Donor site morbidity of the fasciocutaneous radial forearm flap: what does the patient really bother?

The objective of this study was the evaluation of donor site morbidity in head and neck cancer patients after reconstruction using a free vascularized radial forearm flap with emphasis on subjective complaints. Fifty patients who underwent at least 6 months before a reconstruction using a free vascularized radial forearm flap were asked to fill out two questionnaires regarding cosmetics and sensibility and forearm disabilities. Furthermore, a function test including movement extensions (flexion–extension, ulnar–radial deviation and pronation–supination), strength (pinch and grip) and temperature (digiti I and V) of the donor and non-donor site were measured and compared. Thirty-five percent of the patients reported no complaints regarding cosmetics and sensibility and 75% mentioned no forearm disabilities. There was no difference in movement extensions, temperature and grip strength between donor and non-donor sites. The difference in pinch strength appeared to be significant (p < 0.001). The total score of the questionnaire on forearm disabilities correlated significantly with extension, pronation and grip strength of the donor arm. Donor site morbidity of the radial forearm flap measured by objective functional tests was limited but subjective self-ratings revealed complaints regarding cosmestics and sensibility and to a lesser extent regarding forearm disability. The present data may be used for solid patient counselling

18F-NaF PET/CT imaging of bone formation induced by bioactive glass S53P4 after mastoid obliteration

Purpose: Bioactive glass has been successfully used for surgical treatment of chronic infections in bone and bone cavities. Besides infection control, new bone formation is induced by the bioactive glass which is considered to have osteoconductive properties. Evaluation of postsurgical changes after bone graft surgery is generally performed with conventional radiographs or CT/MR imaging, but 18F-NaF PET/CT might be more suitable since it has a high and rapid bone uptake, accompanied by a fast blood clearance leading to a high bone to background ratio. Case: Obliteration with S53P4 bioactive glass of the mastoid and middle ear was performed in a patient suffering from chronic otitis media. Control of the chronic otitis media was achieved, and follow-up imaging after 3 years with 18F-NaF PET/CT showed increased uptake in the obliterated cavity indicating new bone formation. Conclusion: 18F-NaF PET/CT is able to detect new bone formation after obliteration of the mastoid with S53P4 bioactive glass

Intracranial metastases in patients with squamous cell carcinoma of the head and neck

BACKGROUND: Intracranial metastases are rarely clinically diagnosed in patients with head and neck squamous cell carcinoma. Only 7 patients with metastases to the cavernous sinus from head and neck squamous cell carcinomas have been reported. METHODS: A retrospective study revealed 13 patients with intracranial metastases of head and neck squamous cell carcinoma. In a 53-year-old woman a cavernous sinus metastasis of a laryngeal carcinoma was histologically diagnosed by using a CT-guided surgical navigation system and was treated with stereotactic radiotherapy. RESULTS: The mean survival was 4.3 months. Predictive factors for longer survival were absence of extracranial disease, age younger than 60 years, and treatment with radiotherapy. CONCLUSIONS: The prognosis for patients with intracranial disease is poor. The current development of computer-assisted stereotactic navigation and stereotactic radiotherapy may facilitate surgical diagnostic exploration and improve treatment, especially in patients without extracranial disease

Evaluation of donor site function and morbidity of the fasciocutaneous radial forearm flap

To assess the results of the use of the free radial forearm flap in terms of objective morbidity and subjective patient response. The donor sites were examined from 37 patients who underwent reconstruction with a free fasciocutaneous radial forearm flap in the head and neck after ablative tumor surgery. Patients were asked to fill in a written questionnaire. The following additional tests were performed: resting skin temperature of digits I and V, temperature after submersion in iced water, grip and pinch tests, and goniometry. Resting skin temperature was slightly decreased for donor hands 0.69 degrees C (P <.001) and 0.31 degrees C (P = .048) for digits I and V, respectively, but recovery after submersion in iced water showed no differences. The strength tests and goniometry revealed no statistically significant findings between donor and control sides. On the questionnaire, 9 patients (24%) reported slightly impaired function, 14 (38%) could not wear their watch or bracelet, 17 (46%) reported numbness, 5 (14%) reported soreness, 5 (14%) reported itching, 6 (16%) reported cold intolerance, 5 (14%) reported bad cosmetic appearance, and 9 (24%) expressed the opinion that they were insufficiently counseled. There is a negligible objective morbidity of a free radial forearm flap harvest procedure, but a number of patients have subjective complaints when asked. Elaborate presurgical counseling can probably reduce these complaint

Production of Monoclonal Antibodies to Squamous Cell Carcinoma Antigens

• For therapeutic or diagnostic use of monoclonal antibodies in clinical oncology, high-affinity IgG antibodies to tumorassociated antigens have to be generated. In order to find out by what immunization schedule the chance to generate such antibodies is increased, we evaluated three different immunization protocols with and without attempts to induce tolerance to common tissue antigens. Mice were immunized either (1) by repeated intraperitoneal injections, (2) by a single intrasplenic injection, or (3) by an intraperitoneal injection followed by an intrasplenic booster. Whereas a single intrasplenic immunization resulted in low-affinity antibodies to tumor-associated antigen, high-affinity antibodies were generated with the other two protocols, although at a lower frequency. No benefit was seen from tolerance induction. The intraperitoneal/intrasplenic protocol was found to be superior over the other protocols because of minimal antigen dose and immunization time, as well as a higher frequency of hybridoma formation. (Arch Otolaryngol Head Neck Surg. 1990;116:181-185)

Efficacy of S53P4 Bioactive Glass for the Secondary Obliteration of Chronically Discharging Radical Cavities

Abstract Objective Present the results of the secondary obliteration of chronically discharging radical cavities using S53P4 bioactive glass (BAG). Study Design Retrospective cohort study. Setting Single‐center study. Methods A single‐center retrospective cohort study was conducted of all patients that underwent secondary obliteration of persistently draining radical cavities using S53P4 BAG between 2011 and 2022. Patients with middle ear cholesteatoma were excluded. The main outcome was postoperative otorrhea, as indicated by Merchant grading. Results In total, 97 patients were included. The median postoperative follow‐up time was 3.9 years (range 0.5‐10.4). Average time between the original canal wall down surgery and the secondary obliteration was 25.3 years (SD 11.7, range 2‐66). At the most recent follow‐up visit, a Merchant grade of 0 to 1 was observed in 95% of the cases. There were no cases of sensorineural hearing loss or facial palsy, one case developed a retro auricular skin defect and 1 patient developed CSF leakage. Minor complications were seen in 10 patients (10%). Ossicular chain reconstruction with a titanium prosthesis was performed in 42 cases, resulting in a median improvement of 11.2 dB in air conduction thresholds. In 9/42 cases (21%), closure of the postoperative air‐bone gap to ≤20 dB was achieved. Twenty‐five percent of cases could be discharged from out‐patient visits. Conclusion Revision of persistently draining radical cavities with BAG obliteration is feasible and results in a dry and safe ear in 95% of the patients, thereby enabling wearing of a conventional hearing aid. Out‐patient visits could be ceased in 25% of the cases

Cholesteatoma surgery in the pediatric population: remaining challenges in the era of mastoid obliteration

Purpose: To present the first pediatric study on the safety and efficacy of mastoid obliteration using S53P4 bioactive glass (BAG) for cholesteatoma surgery. Methods: A single-center retrospective cohort study was conducted. Inclusion criteria were pediatric cases (≤ 18 years) and at least at least one year of follow-up including non-echo planar diffusion-weighted MRI to assess cholesteatoma recidivism. Both canal wall up (CWU) and canal wall down (CWD) procedures were evaluated. Results: A total of 61 cases (56 patients) were included. Most cases had an otologic history before the development of the cholesteatoma. CWU procedure was performed in 18 cases (30%) and CWD procedure in 43 cases (70%). The cholesteatoma recidivism rate was 33% after a mean follow-up period of 58 months. Kaplan–Meier curve estimated a 5-year recidivism rate of 40%. Few complications were seen that were all minor and resolved spontaneously or after local or systemic treatment. Control of the infection (merchant grade 0–1) was achieved in 98% of the cases. Closure of the air–bone gap within 20 dB was achieved in 22% of the cases with complete audiometric evaluation. Conclusion: In this MRI-controlled study, we show the safety and efficacy of S53P4 BAG for mastoid obliteration in a pediatric cholesteatoma cohort. Postoperative complications were both rare and minor, and a dry ear was achieved in almost all patients. Nevertheless, persistent hearing loss and the apparent high recidivism rate reflect the challenging nature of pediatric cholesteatoma