Factors associated with postoperative delirium after major head and neck surgery.

Postoperative delirium (POD) is an acute change in cognitive status characterized by fluctuating consciousness and is associated with high incidences of morbidity, high complication rates, and long hospitalizations. This study was performed to determine the incidence of POD and the perioperative risk factors in order to predict which patients have an increased risk and thus to prevent POD after major head and neck surgery. The authors retrospectively evaluated 341 patients who underwent laryngectomy or the Commando (combined operation of mouth, mandible, and neck dissection) procedure at Pusan National University Hospital from January 1986 through July 2001.

Closure of large tracheocutaneous fistula using turn-over hinge flap and V-Y advancement flap.

Tracheocutaneous fistula is a frequent sequel of long-term tracheostomy or tracheal fenestration. Closure of fistula is complicated by the presence of extensive scar tissue, mucopurulent secretions, and tension from insufficient advancement of adjacent soft tissue. We report two successfully closed cases of large tracheocutaneous fistulae using a hinge flap and a V-Y advancement flap.