Dexamethasone in head and neck cancer patients with microvascular reconstruction : No benefit, more complications

Objectives: Glucocorticoids are widely used in association with major surgery of the head and neck to improve postoperative rehabilitation, shorten intensive care unit and hospital stay, and reduce neck swelling. This study aimed to clarify whether peri-and postoperative use of dexamethasone in reconstructive head and neck cancer surgery is associated with any advantages or disadvantages. Materials and methods: This prospective double-blind randomized controlled trial comprised 93 patients. A total dose of 60 mg of dexamethasone was administered to 51 patients over three days peri-and post-operatively. The remaining 42 patients served as controls. The main primary outcome variables were neck swelling, length of intensive care unit and hospital stay, duration of intubation or tracheostomy, and delay to start of possible radiotherapy. Complications were also recorded. Results: No statistical differences emerged between the two groups in any of the main primary outcome variables. However, there were more major complications, especially infections, needing secondary surgery within three weeks of the operation in patients receiving dexamethasone than in control patients (27% vs. 7%, p = 0.012). Conclusions: The use of dexamethasone in oral cancer patients with microvascular reconstruction did not provide a benefit. More major complications, especially infections, occurred in patients receiving dexamethasone. Our data thus do not support the use of peri-and postoperative dexamethasone in oropharyngeal cancer patients undergoing microvascular reconstruction. (C) 2016 Elsevier Ltd. All rights reserved.Peer reviewe

Risk factors for evaluating early mortality after microvascular reconstruction of head and neck cancers

Background: Free tissue transfer reconstruction carries significant complication rates in surgical head and neck oncology. A registry-based approach offers a possibility to investigate the factors affecting increased morbidity and early mortality, that is, death within 6 months of treatment. Methods: A retrospective registry review was conducted on a series of 317 consecutive microvascular free tissue transfers in head and neck cancer patients performed during 2013-2017 at the Helsinki University Hospital (Helsinki, Finland). All surviving patients had a minimum follow-up of 2 years (range 24-84 months). Results: Overall, 36 (11.4%) early deaths occurred in this series. In multivariable logistic regression analysis, patients aged 75 years and older (p = 0.019), Adult Comorbidity Evaluation-27 (ACE-27) score of 3 (p = 0.048), tumor class T3 (p = 0.005), lymph node class N2 (p = 0.014), or thrombocyte count of 360 (x 10(9) L) or more (p = 0.001) were more likely to die within 6 months of surgery. Of these 36 patients, 27 (75%) had a complication warranting hospital care and most (n = 22, 61%) had several complications. Conclusions: Early postoperative mortality most frequently affects patients aged 75 years and above, with a high ACE-27 score, advanced tumor stage, or high thrombocyte count. Therefore, preoperative assessment and patient selection should have a crucial role in this patient population.Peer reviewe

VCA in the Era of the COVID-19 Pandemic

Peer reviewe

Validation of the Finnish FACE-Q for use in patients undergoing surgery for functional problems or malignancy

The aim of this study was to produce a Finnish version of the FACE-Q scales Satisfaction with Forehead and Eyebrows, Adverse effects: Forehead, Eyebrows and Scalp, and Adverse effects: Cheeks, Lower face and Neck, and assess the performance of these scales and the Satisfaction with Facial Appearance, Satisfaction with Outcome and Appearance-related Psychosocial Distress in patients who had undergone surgery for functional problems or malignancy affecting the forehead or cheeks. The general health-related outcomes instrument 15 D was used as a reference. Patients who had undergone a frontal lift, a direct brow lift, a facelift or an excision of a facial tumor in Helsinki University Hospital plastic surgery department in 2009-2019 were identified. A postal survey study was conducted with 305 patients, of whom 135 (44%) responded. Diagnoses included facial nerve dysfunction (53%), brow ptosis (21%) and skin, mucosal or salivary gland tumor (20%). The FACE-Q scales displayed high internal consistency (Cronbach's alphas >= 0.80) and good reliability on repeat administration. The exploratory factor analysis revealed unifactorial influences for all scales except the Adverse effects: Forehead, Eyebrows and Scalp. Weak correlations with 15 D dimensions were detected. The FACE-Q scales evaluated here are suitable for use in patients with functional problems or malignancy.Peer reviewe

Application of the FACE-Q rhinoplasty module in a mixed reconstructive and corrective rhinoplasty population in Finland

The FACE-Q Rhinoplasty module is a patient-reported outcome instrument developed for the assessment of primarily aesthetic outcomes of rhinoplasty. The aim of our study was to produce a Finnish version of the instrument and validate it for use in patients undergoing nasal reconstruction as well as those treated with a rhinoplasty. Finnish versions of the FACE-Q scales Satisfaction with Nose, Satisfaction with Nostrils and Adverse Effects: Nose, were translated following established guidelines. Patients undergoing nasal resection, reconstruction or rhinoplasty in Helsinki University Hospital plastic surgery department in 2009-2019 were identified using theatre records. A total of 240 Finnish-speaking patients 18-85 years old were approached with a postal survey questionnaire. The questionnaire included the translated FACE-Q modules and those for Satisfaction with Facial Appearance, Appearance-Related Psychosocial Distress and Satisfaction with Outcome, as well as the general health-related quality of life instrument 15 D. The FACE-Q scales translated readily to Finnish. Eighty-three patients (35%) responded to the survey. Most FACE-Q scales performed well with high internal consistency (Cronbach's alphas 0.87-0.92) and repeatability. Only the Adverse Effects: Nose scale displayed poor consistency and a floor effect with 18% of the patients reporting no adverse outcomes. Answers to the Appearance-Related Psychosocial Distress scale were skewed towards no experienced stress. Answers to the other scales were normally distributed with weak correlation with 15 D dimensions. The Finnish translations of the FACE-Q Rhinoplasty scales perform well at assessing a diverse group of patients including those undergoing nasal reconstruction as well as those undergoing rhinoplasty.Peer reviewe

Olfactory and gustatory functions after free flap reconstruction and radiotherapy for oral and pharyngeal cancer : a prospective follow-up study

The senses of smell and taste can be adversely affected by both tumour- and treatment-related factors amongst head and neck cancer patients. The consequences may negatively impact nutritional status as well as quality of life in this patient population. This prospective longitudinal follow-up study is consisted of 44 patients treated for oral cavity, oropharyngeal or hypopharyngeal cancer with tumour resection and microvascular free tissue transfer reconstruction at the Helsinki University Hospital, Helsinki, Finland. Thirty-nine (89%) of them also received radiotherapy. The senses of smell (odour detection, identification and threshold test) and taste (electrogustometry) and quality of life (UW-QOL) were evaluated preoperatively, and at 6 weeks, 3 months, 6 months and 12 months, postoperatively. There were higher scores in the odour detection values in the 6-week and 3-month tests compared with preoperative values for the tumour side. Other detection scores did not differ statistically from the preoperative values neither in the tumour nor the contralateral side. However, in the odour identification test, all posttreatment values were statistically significantly higher than pretreatment ones. In the olfactory threshold test, no statistically significant differences were found between pre- and posttreatment values. Electrogustometry values for the taste on the tumour side were statistically significantly impaired at 6 weeks (p <0.05) and at 3 months (p <0.01) compared with the pretreatment results. They were also impaired at 6 months and at 12 months, although the differences were not statistically significant. The quality of life was impaired after treatment in this patient series. However, the correlation between quality of life and sense of taste was found only at one time point (3 months) and only with contralateral side measurements. We conclude that in oral and pharyngeal cancer patients the postoperative taste problems are related to the impairment on the taste sensation in the tongue but not with the sense of smell. Moreover, the impairment in the quality of life is not clearly related to the impaired sense of taste.Peer reviewe

Systemaattiset kriteerit potilasvalintaan kasvojensiirtoa varten

Kasvoilla on useita tehtäviä vuorovaikutuksesta tärkeiden elintoimintojen ylläpitoon. Perinteisten plastiikkakirurgisten menetelmien lisäksi kasvojensiirto aivokuolleelta luovuttajalta on vakiinnuttamassa paikkaansa vaikeasti kasvoistaan vammautuneiden potilaiden hoitomuotona. Toimenpiteeseen ja elinikäiseen hyljinnänestolääkitykseen liittyvät haitat rajoittavat kasvojensiirtoon soveltuvia potilaita. Toistaiseksi potilasvalinta on tehty tapauskohtaisesti, ja systemaattiset potilasvalintakriteerit puuttuvat. Esittelemme vaikeasti kasvoiltaan vammautuneita potilaita, ja arvioimme systemaattisesti heidän soveltuvuuttaan kasvojensiirtoa varten. Kymmenen vaikean kasvovamman vuoksi hoidetuista potilaista vuosilta 1995-2017 valittiin tutkimukseen. Tietoa kerättiin potilasasiakirjoista sekä kliinisistä tutkimuksista. Vammojen laajuus jaettiin osa-alueisiin: anatominen laajuus (10), toiminnallinen haitta, esteettinen haitta (asteikko 0-9), elämänlaatuarvio (15D-lomake) ja sosiaalinen hyvinvointi. Lisäksi arvioitiin kunkin potilaan immunologinen tila ja vasta-aiheet toimenpiteelle. Vammojen etiologioita olivat palovammat (4), ampuma-asevammat (3), tylpän esineen aiheuttama vamma (1), räjähdysvamma (1) ja neurofibromatoosi (1). Kaikilla potilailla esiintyi keskikasvojen vaurioita, ja kuudella potilaalla oli vähintään 8/10 kasvojen osa-alueista vaurioitunut. Kaikilla potilailla ilmeni jonkin asteinen toiminnallinen vajaus. Arvioitu esteettinen vajaus oli mediaaniltaan 7/9. Elämänlaadun laskun mediaani oli -0.107. Immunologisia vasta-aineita ei havaittu, mutta viidellä potilaalla ilmeni muita vasta-aiheita toimenpiteeseen. Kuudesta vaikeasti vammautuneesta potilaasta kolme todettiin soveltuvaksi kasvojensiirtoleikkaukseen. Vaikeasti kasvoistaan vammautuneet potilaat muodostavat monimuotoisen potilasryhmän. Aiemmin käytetyt potilasvalintakriteerit ovat epätarkkoja, eivätkä ne sisällä painotuksia eri kasvojen toimintojen välillä tai elämänlaadullista arviota. Esittelemme systemaattisen arviointimenetelmän vaikeasti kasvoiltaan vammautuneiden arvioon. Arviointimenetelmä on hyödyllinen myös toimenpiteen onnistumisen ja potilaiden toipumisen seurannassa.Aim. There is a need for a systematic approach to evaluate patients for potential face transplantation (FT). Materials and Methods. Ten patients with severe facial defects treated between 1995-2017 formed the study group. Data was collected from patient charts and examinations. Facial deficiencies were subdivided into different categories: anatomical region (10 regions), facial function, aesthetic defect (range 0-9-worst), impact on health-related quality of life (HRQoL) (15D questionnaire, range 0-1) and social well-being. Immunological status and contraindications were also evaluated. Results. Defect aetiology consisted of burns (4), ballistic injury (3), blunt injury (1), blast injury (1), and neurofibromatosis type I (1). All patients had central facial deficiencies and 6 patients had 8 or more injured regions. All patients had at least partial loss of facial function. The median aesthetic disfigurement score was 7. The median lowering of 15D score was -0.107. None were significantly sensitized although 5 patients had significant contraindications for FT. Three of the 6 patients with a severe overall facial deficiency, were considered as potential FT candidates. Conclusions. We herein propose a comprehensive and systematic tool to evaluate potential candidates for FT. This approach includes assessment of anatomical regions affected, facial function, aesthetics, social well-being and HRQoL