Moustafa Mourad

Systematic review and meta-analysis of venous thromboembolism in otolaryngology-head and neck surgery.

The purpose of this study was to present our systematic review and meta‐analysis of the data on venous thromboembolism (VTE; deep venous thrombosis [DVT] and/or pulmonary embolism [PE]) in otolaryngology–head and neck surgery (OHNS).

Carotid Artery Sacrifice and Reconstruction in the Setting of Advanced Head and Neck Cancer

Objective To determine oncological and neuromorbidity outcomes in patients with advanced head and neck cancer (stage IVB) requiring sacrifice and reconstruction of the carotid artery. Study Design Case series with chart review. Setting Tertiary care referral center. Subjects and Methods Overall, 51 patients underwent carotid artery sacrifice during surgical treatment of the neck, in both the primary and salvage setting. All patients underwent autogenous in-line carotid artery bypass grafting with either saphenous vein or the deep femoral vein in conjunction with vascular surgery. In all, the study included 39 males and 12 female subjects, with age ranging from 39 to 82 (mean, 62.7). Results Two patients (3.9%) had a cerebral vascular accident in the immediate postoperative period. The remaining 49 patients (96%) had no neurologic sequela. Serial ultrasonic evaluation revealed 4 patients with intra-luminal thrombus within the site of reconstruction. Perioperative mortality occurred in a single patient. Disease-related mortality occurred in 9.8% (5) of patients, with an overall 2-year survival of 82%. Conclusions We presently report the largest series of surgical treatment for advanced head and neck cancer with carotid artery involvement. We document an overall 2-year survival of 82% in the setting of low perioperative neuromorbidity and mortality rates. We therefore consider carotid artery sacrifice and autogenous vein graft reconstruction in the absence of distant metastatic disease as a viable treatment option for what was once thought to be a palliative procedure.

Management of the thyroid gland during total laryngectomy in patients with laryngeal squamous cell carcinoma

The goal of the study was to determine the role of routine total thyroidectomy and hemithyroidectomy in patients undergoing total laryngectomy for laryngeal squamous cell carcinoma.

Geographic trends in management of early-stage laryngeal cancer.

The goal of the study was to identify geographic trends in the primary treatment of early‐stage glottic cancer.

Intraoperative nerve monitoring during parathyroid surgery: The Fort Worth experience

Avoidance of recurrent laryngeal nerve (RLN) injury during parathyroid surgery is of paramount important. The purpose of this study was to determine if intraoperative nerve monitoring allowed for decreased rates of RLN injury during parathyroid surgery.

Supraclavicular Flap Reconstruction of Cutaneous Defects Has Lower Complication Rate than Mucosal Defects

Background The objective of this study was to determine whether there was a difference in complication rate between cutaneous and mucosal defects reconstructed with the supraclavicular artery flap. Methods Retrospective review of postoperative complications in 63 patients from 2008 to 2015 with cutaneous and mucosal head and neck defects following oncologic ablation reconstructed with the supraclavicular flap, with a minimum follow‐up duration of 6 months. Of the 63 patients, 38 patients had cutaneous defects, whereas 25 had mucosal defects. Patients were followed up postoperatively to determine the presence of wound infection, partial flap necrosis, complete flap necrosis, and fistula formation. Complications in both defect groups as well as a statistical comparison of total complications were analyzed. Results Patients with cutaneous defects reconstructed with the supraclavicular flap had significantly lower postoperative complications than those with mucosal defects (p = 0.002). Flap necrosis, both partial and complete, was also lower in this same group (p = 0.0052). Conclusion The supraclavicular artery flap may be a more suitable option for patients with cutaneous defects, given the reliability and lower propensity for postoperative complications Level of Evidence The level of evidence is 4.

Internal to external jugular vein bypass allowing for simultaneous bilateral radical neck dissection.

The goal of the study was to determine the role of internal jugular vein (IJV) to external jugular vein (EJV) bypass grafting in the setting of bilateral radical neck dissection with IJV sacrifice.

Reply to Letter to the Editor regarding “Systematic review and meta-analysis of venous thromboembolism in otolaryngology-head and neck surgery”

Dear Editor, We thank Cramer for thoroughly reviewing our study. It is a pleasure to stimulate discussions around the important issue of venous thromboembolism (VTE) prophylaxis in otolaryngology-head and neck surgery (OHNS). Although some of the points raised by Cramer are interesting, many are based on false premises. First, some institutions (such as Stanford, for instance) still recommend VTE chemoprophylaxis for outpatient surgical patients with high Caprini scores. Many, if not most, patients receiving surgery by OHNS, receive outpatient care. Excluding this patient population would significantly undermine our systematic review because many procedures in OHNS are outpatient procedures. The study cited in support of excluding outpatient surgery that shows increased rates of VTE in inpatients does not include any OHNS patients. In our specialty, the inpatient population (such as for a total thyroidectomy, or a rhinoplasty with a rib graft) may still have a lower VTE risk than other surgical populations due to younger and healthier patients. Furthermore, there has been an increasing trend toward same-day discharge even for procedures that were historically inpatient procedures (eg, thyroidectomy) and, therefore, the needle is constantly moving on what is considered inpatient versus outpatient OHNS surgery. Second, heterogeneity in our included studies was a priori expected to be high due to inclusion of different patient populations. This was thoroughly addressed and discussed in the methods, results, and discussion sections. The third point is unfortunately a common misconception. The 2012 CHEST guidelines do not state that OHNS data is similar to plastic and reconstructive surgery (PRS) data, and this is not proven in any literature, to the best of our knowledge. Moreover, the table included by Cramer shows that the risk categories are different in PRS and OHNS. The risk of VTE in PRS patients with Caprini scores of 3–4, 5–6, and 7–8 are 0.6%, 1.3%, and 2.7%, respectively. Although we agree that VTE prophylaxis could be useful in OHNS patients with a Caprini score >8, the purpose of our meta-analysis was not to evaluate the applicability of the Caprini scoring system in OHNS. However, this is of interest and Cramer could expand on the table presented in his letter in order to perform such an analysis. Our main conclusion is that in patients with squamous cell carcinoma or free flap patients in OHNS, the risk of VTE greatly surpasses the risk of hemorrhagic complications. Therefore, we would likely recommend chemoprophylaxis in this patient population. As for the issue of Caprini stratification in OHNS, specialty-specific data needs to be analyzed in a consensus statement as data from other specialties, such as PRS, cannot be extrapolated.

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.

Options in Repositioning the Asymmetric Brow from Paralysis and Trauma

Abstract Brow asymmetry is a relatively common occurrence, especially in the facial plastic surgeons office. In this article, the authors review causes of brow asymmetry, pertinent anatomy, and a litany of treatment options including nonsurgical and surgical approaches. They offer an algorithm that summarizes the various techniques for management with the goal of tailoring treatment tactics to the individual patients needs.