Publications by authors named "Pablo Llerena"
Background: Flow-through flaps (FTFs) are an advanced technique in which a free flap is anastomosed to the pedicle of another free flap to reconstruct extensive head and neck defects when recipient vessels are scarce.
Methods: A multi-institutional cohort of FTFs used for head and neck reconstruction were reviewed. For comparison, FTF outcomes were compared to free flaps that required vein grafts (VG) to reach distant recipient vessels.
Immune Checkpoint Inhibitors for Head and Neck Squamous Cell Carcinoma-Reply.
JAMA Otolaryngol Head Neck Surg
November 2024
Purpose: We evaluated whether IDO-inhibitor BMS986205 (IDOi) + PD-1 inhibitor nivolumab enhanced T-cell activity and augmented immune-mediated antitumor responses in untreated, resectable HNSCC. We employed response-adaptive surgical timing to identify responders to immunotherapy and enhance their response.
Patients And Methods: Patients with HNSCC were 3:1 randomized to receive nivolumab with or without BMS986205 PO daily (NCT03854032).
Objective: Application of virtual reality (VR) for surgical planning may improve clinical outcomes for head and neck cancer (HNC) resection. There is a lack of randomized trials and meaningful metrics to assess such technological applications. Our objective was to evaluate the feasibility of a VR protocol for oncologic surgical planning and assess the impact on surgical outcomes.
View Article and Find Full Text PDFAtypical Presentation and Postoperative Management of Vagal Nerve Tumors.
Ann Otol Rhinol Laryngol
December 2024
Article Synopsis
- The study focuses on managing tumors involving the vagus nerve, which often don't show obvious symptoms. It highlights various clinical cases and the unique challenges in treatment.
- Five patients with different presentations of vagal nerve tumors underwent surgery, with four experiencing symptom resolution post-operation.
- The findings suggest that innovative approaches, like ligating blood supply to certain tumors instead of complete removal, can effectively alleviate symptoms while preserving nerve function.
Article Synopsis
- Vessel grafting is a technique used in head and neck reconstruction when a direct artery connection isn't possible, and there’s limited data on interposition artery grafts for this purpose.
- A study reviewed records from four hospitals, focusing on patients who underwent free tissue transfer using interposition artery grafts, assessing factors like graft types, reasons for using grafts, and postoperative complications.
- Nine patients were included in the study, with common grafts from the lateral circumflex femoral artery and facial artery, and no major complications were reported; however, two patients did experience flap failure due to clot formation.
Obesity and Survival After Immune Checkpoint Inhibition for Head and Neck Squamous Cell Carcinoma.
JAMA Otolaryngol Head Neck Surg
August 2024
Importance: For patients treated with immune checkpoint inhibitors (ICIs), recent data suggest that obesity has a beneficial effect on survival outcomes in various cancer types. Reports on this association in head and neck cancer are limited.
Objectives: To compare overall survival (OS) to 5 years and functional outcomes in patients with head and neck squamous cell carcinoma (HNSCC) treated with ICIs based on pretreatment body mass index (BMI).
Objective: Placement of an active transcutaneous bone-conduction implant (BCI) requires drilling of a precise bone bed to accommodate the device and allow for fixation points to make appropriate contact with bone, which can be difficult even when lifts are used. We describe a subtemporalis muscle middle cranial fossa bone-island craniotomy technique that simplifies the procedure and obviates the need for lifts in securing the device.
Study Design: Prospective case series.
Importance: Studies comparing perioperative outcomes of fibula free flaps (FFFs), osteocutaneous radial forearm free flaps (OCRFFFs), and scapula free flaps (SFFs) have been limited by insufficient sample size.
Objective: To compare the perioperative outcomes of patients who underwent FFFs, OCRFFFs, and SFFs.
Design, Setting, And Participants: This cohort study assessed the outcomes of 1022 patients who underwent FFFs, OCRFFFs, or SFFs for head and neck reconstruction performed at 1 of 6 academic medical centers between January 2005 and December 2019.
Objective: The larynx is the most common site of localized head and neck amyloidosis. Our study aimed to review the clinical features, treatments, and outcomes associated with localized laryngeal amyloidosis (LA). We also compared these features between two different time periods to evaluate the evolution of LA management.
View Article and Find Full Text PDFObjective: Positive surgical margins (PSM) are associated with worse survival in oropharyngeal salivary gland malignancies (OPSGM), but existing literature is limited to small series. Our objective was to identify risk factors for PSM using the national cancer database (NCDB), including a transoral robotic surgical (TORS) approach.
Methods: NCDB was queried for patients with T1-T4a OPSGM undergoing resection between 2010 and 2017.
Objectives: (1) To compare perioperative outcomes and overall survival of patients with oropharyngeal salivary gland malignancies (OPSGMs) treated with transoral robotic surgery (TORS) versus other approaches. (2) To identify clinical factors associated with a robotic surgical approach.
Study Design: Retrospective analysis of the National Cancer Database (NCDB).