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Journal of Clinical Medicine May 2022The supraclavicular artery island flap (SCAIF) is a reliable, easy-to-harvest and versatile fasciocutaneous flap that can be used for pharynx reconstruction. Instead of... (Review)
Review
The supraclavicular artery island flap (SCAIF) is a reliable, easy-to-harvest and versatile fasciocutaneous flap that can be used for pharynx reconstruction. Instead of free flaps, it requires no microsurgical technique, reduced operating time and postoperative care, making it an ideal option, especially during the COVID-19 pandemic. The primary aim of our study was to present two cases of a total laryngectomy and reconstruction with the SCAIF during the pandemic. The secondary aim was to review the literature concerning surgical techniques, complications and contradictions of the SCAIF for pharynx reconstruction. A literature search was performed using the PubMed, ScienceDirect, Wiley Online Library, Google Scholar, Scopus and Cochrane Library databases, using MeSH terms: larynx AND reconstruction AND flap. Ten full-text articles comprising 92 patients with 93 supraclavicular flaps were included. The patch graft, pharyngeal interposition graft, tubularization or "U"-shaped SCAIF were the main surgical techniques. Pharyngocutaneous fistula was the most frequent postoperative complication, especially in patients with previous radiotherapy, but just 19% of patients required secondary intervention. The lack of donor-site morbidity, low flap loss rates and stenosis rates favored this reconstructive option. This review underlined that the SCAIF has comparable results with other reconstructive options, consolidating this flap in the workhorse of pharynx reconstruction.
PubMed: 35683510
DOI: 10.3390/jcm11113126 -
Zhonghua Jie He He Hu Xi Za Zhi =... Oct 2023Tracheostomy is a common procedure in critically ill patients who require mechanical ventilation. Tracheostomies have several advantages over endotracheal tubes,...
Tracheostomy is a common procedure in critically ill patients who require mechanical ventilation. Tracheostomies have several advantages over endotracheal tubes, including less sinusitis or pharyngeal injuries, fewer sedative drugs, improved oropharyngeal hygiene, easier communication, more comfort, preservation of vocal cord function, and so on. However, patients with a tracheostomy require high quality care and often suffer from dysphagia, dysphonia, tracheal stenosis, or excessive airway secretions, . In China, there are currently no comprehensive evidence-based clinical guidelines or consensus documents on the management and rehabilitation of patients with a tracheostomy. Approaches to tracheostomy care are inconsistent among different institutions and clinicians. Therefore, a group of top experts specialized in this field in China were gathered to draft this document to reduce variations in practice in the management of patients with a tracheostomy and to minimize complications. Panel members were asked to complete surveys on various aspects of adult tracheostomy care, followed by a conference at which the results were presented and a number of themes outlined for a formal literature review and a preliminary draft. Several conferences were then held to discuss the differences of opinion among the panel members. In general, the panel reached a consensus and a total of 9 issues were covered in the document. At first, the importance of a standardized management protocol, pathophysiological characteristics, indications, complications, contradictions, and techniques used for tracheostomies were discussed. Then, more emphasis was placed on post-operative care such as airway clearance therapy, tube changes, and decannulation criteria, . In addition, the most important topic was elaborated, namely the methods used to promote the rehabilitation and decannulation of patients with a tracheostomy, including respiratory and other skeletal muscle training, dysphagia and verbal communication intervention, ventilation support, chest physiotherapy, and specifically the traditional Chinese medical therapies that were excellent in this area, such as acupuncture, moxibustion, and herbal medicine, . Finally, a flow chart was created to summarize the suggestions for managing and promoting rehabilitation or decannulation of patients with a tracheostomy. Proposed by Respiratory Equipment Committee of China Association of Medical Equipment, Young and Middle-Aged Pulmonary Rehabilitation Group of Pulmonary Rehabilitation Committee of China Association of Rehabilitation of Disabled Person, and Critical Illness Rehabilitation Group of China Association of Rehabilitation Medicine, and sponsored by several national or provincial natural science research projects, this work is expected to provide clear guidance for the general treatment of adult patients with a tracheostomy in China in the future.
Topics: Adult; Humans; Middle Aged; Critical Illness; Deglutition Disorders; Intubation, Intratracheal; Respiration, Artificial; Tracheostomy
PubMed: 37554082
DOI: 10.3760/cma.j.cn112147-20230331-00153 -
B-ENT 2016Long-term complications after facial, pharyngeal, laryngeal and tracheal traumas. (Review)
Review
UNLABELLED
Long-term complications after facial, pharyngeal, laryngeal and tracheal traumas.
OBJECTIVE
To review and summarize the existing evidence for long-term anatomical and functional complications after pharyngeal, laryngeal and tracheal traumas.
DATA SOURCES
The MEDLINE database and the bibliographies of relevant studies were selected, analysed and appraised prior to December 2015.
METHODS
With regard to the search strategy, the selected items were: ((long-term complications) AND pharyngeal) AND laryngeal) AND tracheal) AND traumas. Abstracts and titles were screened for relevance, while full articles of the se- lected records were evaluated and critically appraised after inclusion. Data concerning life-threatening situations, as well as long-term severe adverse effects were collected.
Topics: Burns; Cicatrix; Depression; Eye Diseases; Facial Injuries; Humans; Laryngostenosis; Larynx; Pain; Pharynx; Stress Disorders, Post-Traumatic; Tooth Avulsion; Trachea; Tracheal Stenosis; Vocal Cord Paralysis
PubMed: 29558581
DOI: No ID Found -
European Journal of Surgical Oncology :... Jan 2017Management paradigms in laryngeal cancer have shifted to "organ preservation" chemoradiotherapy protocols. In the event of treatment failure, salvage total laryngectomy... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND OBJECTIVES
Management paradigms in laryngeal cancer have shifted to "organ preservation" chemoradiotherapy protocols. In the event of treatment failure, salvage total laryngectomy remains the only curative treatment option. However a comprehensive review of the complications of this procedure has not been reported.
METHODS
A systematic review of the literature was performed using keywords "salvage laryngectomy" to retrieve relevant publications between January 2000 and August 2015.
RESULTS
Of the 407 articles retrieved from the literature search, 50 studies encompassing 3292 patients were included. Forty-nine studies reported pharyngocutaneous fistula which occurred in 859 patients (pooled incidence 28.9%; 95% confidence intervals 25.5-32.5%). Twenty-four studies reported complications in addition to PCF and these included wound complications (infection, dehiscence and necrosis), dysphagia, bleeding, and pharyngeal and stomal stenosis.
CONCLUSIONS
Overall complication rate was 67.5%, Pharyngocutaneous fistula was the commonest complication with a pooled incidence of 28.9%.
Topics: Humans; Laryngeal Neoplasms; Laryngectomy; Postoperative Complications; Salvage Therapy
PubMed: 27265037
DOI: 10.1016/j.ejso.2016.05.017 -
American Journal of Otolaryngology 2021Pharyngoesophageal stenosis (PES) is a serious complication that substantially impacts functional outcomes and quality of life (QOL) for up to a third of head and neck... (Review)
Review
BACKGROUND
Pharyngoesophageal stenosis (PES) is a serious complication that substantially impacts functional outcomes and quality of life (QOL) for up to a third of head and neck cancer patients who undergo radiotherapy. Dysphagia is often multifactorial in nature and is a devastating complication of treatment that impacts patients' QOL, general health and overall wellbeing. The authors detail the clinical presentation, risk factors, imaging characteristics, preventive measures, and multimodality treatment options for PES.
METHODS
The authors present a comprehensive management algorithm for PES, including treatment by dilation, stenting, spray cryotherapy and dilation, and reconstructive treatment options utilizing different pedicled and free flaps.
RESULTS
The authors advocate for a thorough assessment of the extent and degree of pharyngoesophageal involvement of PES to determine the optimal management strategy.
CONCLUSIONS
The development of post treatment dysphagia requires appropriate imaging and biopsy, when indicated, to rule out the presence of persistent/recurrent cancer. Multidisciplinary management by a team of physicians well-versed in the range of diagnostic and therapeutic interventions available for PES is critical to its successful management.
Topics: Combined Modality Therapy; Constriction, Pathologic; Cryotherapy; Deglutition Disorders; Diagnostic Imaging; Dilatation; Endoscopy; Esophageal Stenosis; Head and Neck Neoplasms; Humans; Pharynx; Quality of Life; Radiotherapy; Plastic Surgery Procedures; Stents; Surgical Flaps; Treatment Outcome
PubMed: 33894689
DOI: 10.1016/j.amjoto.2021.103003 -
The Journal of the Louisiana State... 2017A 50 year old African-American woman with diabetes, hypertension, and hyperlipidemia presented with progressively worsening retro-sternal chest pain, exacerbated by...
CASE
A 50 year old African-American woman with diabetes, hypertension, and hyperlipidemia presented with progressively worsening retro-sternal chest pain, exacerbated by activity and relieved by rest. She also endorsed a thirty-pound unintentional weight loss, and dysphagia. She was dysarthric with left-sided Bell's Palsy and a palpable left axillary lymph node. She had been evaluated at several hospitals in the previous months for similar typical chest pain. Her troponin values were normal, and an EKG showed T-wave inversions in leads I and aVL. On echocardiography, her ejection fraction was 45 percent with anterolateral hypokinesis. She was treated for NSTEMI, and an angiogram showed 95 percent stenosis of the right coronary artery. A modified barium swallow study revealed weakened swallowing with aspiration of thin liquids. An MRI Brain demonstrated scattered T2/ FLAIR hyper-intense foci in the subcortical white matter and focal meningeal thickening. ANA, dsDNA, ANCA, and Lyme antibodies were all negative, and a chest CT showed hilar lymphadenopathy. Cardiac MRI demonstrated scattered foci of delayed enhancement in the mid-myocardium and sub-epicardium without infarction. An endobronchial biopsy of hilar lymph nodes showed two small epithelioid granulomas, consistent with Sarcoidosis. She was started on high-dose corticosteroids with rapid improvement. A repeat modified barium swallow study was normal and a repeat echocardiogram demonstrated recovered ejection fraction of 55 percent with improved wall motion in the septum and apex. Additionally, her left-sided Bell's Palsy and dysarthria improved after several days of therapy.
DISCUSSION
To our knowledge, this report is the third case of multi-organ Sarcoidosis presenting as ACS. This case depicts the simultaneous presentation of neurologic, pharyngeal, pulmonary, and cardiac Sarcoidosis. Myocardial involvement in Sarcoidosis is rare and usually presents as conduction abnormalities with arrhythmia rather than ACS. Though her symptoms were consistent with Sarcoidosis, she had multiple risk factors for coronary atherosclerosis including diabetes, hypertension, and hyperlipidemia. This case highlights the importance of including Sarcoidosis in the differential diagnosis for patients with recurrent typical chest pain of uncertain etiology.
PubMed: 28414663
DOI: No ID Found -
Der Nervenarzt Aug 2023Persistent dysphagia is a major predictor of prolonged ventilation weaning and unsuccessful attempts at decannulation. Due to the high incidence of dysphagia in... (Review)
Review
Persistent dysphagia is a major predictor of prolonged ventilation weaning and unsuccessful attempts at decannulation. Due to the high incidence of dysphagia in tracheotomized patients, tracheal cannula management and dysphagia treatment must be coordinated. A central element of tracheal cannula management in dysphagia treatment is the establishment of physiological airflow. This enables voluntary clearing functions, such as coughing and throat clearing and significantly reduces aspiration. A distinction is made between spontaneous and staged decannulation pathways with expansion of cuff unblocking times and occlusion training. Other therapeutic measures include secretion and saliva management, cough function training with improvement of strength and sensitivity, pharyngeal electrical stimulation, adaptation of tracheal tubes to optimize respiratory and swallowing function, control and treatment of airway stenosis, and standardization of processes for quality assurance.
Topics: Humans; Deglutition Disorders; Tracheostomy; Ventilator Weaning; Respiration, Artificial; Stroke
PubMed: 37219566
DOI: 10.1007/s00115-023-01489-1 -
Head & Neck Nov 2022The aim of this study is to determine whether the preventive positioning of a salivary bypass tube (SBT) after total laryngectomy (TL) reduces the incidence of... (Meta-Analysis)
Meta-Analysis Review
The aim of this study is to determine whether the preventive positioning of a salivary bypass tube (SBT) after total laryngectomy (TL) reduces the incidence of postoperative pharyngocutaneous fistula (PCF) and pharyngeal stenosis (PS). This study was conducted in conformity with the PRISMA statement. 1960 patients with a median age of 62.0 years were included. A SBT was placed in 980 (50%) patients (SBT group). The cumulative PCF incidence in the SBT group was 15.8% (95% CI: 9.3-23.6). The measured pooled OR comparing PCF incidence in patients with SBT compared to those without was 0.40 (95% CI: 0.24-0.65). The pooled PS incidence in the SBT group was 12.3% (95% CI: 5.4-21.6). The measured pooled OR comparing PS incidence in patients with SBT compared to those without was 0.43 (95% CI: 0.24-0.65). PCF and PS could be prevented by the intra-operative placement of a SBT.
Topics: Cutaneous Fistula; Humans; Laryngeal Neoplasms; Laryngectomy; Middle Aged; Pharyngeal Diseases; Postoperative Complications; Retrospective Studies
PubMed: 35920404
DOI: 10.1002/hed.27169 -
The British Journal of Oral &... Jun 2021Tracheotomy in infancy helps patients with Pfeiffer syndrome to survive by preventing respiratory crisis, but difficulty in decannulation may consequently be a...
Tracheotomy in infancy helps patients with Pfeiffer syndrome to survive by preventing respiratory crisis, but difficulty in decannulation may consequently be a challenge. This study has investigated the regional abnormalities of the nasopharyngeal airway in children with Pfeiffer syndrome to provide an anatomical basis for the surgical treatment and decannulation of the upper airway. Seventy-two preoperative computed tomograms (CT) (Pfeiffer syndrome n=30; control n=42) were included. The airway volume, cross-sectional area, and cephalometrics were measured using Materialise software. Patients with Pfeiffer syndrome developed a 50% (p<0.001) reduction of nasal airway volume, and a 44% (p=0.003) restriction in pharyngeal airway volume. In patients with Pfeiffer syndrome the cross-sectional area at the choana was only half that of the controls (p<0.001). The posterior width of the nasal airway in patients with Pfeiffer syndrome was shortened by 13% (p=0.003), and the height reduced by 21% (p<0.001). The cross-sectional areas at the condylion and gonion levels, which indicate the calibre of the pharyngeal airway at the entrance and midsection, were reduced by 67% (p<0.001) and 47% (p<0.001), respectively, when compared with the controls. The volume of the nasal airway in patients with Pfeiffer syndrome was significantly restricted in length, height, and width, and by choanal stenosis in all cases in this cohort. The reduced anteroposterior length of the nasal airway contributed to the shortened maxilla more than the anteroposterior position. The limited height and width of the nasal pathway was the result of a hypoplastic sphenoid. Restricted mediolateral and anteroposterior dimensions were evident across the entire course of the pharyngeal airway. Mediolateral maxillary expansion in addition to maxillomandibular advancement is therefore likely to benefit these patients.
Topics: Acrocephalosyndactylia; Cephalometry; Child; Cone-Beam Computed Tomography; Humans; Maxilla; Palatal Expansion Technique; Pharynx
PubMed: 33863588
DOI: 10.1016/j.bjoms.2020.10.008 -
European Annals of Otorhinolaryngology,... Jun 2018Distal anastomosis by tubed free flap is one of the main technical difficulties encountered during hypopharyngeal reconstruction. Although high flap survival probability...
Distal anastomosis by tubed free flap is one of the main technical difficulties encountered during hypopharyngeal reconstruction. Although high flap survival probability can be achieved by experienced surgical teams, two complications are commonly observed at the flap-oesophagus junction: fistula and stenosis. Use of a circular stapler reduced the frequency of these complications by ensuring a perfectly circular and resistant suture line. Salivary stent placement is therefore unnecessary, allowing earlier resumption of feeding. The stapling procedure is simple, but a few technical skills are required, as the stapler is not specifically designed for this purpose. We describe the indications, surgical procedure and global results based on our series. We consider the forearm flap to be the gold standard for this reconstruction, but thicker flaps, such as pectoralis major flap, can also be used, but with poorer results in terms of healing and swallowing performance.
Topics: Anastomosis, Surgical; Humans; Hypopharynx; Surgical Flaps; Surgical Staplers; Surgical Stapling
PubMed: 29398503
DOI: 10.1016/j.anorl.2018.01.003