Contemporary use of sentinel lymph node biopsy in the head and neck

Sentinel lymph node biopsy has become a well-established and commonplace practice in many oncologic disease sites as a means to stage the regional lymphatics, avoid unnecessary surgery and decrease patient morbidity. In the head and neck, its role is well established for cutaneous melanoma with proven fidelity and survival benefit. Its role in use for other sites such as oral cavity carcinoma continues to develop with promising results from several recent trials. Although not widely adopted, the potential benefits of sentinel lymph node biopsy in the management of oral cavity carcinoma are apparent. Refinements in technology and protocols including development of novel radiopharmaceutical tracers, routine incorporation of detailed anatomic imaging, increasing surgeon experience and development of new intraoperative identification aids will likely lead to improvements in the use and accuracy of this technique. Keywords: Oral cavity cancer, Sentinel lymph node, Head and neck cancer, Squamous cell carcinoma, Lymphoscintigraph

Giant parathyroid adenoma causing primary hyperparathyroidism

Giant Parathyroid Adenoma (GPA) is a rare cause of primary hyperparathyroidism (PHPT) with unique clinical and operative implications. While symptoms of GPA are similar to that of enlarged parathyroids in the setting of PHPT, key differences exist. The tissue and receptor composition of GPAs differ from their parathyroid adenoma counterparts; hence their size does not always correlate with a commensurate elevation of parathyroid hormone (PTH). Further, the mass of GPA increases the rate of migration into the mediastinum and can apply pressure on vital structures, leading to more challenging resections and unique clinical presentations such as recurrent syncope. We report a case of a GPA with extension into the superior mediastinum, the surgical challenges associated with its resection and its pre- and post-operative implications on clinical symptoms and biochemical markers. The data shared in this report may contribute to the creation of a more comprehensive database on GPA and a better understanding of this distinct entity

A Deployable Curriculum with 3D Printed Skills Trainers for Altered Airway Management

http://deepblue.lib.umich.edu/bitstream/2027.42/191954/2/2024_BMC Med Ed_Deployable Curriculum with 3D Printing for Altered Airways.pdfPublished versionDescription of 2024_BMC Med Ed_Deployable Curriculum with 3D Printing for Altered Airways.pdf : Published versio

Review of cost and surgical time implications using virtual patient specific planning and patient specific implants in midface reconstruction

Aim: Summarize the available data on midfacial virtual patient specific planning and patient specific implants, highlighting the financial costs and savings, and additionally emphasize the potential cost implications of transitioning to “in-house” virtual 3D modeling and printing.Methods: Review of current literature.Results: Current literature suggests cost benefits of virtual patient specific planning and patient specific implants in the form of improved ischemia time, better boney apposition between flaps, and reduced patient complications. This reduction of complications includes a reduction in blood loss and time spent in the intensive care unit from flap failure. Improved boney apposition results in a higher likelihood of boney union and a further reduction in failure and complications. Subjective benefits of virtual patient specific planning and patient specific implants are shown in the form of improved reconstructive surgeon mental energy. In-house production of 3D models and presurgical planning provides additional cost benefits for providers as they can produce viable models at a fraction of the price of that which is produced by industrial companies. Providers can also construct and use models in an expedient manner compared to industrial models, allowing for the opportunity to be utilized in more acute settings. The foundation of developing an in-house workflow is adequate funding, resources, and clinical volume. Facilities also must focus on appropriate quality and safety measures, as well as appropriate workflow development for adequate production of models.Conclusion: Virtual patient specific planning and patient specific implants show benefits in midfacial reconstructive outcomes, resulting in realized financial and temporal gains for both patient and provider. These gains may be enhanced by moving to in-house planning and printing

Transformation of facial basal cell carcinoma to squamous cell carcinoma following vismodegib

Objective(s): Vismodegib, a unique hedgehog pathway inhibitor, has been demonstrated to be effective in the treatment of non-operable and metastatic basal cell carcinoma (BCC). While effective, concerns regarding its role in the development of cutaneous squamous cell carcinoma (CSCC) remain. The primary objective is to describe a unique case of locally advanced BCC of the face and subsequent transformation to CSCC following treatment with vismodegib. Methods: Case report. Results: A 64-year-old Caucasian female presented with a 3-year history of a progressive and erosive lesion involving the entirety of her forehead with involvement of the left medial canthus and upper eyelid. Biopsies performed at the periphery of the lesion demonstrated superficial and nodular BCC. As surgical management would result in significant morbidity, the patient elected for treatment with oral vismodegib, 150 mg daily, with curative intent. Dramatic tumor response was experienced over an 18-month period; however, surveillance MRI demonstrated concern for tumor progression at the periphery of the mass without evidence of intracranial extension or metastases. Subsequent biopsies at the superior and left supraorbital margins demonstrated invasive SCC. Following immunohistochemistry analysis, intravenous nivolumab, 480 mg monthly was initiated; the patient remains progression-free after 18 months of therapy. Conclusion: This case highlights the importance of close surveillance in patients treated with vismodegib for non-operable BCC. Serial biopsies of new or suspicious appearing tumors should be performed given the potential for CSCC transformation

Additional file 1 of A deployable curriculum with 3D printed skills trainers for altered airway management

Additional file 1. Course surveys and assessments. Includes full pre and post course surveys and knowledge assessment questions as well as the formal skills competency assessment

Expanding use of osseointegrated implantation using 3-dimensional surgical planning: a paradigm shift in dental reconstruction

Medical modeling and 3-dimensional (3D) virtual surgical planning represent a rapidly expanding, technological advancement especially useful in complex mandibular or maxillary defects in head and neck reconstruction. With utilization of 3D surgical planning, the reconstructive surgeon can initiate dental rehabilitation during the primary surgery with osseointegrated implants (OI), streamlining a typically lengthy process to full oral rehabilitation. Careful patient selection is important to optimize outcomes with immediate OI, and factors to consider during the evaluation process include pathology, prognosis, anticipated defect, dental status, donor site availability, and patient motivation and resources. Synthesizing this information and developing a reconstructive plan with a multidisciplinary team approach is critical to expedite dental rehabilitation for select patients. A review of relevant literature and our surgical planning algorithm for selecting candidates for immediate OI is provided, along with our experience using this decision algorithm in a uniquely complex clinical case

Anterior skull base reconstruction: a contemporary review

Anterior skull base (ASB) defects present a significant challenge in head and neck reconstructive surgery. The main goal of skull base reconstruction is to create a watertight separation between the intracranial cavity and aerodigestive tract. Successful reconstruction aims to prevent cerebrospinal fluid (CSF) leak, pneumocephalus, and a range of infectious manifestations. Functional outcomes and cosmesis are also critical considerations when developing a reconstructive plan. Advancements with endoscopic endonasal approaches have revolutionized skull base surgery but also have created new reconstructive challenges due to the narrow operative corridor, especially for extensive defects or salvage cases where microvascular free tissue transfer is required. Though a variety of techniques including local, regional, and free flaps have been described, ASB reconstruction remains a difficult undertaking due to the complex anatomy and high risk for post-operative complications. This review provides a comprehensive discussion of available reconstructive techniques that can be used after both open and endoscopic ASB resections to help determine the optimal reconstruction for a variety of defects