scholarly journals Preemptive Utilization of Anterior Belly of the Digastric Muscle Flaps in Transoral Robotic Radical Tonsillectomy

OTO Open ◽  
2021 ◽  
Vol 5 (3) ◽  
pp. 2473974X2110351
Author(s):  
Olivia Daigle ◽  
James Reed Gardner ◽  
Deanne King ◽  
Mauricio Alejandro Moreno ◽  
Jumin Sunde ◽  
...  
Keyword(s):  
Neck Dissection ◽  
Care Center ◽  
Tertiary Care ◽  
Muscle Flap ◽  
Fistula Formation ◽  
Pharyngocutaneous Fistula ◽  
Digastric Muscle ◽  
Muscle Flaps ◽  
Reconstructive Option ◽  
Anterior Belly

Objective To demonstrate the use of an anterior belly of the digastric muscle flap (ABDMF) during transoral robotic radical tonsillectomy (TORRT) with concomitant neck dissection with the intent of preventing the formation of postoperative pharyngocutaneous fistulas. Study Design Retrospective study. Setting Single academic tertiary care center. Methods In this study, all patients were included who underwent TORRT plus limited pharyngectomy with concomitant neck dissection and ABDMF for the treatment of oropharyngeal squamous cell carcinoma between September 2012 and September 2020. The rate of fistula formation was assessed in patients with preemptive utilization of ABDMF. Results A total of 43 patients underwent TORRT with neck dissection and ABDMF. No patients developed a fistula in the postoperative period or associated morbidity with the use of this flap. Conclusion Preemptive use of ABDMF in TORRT with concomitant neck dissection represents a reconstructive option that may help prevent the formation of pharyngocutaneous fistula by reinforcing the posteroinferior boundary of the parapharyngeal space.

Comparative Morbidity Profile of Elective vs Therapeutic Neck Dissection

2021 ◽  
pp. 019459982110089
Author(s):  
Quinn Dunlap ◽  
James Reed Gardner ◽  
Amanda Ederle ◽  
Deanne King ◽  
Maya Merriweather ◽  
...  
Keyword(s):  
Neck Dissection ◽  
Surgical Complications ◽  
Chart Review ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Neck Surgery ◽  
Continuous Variables ◽  
Significant Difference ◽  
History Of

Objective Neck dissection (ND) is one of the most commonly performed procedures in head and neck surgery. We sought to compare the morbidity of elective ND (END) versus therapeutic ND (TND). Study Design Retrospective chart review. Setting Academic tertiary care center. Methods Retrospective chart review of 373 NDs performed from January 2015 to December 2018. Patients with radical ND or inadequate chart documentation were excluded. Demographics, clinicopathologic data, complications, and sacrificed structures during ND were retrieved. Statistical analysis was performed with χ2 and analysis of variance for comparison of categorical and continuous variables, respectively, with statistical alpha set a 0.05. Results Patients examined consisted of 224 males (60%) with a mean age of 60 years. TND accounted for 79% (n = 296) as compared with 21% (n = 77) for END. Other than a significantly higher history of radiation (37% vs 7%, P < .001) and endocrine pathology (34% vs 2.6%, P < .001) in the TND group, no significant differences in demographics were found between the therapeutic and elective groups. A significantly higher rate of structure sacrifice and extranodal extension within the TND group was noted to hold in overall and subgroup comparisons. No significant difference in rate of surgical complications was appreciated between groups in overall or subgroup analysis. Conclusion While the significantly higher rate of structure sacrifice among the TND population represents an increased morbidity profile in these patients, no significant difference was found in the rate of surgical complications between groups. The significant difference seen between groups regarding history of radiation and endocrine pathology likely represents selection bias.

Pharyngocutaneous fistula and total laryngectomy: possible predisposing factors, with emphasis on pharyngeal myotomy

2000 ◽  
Vol 114 (10) ◽  
pp. 768-771 ◽  
Author(s):  
A. Ö. İkiz ◽  
M. Uça ◽  
E. A. Güneri ◽  
T. K. Erdağ ◽  
S. Sütay
Keyword(s):  
Neck Dissection ◽  
Nasogastric Tube ◽  
Total Laryngectomy ◽  
Positive Association ◽  
Fistula Formation ◽  
Pharyngocutaneous Fistula ◽  
Technical Error ◽  
Significant Positive Association ◽  
Positive Surgical Margins ◽  
Tumour Differentiation

Ninety-two total laryngectomy cases were investigated with reference to post-laryngectomy fistula formation. Fistula was observed in eight cases (8.69 per cent). There were no statistically significant differences between the fistula group and the non-fistula group with regard to pre-operative tracheotomy, tumour differentiation, positive surgical margins, concurrent neck dissection, previous radiotherapy, T stage of the tumour, presence of extended hypopharyngeal mucosal excision, and placement of nasogastric tube. The only statistically significant positive association was found with primary pharyngeal myotomy. Myotomy was performed in six of the fistula patients and in two cases a technical error was observed. In these cases myotomy was performed adjacent to the edge of hypopharyngeal mucosa resulting in a weakened area of pharyngeal closure, possibly contributing to the fistula. This should be kept in mind and avoided at all costs during the performance of myotomy. Since it was not possible to find out any specific causal relationship with myotomy in four other cases, further studies are needed to establish the association of myotomy with pharyngocutaneous fistula.

Management of chyle fistulization in association with neck dissection

2000 ◽  
Vol 122 (3) ◽  
pp. 434-439 ◽  
Author(s):  
R. T. Gregor
Keyword(s):  
Neck Dissection ◽  
Personal Experience ◽  
Skin Flap ◽  
Fistula Formation ◽  
Protein Loss ◽  
Muscle Flaps ◽  
Chylous Leakage ◽  
Chylous Fistula ◽  
Lymph Duct ◽  
Skin Flap Necrosis

Chylous fistula after neck dissection is a relatively rare but potentially lethal complication. Sequelae range from severe fluid, electrolyte, and protein loss to fistula formation, skin-flap necrosis, and carotid blowout. A thorough knowledge of the anatomy is essential to avoid injury to the thoracic duct or right lymph duct. After surgery, drainage of large amounts of fluid, particularly if milky, may alert the surgeon to the danger of chylous leakage. Certain diagnosis, however, is not so easy. Once the diagnosis is made, the management has to address the immediate and late effects of the loss of chyle into an operative site. This article seeks to examine these factors through review of the literature and personal experience with the problem. Total parenteral nutrition allows for control of the fluid and protein loss while avoiding flow of chyle, and in most cases it results in resolution. In those cases that do not resolve, fibrin glue with some type of mesh and muscle flaps usually succeed in closure.

scholarly journals Outpatient versus inpatient superficial parotidectomy: clinical and pathological characteristics

2021 ◽  
Vol 50 (1) ◽  
Author(s):  
Daniel J. Lee ◽  
David Forner ◽  
Christopher End ◽  
Christopher M. K. L. Yao ◽  
Shireen Samargandy ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Fistula Formation ◽  
Secondary Outcome ◽  
Complication Rates ◽  
Superficial Parotidectomy ◽  
Outpatient Procedure ◽  
Tumor Pathology ◽  
Outpatient Group ◽  
Significant Difference

Abstract Background Superficial parotidectomy has a potential to be performed as an outpatient procedure. The objective of the study is to evaluate the safety and selection profile of outpatient superficial parotidectomy compared to inpatient parotidectomy. Methods A retrospective review of individuals who underwent superficial parotidectomy between 2006 and 2016 at a tertiary care center was conducted. Primary outcomes included surgical complications, including transient/permanent facial nerve palsy, wound infection, hematoma, seroma, and fistula formation, as well as medical complications in the postoperative period. Secondary outcome measures included unplanned emergency room visits and readmissions within 30 days of operation due to postoperative complications. Results There were 238 patients included (124 in outpatient and 114 in inpatient group). There was no significant difference between the groups in terms of gender, co-morbidities, tumor pathology or tumor size. There was a trend towards longer distance to the hospital from home address (111 Km in inpatient vs. 27 in outpatient, mean difference 83 km [95% CI,- 1 to 162 km], p = 0.053). The overall complication rates were comparable between the groups (24.2% in outpatient group vs. 21.1% in inpatient, p = 0.56). There was no difference in the rate of return to the emergency department (3.5% vs 5.6%, p = 0.433) or readmission within 30 days (0.9% vs 0.8%, p = 0.952). Conclusion Superficial parotidectomy can be performed safely as an outpatient procedure without elevated risk of complications. Graphical abstract

Management of Chyle Fistulization in Association with Neck Dissection

2000 ◽  
Vol 122 (3) ◽  
pp. 434-439 ◽  
Author(s):  
R. T. Gregor
Keyword(s):  
Neck Dissection ◽  
Personal Experience ◽  
Skin Flap ◽  
Fistula Formation ◽  
Protein Loss ◽  
Muscle Flaps ◽  
Chylous Leakage ◽  
Chylous Fistula ◽  
Lymph Duct ◽  
Skin Flap Necrosis

Chylous fistula after neck dissection is a relatively rare but potentially lethal complication. Sequelae range from severe fluid, electrolyte, and protein loss to fistula formation, skin-flap necrosis, and carotid blowout. A thorough knowledge of the anatomy is essential to avoid injury to the thoracic duct or right lymph duct. After surgery, drainage of large amounts of fluid, particularly if milky, may alert the surgeon to the danger of chylous leakage. Certain diagnosis, however, is not so easy. Once the diagnosis is made, the management has to address the immediate and late effects of the loss of chyle into an operative site. This article seeks to examine these factors through review of the literature and personal experience with the problem. Total parenteral nutrition allows for control of the fluid and protein loss while avoiding flow of chyle, and in most cases it results in resolution. In those cases that do not resolve, fibrin glue with some type of mesh and muscle flaps usually succeed in closure.

Repair of Rectourethral Fistula Using Gracilis Muscle Flap Interposition—a Tertiary Care Center Experience

2021 ◽  
Author(s):  
Prashant Singh ◽  
Sanjay Kumar ◽  
Sridhar Panaiyadiyan ◽  
Prabhjot Singh ◽  
Premnath Dogra ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Muscle Flap ◽  
Gracilis Muscle ◽  
Rectourethral Fistula ◽  
Tertiary Care Center ◽  
Gracilis Muscle Flap

EPIDEMIOLOGY AND OUTCOMES OF ELECTRIC BURN INJURY AT TERTIARY CARE CENTER IN JODHPUR, RAJASTHAN

2019 ◽  
Vol 3 (6) ◽  
Author(s):  
Bharti Saraswat ◽  
Ashok Yadav ◽  
Krishna Kumar Maheshwari
Keyword(s):  
Burn Injury ◽  
Low Voltage ◽  
Care Center ◽  
Tertiary Care ◽  
The Body ◽  
Electrical Injury ◽  
Age Group ◽  
Electric Circuits ◽  
Medical College ◽  
Social Burden

Background- Electric burns and injuries are the result of electric current passing through the body. Temporary or permanent damage can occur to the skin, tissues, and major organs. Methods- This prospective study was carried out on patients admitted in burn unit of department of surgery M.G. Hospital associated with Dr. S.N. Medical College Jodhpur. Records of the patients admitted from January 2018 to December 2018 were studied. Bed head tickets of the patients evaluated in detail. Results- In our study out of 113 patients maximum no. of patients were in age group of 21-30 years 44 (38.94%) followed by age group <11 years in 21 (18.58%) patients and age group of > 60 years in only 3 (2.65%).39 (34.51%) patients were farmer and 15 (13.27%) were electrician in out of 113 total patients, while 37 (32.74%) were without any occupation. 65 (57.52%) cases of high voltage (HV) electrical injury and 48 (42.48%) cases were of low voltage (LV) electrical injury. Conclusion- Morbidity leading to permanent disabilities make the person physically dependent on others. It can be prevented by educating the people about the proper handling to electric circuits & devices. Proper communication among the electricians may help in lowering such accidents. Proper rehabilitation of the handicapped person & employment to the member of the affected family may reduce the social burden caused by such electricity concerned accidents.

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