft lip nasal deformity, and may represent a challenge for the plastic and reconstructive surgeon attempting correction in the setting of facial contouring, rhinoplasty, or reconstruction following oncologic resection or trauma. Aesthetically, premaxillary retrusion may be coincident with an acute nasolabial angle and ptotic nasal tip. Minor deformities may be addressed with use of either alloplastic implants, autogenous tissue, lipotransfer, or injectable filler. Larger composite defects may require reconstruction with implementation of free tissue transfer. Herein, we describe techniques that aim to augment, or reconstruct, the premaxillary region in the context of nasal deformity, osseous resorption, or composite maxillofacial defects.
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http://dx.doi.org/10.1055/s-0040-1709175DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202913PMC
May 2020

Special Topics in Palatal and Maxillary Reconstruction.

Authors:
Sameep Kadakia

Semin Plast Surg 2020 May 6;34(2):67-68. Epub 2020 May 6.

Department of Plastic and Reconstructive Surgery, Wright State University, Dayton, Ohio.

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http://dx.doi.org/10.1055/s-0040-1709468DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202909PMC
May 2020

Open Versus Closing Wedge Osteotomy and Application to Mandibular Reconstruction.

J Craniofac Surg 2020 Jun;31(4):e380-e384

Department of Otolaryngology-Head and Neck Surgery, Westchester Medical Center, New York, NY.

Purpose: To review the specific techniques of closing wedge osteotomy and open osteotomy, compare their clinical and radiographic outcomes, and apply these findings to mandibular reconstruction.

Methods: A thorough review of the otolaryngology, facial plastic and reconstructive surgery, oral and maxillofacial surgery, and orthopedic surgery literature was conducted in the Ovid MEDLINE, EMBASE, and Google Scholar databases using the terms 'osteotomy' and 'mandibular reconstruction.'

Results: Traditionally, open osteotomies were thought to result in greater rates of malunion. However, multiple meta-analyses within the orthopedic literature have refuted this. Closing wedge osteotomies, on the other hand, may increase the chance of damaging a perforator. Again, no studies have evaluated the relationship between type of osteotomy and flap survival or wound healing. The particular type of osteotomy performed often depends on the type of osseous flap being utilized.

Conclusions: Open osteotomies are a viable and even preferred alternative, particularly in flaps without consistent perforators, such as scapular free flaps.
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http://dx.doi.org/10.1097/SCS.0000000000006344DOI Listing
June 2020

Complex Wound Management.

Facial Plast Surg 2019 Dec 29;35(6):672-677. Epub 2019 Nov 29.

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

Despite the generous blood supply, and resultant healing capacity within the head and neck, complex wounds in this area may be extremely debilitating and present an obstacle to treatment for the reconstructive surgeon. Delayed, incomplete, or otherwise suboptimal wound healing within this anatomical region may lead to both functional and aesthetically displeasing outcomes, resulting in impaired speech or swallowing, social stigma, and, in severe cases, exposure of critical underlying structures. Due to implications, with regard to wound formation following surgical intervention, the facial reconstructive surgeon, in particular, must be familiar with the multitude of treatment modalities available. This article serves as a review of the underlying pathophysiology of wound healing, local and systemic processes that may influence the healing process, and treatments that facilitate tissue restoration while mitigating future complications.
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http://dx.doi.org/10.1055/s-0039-1700889DOI Listing
December 2019

Nasal Fractures: The Role of Primary Reduction and Secondary Revision.

Facial Plast Surg 2019 Dec 29;35(6):590-601. Epub 2019 Nov 29.

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

The nasal bones are among the most commonly fractured bones in the facial skeleton. Proper management of nasal trauma acutely is important in minimizing secondary deformities and impaired function with nasal airway obstruction. Septal hematoma, if present, should be drained right away. Acutely closed nasal reduction and limited septoplasty can be performed. Unrecognized septal fracture may play a role in the failure of closed nasal reduction of fractured nasal bones. Complex nasoorbitoethmoid fractures are approached openly and treated with rigid fixation. Primary use of open rhinoplasty in an acute setting is debated, and there are no clearly accepted indications for timing, patient selection, and surgical technique. However, open septorhinoplasty is more commonly used in a delayed fashion to provide definitive correction of any residual cosmetic or functional problems. Recent algorithms provide a systematic approach to nasal trauma and may improve secondary deformity rates following closed reduction.
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http://dx.doi.org/10.1055/s-0039-1700801DOI Listing
December 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.
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http://dx.doi.org/10.1055/s-0039-1685479DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6486384PMC
May 2019

Orbitocranial Approaches to the Skull Base.

Semin Plast Surg 2019 May 26;33(2):114-119. Epub 2019 Apr 26.

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

There are a myriad of approaches and surgical options for removal and treatment of skull base diseases. While, historically, large open approaches have been preferred, several endoscopic and minimally invasive techniques are now available that preserve intraoperative visualization and surgical success while minimizing morbidity and recovery times. Herein, the authors review common open, minimally invasive, and endoscopic approaches to the anterior skull base.
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http://dx.doi.org/10.1055/s-0039-1685478DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6486386PMC
May 2019

Considerations in Orbital Exenteration.

Semin Plast Surg 2019 May 26;33(2):103-105. Epub 2019 Apr 26.

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

Orbital exenteration (OE) is a radical operation associated with significant psychosocial disability and functional impairment. Indications for OE include primary tumors of the eye, oral cavity, paranasal sinuses, skin, and brain. Careful consideration regarding the likelihood of local control and cure is needed before proceeding with this operation. Multidisciplinary work-up should be performed before proceeding with surgery. The method of reconstruction after OE should be tailored to the defect and the postoperative needs of the patient. Appropriate follow-up and rehabilitation should be arranged for the patient.
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http://dx.doi.org/10.1055/s-0039-1685209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6486380PMC
May 2019

Orbital Reconstruction.

Authors:
Sameep Kadakia

Semin Plast Surg 2019 May 26;33(2):83-84. Epub 2019 Apr 26.

Department of Plastic and Reconstructive Surgery, Boonshoft School of Medicine at Wright State University, Dayton, Ohio.

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http://dx.doi.org/10.1055/s-0039-1685210DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6486365PMC
May 2019

Aggressive Necrotizing Fasciitis of the Head and Neck Resulting in Massive Defects.

Ear Nose Throat J 2019 Apr-May;98(4):197-200. Epub 2019 Apr 15.

2 Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, TX, USA.

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http://dx.doi.org/10.1177/0145561319839789DOI Listing
December 2019

Free-Flap Reconstruction of Skull Base and Orbital Defects.

Semin Plast Surg 2019 Feb 8;33(1):72-77. Epub 2019 Mar 8.

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

Orbital and anterior skull base defects present a significant challenge for reconstruction due to the complexity of the anatomy and the need for separation of intracranial and extracranial contents in this area. While endoscopic techniques have revolutionized the treatment of many anterior skull base defects, microvascular free tissue transfer is a viable option for large volume defects not suitable for traditional open approaches or for cases where endoscopic techniques have failed. The various free tissue transfer techniques for anterior skull base and orbit, as well as the advantages and disadvantages, are reviewed.
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http://dx.doi.org/10.1055/s-0039-1677881DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6408239PMC
February 2019

Free Tissue Reconstruction of the Scalp.

Semin Plast Surg 2019 Feb 8;33(1):67-71. Epub 2019 Mar 8.

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

Reconstruction of scalp defects can be accomplished by many methods, but larger defects, especially those in which the periosteum is absent or calvarial defects are present, require free tissue transfer. Various methods of scalp reconstruction, as guided by the defect components and size, are presented herein, with a focus on free tissue transfer. Different free flaps for scalp reconstructed are described with a comparison of their advantages and disadvantages. Overall, free tissue transfer for scalp defects provides a reliable, durable, and cosmetically adequate reconstructive option.
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http://dx.doi.org/10.1055/s-0039-1678470DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6408242PMC
February 2019

TORS excision of lingual thyroid carcinoma: Technique and systematic review.

Am J Otolaryngol 2019 May - Jun;40(3):435-439. Epub 2019 Feb 18.

Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, TX, USA. Electronic address:

Objective: Clinically significant lingual thyroid tissue has a prevalence of 1/3000-10,000, and in 70% of these individuals, the lingual thyroid is their only thyroid tissue. Malignant transformation is exceedingly rare. Herein, we present a case of lingual thyroid carcinoma with a systematic literature review and description of our treatment technique.

Data Sources: PubMed, Ovid.

Review Method: The primary author performed a search of the literature for reports of lingual thyroid carcinoma or ectopic thyroid carcinoma associated with the tongue. Articles that did not present novel data, presented cases of ectopic thyroid carcinoma outside the tongue, non-malignant cases, non-thyroid carcinomas, or were non-English articles were excluded. Studies were limited to those published in the last 60 years.

Results: There are 39 cases reported in the literature. 23 cases occurred in females. Age at diagnosis ranged from 12 to 86; cases were more commonly diagnosed in the second decade of life, then in the 5th and 6th decades of life. Dysphagia, globus sensation, episodes of bleeding, voice changes, and presence of a neck mass were common symptoms at initial presentation. Nearly all patients underwent some form of pre-operative imaging, but practices varied as to the type of imaging. Treatment included surgical excision of the tumor in all but one case that was successfully treated with radioactive iodine therapy alone.

Conclusions: Surgeons should be aware of lingual thyroid, its presentation, workup, and carcinoma treatment. Tumors are amenable to surgical excision, possibly followed by radioactive iodine therapy. Advances in robotic and endoscopic surgery over the past decade now allow for less morbid excisions of lingual thyroid tumors.
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http://dx.doi.org/10.1016/j.amjoto.2019.02.013DOI Listing
October 2019

Reconstruction of a subtotal septorhinectomy defect with a chimeric paramedian-pericranial forehead flap.

Am J Otolaryngol 2019 May - Jun;40(3):445-447. Epub 2019 Feb 19.

Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, TX, United States of America.

The nose is a complex structure important for aesthetic appearance, social interaction, and respiration. Full thickness nasal defects with resection of the septum pose a significant challenge to the reconstructive surgeon due to the lack of local tissues to replace the nasal lining and significant risk of nasal collapse owing to the paucity of rigid infrastructure. The purpose of this paper is to present a unique case of nasal reconstruction utilizing a bilaminar paramedian forehead flap (combined pericranial flap and forehead flap) with embedded cantilever rib graft in a patient who underwent resection for an intranasal malignancy involving the septum and soft tissue envelope. This case serves to demonstrate the great utility in using chimeric flaps based on a single pedicle given the low patient morbidity, predictable results, and rapid recovery period.
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http://dx.doi.org/10.1016/j.amjoto.2019.02.014DOI Listing
October 2019

Alopecia and techniques in hair restoration: an overview for the cosmetic surgeon.

Oral Maxillofac Surg 2019 Jun 21;23(2):123-131. Epub 2019 Feb 21.

Department of Orthopedics and Plastic Surgery, Wright State University, Dayton, OH, USA.

Purpose: Alopecia is a debilitating disorder affecting millions of individuals worldwide. Although challenging to treat, advances in hair restoration technologies have led to multiple viable options with excellent clinical results. This paper seeks to provide an overview of hair loss and the currently utilized techniques in hair transplantation in order to serve as a reference source for the facial plastic surgeon.

Methods: A comprehensive review of recent literature regarding the evaluation of, and management modalities for, alopecia was performed.

Results: The follicular unit extraction technique and the strip harvest technique are both widely used for patients desiring transplantation. While both techniques can lead to successful outcomes, each has pros and cons that are important to understand prior to engaging in the procedure.

Conclusion: Advancements in hair restoration technologies implementing robotics, manual, or motorized follicular unit extraction have facilitated optimization of outcomes. Adjuvant treatment modalities including robotics and platelet-rich plasma injections have shown utility in augmenting transplantation.
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http://dx.doi.org/10.1007/s10006-019-00750-9DOI Listing
June 2019

Comparison of radial forearm free flap and gastric pull-up in pharyngo-oesophageal reconstruction.

Clin Otolaryngol 2019 05 22;44(3):405-407. Epub 2019 Feb 22.

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

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http://dx.doi.org/10.1111/coa.13279DOI Listing
May 2019

In Response to combination of panendoscopy and positron emission tomography/computed tomography increases detection of unknown primary head and neck carcinoma.

Laryngoscope 2019 04 14;129(4):E121. Epub 2018 Dec 14.

Department of Otolaryngology, University of Colorado School of Medicine Aurora, Colorado.

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http://dx.doi.org/10.1002/lary.27691DOI Listing
April 2019

The Paramedian Forehead Flap for Nasal Reconstruction: From Antiquity to Present.

J Craniofac Surg 2019 Mar/Apr;30(2):330-333

Columbia Presbyterian Medical Center, New York City, NY.

Nasal reconstruction is considered the historic foundation of facial plastic surgery, and the forehead flap remains the workhorse of repair. To recreate both the aesthetic contour and function of the nose, all anatomic layers must be addressed-covering, lining, and structural support. This article reviews the noteworthy history underlying the development of the paramedian forehead flap as the primary tool in reconstruction of large nasal defects while highlighting its implications on modern nasal repair. Current developments in the use of 2-staged paramedian forehead flap reconstruction are examined and a modern technique is presented.
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http://dx.doi.org/10.1097/SCS.0000000000004976DOI Listing
August 2019

Factors associated with complications in total laryngectomy without microvascular reconstruction.

Head Neck 2018 11 11;40(11):2409-2415. Epub 2018 Oct 11.

Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.

Background: There is little population-level data evaluating risk factors for postoperative complications after total laryngectomy.

Methods: We conducted a retrospective review of the American College of Surgeons National Quality Improvement Program identifying patients who underwent total laryngectomy as a primary procedure from 2005 to 2014. Multivariate analysis was performed to identify variables that were independently associated with overall and major complications.

Results: Eight hundred seventy-one cases met inclusion criteria. Three hundred twenty-eight patients (37.7%) had complications, with operative time (hours; P < .0001), class III (P < .001) wound status, and patient age (decade; P = .003) associated with overall complications. Two hundred one patients had major complications that were associated with steroid use (P = .01) and class III (P = .0083) wound classification. Preoperative hematocrit was correlated with a reduction of all and major complications on multivariate analysis (P < .0001 and P = .036).

Conclusion: Identifying and optimizing risk factors may improve outcomes in total laryngectomy.
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http://dx.doi.org/10.1002/hed.25363DOI Listing
November 2018

Higher Complication Rates in Self-Inflicted Gunshot Wounds After Microvascular Free Tissue Transfer.

Laryngoscope 2019 04 24;129(4):837-840. Epub 2018 Sep 24.

Department of Facial Plastic and Reconstructive Surgery, Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas, U.S.A.

Objectives/hypothesis: Microvascular free tissue transfer is often employed to reconstruct significant facial defects from ballistic injuries. Herein, we present our comparison of complications between self-inflicted and non-self-inflicted gunshot wounds after microvascular free tissue transfer.

Study Design: Retrospective case review.

Methods: Approval was obtained from the JPS institutional review board. We performed a retrospective review of cases of ballistic facial injuries between October 1997 and September 2017 that underwent vascularized free tissue transfer for reconstruction. Comparisons were made between self-inflicted and non-self-inflicted gunshot wounds after microvascular free tissue transfer. The χ test was used for all comparisons. P value and 95% confidence interval (CI) were reported.

Results: There were 73 patients requiring free flap reconstruction after gunshot wounds to the face during the study period. There was a statistically significant difference in the rates of nonunion between self-inflicted and non-self-inflicted wounds (P = .02, 95% CI: 0.9 to 35.8) There were also no significant differences in flap failure (P = .10, 95% CI: -2.8 to 24.2), plate exposure (P = .28, 95% CI: -6.7 to 33.0), wound infection (P = .40, 95% CI: -8.9 to 31.2), scar contracture (P = .60, 95% CI: -8.1 to 25.1), and fistula formation (P = .13, 95% CI: -2.8 to 28.8) between patients with self-inflicted and those with non-self-inflicted wounds. Overall, complication rates were significantly higher in the self-inflicted group compared to the non-self-inflicted group (P < .0001, 95% CI: 32.6 to 68.6).

Conclusions: Patients with self-inflicted injuries had more complications postoperatively than those with non-self-inflicted injuries. This is likely helpful in surgical planning and patient counseling.

Level Of Evidence: 4 Laryngoscope, 129:837-840, 2019.
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http://dx.doi.org/10.1002/lary.27391DOI Listing
April 2019

Combination of panendoscopy and positron emission tomography/computed tomography increases detection of unknown primary head and neck carcinoma.

Laryngoscope 2018 11 8;128(11):2573-2575. Epub 2018 Sep 8.

Department of Facial Plastic and Reconstructive Surgery , Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas, U.S.A.

Objectives/hypothesis: With positron emission tomography/computed tomography (PET/CT) now commonplace as a diagnostic tool, new questions have arisen regarding the utility and cost-effectiveness of panendoscopy. In this retrospective review of a large cohort of head and neck squamous cell carcinoma of unknown primary (HNSCC-UP), we describe the enduring utility of panendoscopy in the detection of the primary site of mucosal disease even when PET/CT is negative.

Study Design: Retrospective cohort study.

Methods: A retrospective analysis of patients presenting to the senior author (y.d.) from July 1 1997 to July 1 2017 with fine-needle aspiration-proven metastatic squamous cell carcinoma to the neck. All patients underwent formal panendoscopy (direct laryngoscopy, bronchoscopy, and rigid esophagoscopy). Presence of squamous cell carcinoma on final pathology was examined.

Results: A total of 190 patients had HNSCC-UP, with 87 positive and 103 negative on PET/CT. Of the PET/CT-negative patients, 71 patients retained the HNSCC-UP designation after panendoscopy. Eighteen patients (56% of cases) were found to have primary tonsillar squamous cell carcinoma. Eight of 32 primary sites were found in the base of tongue (25%), with HPV positivity in two of these patients. The sensitivity and negative predictive value of PET/CT in detecting the primary site in unknown primary head and neck squamous cell carcinoma in the total study population were 73.1% and 68.9%, respectively.

Conclusions: Surgical panendoscopy has an important role in the workup of patients with unknown primary head and neck squamous cell carcinoma. There is a high rate of cancer diagnosis, even in PET/CT negative patients.

Level Of Evidence: 4 Laryngoscope, 2573-2575, 2018.
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http://dx.doi.org/10.1002/lary.27268DOI Listing
November 2018

Temporoparietal Fascia Free Flap for Nasoseptal Perforation Repair.

Craniomaxillofac Trauma Reconstr 2018 Sep 25;11(3):238-241. Epub 2017 Aug 25.

Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, New York.

Nasoseptal perforations can be a challenging defect for the reconstructive surgeon, with repair limited by the surrounding tissue availability and the defect size. In patients with a history of cocaine use, often the integrity of surrounding vasculature is questionable and large defects may not be well suited for local reconstruction. In the otolaryngology literature, several reconstructive options using local tissue and synthetic materials have been described, but there have been no reports of microvascular free flaps utilized in this regard. We present a unique case of a 37-year-old woman with a 3.0 cm × 3.5 cm nasoseptal perforation secondary to cocaine use successfully reconstructed with a temporoparietal fascia free flap anastomosed to the facial artery and vein. Postoperatively, the patient had a well-healed septal defect from the free flap reconstruction This new technique shows promise as a feasible option for patients with large defects and for those with limited local reconstructive options. The ease of harvest and low donor-site morbidity make the temporoparietal fascia flap a suitable option for repair of complex nasoseptal defects.
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http://dx.doi.org/10.1055/s-0037-1604425DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6078690PMC
September 2018