scholarly journals Application of Viscoelastic testing to the field of Otolaryngology Head and Neck Surgery: A Scoping Review

2020 ◽  
Vol 3 ◽  
Author(s):  
Faisal Shariff ◽  
Mathew Marsee ◽  
Mark Walsh
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Scoping Review ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Sinus Surgery ◽  
Facial Trauma ◽  
Blood Component ◽  
Inclusion Criteria ◽  
Obstructive Sleep

Background:  In Otolaryngology Head and Neck Surgery (OHNS), hematologic management requires attention to the intricate nature of hemostatic competence. Elderly patients can experience drug induced coagulopathies. Strategies are needed in order to minimize hemorrhagic and thromboembolic risk and maximize positive outcomes. Viscoelastic tests (VETs) such as Thromboelastography (TEG) and Rotational Thromboelastometry (ROTEM) have been used to guide blood component therapy. The purpose of this scoping review is to understand the utilization of VETs in OHNS.    Methods:     This scoping review included studies that discussed the utilization of VETs in the field of OHNS. The inclusion criteria was studies that discussed the application of VETs in Flap/Plastic Reconstruction, Facial Trauma/Resuscitation, Tonsillectomy, Obstructive Sleep Apnea (OSA), Epistaxis, Sinus Surgery, and HNC Resection. Studies that focused on general medical VET use were not included.    Results:    Fourteen articles met the study inclusion criteria from an initial pool of 45 articles. Seven articles discussed the use of VETs in free flap/reconstructive surgery, five articles explored use in HNC, two articles discussed use in facial trauma and resuscitation, one article mentioned use in OSA, and one article examined use in epistaxis.     Conclusion and potential impact:    Of the fourteen articles included, two articles found no clinically significant association between TEG parameters and flap loss or complications. Five studies found that TEG or ROTEM helpful in predicting coagulation clotting, a prothrombotic state, or a hyperfibrinolytic state in free flap and HNC patients. For facial trauma and HNC cancer patients two different studies found ROTEM helpful in guiding blood component resuscitation. Using the TEG, one study demonstrated a hypercoagulable state in OSA patients. This review encourages wider use of VETs in OHNS in order to monitor hemostasis and improve surgical outcomes. Further research is necessary to better understand how VETs can tailor hematologic management of OHNS patients. 

scholarly journals Late Free Flap Failure in Head and Neck Reconstruction: A Systematic Review

2018 ◽  
Vol 97 (7) ◽  
pp. 213-216 ◽  
Author(s):  
David Forner ◽  
Blair A. Williams ◽  
Fawaz M. Makki ◽  
Jonathan R.B. Trites ◽  
S. Mark Taylor ◽  
...  
Keyword(s):  
Systematic Review ◽  
Head And Neck ◽  
Free Flap ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Head And Neck Reconstruction ◽  
Time To Failure ◽  
Close Monitoring ◽  
Flap Failure ◽  
Vascular Compromise

Our objectives were to review all reported cases of late flap failure in head and neck surgery and describe any relevant patterns. We conducted a systematic review of all published cases of free flap failure after postoperative day 7 in head and neck surgery from January 1990 to January 2018. Data were collected with respect to flap type, site of reconstruction, reason for failure, and time to failure. A total of 45 cases of late free flap failure in the head and neck were identified. Among the 34 cases in which the necessary data were available for analysis, 50% of late failures occurred between postoperative day 7 and 14. Common reasons for failure were abscess and vascular compromise. We conclude that most late flap failures occur in the second postoperative week. In patients with risk factors for flap failure, close monitoring for up to 14 days after surgery could detect flap compromise before the flap is lost.

Australian training for contemporary airway management of obstructive sleep apnoea in ENT surgery: current status and future recommendations

2014 ◽  
Vol 129 (S1) ◽  
pp. S8-S15 ◽  
Author(s):  
S Mackay ◽  
S Holmes ◽  
A Jones
Keyword(s):  
Head And Neck ◽  
Obstructive Sleep Apnoea ◽  
Neck Surgery ◽  
Sleep Apnoea ◽  
Head And Neck Surgery ◽  
Current Status ◽  
Cadaver Dissection ◽  
Australian Society ◽  
Sleep Surgery ◽  
Obstructive Sleep

AbstractBackground:The identification and treatment of adult obstructive sleep apnoea and other sleep-related breathing issues demands nuanced clinical judgement to determine if surgery is appropriate and which surgery should be performed. No study to date has evaluated the sleep medicine curriculum from the perspective of the Australian ENT surgical trainee, or addressed potential strategies for improving levels of surgical skill and knowledge in this field.Methods:A cross-sectional survey was used to assess knowledge of sleep surgery in trainees enlisted with the Australian Society of Otolaryngology Head and Neck Surgery. After a cadaver dissection workshop on the latest reconstructive surgical techniques in adult OSA, a second survey was used to assess changes in the likelihood of applying techniques.Results:Overall, trainee confidence, knowledge and exposure to sleep-disordered breathing cases averaged below 50 per cent. The cadaver dissection workshop achieved consistent improvements in all areas assessed.Conclusion:Low confidence and lack of exposure to sleep surgery cases for ENT trainees supports a broadening of the Australian Society of Otolaryngology Head and Neck Surgery curriculum. This paper outlines possible ways to improve this situation.

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