Mofiyinfolu Sokoya

Causes and Prevention of Secondary Obstruction.

Secondary nasal obstruction occurs when surgery fails to improve a patients nasal obstruction symptoms. This may occur from failure to recognize a problem preoperatively or failure to address mucocutaneous medical ailments. Secondary obstruction may even occur despite perfect execution of the operative plan. In this article, we discuss the etiology, intraoperative pitfalls, and surgical correction of secondary obstruction after primary rhinoplasty. When managing postrhinoplasty secondary obstruction, care must be taken to correct the cause of obstruction without creating new problems.

Scalp and Forehead Reconstruction

Abstract Reconstructing the scalp and forehead is a challenging endeavor frequently undertaken by facial plastic and reconstructive surgeons. There are many anatomical factors to be considered in this area, including multiple neurovascular structure present that should be identified and preserved. Hair morphology and physiology should be considered, and trichophytic techniques should be incorporated into incision planning and closure. The reconstructive ladder must be used when considering options in reconstructing scalps and forehead defects. This article reviews reconstructive options including secondary intention, primary closure, skin grafting, allografts, tissue expanders, and local, regional, and free tissue transfers, among others in the surgical management of forehead and scalp defects. The reconstructive surgeon should be familiar with these techniques and be able to use them when indicated, based on the size, shape, and location of defects.

Combination of panendoscopy and positron emission tomography/computed tomography increases detection of unknown primary head and neck carcinoma: Panendoscopy and Unknown Primary

With positron emission tomography/computed tomography (PET/CT) now commonplace as a diagnostic tool, new questions have arisen regarding the utility and cost‐effectiveness of panendoscopy. In this retrospective review of a large cohort of head and neck squamous cell carcinoma of unknown primary (HNSCC‐UP), we describe the enduring utility of panendoscopy in the detection of the primary site of mucosal disease even when PET/CT is negative.

Higher Complication Rates in Self-Inflicted Gunshot Wounds After Microvascular Free Tissue Transfer: Facial Self-Inflicted Gunshot Wounds

Microvascular free tissue transfer is often employed to reconstruct significant facial defects from ballistic injuries. Herein, we present our comparison of complications between self‐inflicted and non–self‐inflicted gunshot wounds after microvascular free tissue transfer.

The radial forearm free flap for scalp and forehead reconstruction: A 20-year experience

1.The ideal free flap for scalp reconstruction has adequate thickness, surface area, and vascular pedicle length 2.The simplest possible method of reconstruction should be considered in all patients while achieving adequate resection and a good functional outcome. 3.The radial forearm free flap provides excellent texture, color, pedicle length, and reliability. It provides for outstanding coverage of the forehead, temple, vertex, and occiput reconstruction. 4.In our experience, it is as hardy as the latissimus dorsi flap in withstanding postoperative adjuvant radiation, and confers multiple advantages over the latissimus dorsi free flap including faster healing times and shorter hospital stays. This article is protected by copyright. All rights reserved.

Effect of allergic rhinitis on nasal obstruction outcomes after functional open septorhinoplasty

OBJECTIVE To evaluate whether a diagnosis of allergic rhinitis affects surgical outcomes of open septorhinoplasty (OSR) and to examine whether OSR provides the same level of improvement in quality of life to patients with and without allergic rhinitis. STUDY DESIGN, SETTING, SUBJECTS AND METHODS We performed a retrospective evaluation of 646 patients who underwent open septorhinoplasty in a tertiary otolaryngology practice between 2008 and 2015. Preoperative and postoperative quality of life (QoL) measurement using the validated Nasal Obstruction Symptom Evaluation (NOSE) Scale was performed on 307 patients meeting inclusion criteria. These patients were then divided into two groups based on a diagnosis of allergic rhinitis (non-AR vs AR). Comparisons were then made based on quality of life improvements by the NOSE score. RESULTS There were 213 patients in the non-AR group vs. 94 patients in the AR group. After OSR, patients in both groups experienced significant improvement in nasal airway obstruction. Pre-op NOSE score averages were similar for the non-AR and AR groups (69.9 vs 73.4 p = 0.087). Average improvement in NOSE score for the non-AR and AR groups at 30 days was 48.6 vs 45.9 (p = 0.41); and at 90 day of 48.1 vs 51.5 (p = 0.402). CONCLUSION Patients with and without allergic rhinitis experience similar OSR outcomes as measured by the NOSE score. Open septorhinoplasty addresses multiple components contributing to nasal airway obstruction, and may offset the effects of allergic rhinitis. When indicated, it should be offered to patients with allergic rhinitis after complete medical management.

Preoperative Radiation and Complication Rates after Double Free Flap Reconstruction of Head and Neck Cancer

INTRODUCTION In this study, we explore whether preoperative external beam radiation affects complication rates in patients that have undergone double simultaneous free tissue transfer for head and neck defects. STUDY DESIGN, SETTING, SUBJECTS AND METHODS Approval was obtained from the JPS Institutional Review Board. We performed a retrospective analysis of patients who underwent double free flap reconstruction of head and neck defects between August 1997 and April 2017. Minimum follow up was 6 months. Patients were grouped according to preoperative radiation status (XRT vs non-XRT). The chi-squared test was used for all comparisons. P-values and 95% confidence intervals (CI) were reported as (P, 95% CI). RESULTS 90 flaps were performed on 45 patients. The most common flap combination utilized was fibula plus radial forearm free flap (RFF) in 17 out of 45 patients. There were no statistically significant differences in frequency of flap failure (0.35, -15.9-20.1), wound infection (0.75, -22.1-19.3), hematoma (0.16, -5.3-36.7), or fistula formation (0.69, -22.5-24.6). There were also no statistically significant differences in cardiac complications (0.57, -10.3-28.2) and DVT (0.22, -12.4-25.3). CONCLUSION Our findings suggest that double free flap patients who had preoperative radiation are not more likely to have complications compared to non- radiated patients. Simultaneous double free flaps should be reserved for the most complex cases. Extensive discussion should be had with the patient about possible morbidity and mortality.

Total mandibulectomy defect in the setting of chronic bisphosphonate use

Bisphosphonates are among several drugs known in modern medicine to have a potentially deleterious effect on the mandible with chronic use. While purportedly causing a necrotic reaction in the bone, the complete mechanism is not fully elucidated yet as cases are quite rare in the general public. Despite the esoteric nature of this entity, patients suffering from bisphosphonate induced necrosis have a complicated and prolonged course often involving varying degrees of mandibular debridement with severe cases requiring reconstruction. In this report, we present the unique case of a patient with a progressive mandibular osteonecrosis requiring complete mandibulectomy and fibula flap reconstruction.

Complications of Skull Base Surgery

&NA; Approaches to surgical management of skull base pathology and reconstruction of skull base defects have evolved over the past several decades. The goal, however, remains the same—to effectively address the pathology with minimal complications. In this article, the authors try to explore multiple complications of skull base surgery, discussing their incidence, natural course, and prevention. This will prove beneficial in optimal management of patients with a myriad of skull base disorders.

Prophylactic Measures to Prevent Soft Tissue Abnormalities after Trauma

Abstract The goal of any reconstructive procedure is a complete return to premorbid form and function. Unfortunately, a return of pretraumatic form is routinely not considered during surgical planning. This leads to uncontrolled contracture of the soft tissue elements and permanent disfigurement. The goal of this article is to review interventions that improve soft tissue healing and long‐term outcomes.