Publications by authors named "Yadranko Ducic"

204 Publications

Maxillofacial Bony Considerations in Facial Transplantation.

Facial Plast Surg 2021 Apr 20. Epub 2021 Apr 20.

Department of Oral and Maxillofacial Surgery, Texas A&M Health Science Center, Dallas, Texas.

Alloplastic facial transplantation has become a new rung on the proverbial reconstructive ladder for severe facial wounds in the past couple of decades. Since the first transfer including bony components in 2006, numerous facial allotransplantations across many countries have been successfully performed, many incorporating multiple bony elements of the face. There are many unique considerations to facial transplantation of bone, however, beyond the considerations of simple soft tissue transfer. Herein, we review the current literature and considerations specific to bony facial transplantation focusing on the pertinent surgical anatomy, preoperative planning needs, intraoperative harvest and inset considerations, and postoperative protocols.
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http://dx.doi.org/10.1055/s-0041-1726443DOI Listing
April 2021

Reconstruction of the Mandibular Condyle.

Facial Plast Surg 2021 Apr 20. Epub 2021 Apr 20.

Facial Plastic Surgery Associates, Fort Worth, Texas.

The mandibular condyle is an integral structure in the temporomandibular joint (TMJ) serving not only as the hinge point for mandibular opening, but also facilitating mandibular growth and contributing to facial aesthetics. Significant compromise of the TMJ can be debilitating functionally, psychologically, and aesthetically. Reconstruction of the mandibular condyle is rarely straightforward. Multiple considerations must be accounted for when preparing for condylar reconstruction such as ensuring eradication of all chronically diseased or infected bone, proving clear oncologic margins following tumor resection, or achieving stability of the surrounding architecture in the setting of a traumatic injury. Today, there is not one single gold-standard reconstructive method or material; ongoing investigation and innovation continue to improve and transform condylar reconstruction. Herein, we review methods of condylar reconstruction focusing on autologous and alloplastic materials, surgical techniques, and recent technological advances.
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http://dx.doi.org/10.1055/s-0041-1726444DOI Listing
April 2021

Pilot Study of External Beam Radiotherapy for Recurrent Unremitting Tracheal Stenosis.

Ann Otol Rhinol Laryngol 2021 Feb 25:3489421995064. Epub 2021 Feb 25.

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

Objective: Tracheal stenosis can have a variety of presentations, severities, causes, and be a difficult condition to treat. Some patients demonstrate recurrent stenosis after multiple endoscopic treatments and are either poor candidates for open procedures or do not desire open surgery. We sought to evaluate low-dose postoperative external beam radiotherapy (EBRT) as a novel therapy for patients with recurrent tracheal stenosis refractory to endoscopic therapies.

Method: We performed a retrospective review of patients with recurrent tracheal stenosis who underwent EBRT in addition to endoscopic dilation. We compared the number of endoscopic procedures required in the 6 months before EBRT to the number required in the 6 months after EBRT.

Results: Six patients met criteria for inclusion in our study. The cause of stenosis was variable among the study population. In the 6 months leading up to EBRT, patients underwent an average 6.2 endoscopic procedures. This dropped to an average 1.9 procedures in the 6 months following EBRT ( < .001).

Conclusion: Herein, we show that low-dose postoperative external beam radiotherapy (EBRT), a novel therapy for patients with recurrent tracheal stenosis refractory to endoscopic therapies, is effective in decreasing the frequency of endoscopic dilations.

Level Of Evidence: 4.
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http://dx.doi.org/10.1177/0003489421995064DOI Listing
February 2021

Considerations in Free Flap Reconstruction of the Midface.

Facial Plast Surg 2021 Feb 15. Epub 2021 Feb 15.

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

Midface reconstruction has been a consistent challenge for reconstructive surgeons even with the significant advances in technology and technique achieved over the recent years. A meticulous preoperative assessment of the patient is required to properly assess the defect or anticipated defect, determine proper reconstructive surgical plan, and discuss expected functional and aesthetic outcomes with the patient. For years we have employed local flaps, regional flaps, obturators, alloplastic implants, free flaps, or a combination of the previously mentioned techniques to address complex midface reconstruction. Free flap reconstruction in the midface requires special considerations for the pedicle, flap selection, and flap design to ensure an optimal outcome. The introduction of virtual surgical planning for reconstruction has enhanced patient outcomes to include advances in immediate dental rehabilitation at the time of free flap surgery. Postoperative considerations including quality of life, functional and aesthetic outcomes, and management of complications will also be discussed.
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http://dx.doi.org/10.1055/s-0041-1722981DOI Listing
February 2021

Facial Protection to Prevent Facial Trauma and Allow for Optimal Protection after Facial Fracture Repair.

Facial Plast Surg 2021 Feb 1. Epub 2021 Feb 1.

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

Facial skeletal fractures continue to affect humankind, and many methods to alleviate and prevent the injuries outright have been sought after. Prevention is desired, but the implementation and general compliance may contribute to missed opportunities to decrease the burden of facial skeletal trauma. In this article, we explore the preventative as well as postoperative options for the protection of the facial skeleton.
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http://dx.doi.org/10.1055/s-0041-1723006DOI Listing
February 2021

Erratum: Surgical Techniques to Improve the Soft Tissue Triangle in Rhinoplasty: A Systematic Review.

Facial Plast Surg 2021 Jan 11. Epub 2021 Jan 11.

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

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http://dx.doi.org/10.1055/s-0040-1718516DOI Listing
January 2021

Rugby-related adult maxillofacial trauma injuries: a NEISS database study.

Oral Maxillofac Surg 2021 Jan 7. Epub 2021 Jan 7.

Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine, 1501 N. Campbell Avenue, Tucson, AZ, 85724, USA.

Purpose: The primary objective of this study is to delineate the data on maxillofacial trauma in rugby utilizing the National Electronic Injury Surveillance System (NEISS) database. Specifically, we want to establish the prevalence of facial rugby injuries in terms of age, mechanism of injury, and degree of injury in order to develop ways to limit facial trauma in the future.

Methods: The NEISS database was accessed in February 2020 in order to identify adult patients (> 19 years of age) presenting to the emergence department (ED) for rugby-related head and facial injuries from the previous 10 years (2009-2018). Descriptive statistics were organized and presented. Chi-squared testing (χ) was performed to compare categorical variables, and ANOVA was performed to compare continuous variables.

Results: A total of 507 patients (national estimate = 18,952) from 2009 to 2018 were identified as appropriate for study inclusion. The most common injuries were those to the facial region including the eyelid, eye area, and nose (59.4%). The most frequently encountered facial fracture while playing rugby was the nasal bone (58.6%). Overall, 98.4% of patients who presented to the ED with rugby injuries were treated and released, 1.2% were admitted or observed, and 0.4% left against medical advice.

Conclusions: When evaluating a patient with a rugby-related injury, one should expect injuries to the eyelid, eye area, or nose. The most common fracture pattern will most likely be nasal bone. Despite these injuries, the vast majority of patients will be treated and released.
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http://dx.doi.org/10.1007/s10006-020-00925-9DOI Listing
January 2021

Flap Failure and Salvage in Head and Neck Reconstruction.

Semin Plast Surg 2020 Nov 24;34(4):314-320. Epub 2020 Dec 24.

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

With advanced head and neck ablative surgery comes the challenge to find an ideal reconstructive option that will optimize functional and aesthetic outcomes. Contemporary microvascular reconstructive surgery with free tissue transfer has become the standard for complex head and neck reconstruction. With continued refinements in surgical techniques, larger surgical volumes, and technological advancements, free flap success rates have exceeded 95%. Despite these high success rates, postoperative flap loss is a feared complication requiring the surgeon to be aware of potential options for successful salvage. The purpose of this article is to review free flap failure and ways to optimize surgical salvage in the scenario of flap compromise.
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http://dx.doi.org/10.1055/s-0040-1721766DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759432PMC
November 2020

Paradigms in Complex Facial Scar Management.

Semin Plast Surg 2020 Nov 24;34(4):305-313. Epub 2020 Dec 24.

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

The process of scar formation is a sequela of the healing following soft tissue injury extending to, or through, the reticular dermis. Scars, within the head and neck in particular, may be physically disfiguring with resultant psychosocial implications. Mitigation of excessive scar formation during the healing process following surgery, or in the setting of trauma, begins with meticulous soft tissue handling and reconstructive technique. The reconstructive surgeon's armamentarium must therefore include techniques that minimize initial scar formation and revision techniques that address unfavorable outcomes. With this in mind, this article reviews both conservative nonsurgical and surgical treatment modalities that mitigate scar formation or address mature scar formation.
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http://dx.doi.org/10.1055/s-0040-1721768DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759425PMC
November 2020

Fistula Management in Head and Neck Cancer.

Semin Plast Surg 2020 Nov 24;34(4):299-304. Epub 2020 Dec 24.

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

Fistulas in head and neck cancer patients are a common and challenging issue. Despite their commonality, there is little consensus regarding optimal treatment strategies or in preventative measures that might be taken preoperatively. A general knowledge and understanding of what factors correlate with fistula formation can assist a surgeon in optimizing a patient for surgery, thus decreasing prevalence. In addition, surgical techniques can aid in both the prevention and treatment of fistulas once they form. This review details risk factors for fistula formation, the use of vascularized tissue as a preventative measure, conservative and nonconservative treatment of fistulas, and possible strategies to decrease the likelihood of their formation.
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http://dx.doi.org/10.1055/s-0040-1721825DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759424PMC
November 2020

Regional Salvage Flap Options in Head and Neck Reconstruction.

Semin Plast Surg 2020 Nov 24;34(4):293-298. Epub 2020 Dec 24.

Otolaryngology and Facial Plastic Associates, Fort Worth, Texas.

Microvascular free tissue transfer is the standard in the complex head and neck reconstruction with success rates greater than 95%. Free tissue transfer allows for more versatility in reconstructing complex defects with better tissue match. Failures, however, do occur and subsequent free tissue transfer might not be an option due to either the patients' health or in a vessel depleted neck. In these challenging salvage scenarios, the head and neck reconstructive surgeon must turn to regional flaps for reconstruction. Here, we review multiple regional flap options for salvage head and neck reconstruction.
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http://dx.doi.org/10.1055/s-0040-1721767DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759422PMC
November 2020

Complications in Skull Base Surgery and Subsequent Repair.

Semin Plast Surg 2020 Nov 24;34(4):286-292. Epub 2020 Dec 24.

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

Over the past several decades, endoscopic sinus surgery has revolutionized the approach to skull base surgery. Open skull base approaches remain a viable option for advanced skull base tumors. Complications have gone down with increased reliability of vascularized tissue transfer. In this article, the authors explore the various complications that can present following skull base surgery and review the approaches for repair when such issues are encountered.
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http://dx.doi.org/10.1055/s-0040-1721765DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759428PMC
November 2020

Modern Management of Facial Nerve Disorders.

Semin Plast Surg 2020 Nov 24;34(4):277-285. Epub 2020 Dec 24.

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

Facial paralysis is a devastating condition, encompassing a spectrum of disorders, with resultant psychosocial, functional, and aesthetic sequelae. With this in mind, an individualized treatment approach based on the cause, pattern, and duration of palsy is necessary. Treatment options include pharmacologic agents, corneal protective interventions, physical therapy, and surgical procedures. The use of steroids and antivirals in the setting of idiopathic facial paralysis or virus-associated facial paralysis is well supported. Despite the diversity of surgical interventions described, there is a lack of consensus regarding optimal treatment. This article provides an overview of the current management of facial paralysis. Medical, surgical, and physical treatment options are discussed with a review of the relevant literature.
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http://dx.doi.org/10.1055/s-0040-1721824DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759435PMC
November 2020

Complications in Facial Esthetic Surgery.

Semin Plast Surg 2020 Nov 24;34(4):272-276. Epub 2020 Dec 24.

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

Esthetic surgery continues to become increasingly popular both in the United States and globally. Facial esthetic procedures in particular account for a large proportion of procedures performed. This increase in popularity will inevitably result in the number of potential complications associated with these procedures. In this review, the authors describe common complications encountered with frequently performed cosmetic facial procedures and their associated management. This article is meant as a general overview and introduction to potential complications surgeons may encounter, interested readers are encouraged to further review comprehensive subspecialty literature for more detailed discussion.
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http://dx.doi.org/10.1055/s-0040-1721764DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759431PMC
November 2020

Radiation Necrosis of the Lateral Skull Base and Temporal Bone.

Semin Plast Surg 2020 Nov 24;34(4):265-271. Epub 2020 Dec 24.

Neurotology, Head and Neck Surgery, Fort Worth, Texas.

Radiation therapy plays a critical role in the treatment of malignancies involving the head and neck. Although the therapeutic effects of ionizing radiation are achieved, normal tissues are also susceptible to injury and significant long-term sequelae. Osteoradionecrosis of the temporal bone (ORNTB) is among the many complications that can arise after therapy. ORNTB is a debilitating and potentially lethal condition that continues to challenge patients and treating physicians. Herein, we review the pathophysiology, presentation, work-up, and management of ORNTB.
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http://dx.doi.org/10.1055/s-0040-1721763DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759429PMC
November 2020

Avoiding Complications in Functional and Aesthetic Rhinoplasty.

Semin Plast Surg 2020 Nov 24;34(4):260-264. Epub 2020 Dec 24.

Dallas Rhinoplasty, Dallas, Texas.

Historically, nasoseptal surgery favoring functional considerations has compromised aesthetic ones, and vice versa, but modern techniques have evolved that allow symbiotic achievement of both goals. Nasoseptal surgery is among the most commonly performed plastic surgical procedures in the United States, and while it is generally well tolerated, there are a few surgical and aesthetic complications of which to be aware. Herein, we review surgical techniques that improve the nasal airway and nasal aesthetics in a top-down approach with a discussion of possible ensuing complications.
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http://dx.doi.org/10.1055/s-0040-1721762DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759433PMC
November 2020

Secondary Reconstruction of the Zygomaticomaxillary Complex.

Semin Plast Surg 2020 Nov 24;34(4):254-259. Epub 2020 Dec 24.

Department of Oral and Maxillofacial, College of Dentistry, Texas A&M Health Science Center, Dallas, Texas.

Zygomaticomaxillary (ZMC) fractures are the second most common facial fractures after nasal bone fractures. The zygoma, with its location and multiple points of articulations, lends itself to both facial structure and esthetics. Secondary ZMC deformities are complications of inadequate primary correction, delayed repair, or lack of repair. Secondary revisions of ZMC aim to correct ZMC displacement and projection and to address orbital discrepancies. Extensive correction involving significant orbital and malar defects requires zygomatic repositioning osteotomies and would greatly benefit from the utilization of virtual surgical planning, intraoperative navigation, and imaging. Minor corrections in malar projection can be corrected by onlay grafting and soft tissue augmentation and resuspension. Isolated or minor orbital corrections can be managed by autogenous or alloplastic material to restore lost orbital volume and anatomy.
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http://dx.doi.org/10.1055/s-0040-1721761DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759427PMC
November 2020

Facial Transplantation: Complications, Outcomes, and Long-Term Management Strategies.

Semin Plast Surg 2020 Nov 24;34(4):245-253. Epub 2020 Dec 24.

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

Within the past two decades, vascularized facial composite allotransplantation has evolved into a viable option in the reconstructive surgeons' armamentarium for patients with extensive facial disfigurements. As it has expanded the frontiers of microsurgical reconstructive techniques, facial transplantation has come to garner widespread interest within both the medical community and the general public. The procedure has established itself as an amalgamation of the forefronts of reconstructive microsurgery, immunology, and transplantation science. Therein too lies its complexity as multifaceted scientific developments are met with ethical and social issues. Both patients and physicians are faced with the everlasting challenges of immunosuppression regimens and their inherent complications, long-term aesthetic and functional considerations, the role of revision procedures, and the inevitable psychosocial implications. This article reflects on the medical and surgical advancements in facial transplantation surgery and highlights anticipated future challenges. It aims to encourage discussion regarding anticipated barriers to current practice and suggest future directions as we transition into the next phase of facial allograft transplantation.
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http://dx.doi.org/10.1055/s-0040-1721760DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759434PMC
November 2020

Osteoradionecrosis of the Midface and Mandible: Pathogenesis and Management.

Semin Plast Surg 2020 Nov 24;34(4):232-244. Epub 2020 Dec 24.

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

Radiation therapy is an important and commonly used treatment modality for head and neck cancers. Osteoradionecrosis (ORN) is a potential debilitating complication of treatment, which most commonly affects the mandible. Management strategies are tailored to the severity of disease. Medical management including oral rinses, irrigations, antibiotics, and pharmacological treatments is viable for mild-to-moderate ORN. More severe disease is best addressed with a combination of medical management and surgical intervention aimed at aggressively removing devitalized tissue until bleeding bone is encountered and reconstructing the soft tissue and bone defect. Reconstruction with either regional vascularized flaps or vascularized osteocutaneous free flaps in case of larger full-thickness bone defects (greater than 6 cm) or anterior mandible (medial to mental foramen) is most appropriate. Maxillary ORN complications can present with a wide range of functional problems and facial disfigurement. Life-threatening and time-sensitive problems should be treated first, such as skull base bone coverage or correction of severe ectropion, to avoid blindness from exposure keratopathy. Then, less time-sensitive issues can be addressed next, such as nasal obstruction, velopharyngeal insufficiency, and chronic tearing. It may require a combination of specialists from different disciplines to address various issues that can arise from maxillary ORN.
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http://dx.doi.org/10.1055/s-0040-1721759DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759426PMC
November 2020

Complications and Secondary Management and Repair in Head, Neck and Plastic Surgery.

Authors:
Yadranko Ducic

Semin Plast Surg 2020 Nov 24;34(4):223-224. Epub 2020 Dec 24.

Otolaryngology and Facial Plastic Associates, Fort Worth, Texas.

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http://dx.doi.org/10.1055/s-0040-1721809DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759423PMC
November 2020

Septal Perforation Repair Using Bilateral Rotational Flaps With Interposed Mastoid Periosteal Graft.

Laryngoscope 2020 Dec 28. Epub 2020 Dec 28.

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

Objectives/hypothesis: To evaluate the outcomes of endonasal repair of septal perforations utilizing opposing bilateral rotational flaps and a periosteum interposition graft.

Methods: Retrospective review of a single surgeon, tertiary referral center experience of patients who underwent septal perforation repair. Patient demographics, etiology of perforation, closure rate, and complication data were obtained. Patients screening positively for cocaine use or anti-neutrophil cytoplasmic antibodies (ANCA) were not offered repair.

Results: A total of 104 patients were included, 65 male and 39 female with mean age of 45.4 years. Etiology of perforations included prior surgery in 45, trauma in 15, and unknown in 44, and the average perforation size in each etiologic group were 1.35 cm, 1.25 cm, and 1.30 cm, respectively. The greatest dimension of perforations repaired ranged from 0.5 cm to 1.5 cm. The overall success rate was 87.5% at 6 month follow-up. Successful closure was achieved in 95.6%, 86.7%, and 79.5%, respectively (χ = 5.264, P = .0218).

Conclusion: Our described technique is a reliable endonasal approach with predictable outcomes in septal perforations up to 1.5 cm in size. Having an unknown etiology of septal perforation may be a risk factor for failure.

Level Of Evidence: IV. Laryngoscope, 2020.
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http://dx.doi.org/10.1002/lary.29347DOI Listing
December 2020

Palatomaxillary Obturation and Facial Prosthetics in Head and Neck Reconstruction.

Facial Plast Surg 2020 Dec 24;36(6):715-721. Epub 2020 Dec 24.

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

Rehabilitation of head and neck defects following trauma, oncologic resection, or congenital malformation is a challenging task. Not only is the restoration of three-dimensional form necessary for acceptable cosmesis, but simultaneous restoration of functional speech and swallow is also essential for optimal reconstruction outcomes. While advances in free tissue transfer have allowed surgical reconstruction of head and neck defects once considered inoperable and associated with poor quality of life, not all patients are ideal surgical candidates. As such, nonsurgical solutions to both functional and cosmetic restoration remain a necessary alternative option. Facial prostheses and palatomaxillary obturators have evolved with increasingly biocompatible materials as well as retention systems to address significant defects that challenge the limits of surgical reconstruction.
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http://dx.doi.org/10.1055/s-0040-1721114DOI Listing
December 2020

Customized Orbit and Frontal Bone Implants.

Facial Plast Surg 2020 Dec 24;36(6):711-714. Epub 2020 Dec 24.

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

Orbitocranial reconstruction objectives include creation of a solid barrier between intracranial contents and the environment allowing restoration of physiologic homeostasis and restoration of aesthetic craniofacial contours. Historically, bone grafts have been used for reconstruction but were fraught with unpredictable resorption and imperfect contouring given the complex anatomy of the orbitofrontal bones. With advances in three-dimensional modeling technology, alloplastic custom implants in orbital and frontal bone reconstruction have allowed for rapid fixation reducing surgical times and improved cosmesis.
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http://dx.doi.org/10.1055/s-0040-1721109DOI Listing
December 2020

Safety of fibula free flap in patients following total knee replacement.

Head Neck 2021 Feb 21;43(2):585-589. Epub 2020 Oct 21.

Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Sciences University, Portland, Oregon, USA.

Background: Fibula free flap (FFF) is the preferred osteocutaneous flap for reconstruction of large head and neck composite defects. There is a paucity of data whether FFF can be performed safely in patients with knee replacement (total knee arthroplasty [TKA]).

Methods: Multi-institutional review of outcomes following FFF in patients who had prior TKA.

Results: Ten surgeons reported successful FFF in 53 patients with prior TKA. The most common preoperative imaging was a CT angiogram of the bilateral lower extremities. There was no evidence of intraoperative vascular abnormality. Physical therapy began between postoperative day 1 to postoperative day 3. At 1 month postoperatively, 40% of patients were using a cane or walker to ambulate, but by 3 months all had returned to baseline ambulatory status. At >1 year, there were no gait complications.

Conclusion: FFF appears safe in patients with prior knee replacement without an increased risk of complications compared to baseline.
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http://dx.doi.org/10.1002/hed.26519DOI Listing
February 2021

Treatment of Oligometastatic Disease in Squamous Cell Carcinoma of the Head and Neck.

Laryngoscope 2021 05 12;131(5):E1476-E1480. Epub 2020 Oct 12.

Facial Plastic Surgery Associates, Fort Worth, Texas, U.S.A.

Objective: No surgical or radiotherapeutic treatment guidelines exist for oligometastatic head and neck squamous cell carcinoma (oHNSCC), and only recently have interventions with curative intent been studied. Herein, we sought to elucidate survival rates among patients with oHNSCC to determine if treatment with curative intent is warranted in this population.

Study Design: Retrospective chart review.

Methods: We retrospectively reviewed cases of oHNSCC treated between March 1998 and March 2018. Fisher's exact test was used to compare patients treated with radiotherapy (RT) to those who underwent surgical excision and to compare outcomes of patients with oligometastases at the time of initial presentation to those that developed oligometastatic disease after primary treatment.

Results: Eighty one patients with metastases to the lungs, ribs, pelvis, vertebral column, liver, clavicle, and sternum were included. Overall, 32 patients (40%) were alive 5 years post-treatment. The site of metastasis, the modality of treatment, and the time of development of oligometastatic disease did not significantly affect 5-year survival.

Conclusion: Herein, we demonstrate that multi-modality treatment of oHNSCC is warranted for some patients with an estimated 40% 5-year survival. Aggressive treatment of the primary and regional sites is necessary in addition to treatment of the metastatic site and incurs a survival benefit compared to patients with metastatic HNSCC treated with systemic therapy alone. oHNSCC should be approached separately from polymetastatic disease. Patients should be counseled about the possibility for long-term survival, and aggressive initial treatment with the intention for cure should be considered in this population.

Level Of Evidence: 4 Laryngoscope, 131:E1476-E1480, 2021.
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http://dx.doi.org/10.1002/lary.29115DOI Listing
May 2021

Reconstructive Options During Nonfunctional Laryngectomy.

Laryngoscope 2021 05 10;131(5):E1510-E1513. Epub 2020 Oct 10.

Facial Plastic Surgery Associates, Fort Worth, Texas, U.S.A.

Objective: A paucity of data exists regarding surgical outcomes for patients undergoing total laryngectomy for a dysfunctional larynx. Herein, we present the largest study evaluating the method of closure on postoperative fistula rate and swallowing ability.

Method: We performed a retrospective review of patients undergoing total laryngectomy for a dysfunctional larynx after primary radiation or chemoradiation therapy for laryngeal carcinoma from 1998 to 2020. Demographic information, operative details, length of hospitalization, fistula formation, method of fistula treatment, and need for enteral feeding 6 months after surgery were analyzed.

Results: A total of 268 patients were included. Flaps were performed in 140 (52.2%) patients, including radial forearm free flaps (RFFF), pectoralis flaps, and supraclavicular flaps. Sixty-four (23.9%) patients developed postoperative fistulas. There was no significant difference in the fistula rate between flap and primary closure methods (P = .06). However, among patients who had a flap, RFFF had a significantly lower fistula rate (P = .02). Significantly more patients who had initial closure with a pectoralis flap required an additional flap for fistula repair than those who underwent RFFF or primary closure (P < .05). Last, whereas 87 patients (32.5%) required an enteral feeding tube 6 months after surgery, significantly fewer patients who underwent RFFF were feeding tube-dependent (P = < .0001).

Conclusion: Herein, we present the largest study of outcomes after total laryngectomy for dysfunctional larynx. Postoperative fistula rates are high, 23%; however, the majority of patients, 67%, will not require long-term enteral support. The RFFF is an excellent option demonstrating the lowest rates of postoperative fistula and enteral feeding tube dependence.

Level Of Evidence: 4 Laryngoscope, 131:E1510-E1513, 2021.
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http://dx.doi.org/10.1002/lary.29154DOI Listing
May 2021

Volleyball-related Adult Maxillofacial Trauma Injuries: A NEISS Database Study.

J Craniofac Surg 2020 Sep 4. Epub 2020 Sep 4.

Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine, Tucson, AZ.

Introduction: Craniofacial trauma among athletes of various sports has been well detailed and described. Despite this research, there is a dearth of literature describing the nature of facial trauma secondary to volleyball, despite its global popularity.

Methods: A cross-sectional analysis of volleyball-related facial trauma was conducted using the National Electronic Injury Surveillance System (NEISS) database from 2009 to 2018. Patient demographics (age, sex, and race), medical injury information (injury type and location), and disposition (observed and discharged, admitted, deceased) were collected and analyzed. χ testing was performed to compare categorical variables.

Results: A total of 235 volleyball-related facial traumas were recorded with an estimated 10,424 visits occurring nationally. The majority of injuries were among young adults aged 20 to 29 years (52.3%) and was evenly distributed for men and women. Lacerations were the most frequent injury type (37.9%), whereas the face was the most common site of injury (41.7%). The majority of fractures involved the nose (71.4%) and among individuals aged 20 through 49 (90.5%). Males had significantly more lacerations than females (75.3% vs 24.7%), whereas females had significantly more contusions/abrasions (64.5% vs 35.5%) and concussions (72.9% vs 27.1%).

Conclusions: Volleyball-related craniofacial injuries can vary depending on patient demographics. This information can help with the development of safety and preventative measures for individuals participating in the sport.
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http://dx.doi.org/10.1097/SCS.0000000000006984DOI Listing
September 2020

Dangers beyond drowning: craniomaxillofacial trauma in adult water activities.

Oral Maxillofac Surg 2020 Dec 29;24(4):441-446. Epub 2020 Jun 29.

Otolaryngology and Facial Plastic Surgery Associates, 923 Pennsylvania Ave, Fort Worth, TX, 76104, USA.

Purpose: Water recreation is one of the most popular activities for both fitness and leisure. The dangers of water activities have mostly been examined in the context of drowning and general bodily injuries. Despite the existing research, little is known about adult maxillofacial injuries in these settings.

Methods: We accessed the National Electronic Injury Surveillance System in order to identify adult patients presenting to emergency departments with traumatic maxillofacial injuries secondary to a water-based sport or activity over the most recent 10-year period (2009-2018). Data collected included demographical information, anatomical location, mechanism of injury, and visit circumstances, as well as visit disposition.

Results: A total of 1350 total patients were identified as appropriate for study inclusion. Young, Caucasian male adults were the most common age group to present with maxillofacial injuries secondary to water sport activities. Surfing and water skiing were associated with lacerations, while diving board incidents posed a higher fracture risk. Patients participating in all water activities were more likely to be treated and released rather than admitted.

Conclusion: There appears to be a distinct pattern profile for individuals who sustain maxillofacial trauma while participating in water sports: young, Caucasian males in particular. Additionally, specific activities may be associated with varying injury types. The results of this study may increase interest in legislature and patient counseling when seeking such activities.
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http://dx.doi.org/10.1007/s10006-020-00869-0DOI Listing
December 2020

Tennis-related adult maxillofacial trauma injuries.

Phys Sportsmed 2021 Feb 18;49(1):64-67. Epub 2020 May 18.

Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine , Tucson, AZ, USA.

Tennis participation continues to increase amongst adults across the United States. The purpose of this study was to analyze trends in adult tennis-related facial injury epidemiology, demographics, diagnoses, and locations of injury. : The National Electronic Injury Surveillance System was evaluated for tennis-related facial injuries in adults from 2009 through 2018. Number of injuries were extrapolated, and data were analyzed for age, sex, specific injury diagnoses, locations, and discharge disposition. Descriptive statistics were used to present and describe variables of interest. Chi-squared testing (χ2) was performed to compare categorical variables. : During the study period, 342 tennis-related facial trauma ED visits were analyzed. Lacerations were the most common injury (45%), followed by contusions or abrasions (33.3%), concussions (11.7%), and fractures (8.5%). The most common sites of injury were the face (47.4%) and head (27.2%) regions. Males accounted for 62.0% of injuries, while females accounted for the remaining 38.0%. Patients between 34-65 years-old accounted for 47.7% of all injuries, and athletes over 65 years-old had the highest rate of fractures (10.1%). : Facial trauma incurred secondary to tennis may follow patient-specific patterns. The incidence of tennis-related facial trauma is smaller compared to other sports, but the severity of such injuries remain a danger. Facial protection and enforcement in tennis is virtually absent, and these findings strengthen the need to educate athletes, families, and physicians on injury awareness and prevention.
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http://dx.doi.org/10.1080/00913847.2020.1768451DOI Listing
February 2021

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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September 2020