Interpolated subcutaneous fat pedicle melolabial flap for large nasal lining defects

Full‐thickness nasal deformities are a reconstructive challenge. Restoration of a reliable internal lining is critical for a successful reconstruction. Septal hinge flaps are the workhorse for internal lining defects. However, these and other intranasal mucosal flaps are sometimes unavailable due to prior harvest or previous oncologic resection. We present the two‐stage interpolated subcutaneous fat pedicle melolabial flap for lining large defects when traditional intranasal flaps are unavailable. This approach is particularly useful when one forehead flap has already been expended, preserving the patient's remaining forehead tissue for external cover. Laryngoscope, 2012Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/96708/1/23595_ftp.pd

Microvascular cricoid cartilage reconstruction with the thoracodorsal artery scapular tip autogenous transplant

Conservation laryngeal surgery has been limited by difficulties with partial resection of the cricoid. Numerous options have been suggested that include temporoparietal flaps, free cartilage grafts, radial forearm free tissue transfers, and tracheal autotransplantation with vascular carriers. The authors present a one‐stage procedure for the reconstruction of the cricoid cartilage based on the thoracodorsal artery scapular tip (Tdast) autogenous transplant that uses the curved tip of the scapula and does not create a secondary tracheal defect. Because the Tdast is a vascularized graft it may withstand radiation treatment.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90190/1/22386_ftp.pd

Response rates for mailout survey-driven studies in patients with head and neck cancer

Background: Mailout survey studies are becoming more prevalent in the head and neck literature. The objective of this paper is to summarize response rates in patients with head and neck cancer, and to provide recommendations surrounding methodology used to design and implement mailout survey questionnaires. Methods: The results of this paper are from a study assessing the measurement properties of the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) in head and neck cancer patients. A modified Dillman tailored design approach was used. Results: The methods used yielded a response rate of 80% with this patient population. Conclusion: This is a considerably higher response rate than other reports in the oncology literature. © 2010 Wiley Periodicals, Inc. Head Neck, 2010Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78489/1/21363_ftp.pd

Italian validation of the Neck Dissection Impairment Index questionnaire

Objective: The Neck Dissection Impairment Index (NDII) questionnaire is a useful and validated Quality of Life (QoL) evaluation instrument in patients undergoing major head-neck surgery. Its English version has been used in several studies in the last years. The aim of this work is to validate the NDII in Italian for both patient assessment and future studies. Materials and methods: Cross-cultural adaptation of the NDII was performed using standard techniques. Items of the original NDII were translated into Italian by a professional translator and two bilingual investigators. A final consensus version was obtained and given to two professional translators to produce a literal translation into English. The two translators and an expert committee synthesised the results of the translations in an English back-translated version that was compared with the original to check that they had the same semantic value. Results: Finally, a total of 42 patients completed both copies of the translated questionnaires. Internal consistency proved to be excellent, with Cronbach's alpha = 0.95. Conclusions: The NDII was successfully translated into Italian and its use was easy for patients. The translation of the NDII can represent a useful tool for individual patient assessment and future research

Neck spasm after chemoradiotherapy for head and neck cancer: Natural history and dosimetric correlates

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102727/1/hed23284.pd

Incidence and management of rhinosinusitis after complex orbitofacial reconstruction.

OBJECTIVE: To examine the sinus-related sequelae of free flap reconstruction for complex orbitofacial defects. STUDY DESIGN: Retrospective chart review METHODS: Demographic, clinical, and radiographic data on a series of 55 patients who had undergone free tissue transfer for orbitofacial reconstruction was retrospectively reviewed. Follow-up of ≥ 3 months was available for 49 patients. Outcome measures studied included clinical or radiographic evidence of sinusitis and the need for sinus surgery. RESULTS: The most commonly involved sinuses were the ethmoid (n=40) and maxillary (n=38) sinuses, and the anterolateral thigh was the most common flap used (n=41). Clinical and/or radiographic sinusitis was evident in 21 patients (43%), and 10 patients (20%) required sinus surgery at some point during follow-up. Involvement of multiple sinuses in the initial orbitofacial surgery was associated with a significantly increased need for subsequent sinus surgery (p=0.009). Adjuvant radiotherapy and adjuvant chemo-radiotherapy were associated with a significantly increased risk for the development of rhinosinusitis (p=0.045 and 0.016 respectively). CONCLUSION: Rhinosinusitis and the need for operative management of sinus obstruction are common in patients having undergone complex orbitofacial reconstruction. Careful management of the paranasal sinuses is an important component of the multidisciplinary treatment of such patients

Role of parathyroid hormone therapy in reversing radiation‐induced nonunion and normalization of radiomorphometrics in a murine mandibular model of distraction osteogenesis

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/101851/1/hed23216.pd

Role of parathyroid hormone in regeneration of irradiated bone in a murine model of mandibular distraction osteogenesis

BackgroundThe purpose of this study was to measure the histologic and histomorphometric effects of parathyroid hormone (PTH) treatment on irradiated bone undergoing distraction osteogenesis (DO).MethodsThirty‐four rats were divided into 3 groups. The control group underwent DO and the radiation control group underwent radiotherapy (RT) before DO. The PTH group underwent RT and received PTH during DO. Quantitative histology and histomorphometry were performed.ResultsRT resulted in a depletion of osteocytes and increase in empty lacunae. Treatment with PTH resulted in an increase in osteocyte counts and decrease in empty lacunae (p < .05), restoring osteocytes to levels seen in nonradiated bone (p = .121). RT decreased bone volume to tissue volume (BV‐TV) ratio and increased osteoid volume to tissue volume (OV‐TV) ratio, signifying increased immature bone formation. PTH treatment restored OV‐TV ratio to that observed in nonradiated bone.ConclusionPTH treatment of irradiated bone enhanced bone regeneration and restored osteocyte counts and OV‐TV ratio to levels comparable to nonradiated bone. © 2016 Wiley Periodicals, Inc. Head Neck 39: 464–470, 2017Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136287/1/hed24612.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136287/2/hed24612_am.pd

Assessment of the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire for use in patients after neck dissection for head and neck cancer

BackgroundIn this cross‐sectional study, the sensibility, test‐retest reliability, and validity of the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire were assessed in patients who underwent neck dissection.MethodsSensibility was assessed with a questionnaire. Test‐retest reliability was performed with completion of the DASH questionnaire 2 weeks after initial completion; validity, by evaluating differences in scores between patients undergoing different types of neck dissections and correlating DASH scores with Neck Dissection Impairment Index (NDII) scores.ResultsThe DASH questionnaire met sensibility criteria. For test‐retest reliability analysis, the intraclass coefficient was 0.91. The DASH questionnaire showed differences between patients who underwent accessory nerve‐sacrifice and nerve‐sparing neck dissection. DASH questionnaire scores strongly correlated with NDII scores (r = ‐0.86).ConclusionAlthough this study provides preliminary data on some psychometric properties of the DASH questionnaire in patients who have undergone a neck dissection, further assessment of responsiveness and other properties are required. © 2014 Wiley Periodicals, Inc. Head Neck 37: 234‐242, 2015Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110617/1/hed23593.pd

Prevention of wound complications following salvage laryngectomy using free vascularized tissue

Background. Total laryngectomy following radiation therapy or concurrent chemoradiation therapy is associated with unacceptably high complication rates because of wound healing difficulties. With an ever increasing reliance on organ preservation protocols as primary treatment for advanced laryngeal cancer, the surgeon must develop techniques to minimize postoperative complications in salvage laryngectomy surgery. We have developed an approach using free tissue transfer in an effort to improve tissue vascularity, reinforce the pharyngeal suture line, and minimize complications in this difficult patient population. The purpose of this study was to outline our technique and determine the effectiveness of this new approach. Methods. We conducted a retrospective review of a prospective cohort and compared it with a historical group (surgical patients of Radiation Therapy Oncology Group (RTOG)-91-11 trial). Eligibility criteria for this study included patients undergoing salvage total laryngectomy following failed attempts at organ preservation with either high-dose radiotherapy or concurrent chemo/radiation therapy regimen. Patients were excluded if the surgical defect required a skin paddle for pharyngeal closure. The prospective cohort consisted of 14 consecutive patients (10 males, 4 females; mean age, 58 years) who underwent free tissue reinforcement of the pharyngeal suture line following total laryngectomy. The historical comparison group consisted of 27 patients in the concomitant chemoradiotherapy arm of the RTOG-91-11 trial who met the same eligibility criteria (26 males, 1 female; mean age, 57 years) but did not undergo free tissue transfer or other form of suture line reinforcement. Minimum follow-up in both groups was 12 months. Results. The overall pharyngocutaneous fistula rate was similar between groups—4/14 (29%) in the flap group, compared with 8/27 (30%) in the RTOG-91-11 group. There were no major wound complications in the flap group, compared with 4 (4/27, 14.8%) in the RTOG-91-11 group. There were no major fistulas in the flap group, compared with 3/27 (11.1%) in the RTOG-91-11 group. The rate of pharyngeal stricture requiring dilation was 6/14 (42%) in the flap group, compared with 7/27 (25.9%) in the RTOG-91-11 group. In our patients, the rate of tracheoesophageal speech was 14/14 (100%), and complete oral intake was achieved in 13/14 (93%) patients. Voice-Related Quality of Life Measure (V-RQOL) and Performance Status Scale for Head and Neck Cancer Patients (PSS-HN) scores suggest that speech and swallowing functions are reasonable following free flap reinforcement. Conclusions. Free vascularized tissue reinforcement of primary pharyngeal closure in salvage laryngectomy following failed organ preservation is effective in preventing major wound complications but did not reduce the overall fistula rate. Fistulas that developed following this technique were relatively small, did not result in exposed major vessels, and were effectively treated with outpatient wound care rather than readmission to the hospital or return to operating room. Speech and swallowing results following this technique were comparable to those following total laryngectomy alone. © 2007 Wiley Periodicals, Inc. Head Neck 2007Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/56020/1/20492_ftp.pd