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Oral Oncology Nov 2021Elective neck dissection of levels I, II and III is being increasingly used for detecting occult node metastases in patients with oral squamous cell carcinoma (OSCC) and... (Meta-Analysis)
Meta-Analysis Review
Elective neck dissection of levels I, II and III is being increasingly used for detecting occult node metastases in patients with oral squamous cell carcinoma (OSCC) and clinically negative neck (cN0). The most frequent potential long-term complication of this procedure is shoulder dysfunction, because of micro- or macroscopic damage to the spinal accessory nerve (SAN). In particular, many studies have reported an association between SAN damage and dissection of level 2b. Furthermore, level 2b dissection is a technically demanding and time-consuming procedure. Our study aims to clarify whether level 2b sparing in cN0 patients with OSCC can be oncologically justifiable. The PubMed, Cochrane and Scopus databases were searched by three different authors for articles on this topic. The primary endpoint of the meta-analysis was the overall prevalence of occult metastases in cervical level 2b nodes in patients with OSCC and clinically negative neck. The meta-analysis was performed using R version 4.0.1. A total of 13 studies and 937 patients were included. The cumulative rate of occult nodal metastases in level 2b was 0.8% (n = 937, 95% CI: 0.1% - 2.2%, τ = 0.004). No isolated level 2b metastases was found among the patients with positive level 2b, and in the six studies that reported this association, all patients with nodal disease in level 2b had a positive level 2a. This meta-analysis highlights how level 2b can be safely spared in supraomohyoid neck dissection (SOHND) of patients with OSCC and clinically negative neck, reducing the risk of postoperative shoulder dysfunction.
Topics: Humans; Lymph Nodes; Lymphatic Metastasis; Mouth Neoplasms; Neck Dissection; Neoplasm Staging; Prevalence; Retrospective Studies; Squamous Cell Carcinoma of Head and Neck
PubMed: 34598036
DOI: 10.1016/j.oraloncology.2021.105540 -
Microsurgery Feb 2020Restoration of elbow flexion is the priority in traumatic brachial plexus injuries. Surgical approaches commonly include nerve transfers and nerve grafting. Our... (Meta-Analysis)
Meta-Analysis Review
UNLABELLED
Restoration of elbow flexion is the priority in traumatic brachial plexus injuries. Surgical approaches commonly include nerve transfers and nerve grafting. Our objective was to evaluate the safety and efficacy profile of nerve transfers versus grafting for traumatic nonobstetric brachial plexus injuries.
METHODS
This systematic literature review was performed according to the PRISMA guidelines. A random-effects model meta-analysis was conducted, and the I-square was used to assess heterogeneity. The Medical Research Scale (MRC) score was used to assess the efficacy of the procedures.
RESULTS
Nine studies comprising 490 patients overall were identified. In the pooled analysis, functional recovery of elbow flexion defined as MRC ≥ M3, was superior in the transfer (N = 272/350, 77.7%) compared to the graft group (N = 99/140, 70.7%); however statistical significance was not reached (OR: 1.95; 95%CI: 0.79-4.83; I : 58.8%). However, the odds for successful restoration of elbow flexion (MRC≥M3) were significantly higher when the ulnar (OR:12.20; 95%CI:3.05-48.80; I :0%) or pectoral nerves (OR: 9.69; 95% CI: 1.83-51.25; I : 0%) were used as healthy donors for the transfer compared to the graft procedures. Results between the two groups were similar when the intercostal, spinal accessory, thoracodorsal, contralateral C7 and phrenic nerves were used as donors for the transfer procedures.
CONCLUSIONS
The ulnar or pectoral nerve transfer to musculocutaneous is associated with statistically significant superior rates of elbow flexion recovery as compared to graft. No differences were identified in the pooled analysis or the subgroups of other donors used in nerve transfers. Future randomized studies or prospective cohorts are needed to validate our results.
Topics: Brachial Plexus; Brachial Plexus Neuropathies; Elbow; Humans; Nerve Transfer; Prospective Studies; Range of Motion, Articular
PubMed: 31486132
DOI: 10.1002/micr.30510 -
The Laryngoscope Sep 2017To review the evidence for level V dissection in the management of previously untreated mucosal squamous cell carcinoma (SCC) of the head and neck presenting with nodal... (Review)
Review
OBJECTIVE
To review the evidence for level V dissection in the management of previously untreated mucosal squamous cell carcinoma (SCC) of the head and neck presenting with nodal metastasis when level V is clinically uninvolved.
DATA SOURCE
The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) were used to conduct a systematic review of the current literature, including all English language articles published after 1990. A literature search was performed on November 29, 2015, of Medline, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Library.
REVIEW METHODS
The search yielded a total of 270 papers. Strict inclusion and exclusion criteria were applied, leaving 20 eligible papers. Overall prevalence was calculated using random effect meta-analysis.
RESULTS
The overall prevalence of level V occult disease in the node (N)-positive neck, irrespective of subsite, was 2.56% (95% confidence interval 1.29-3.84) (2,368 patients and 2,533 necks). The prevalence of occult level V metastasis was up to 7.7% for oral cavity and 8.3% for oropharyngeal tumors. Five studies reported regional recurrence rates over variable time periods. There is exceedingly limited data on outcomes, such as spinal accessory nerve function, quality of life, and perioperative complications.
CONCLUSION
Mucosal head and neck SCC presenting with nodal metastasis but with level V clinically uninvolved has a low prevalence of occult level V disease. Routine dissection of level V does not appear to be warranted; however, a definitive conclusion is unable to be drawn due to limited data on morbidity and oncological outcomes. Laryngoscope, 127:2074-2080, 2017.
Topics: Carcinoma, Squamous Cell; Head and Neck Neoplasms; Humans; Lymph Nodes; Lymphatic Metastasis; Mouth Neoplasms; Neck; Neck Dissection; Neoplasm Staging; Neoplasms, Glandular and Epithelial; Oropharyngeal Neoplasms; Prophylactic Surgical Procedures; Squamous Cell Carcinoma of Head and Neck; Treatment Outcome
PubMed: 28411387
DOI: 10.1002/lary.26573 -
European Urology Oct 2006Erectile dysfunction is common after surgery for prostate cancer. Potency rates after radical retropubic prostatectomy (RRP) vary widely among different studies. Since... (Review)
Review
OBJECTIVES
Erectile dysfunction is common after surgery for prostate cancer. Potency rates after radical retropubic prostatectomy (RRP) vary widely among different studies. Since the introduction of the nerve-sparing technique potency rates have increased. Erectile function recovery rates for selected groups of patients are high. However, studies from community practices have shown less favourable outcomes after RP.
METHODS
We have performed a systematic review of the literature concerning sexual function after RRP and focused on prognostic indicators for a successful sexual outcome.
RESULTS
Most important prognostic factors for the return of potency after RRP are preservation of the neurovascular bundles, age of the patient and sexual function before the operation. Neurogenic and vasculogenic factors seem to play an important role in the aetiology of the erectile dysfunction after surgery. The role of preserving the accessory pudendal artery is not certain, although some investigators found significant hemodynamic changes after sacrificing the accessory pudendal artery. Colour Doppler ultrasound studies in combination with intracavernous injection of vasoactive drugs or after PDE-5 inhibitors administration has shown to be a reliable test for vascular factors.
CONCLUSIONS
After bilateral nerve-sparing RRP sexual potency is preserved in 31-86% of sexually active men with organ-confined disease. The aetiology of impotence following RRP is multifactorial, but neurogenic factors seem to play a major role. Vascular factors may be of importance in selective cases. Colour Doppler ultrasound appears to be the most reliable, non-invasive diagnostic test for erectile dysfunction after RRP in patients who do not respond to pharmacotherapy.
Topics: Erectile Dysfunction; Humans; Male; Penile Erection; Prognosis; Prostatectomy
PubMed: 16846679
DOI: 10.1016/j.eururo.2006.06.009 -
Facial Plastic Surgery & Aesthetic... 2023Facial palsy patients face significant challenges. Gracilis free flap transfer is a key procedure in facial reanimation. This study aims to analyze oral commissure... (Meta-Analysis)
Meta-Analysis
Facial palsy patients face significant challenges. Gracilis free flap transfer is a key procedure in facial reanimation. This study aims to analyze oral commissure excursion improvement after gracilis free flap transfer and the differences regarding donor nerve: cross-facial nerve graft (CFNG), hypoglossal or spinal accessory nerves, motor nerve to masseteric (MNTM), and most recently, double anastomosis using both the MNTM and CFNG. A systematic review and meta-analysis were conducted of studies reporting oral commissure excursion improvement after free gracilis muscle transfer. Pooled proportions were calculated using a random-effects model. Eighteen studies, 453 patients, and 488 free gracilis flaps were included. The mean change in perioperative oral commissure excursion was 7.0 mm, for CFNG 7.2 mm, for MNTM 7.7, and for double anastomoses 5.5 mm. There is a significant improvement in oral commissure excursion after gracilis muscle-free flap. Unfortunately, we could not make definitive conclusions regarding the optimal choice of donor nerve.
Topics: Humans; Gracilis Muscle; Facial Paralysis; Smiling; Plastic Surgery Procedures; Free Tissue Flaps
PubMed: 36787475
DOI: 10.1089/fpsam.2022.0283 -
Oral Surgery, Oral Medicine, Oral... Jun 2019The aim of this study was to conduct a systematic review of the frequency, location, diameter, variations in course, relationship to the course of the anterior superior...
OBJECTIVE
The aim of this study was to conduct a systematic review of the frequency, location, diameter, variations in course, relationship to the course of the anterior superior alveolar nerve (ASAN), patient age and gender, and surgical implications of canalis sinuosus (CS), identified through imaging examinations, macerated skulls, or cadaver heads.
STUDY DESIGN
Medline, Scopus, and Web of Science databases were searched, and the retrieved articles were analyzed by 2 reviewers. The articles were selected by using well-established inclusion criteria. The Hawker scale was used for quality analysis. A kappa test was used to measure interobserver agreement.
RESULT
The search identified 70 articles, of which 11 were selected for extraction and data analysis. Most studies consisted of cone beam computed tomography examinations of the location, diameter, and variable presence of accessory channels (ACs) in the CS. In total, 90.9% of the studies were of high or moderate quality.
CONCLUSIONS
The CS may present variations in its course, location, and diameter. It involves ASAN and a extension to the anterior palate region, the ACs. No statistically significant differences with regard to age or gender were discovered in the studies. Most articles report the relevance of the CS identification in surgical procedures close to the canal and emphasize the importance of awareness of the variable appearance of the CS.
Topics: Cone-Beam Computed Tomography; Humans; Maxilla; Maxillary Nerve; Palate, Hard; Skull
PubMed: 30772255
DOI: 10.1016/j.oooo.2018.12.017 -
The Journal of Laryngology and Otology Jan 2020Accessory nerve palsy affects a proportion of patients following neck dissection, and results in shoulder dysfunction and regional pain. This project aimed to establish...
OBJECTIVE
Accessory nerve palsy affects a proportion of patients following neck dissection, and results in shoulder dysfunction and regional pain. This project aimed to establish the evidence supporting post-operative physiotherapy for the shoulder following neck dissection.
METHOD
A systematic review was conducted of prospective trials investigating the efficacy of rehabilitation for shoulder or upper limb dysfunction and pain following any type of neck dissection.
RESULTS
A total of 820 papers were identified; through a staged review process, 7 trials were found that fulfilled the inclusion criteria. These included three randomised, controlled trials and four non-randomised studies. Five out of the seven trials demonstrated a statistically significant benefit of physiotherapy.
CONCLUSION
Current evidence shows a benefit from physiotherapy in patients with shoulder dysfunction following neck dissection. Some evidence suggests progressive resistance is superior to other types of physiotherapy. Long-term benefit and cost efficacy have not been studied.
PubMed: 31964434
DOI: 10.1017/S0022215120000079