Primary Orbital Melanoma: An Investigation of a Rare Malignancy Using the National Cancer Database

xlomafota13 shared this article with you from Inoreader Primary Orbital Melanoma: An Investigation of a Rare Malignancy Using the National Cancer Database Via The Laryngoscope Objectives Primary orbital melanoma (POM) is a rare disease with limited data on survival and best treatment practices. Here we utilize the National Cancer Database (NCDB) to determine the overall survival (OS) and covariates that influence mortality. Study Design: Retrospective cohort study. Methods All patients diagnosed with POM from 2004 to 2016 were identified in the NCDB. Patient and oncologic data were analyzed using the Kaplan–Meier method and multivariate models for the primary outcome of OS. Results A total of 129 patients were identified. Median OS was 36.9 months (95% confidence interval [CI] 24.1–78.7 months) with mean 5‐year survival of 42.0% (CI 33.2%–53.2%). Treatments received included surgery alone (43.4%), radiation alone (23.3%), and surgery followed by radiation (20.2%). The multivariate model demonstrated an increased risk of death associated with age over 80 years (hazard ratio [HR] 3.41, CI 1.31–8.86, P = .012), a Charlson‐Deyo comorbidity score of 2 or greater (HR 5.30, CI 1.87–15.03, P = .002), and no treatment (HR 2.28, CI 1.03–5.06, P = .042). For every 1 cm increase in tumor size, there was an increased risk of death (HR 1.06, CI 1.00–1.13, P = .039). When compared to surgery alone, no other treatment modality had an effect on OS. Conclusions This study leveraged multiyear data from the NCDB to provide prognostic and demographic information on the largest known cohort of POM cases. Increased age, increased comorbidities, not receiving treatment, and larger tumor size were associated with increased mortality. There was no clear survival advantage for specific treatments. Level of Evidence IV Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Complications of Free Flaps for Oromandibular Reconstruction

xlomafota13 shared this article with you from Inoreader A Comprehensive Analysis of Complications of Free Flaps for Oromandibular Reconstruction Via The Laryngoscope Objectives/Hypothesis To determine the frequency and management of short‐ and long‐term complications related to oromandibular free flap reconstruction and identify potentially predictive factors of hardware complications. Study Design Retrospective chart review. Methods A retrospective database from chart review was formed consisting of 266 oromandibular free flap reconstructions performed at a single institution over a 15‐year period. Data were collected on demographics, surgical treatment, complications, and management of complications. Subgroup univariate and multivariate analyses were performed to compare patients with hardware complications and those without. Results Eighty‐one of 266 patients (30.5%) that underwent oromandibular reconstruction had an early complication (<4 weeks after surgery), and the most common complications were cervical wound dehiscence (11.3%) and fistulas (9.40%). Eighty of 266 patients (30.1%) had a long‐term complication (>4 weeks after surgery) and the most common complication was plate exposure (26.7%). Univariate and multivariate analyses showed no association between whether there was hardware extrusion and fibula versus scapula, smoking history, virtual surgical planning (VSP), and dental implantation (P > .05). Only early complications (OR, 3.59, 95% CI, 1.83–7.05, P < .01) and patients undergoing oromandibular reconstruction for osteoradionecrosis (OR, 2.26, 95% CI, 1.10–4.64, P = .03) were strongly and independently associated with subsequent hardware extrusion on univariate analysis. Conclusions Both short‐ and long‐term complications are common after oromandibular reconstruction. The most important predictive factor for a late complication is an early complication and prior radiation. There was no difference of plate complications among the various free flap types. Dental implantation and use of VSP were not associated with hardware complications. Level of Evidence 4 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Trends in Operative Complex Middle and Upper Maxillofacial Trauma: A 17‐Year Study

xlomafota13 shared this article with you from Inoreader Trends in Operative Complex Middle and Upper Maxillofacial Trauma: A 17‐Year Study Via The Laryngoscope Objectives/Hypothesis Over 3 million incidents of facial trauma occur each year in the United States. This study aims to determine trends in operative middle and upper maxillofacial trauma in one of the largest US cities. Study Design Retrospective case‐control study. Methods Retrospective chart review of all operative middle and upper maxillofacial trauma from July 1993 to July 2010 presenting to Los Angeles County Hospital, a Level I Trauma Center. Data included demographics, mechanism of injury, and fracture characteristics. Results Analysis was performed for a total of 4,299 patients and 5,549 facial fractures. Mean patient age was 34.6, and most patients were male (88%). Between the two time periods (1993–2001 and 2002–2010), there was a 42% reduction in operative maxillofacial trauma (3,510 to 2,039). Orbital floor and zygomaticomaxillary complex fractures were the most prevalent types of fractures. Panfacial fractures demonstrated the largest reduction in number of fractures (325 to 5, P<0.01). Assault and motor vehicle accidents (MVA) were the two most common mechanisms of injury. Operative fractures due to MVAs decreased (390 to 214, P = .74), whereas fractures due to assault increased (749 to 800, P<0.01). Compared to adults, pediatric facial trauma (age < 18) were caused by a higher percentage of MVAs (27% vs. 13%), auto versus pedestrian (9% vs. 5%), and gunshot wounds (8% vs. 4%) (P<0.01). Conclusions Operative middle and upper maxillofacial trauma decreased over a 17‐year period. Assault was the most significant mechanism of trauma overall. These trends suggest that focusing future prevention strategies on curtailing interpersonal violence may more effectively address the burden of facial trauma. Level of Evidence 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Extracranial/Intracranial Vascular Bypass in the Treatment of Head and Neck Cancer ‐ Related Carotid Blowout Syndrome

xlomafota13 shared this article with you from Inoreader Extracranial/Intracranial Vascular Bypass in the Treatment of Head and Neck Cancer ‐ Related Carotid Blowout Syndrome Via The Laryngoscope Objective/Hypothesis To investigate the endovascular intervention or extracranial/intracranial (EC/IC) vascular bypass in the management of patients with head and neck cancer‐related carotid blowout syndrome (CBS). Study Design Retrospective case series. Methods Retrospective analysis of clinical data of patients with head and neck cancer‐related CBS treated by endovascular intervention and/or EC/IC vascular bypass, analysis of its bleeding control, neurological complications, and survival results. Results Thrity‐seven patients were included. Twenty‐five were associated with external carotid artery (ECA); twelve were associated with internal or common carotid artery (ICA/CCA). All patients with ECA hemorrhage were treated with endovascular embolization. Of the 12 patients with ICA/CCA hemorrhage, 9 underwent EC/IC bypass, 1 underwent endovascular embolization, and 3 underwent endovascular stenting. For patients with ECA‐related CBS, the median survival was 6 months, and the 90‐day, 1‐year, and 2‐year survival rates were 67.1%, 44.7%, and 33.6%, respectively; the estimated rebleeding risk at 1‐month, 6‐month, and 2‐year was 7.1%, 20.0%, and 31.6%, respectively. For patients with ICA/CCA‐related CBS, the median survival was 22.5 months, and the 90‐day, 1‐year, and 2‐year survival rates were 92.3%, 71.8%, and 41.0%, respectively; the estimated rebleeding risk at 1 month, 6 months, and 2 years is 7.7%,15.4%, and 15.4%, respectively. ICA/CCA‐related CBS patients have significantly longer survival time and lower risk of rebleeding, which may be related to the more use of EC/IC vascular bypass as a definite treatment. Conclusions For patients with ICA/CCA‐related CBS, if there is more stable hemodynamics, longer expected survival, EC/IC vascular bypass is preferred. Level of Evidence 4 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Sirolimus Therapy for Intractable Lymphatic Malformations

xlomafota13 shared this article with you from Inoreader Efficacy of Initial Sirolimus Therapy for 27 Patients with Intractable Lymphatic Malformations Via The Laryngoscope Objective/Hypothesis To evaluate the efficacy of initial sirolimus therapy in the treatment of intractable head and neck lymphatic malformations (LMs) in children. Study Design Prospective open‐label study. Methods In this study, Twenty‐seven children diagnosed with LMs were given oral sirolimus as primary treatment over a minimum 6‐month trial. The major parameter to evaluate therapeutic outcome was percentage of lesion volume change compared with baseline. Average serum sirolimus concentrations, and adverse side effects, were monitored throughout the study period. Results Fifteen girls and twelve boys, average age 27 months (16 days–171 months), constitute the study group. Treatment was deemed effective for twenty‐three participants, judged as fair in seven, good in nine, and excellent in seven. Two patients had minimal improvement, and two had increased volume to some degree. Effectiveness differed among LMs subtypes with responsiveness of macrocystic LMs exceeding that of microcystic LMs (P < .05). Adverse drug reactions totaled 27 events in ten patients, the majority being mild with upper respiratory infections being most common. Conclusions Sirolimus as initial therapy is effective in decreasing lesion volume in intractable LMs in head and neck region, especially in macrocystic subtypes. Although most cases cannot be completely cured, side effects are few and tolerable. Level of Evidence IV Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Simultane Implantation von Epithesenankern und Bonebridge zur Versorgung großer Ohrmissbildungen

xlomafota13 shared this article with you from Inoreader Simultane Implantation von Epithesenankern und Bonebridge zur Versorgung großer Ohrmissbildungen Via Laryngo-Rhino-Otologie Laryngorhinootologie DOI: 10.1055/a-1369-9530 Hintergrund Die chirurgische Versorgung mit einem Hörimplantat und Epithesen bei Ohrmissbildungen bietet eine gute Kombination aus Hörrehabilitation und kosmetischer Rekonstruktion. Oft wird die Versorgung in 2-zeitigen Operationsschritten durchgeführt. Ziel der Arbeit war es, Erfahrungswerte mit einem Vorgehen zu gewinnen, bei dem das Hörimplantat und die Epithesenanker simultan eingesetzt werden. Material und Methoden Vier Ohren von 3 Patienten (nw = 1, nm = 2) mit großen Ohrmissbildungen (Typ III nach Weerda) erhielten jeweils in einer Operation eine MedEL Bonebridge und einen Epithesenanker mit 3 Basispfosten. Zuvor war die Indikation mithilfe des Active Middle Ear Implant (aMEI) -Scores nach Frenzel (2013) gestellt worden. Ergebnisse Alle Patienten erzielten jeweils 4 Punkte im aMEI-Score, was auf eine ungünstige Prognose für eine erfolgreiche Implantation eines aktiven Mittelohrimplantats hinwies. Die Versorgung mit der Bonebridge und einem Epithesenanker konnte daraufhin komplikationslos durchgeführt werden. Postoperativ erfolgten nach 4 Wochen die audiologische Erstanpassung und die Bestückung mit Magneten. In der Audiometrie bestand ein funktioneller Gewinn von bis zu 30 dB sowie ein verbessertes Sprachverständnis. Die Epithese wurde dem gesunden Ohr nachgebildet. Nach der Versorgung waren die Patienten mit dem audiologischen und kosmetischen Ergebnis zufrieden. Schlussfolgerungen Das simultane chirurgische Vorgehen mit einem Hörimplantat und Epithesenankern stellt eine gute Option in der Versorgung von Ohrmissbildungen dar. Der aMEI-Score war ein hilfreiches Instrument zur Indikationsstellung. Durch das Vorgehen konnten das Operationsrisiko und der Aufwand der Versorgung reduziert werden. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract & nbsp;|  Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Extracranial & Intracranial Complications in Chronic Suppurative Otitis Media

xlomafota13 shared this article with you from Inoreader To Study the Prevelance of Extracranial & Intracranial Complications in Chronic Suppurative Otitis Media Via Otolaryngology Indian Abstract Prior to antibiotic era, complications rate of CSOM was 2.3 to 4% cases. With advent of newer antibiotics, radiological surgical techniques the complication greatly reduced to 0.15–0.04% and mortality decreases from 25 to 8% 5, still early diagnoses and management is still the cornerstone of prevention of CSOM complications. To study the prevalence of extracranial and intracranial complications in CSOM. It is a prospective cross sectional study done in one year from January 2018 to January 2019, at Department of ENT, G R Medical College, Gwalior, M P, India. In our study 50 patients presented with complications of CSOM during January 2018 to January 2019, ECC was found more common than ICC ECC—52%, ICC—46%, mastoid abscess was found most commonly in ECC 50%, brain abscess was the most common found intracranial complication of CSOM. Continuous negligence of CSOM leads to various extracranial complications lethal intracranial complications like brain abscess, meningitis, etc. hence it is recommended that health education program should be provided as prevalence is still higher in younger age group and low socioeconomic class especially in rural and tribal regions. In spite of newer antibiotics, radiological modalities and surgical advancement. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.