Decreased Complications After Total Laryngectomy Using a Clinical Care Pathway.

Complications following total laryngectomy can lead to increased hospital length of stay (LOS) and increased health care costs. Our objective was to determine the efficacy of a clinical care pathway for improving outcomes for patients following total laryngectomy. This quality improvement study included all adult patients undergoing total laryngectomy-either primary or salvage-at a tertiary referral center between January 2013 and December 2018.

The Submental Island Flap Is a Viable Reconstructive Option for a Variety of Head and Neck Ablative Defects.

Background: The submental island flap (SIF) is a pedicled flap based upon the submental artery and vein. Its utility in reconstruction following ablative head and neck procedures has been applied to various subsites including skin, lip, buccal mucosa, retromolar trigone, parotidectomy defects, and tongue. We review our experience using the SIF for reconstruction following tumor ablation.

Postoperative anticoagulation after free flap reconstruction for head and neck cancer: A systematic review.

Objective: Postoperative use of anticoagulation after free tissue transfer in head and neck ablative procedures is common practice, but a clear protocol has not been well established. The outcome measures including total flap failure, thrombosis, and hematoma formation for different anticoagulation regimens in free tissue transfer in the head and neck were reviewed.

Data Sources: PubMed, Ovid, and Cochrane databases were examined for patients who underwent free tissue transfer following head and neck ablative procedures.

Minimum lymph node yield in elective level I-III neck dissection.

Objectives/hypothesis: Unlike lymphadenectomy at other sites, there is no discrete lymph node count defining an adequate neck dissection. The purpose of this study was to determine the minimum lymph node yield (LNY) of an elective level I-III neck dissection required to reliably capture any positive nodes present in these nodal basins.

Study Design: Retrospective single-institution analysis.

NSQIP as a Predictor of Length of Stay in Patients Undergoing Free Flap Reconstruction.

Objective: The National Surgical Quality Improvement Program (NSQIP) calculator was created to improve outcomes and guide cost-effective care in surgery. Patients with head and neck cancer (HNC) undergo ablative and free flap reconstructive surgery with prolonged postoperative courses.

Methods: A case series with chart review was performed on 50 consecutive patients with HNC undergoing ablative and reconstructive free flap surgery from October 2014 to March 2016 at a tertiary care center.

Impact of pharyngeal closure technique on fistula after salvage laryngectomy.

Importance: No consensus exists as to the best technique, or techniques, to optimize wound healing, decrease pharyngocutaneous fistula formation, and shorten both hospital length of stay and time to initiation of oral intake after salvage laryngectomy. We sought to combine the recent experience of multiple high-volume institutions, with different reconstructive preferences, in the management of pharyngeal closure technique for post-radiation therapy salvage total laryngectomy in an effort to bring clarity to this clinical challenge.

Objective: To determine if the use of vascularized flaps in either an onlay or interposed fashion reduces the incidence or duration of pharyngocutaneous fistula after salvage laryngectomy compared with simple primary closure of the pharynx.

Oropharyngeal reconstruction using the supraclavicular artery island flap: a new flap alternative.

Unlabelled: Oropharyngeal reconstruction following head and neck oncologic resection has utilized local, regional, and free tissue transfer flap options. The modality utilized is often guided by the type of defect created as well as the surgeon's preference. In this article, the authors introduce the application of the supraclavicular artery island flap as a reconstructive modality following oropharyngeal oncologic ablation.

Mixed medullary-papillary carcinoma of the thyroid: a case report.

With fewer than 40 cases described in the otolaryngology literature, mixed medullary papillary thyroid carcinoma represents a rare but phenotypically distinct tumor. While isolated medullary carcinoma may be admixed with normal follicular structures, true mixed carcinoma displays morphological and immunological characteristics of medullary and papillary carcinoma within a single lesion. We report the case of a 73-year old woman initially evaluated for a multinodular thyroid goiter.

CyberKnife stereotactic radiosurgery for recurrent squamous cell carcinoma of the head and neck following salvage surgery with close or positive margins.

Squamous cell carcinoma of the head and neck (SCCHN) has traditionally been treated with a combination of surgery, chemotherapy, and external beam radiotherapy. While cure is generally the goal of these therapeutic modalities, recurrence is an unfortunately common outcome. Salvage surgery often results in close or positive surgical margins and the patient is at high risk for recurrence.

Combined mycophenolate mofetil and prednisone therapy in tamoxifen- and prednisone-resistant Reidel's thyroiditis.

Background: Mycophenolate mofetil is a recently identified therapy for disorders associated with systemic fibrosis, but has never been reported in the treatment of Reidel's thyroiditis. We report the first case of Reidel's thyroiditis that became resectable after treatment with mycophenolate and prednisone.

Summary: A 27-year-old woman presented to an outside hospital with thyromegaly associated with compressive symptoms.

Synaptic and morphologic properties in vitro of premotor rat nucleus tractus solitarius neurons labeled transneuronally from the stomach.

Neurons in the rat nucleus tractus solitarius (NTS) possess morphologic characteristics that have been correlated with the type of synaptic information they receive. These features have been described for viscerosensory neurons but not for premotor NTS neurons. The morphologic and synaptic features of neurons in the rat caudal NTS were assessed using whole-cell patch-clamp recordings and biocytin labeling in brainstem slices.