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The Annals of Otology, Rhinology, and... Jul 2024This study aims to evaluate the factors most associated with early and late complications following microvascular free tissue transfer (MVFTT) after mandibulectomy.
PURPOSE
This study aims to evaluate the factors most associated with early and late complications following microvascular free tissue transfer (MVFTT) after mandibulectomy.
METHODS
A retrospective review of patients undergoing MVFTT after segmental mandibulectomy from September 2016 to February 2021 was performed across a single academic institution. Surgical variables were collected, including the location of the resultant mandibular defect (anterior vs posterior) and flap type (osseous or non-osseous). The primary outcome variables included postoperative complications (early, <90 days; and late, >90 days) and the patients' functional status (return to oral intake). Descriptive statistics, chi-square test, Fischer's exact test, and 2-sample t tests were used to analyze differences among variables.
RESULTS
We analyzed a cohort of 114 consecutive patients with mandibular defects, comprising 57 anterior and 57 posterior defects. Bony free flaps with hardware were used to reconstruct 98% of anterior defects compared to 58% of posterior defects ( < .001). All soft tissue only flaps did not utilize any hardware during the reconstruction. Anterior defects demonstrated more late complications requiring additional surgery (30% vs 9%, = .04). A secondary analysis of posterior mandibular reconstructions compared soft tissue only flaps and bony free flaps with hardware and showed equivalent rates of early (12% vs 13%, > .99) and late (9% vs 8%, > .99) complications requiring additional surgery while demonstrating a similar return to full oral competence (55% vs 46%, = .52) and recovery of a 100% oral diet (67% vs 54%, = .53).
CONCLUSION
Osseous free tissue transfer for segmental mandibular defects remains the gold standard in reconstruction. In our patient cohort, anterior mandibular defects are associated with greater late (>90 day) complications requiring additional surgery. Comparable outcomes may be achieved with soft tissue only versus osseous free flap reconstruction of posterior mandibular defects.
Topics: Humans; Free Tissue Flaps; Male; Retrospective Studies; Female; Middle Aged; Mandibular Osteotomy; Postoperative Complications; Aged; Mandibular Reconstruction; Adult; Mandibular Neoplasms; Mandible; Plastic Surgery Procedures
PubMed: 38676442
DOI: 10.1177/00034894241250177 -
Cancers Apr 2024To analyze the long-term facial function as well as overall postoperative condition in surgically treated tympanomastoid PGL patients.
OBJECTIVE
To analyze the long-term facial function as well as overall postoperative condition in surgically treated tympanomastoid PGL patients.
STUDY DESIGN
Retrospective study.
METHOD
The medical records of patients with surgically managed class A and B tympanomastoid PGLs between 1983 and 2023 were thoroughly evaluated.
RESULT
Our center has treated a total of 213 cases of tympanomastoid PGL surgically. The mean age of patients was 54, and the male-to-female ratio was 1:6. The most common symptoms at presentation were hearing loss (80%), pulsatile tinnitus (77%), and vertigo (15%). According to the modified Fisch classification, 45% of the cases were classified as class A (A1 and A2), while 55% were classified as class B (B1, B2, and B3). All class A and most class B1 and B2 tumors were removed either with transcanal or retroauricular-transcanal approaches. However, more advanced class B3 lesions were removed with subtotal petrosectomy (SP) along with middle ear obliteration. Facial nerve outcome was excellent in all class A and B cases, while chances of postoperative paresis slightly increased with the size and extent of the tumor ( < 0.05). The hearing outcome is excellent for class A1, A2, B1, and B2 tumors, whereas more advanced class B3 cases have a loss of air conduction (AC) and increased bone conduction (BC) threshold ( < 0.05). Complete surgical removal was achieved in 97% of our cases. The most common late complication was permanent TM perforation (7%), and the recurrence rate was 3%.
CONCLUSIONS
Tympanomastoid PGL represents the most common neoplasm of the middle ear space. The most frequent presenting symptoms include pulsatile tinnitus and hearing loss, whereas the presence of retrotympanic mass was evident in all cases at the time of initial otoscopic evaluation. Proper documentation of facial function and audiometric evaluation are crucial elements of preoperative workup. The most preferred preoperative radiologic examination is high-resolution computer tomography (HRCT), whereas magnetic resonance imaging (MRI) with or without gadolinium enhancement is reserved for cases with a dilemma of carotid artery or jugular bulb involvement. The main goal of tympanomastoid PGL treatment is complete disease removal with preservation of hearing and facial functions. Surgical treatment remains the preferred treatment modality with the benefits of complete disease removal, lower rate of recurrence and complication, and acceptable postoperative hearing level. Here, we present our 40 years of experience, which, to the very best of our knowledge, is the largest series of tympanomastoid PGL in the English literature.
PubMed: 38672548
DOI: 10.3390/cancers16081466 -
Indian Journal of Ophthalmology May 2024The transnasal endoscopic approach is increasingly used for resection of tumors that are located inferiorly and medially within the orbit. However, this usually requires...
The transnasal endoscopic approach is increasingly used for resection of tumors that are located inferiorly and medially within the orbit. However, this usually requires multiple-handed manipulations, which demand a second corridor for an assistant. Here, we introduce a simple transseptal corridor from the contra-nare, to facilitate assistant instrument maneuverability. This simple, minimally invasive skill greatly improves operation efficiency and deserves greater attention in endoscopic orbital surgery.
Topics: Humans; Orbital Neoplasms; Endoscopy; Ophthalmologic Surgical Procedures; Orbit; Nasal Septum
PubMed: 38661263
DOI: 10.4103/IJO.IJO_2644_23 -
Arquivos Brasileiros de Oftalmologia 2024Vascular anomalies comprise a wide spectrum of clinical manifestations related to disturbances in the blood or lymph vessels. They correspond to mainly tumors... (Review)
Review
Vascular anomalies comprise a wide spectrum of clinical manifestations related to disturbances in the blood or lymph vessels. They correspond to mainly tumors (especially hemangiomas), characterized by high mitotic activity and proliferation of the vascular endothelium, and malformations, endowed with normal mitotic activity and no hypercellularity or changes in the rate of cell turnover. However, the classifications of these lesions go beyond this dichotomy and consist various systems adapted for and by different clinical subgroups. Thus, the classifications have not reached a consensus and have historically caused confusion regarding the nomenclatures and definitions. Cavernous venous malformations of the orbit, previously called cavernous hemangiomas, are the most common benign vascular orbital lesions in adults. Herein, we have compiled and discussed the various evidences, including clinical, radiological, morphological, and molecular evidence that indicate the non-neoplastic nature of these lesions.
Topics: Humans; Hemangioma, Cavernous; Orbital Neoplasms; Orbit; Vascular Malformations
PubMed: 38655941
DOI: 10.5935/0004-2749.2023-0338 -
Acta Otorhinolaryngologica Italica :... Apr 2024Endoscopic endonasal surgery is effective in the treatment of sinonasal cancers. However, in cases of well-differentiated locally advanced neoplasms as well as...
OBJECTIVE
Endoscopic endonasal surgery is effective in the treatment of sinonasal cancers. However, in cases of well-differentiated locally advanced neoplasms as well as recurrences, the most appropriate treatment is debated. The purpose of this study is to report a mono-institutional experience on craniofacial surgery performed in a tertiary-care referral centre.
METHODS
This was a retrospective analysis of 90 patients treated with transcranial and/or transfacial resection for sinonasal cancer between 2010 and 2020. Outcome measures included overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS) and recurrence-free survival (RFS).
RESULTS
The 5-year OS, DSS and DFS were 48.2%, 60.6% and 28.7%, respectively. Factors correlated with prognosis were pT-classification (p = 0.002), histotype (p = 0.012) and dural involvement (p = 0.004). Independent prognostic factors were orbital apex infiltration (p = 0.03), age (p = 0.002) and adjuvant therapy (p = 0.03).
CONCLUSIONS
When endoscopic endonasal surgery is contraindicated and chemoradiotherapy is not appropriate, craniofacial and transfacial approaches still represent an option to consider, despite the non-negligible morbidity.
Topics: Humans; Male; Female; Retrospective Studies; Middle Aged; Aged; Paranasal Sinus Neoplasms; Adult; Aged, 80 and over; Endoscopy; Time Factors; Survival Rate; Treatment Outcome; Neoplasm Staging; Prognosis
PubMed: 38651554
DOI: 10.14639/0392-100X-N2375 -
European Review For Medical and... Apr 2024The study's purpose was to compare the quality of life (QoL) in oncologic patients treated with different rehabilitation protocols following maxillary tumor resections.
OBJECTIVE
The study's purpose was to compare the quality of life (QoL) in oncologic patients treated with different rehabilitation protocols following maxillary tumor resections.
PATIENTS AND METHODS
The patients were divided into three groups. Group A: 18 Patients with maxillary obturator prosthesis. Group B: 17 Patients with simultaneous autologous tissue reconstruction. Group C: 12 Patients with prosthesis on zygomatic implants. The post-operative QoL was compared using standard questionnaires, investigating items like pain, mood, social relations, and specific functions that could potentially compromise the post-operative QoL. A secondary analysis compared reconstructed vs. non-reconstructed patients.
RESULTS
Most questionnaire items did not show significant differences among groups. Statistically significant outcomes were found in two parameters (social contact and sexuality), in which patients treated with zygomatic implants had the best satisfaction, and patients with obturator prostheses showed the lowest satisfaction. Patients belonging to the non-reconstructed group showed better moods than those in the reconstructed group, while taste problem complaints and pain were lower in the reconstructed group.
CONCLUSIONS
Although the type of reconstruction procedure depends on the type of maxillectomy to be performed and on the general health situation of each patient, the impact of the rehabilitation protocol on the patients' QoL should be accounted for when planning the treatment.
Topics: Humans; Quality of Life; Palatal Obturators; Maxilla; Maxillary Neoplasms; Pain
PubMed: 38639511
DOI: 10.26355/eurrev_202404_35900 -
Cancer Reports (Hoboken, N.J.) Apr 2024Psammomatoid ossifying fibroma (POF) is a rare craniofacial neoplasm, primarily affecting the maxillofacial region, and typically observed in adolescents and young...
BACKGROUND
Psammomatoid ossifying fibroma (POF) is a rare craniofacial neoplasm, primarily affecting the maxillofacial region, and typically observed in adolescents and young adults. This case report presents a unique occurrence of POF in a 50-year-old male, defying the conventional age range and exhibiting an unusual anatomical location within the frontal sinus.
CASE
A 50-year-old male with a prior history of cecal adenocarcinoma and colectomy presented with left eye proptosis and new-onset headaches. Imaging revealed a well-defined calcified mass in the left frontal sinus, leading to a diagnosis of POF. Open surgical resection was performed to remove the tumor, and histopathological evaluation confirmed its diagnosis as psammomatoid ossifying fibroma. The patient exhibited no postoperative complications or signs of recurrence.
CONCLUSION
This case underscores the diverse clinical presentations and diagnostic challenges associated with POF, emphasizing the importance of accurate diagnosis and multidisciplinary collaboration. Further research is needed to explore the genetic underpinnings and optimal management strategies for this intriguing condition.
Topics: Male; Adolescent; Humans; Middle Aged; Fibroma, Ossifying; Frontal Sinus; Tomography, X-Ray Computed; Soft Tissue Neoplasms
PubMed: 38627899
DOI: 10.1002/cnr2.2063 -
Asia-Pacific Journal of Ophthalmology... 2024
Topics: Humans; Orbital Neoplasms; Eye Neoplasms
PubMed: 38621648
DOI: 10.1016/j.apjo.2024.100059 -
Pathologie (Heidelberg, Germany) Jul 2024We report a rarely occurring hematologic neoplasm in a young adult. Hematologic neoplasms were first described in 2008 and are now included in both accepted tumor...
We report a rarely occurring hematologic neoplasm in a young adult. Hematologic neoplasms were first described in 2008 and are now included in both accepted tumor classification systems, i.e., International Consensus Classification and World Health Organization. This hematologic neoplasm shows a characteristic ALK positivity in immunohistochemical examination and correspondingly, ALK fusion genes in the molecular analysis. Pathologists should be aware of this entity, particularly as it is challenging to differentiate from other more frequent neoplasms of the same disease group or mesenchymal neoplasm with ALK aberration.
Topics: Humans; Diagnosis, Differential; Osteolysis; Mandibular Neoplasms; Male; Adult; Anaplastic Lymphoma Kinase; Young Adult; Female
PubMed: 38602523
DOI: 10.1007/s00292-024-01321-w -
Digital Journal of Ophthalmology : DJO 2024Cavernous hemangioma, currently known as "cavernous venous malformation," is a common, benign, non-infiltrative, slowly progressive vascular malformation of the orbit...
Cavernous hemangioma, currently known as "cavernous venous malformation," is a common, benign, non-infiltrative, slowly progressive vascular malformation of the orbit presenting in adults. We report the case of a 9-year-old girl who presented with a painless palpable mass over the right upper eyelid of 7 years' duration. A computed tomography scan of the orbits revealed a heterogeneously enhancing, well-circumscribed mass in the right upper eyelid with no orbital extension. A transcutaneous excisional biopsy with histopathology disclosed cavernous venous malformation. The majority of cavernous venous malformations are intraconal and present in the fourth to fifth decade of life.
Topics: Adult; Female; Humans; Child; Orbital Neoplasms; Hemangioma, Cavernous; Orbit; Vascular Malformations; Eyelids
PubMed: 38601899
DOI: 10.5693/djo.02.2023.08.002