Osteomyocutaneous Free Fibula Flap Prevents Osteoradionecrosis and Osteomyelitis in Head and Neck Cancer Reconstruction

2021 ◽  
Author(s):  
Kuan-Ying Wang ◽  
Wen-Chung Liu ◽  
Chun-Feng Chen ◽  
Lee-Wei Chen ◽  
Hung-Chi Chen ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Muscle Flap ◽  
Flexor Hallucis Longus ◽  
Free Fibula Flap ◽  
Chi Square ◽  
Fibula Flap ◽  
Free Fibula ◽  
Chi Square Test

Abstract Background Osteoradionecrosis (ORN) is one of the most severe complications of free fibula reconstruction after radiotherapy. The gold standard treatment of osteomyelitis involves extensive debridement, antibiotics, and sufficiently vascularized muscle flap coverage for better circulation. Therefore, we hypothesized that free fibula flap with muscle could decrease the risk of ORN. Methods This study consisted of 85 patients who underwent reconstruction with free fibula flap in head and neck cancer by a single reconstructive surgeon at Kaohsiung Veterans General Hospital over a period of 19 years (1998–2016). Patients with postoperative adjuvant radiotherapy were included in the study and were grouped by either free fibula osteocutaneous flap or free fibula osteomyocutaneous flap (with flexor hallucis longus muscle), and the incidence of ORN was compared. Results Of the 85 patients, 15 were reconstructed with osteocutaneous fibula flap and 70 were with osteomyocutaneous fibula flap. The rate of ORN or osteomyelitis was significantly lower in the muscle group (18.6%, n = 13/70 vs. 46.7%, n = 7/15, p = 0.020, Chi-square test). Conclusion Vascularized muscle transfer increases perfusion of surrounding tissues and the bone flap, thereby decreasing the incidence of osteomyelitis or osteonecrosis.

scholarly journals Analysis of the frequency and degree of temporomandibular disorder in patients with head and neck cancer undergoing radiotherapy

2016 ◽  
Vol 29 (2) ◽  
pp. 361-368 ◽  
Author(s):  
Douglas Roberto Pegoraro ◽  
Barbara Zanchet ◽  
Caroline de Oliveira Guariente ◽  
Josemara de Paula Rocha ◽  
Juliana Secchi Batista
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Temporomandibular Disorder ◽  
Malignant Neoplasm ◽  
Post Treatment ◽  
Chi Square ◽  
Significance Level ◽  
Chi Square Test ◽  
Quantitative Descriptive

Abstract Introduction: Head and neck cancer is responsible for an increasing incidence of primary malignant neoplasm cases worldwide. Radiotherapy is one of the treatments of choice for this type of cancer, but it can cause adverse effects, such as temporomandibular disorder. The objective of this study was to characterize the degree and frequency of temporomandibular disorder in patients with head and neck cancer undergoing radiotherapy. Method: This research was quantitative, descriptive and exploratory. The sample consisted of 22 patients that answered assessment questions and the Helkimo anamnestic questionnaire, modified by Fonseca (1992). The data were collected from May to October 2014, and statistically analyzed using the Chi-square test, with a significance level of p ≤ 0.05. Results: Of the 22 patients, 86.4 % were male, with a mean age of 58.86 ± 9.41 years. Temporomandibular disorder was present in 31.8% of the subjects, based on the assessment prior to radiotherapy, and in 59.1% in the post-treatment assessment. Among all questions, the most frequent was "Do you use only one side of the mouth to chew?" with 22.7% "yes" answers, both at the first assessment and at the post treatment. Conclusion: According to the results of this study, temporomandibular disorder is a disease that is present with a high prevalence in people diagnosed with head and neck cancer undergoing radiotherapy.

scholarly journals CLASSIFICATION OF HEAD AND NECK CANCER TYPES USING MACHINE LEARNING ALGORITHM

2020 ◽  
pp. 198-205
Author(s):  
Prof O. Olabode ◽  
Prof A. O. Adetunmbi ◽  
Folake Akinbohun ◽  
Dr Ambrose Akinbohun
Keyword(s):  
Machine Learning ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Naive Bayes ◽  
Information Gain ◽  
Learning Algorithm ◽  
Naïve Bayes ◽  
Machine Learning Algorithms ◽  
Chi Square

The worldwide incidence of head and neck cancer exceeds half a million cases annually. The morbidity and mortality of head and neck cancers considering thyroid, nasopharyngeal, sinonasal and laryngeal were reported high. The degree of facial disfigurement is unrivalled. Information Gain and Chi Square, Decision and Naïve Bayes were deployed for the study. The dataset was divided into training and test data. The results showed that the performance of Naïve Bayes outperformed Decision Trees. With the application of machine learning algorithms, head and neck cancer can be classified. KEYWORDS: Head and Neck, thyroid, Chi Square, Information Gain

The Evolution of the Free Fibula Flap for Head and Neck Reconstruction: 21 Years of Experience with 128 Flaps

2020 ◽  
Author(s):  
Ehud Fliss ◽  
Ravit Yanko ◽  
Gal Bracha ◽  
Roy Teman ◽  
Aharon Amir ◽  
...  
Keyword(s):  
Head And Neck ◽  
Operative Technique ◽  
Preoperative Planning ◽  
Early Years ◽  
Head And Neck Reconstruction ◽  
Free Fibula Flap ◽  
Neck Reconstruction ◽  
Fibula Flap ◽  
Free Fibula

Abstract Background The free fibula flap is commonly referred to as a “workhorse” for head and neck reconstruction. During our 21-year experience with this flap, we have performed several changes in preoperative planning, operative technique, and postoperative follow-up. Patients and Methods A retrospective cohort study designed to analyze the cohort of patients who underwent free fibula transfer for head and neck reconstruction. Demographics, medical background, operative data, and postoperative outcome were collected. The changes we performed in preoperative planning, operative technique, and postoperative follow-up were assessed and their impact on outcome discussed. Results During 1998 to 2019 a total of 128 free fibula flaps were transferred for head and neck reconstruction. When comparing the patients treated in the early years to those who were treated in recent years we found no statistically significant difference in minor or major nonmicrosurgical complications in the recipient and donor site and in the rate of take backs due to microsurgical reasons. However total flap failure rate improved from 28% in early years to 8% in recent years (p = 0.012). Conclusion During this 21-year period, we performed several changes in our practice. This included the use of a three-dimensional (3D) prefabricated model of the mandible, a shift toward side-table osteotomies, increasing the rate of osteofascial flaps in contrast to osteocutaneous flaps and the use of an implantable Doppler. These changes, together with a learning curve of the surgical team, significantly improved our overall success rates.

Reply to Letter to the Editor: Morbidity of the Free Fibula Flap Reconstruction in Head and Neck Malignancies

2017 ◽  
Vol 33 (05) ◽  
pp. 379-380
Author(s):  
J.N. Lodders ◽  
E.A. Schulten ◽  
J.G. de Visscher ◽  
T. Forouzanfar ◽  
K. Karagozoglu
Keyword(s):  
Head And Neck ◽  
Flap Reconstruction ◽  
Free Fibula Flap ◽  
Head And Neck Malignancies ◽  
Letter To The Editor ◽  
Fibula Flap ◽  
Free Fibula

Anatomy and Vascularization of the Flexor Hallucis Longus Muscle and Its Implication in Free Fibula Flap Transfer

2010 ◽  
Vol 64 (2) ◽  
pp. 233-237 ◽  
Author(s):  
Paolo Sassu ◽  
Robert D. Acland ◽  
Christopher John Salgado ◽  
Samir Mardini ◽  
Tuna Ozyurekoglu
Keyword(s):  
Flexor Hallucis Longus ◽  
Free Fibula Flap ◽  
Flap Transfer ◽  
Fibula Flap ◽  
Longus Muscle ◽  
Free Fibula

scholarly journals Kejadian Mielosupresi Pada Penderita Kanker Kepala Dan Leher Yang Mendapat Kemoterapi Cisplatin Dan Carboplatin Di RSUP Dr. Kariadi Semarang

2020 ◽  
Vol 7 (1) ◽  
pp. 34-40
Author(s):  
Nila Santia Dewi ◽  
Willy Yusmawan ◽  
Rery Budiarti
Keyword(s):  
Head And Neck Cancer ◽  
National Comprehensive Cancer Network ◽  
Head And Neck ◽  
Neck Cancer ◽  
Chi Square ◽  
Exact Test ◽  
Fisher's Exact Test ◽  
Platinum Based Chemotherapy ◽  
Fisher’S Exact Test ◽  
Cancer Network

Latar belakang : Kemoterapi bersifat sistemik dan non selektif sehingga tidak hanya sel kanker yang mati tetapi juga sel normal. National Comprehensive Cancer Network (NCCN) merekomendasikan Platinum-based sebagai rejimen kemoterapi untuk kanker kepala dan leher terutama Cisplatin dan Carboplatin. Cisplatin dan Carboplatin dapat menyebabkan efek samping mielosupresi. Tujuan : Membuktikan bahwa terdapat perbedaan kejadian mielosupresi pada penderita Kanker Kepala dan Leher (KKL) yang mendapat kemoterapi Cisplatin dan Carboplatin. Metode : Penelitian observasional dengan desain penelitian kohort prospektif di klinik THT-KL, bangsal dan bagian rekam medis instalasi rawat jalan/rawat inap RSUP Dr. Kariadi Semarang. Sampel ditentukan sebanyak 90 orang dan mendapat kemoterapi platinum based dengan salah satu komponen berupa Cisplatin atau Carboplatin sebanyak 3 seri. Analisis data dengan uji Pearson Chi-square dan Fisher’s exact test. Hasil : Subyek penelitian 90 orang, 45 orang mendapatkan Paclitaxel Cisplatin dan 45 orang mendapatkan regimen Paclitaxel Carboplatin. Hasil penelitian ini didapatkan 48,9% pasien stadium IV, histopatologi terbanyak WHO 3 (83,3%). Rerata usia terbanyak 50-59 tahun, dan diagnosis terbanyak pada KNF (66,7%). Secara keseluruhan kemoterapi seri I menunjukkan Carboplatin menyebabkan perubahan kadar hemoglobin (p=1,000) dan leukosit (p=0,292) dengan jumlah subyek lebih banyak dibanding Cisplatin. Sedangkan pada kemoterapi seri III, Carboplatin menyebabkan perubahan kadar hemoglobin (p=<0,023), leukosit (p=0,670), dan trombosit (p=1,000) lebih banyak dibandingkan Cisplatin. Simpulan : Kadar hemoglobin berbeda bermakna pada pasien yang mendapatkan kemoterapi Carboplatin seri III (p<0,023). Kata kunci : Kemoterapi Cisplatin/Carboplatin., kanker kepala dan leher, mielosupresi.   Background : Chemotherapy is systemic and non-selective so it often results in not only cancer cells dying but normal cells will also die. The National Comprehensive Cancer Network (NCCN) recommends Platinum-based chemotherapy regimens for head and neck cancer, especially Cisplatin and Carboplatin. Cisplatin and Carboplatin chemotherapy can cause one of the side effects of myelosuppression. Myelosuppression is a decrease in cell production of leukocytes, erythrocytes, and / or platelets.    Objective : Proving the difference incidence of myelosuppression in head and neck cancer patients receiving Cisplatin and Carboplatin chemotherapy. Methode : An observational study with a prospective cohort study design in ENT clinic, ward and medical record department of outpatient installation Dr. Kariadi Semarang. Samples was determined by 90 people and received platinum based chemotherapy with one component in the form of Cisplatin or Carboplatin in 3 series. Data analysis by Pearson Chi-square and Fisher’s exact test. Result : The study subjects were 90 people, 45 people received Paclitaxel Cisplatin regimen and 45 people received Paclitaxel Carboplatin regimen. The results of this study found 48.9% of patients in stage IV conditions with the most histopathological types were WHO 3 (83.3%). Overall series I chemotherapy shows Carboplatin causes changes in hemoglobin (p=1,000) and leukocyte (p=0,292) levels with a greater number of subjects than Cisplatin. Where as in series III chemotherapy, Carboplatin causes more changes in hemoglobin (p=<0,023), leukocyte (p=0,670) and platelet (p=1,000) levels than Cisplatin. Conclusions : Hemoglobin level was significantly different in patients who received Carboplatin series III chemotherapy (p<0,023). Keywords : Chemotherapy, head and neck cancer, myelosuppression, Cisplatin, Carboplatin.  

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