Eyituoyo Okoturo

Quality of Life of Patients With Segmental Mandibular Resection and Immediate Reconstruction With Plates

PURPOSE The surgical management of some head-and-neck pathology affects a patients form and fundamental function and, eventually, the quality of the individuals daily life. Restoring mandibular continuity after resection will improve form, function, and eventually, quality of life (QOL). The aim of this study was to evaluate the effect of our limited restoration with immediate plate reconstruction after segmental mandibular resection on the QOL of patients. PATIENTS AND METHODS A total of 13 patients were included in the study. They were treated for benign but aggressive mandibular pathology. Treatment included segmental mandibular resection with immediate plate reconstruction. A modified University of Washington QOL questionnaire was used to assess QOL. Data on clinico-dermographic variables were also collated. A total of 17 surgeries were undertaken, with 16 implants placed. RESULTS Patients with smaller tumors seemed to have better QOL scores than those with larger tumors. The overall QOL scores for younger patients seemed better than those of older patients. Spontaneous regeneration of the mandible, occurring in our younger patients, was an added reason for this seemingly better QOL. CONCLUSIONS Patients with segmental mandibulectomy and spontaneous mandibular regeneration tended to have a better QOL than those with no reconstruction and immediate plate reconstruction.

Clinical outcome of parotidectomy with reconstruction: Experience of a regional head and neck cancer unit

Background: Salivary gland pathologies represent a histologically diverse group of benign and malignant neoplasms. Currently, World Health Organization recognizes 13 benign and 24 malignant variants of all salivary gland neoplasms. Surgery continues to remain the main-stay for treatment of parotid gland neoplasms. The aim of this study was to document our experiences of the patients treated for parotid tumors and find out if any compelling variable predicted the relative clinical outcomes. Materials and Methods: This was a retrospective study, from records of parotidectomies performed at the operating theatre by the head and neck cancer division of the study institution between 2010 and 2013. Eligibility for study inclusion included cases with benign or malignant parotid neoplasms requiring surgical management with or without adjunct radiotherapy. The predictors of postoperative complications, overall survival (OS), and disease-free survival (DFS) were analyzed. Results: A total of 20 patients underwent parotidectomy. The mean age was 42 years. Tumors were located on the left parotid in 13 cases (65%) and the right parotid in 7 cases (35%). The surgical procedures comprised 16 superficial parotidectomies, 1 total parotidectomy, and 3 radical parotidectomy (inclusive of facial nerve sacrifice) and 2 neck dissections levels II–V. The reconstructive procedures were 2 facial nerve branch cable grafts, 1 end-to-end facial-facial nerve branch anastomoses, and 2 facial re-animation surgeries (temporalis muscle suspensions). A total of five cases (33.3%) had postoperative complications. 2 variables (length of surgery and neck dissection) were found to have an impact on postoperative complications that were statistically significant. Additionally, length of surgery was a significant predictor on the 2 years OS and DFS. Conclusion: The result of this study showed good clinical outcome, especially in the benign cases. The comprehensive clinical outcome of the malignant cases could not be objectively assessed, as the OS and DFS were 50% at 2-years follow-up. It is our submission that a larger sample size is utilized in subsequent studies and quality of life evaluation is included in the methodology.

Regional Myocutaneous Flaps for Head and Neck Reconstruction: Experience of a Head and Neck Cancer Unit.

Background: Pectoralis major myocutaneous pedicle flap and other regional myocutaneous pedicle flaps (RMF), despite the superiority shown by free flaps, have remained relevant in the reconstruction of major head and neck oncologic defects. It has continued to find relevance as the preferred reconstruction of choice in some general head and neck reconstructive applications. While its role has been defined in developed environment, the same cannot be said for developing environment. The aim thus, was to review our experiences with RMFs in head and neck reconstructions, with a view to evaluating the indications and outcomes in a limited opportunity environment with some free flaps expertise. Materials and Methods: This was a retrospective cohort study from records of RMF cases performed for head and neck reconstruction, at the study institution. Eligibility for study inclusion comprised case cohorts with advanced head and neck diseases requiring ablative surgery and reconstruction with pectoralis major flaps and other RMFs. Results: A total of 17 cases were treated with RMFs. 10 were pectoralis major flaps while 7 were other RMFs. The main indications were failed free flaps and financial constraints. No regional pedicle flap failure was recorded; however, complication rate was 35.5% (6/17). Conclusion: Pectoralis major flaps and other RMFs were very reliable option for head and neck reconstruction. Free flap failure and financial constraints were the main indications for RMF reconstruction indications in head and neck reconstruction in a developing environment with some free flap expertise.