1,720,988 research outputs found
Alveolar Ridge Preservation after tooth extraction: a Bayesian Network meta-analysis of grafting materials efficacy on prevention of bone height and width reduction
No full textLymph node ratio (LNR) and lymph node yield (LNY) in head and neck cancer: A systematic review and meta-analysis
Get PDFIntroduction: A growing amount of evidence points at lymph node yield (LNY) and lymph node ratio (LNR) as useful indicators in the prognostic evaluation of patients affected by head and neck squamous cell carcinoma (HNSCC) who require neck dissection. The aim of this study was to assess the importance of LNY and LNR in the prognostic evaluation of head and neck cancer patients. Materials and methods: Included studies were those examining LNY and/or LNR in head and neck cancer patients. We excluded case reports or case series, thyroid cancer or salivary gland cancer studies, a sample size less than 20, and studies with incomplete or missing survival estimate. Of the 2435 studies identified through a database search, 95 were reviewed for full text and 63 were finally included for the final analysis. Electronic databases, including PubMed (MEDLINE), Embase, and Scopus were screened up to January 1, 2024. The systematic review was conducted according to the MOOSE checklist. A set of sub-group meta-analyses were performed for oral cavity, oropharynx, hypopharynx, larynx, and mixed subsites using a random-effects model. Overall survival (OS), Disease Specific Survival (DSS), and Disease-Free Survival (DFS) Hazard Ratios (HR) related to a prespecified LNR and LNY exact value were chosen as summary statistics. Cumulative Hazard Ratios with 95% Confidence Interval (CI) were presented, calculated through the inverse variance method. Heterogeneity was evaluated with I2 statistics. Results: Results of the meta-analysis showed increased OS for a higher LNY (HR 1.33 95% CI 1.23–1.45). Regarding the LNR, a lower LNR value has an impact on survival, with an OS HR of 1.96 (95% CI 1.72–2.24). The same was true for DFS (HR 2.43 95% CI 1.82–3.23), and DSS (HR 2.07 95% CI 1.83–2.33). Conclusions: Our analysis confirms the importance of LNY and LNR as prognostic indicators. Future studies are needed to establish the optimal cut-off values for both factors. LNY and LNR have the potential to be routinely evaluated in patients who undergo neck dissection for HNSCC
Lateral cervical approach for salvage total laryngectomy without pharyngeal reinforcement with pedicled or free flaps: our preliminary experience in six patients
No full textPurpose: To analyze the surgical outcomes in terms of postoperative wound complications in a small case series of six patients treated with lateral cervical approach (LCA) for salvage total laryngectomy (STL) without prophylactic use of the pectoralis major myocutaneous flap (PMMF) or free flaps.
Methods: Between September 2018 and August 2019, six patients with recurrent/residual squamous-cell carcinoma after (chemo)radiotherapy [(C)RT] underwent STL with minimally invasive LCA with the anterior myocutaneous flap (AMCF), sparing the prelaryngeal tissue. Clinical records were retrospectively reviewed.
Results: Wound dehiscence and local complications were prevented in five cases. Pharyngocutaneous fistula (PCF) occurred in one case and the closure was achieved by medical dressing with spontaneous healing within 15 days. Oral intake of liquids started 2 weeks after surgery in the five patients without local complications, after 24 days in the patient with PCF.
Conclusion: STL through the LCA after [(C)RT] failure seems to be feasible and effective in terms of prevention of local complications as wound dehiscence and fistula. More large clinical series are needed to confirm whether the use of LCA reduced the rate of postoperative wound complications following STL without the prophylactic use of pedicled or free flaps
Endoscopic nasopharyngoscopy and ENT specialist safety in the COVID 19 era: the back endoscopy approach to the patient
Get PDFPurpose: To propose a way to safely perform endoscopic nasopharyngoscopy in ENT outpatient clinic during the COVID-19 pandemic.
Methods: This manuscript highlights the importance of endoscopy in daily ENT clinical practice, which is a pivotal procedure in the diagnosis of many head and neck pathologies. However, since the beginning of the COVID-19 outbreak, the authors have witnessed a drastic reduction (91%) in the use of endoscopic nasopharyngoscopy at their institutions. In fact, it is considered at risk of contamination for healthcare professionals, as any upper airway manipulation procedure.
Results: In the "Back approach to the patient" for endoscopic nasopharyngoscopy, the operator positions himself behind the patient and faces the monitor. The endoscopist, not being positioned in front of the patient, should, therefore, be less exposed to airborne transmission of SARS-CoV-2 virus.
Conclusion: This simple variation of the physician's position during endoscopic nasopharyngoscopy could potentially reduce the risk of contagion since the operator is not in the trajectory of droplets and/or aerosols
3D-guided Mentoplasty: Advantages of the Technique and Morphometric Analysis
Get PDFBackground: We aimed to describe a protocol and related surgical treatment for mentoplasty using virtual surgical planning (VSP) and piezosurgery. Methods: Twelve patients requiring mentoplasty underwent VSP based on preoperative computed tomography. Virtual osteotomy was defined and the bone fragment was repositioned. Cutting and repositioning guides were exported as STL files and created using a 3-dimensional (3D) printer with biocompatible material. Plates were preblended on the printed model. Postoperatively, morphometric analysis was performed by comparing the planned and postoperative 3D models: distance between the apex of the cusp of 43 and 33 and lower edge of the chin; distance between the lower edge of the right and left mental foramen and osteotomy; and distance between the mandibular lingual fossa and pogonion. Results: Six cutting guides were made composite and six were monobloc. The repositioning guides were all made monobloc. No adverse intraoperative events were observed. Postoperative transient hypoesthesia was reported in 1 case. The average distance between the planned and postoperative 3D models of the chin was recorded in translation (1.91 mm), rotation (right, 1.38 mm; left, 1.30 mm), and cranial-caudal repositioning (right, 1.39 mm; left, 1.23 mm). VSP and 3D printing have improved surgical precision and reproducibility; they help the surgeon decide the extent of chin movement and the most suitable type of surgical guide in advance. Conclusions: Mentoplasty using 3D-printed guides and piezosurgery is simple, accurate, and safe. The costs of guide production are reduced using 3D printers by approximately €400-€800 per case compared with industrial printers
Bone reconstruction using CAD/CAM technology in head and neck surgical oncology. A narrative review of state of the art and aesthetic-functional outcomes
Get PDFBone defects following resections for head and neck tumours can cause significant functional and aesthetic defects. The choice of the optimal reconstructive method depends on several factors such as the size of the defect, location of the tumour, patient's health and surgeon's experience. The reconstructive gold standard is today represented by revascularised osteo-myocutaneous or osteomuscular flaps with osteosynthesis using titanium plates. Commonly used donor sites are the fibula, iliac crest, and lateral scapula/scapular angle. In recent years, computer -aided design (CAD)/computer assisted manufacturing (CAM) systems have revolutionised the reconstructive field, with the introduction of stereolithographic models, followed by virtual planning software and 3D printing of plates and prostheses. This technology has demonstrated excellent reliability in terms of accuracy, precision and predictability, leading to better operative outcomes, reduced surgical times and decreased complication rates. Among the disadvantages are high costs, implementation times and poor planning adaptability. These problems are finding a partial solution in the development of "in house" laboratories for planning and 3D printing. Strong indications for the use of CAD/CAM technologies today are the reconstruction of total or subtotal mandibular or maxillary defects and secondary bone reconstructions
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Head and neck cutaneous basal cell carcinoma: a retrospective analysis of tumour features, surgical margins and recurrences
Get PDFPurpose: The aim of this study was to analyse the factors affecting the status of surgical margins and recurrence of basal cell carcinoma (BCC) of the head and neck. A secondary aim was to provide detailed demographic, clinical and topographic data to understand the biological behaviour of this skin cancer in head and neck area. Methods: A retrospective analysis was conducted analysing all primary head and neck BCCs treated from July 2014 to October 2021. Chi-square and logistic regression were used to assess the presence of statistically significant associations. Results: The study cohort included 307 patients who underwent resection of 377 BCCs. The mean age of the patients was 76.86 years. There were 251 (67%) clean surgical margins, 80 (21%) positive and 46 (12%) closed. Recurrences were observed in 11 (5%) out of 218 BCCs of patients with a minimum follow-up of 24 months. The median follow-up time was 35 months. Positive margin status was significantly associated with BCC of the nose, while clean margin was correlated with neck localization (p<0.05). Clean margin status was linked with direct closure (p<0.05), while positive and closed margins were significantly associated to local flaps (p<0.05). Positive margin status was significantly related to depth of invasion below the dermis (p<0.05). Conclusion: The location, depth of invasion and method of reconstruction of head and neck BCC influence the completeness of surgical resection. Considering the low recurrence rate, clinical observation is an acceptable management option in patients with compromised margins, especially in elderly and frail patient populations
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