[Pain when removing a silicon Blake drain]

Digastric and sternocleidomastoid muscle flaps after conservative total parotidectomy for cancer: A CARE case report

OBJECTIVE

To describe, according to the CARE guidelines, an easily reproducible technique using two local muscle flaps to reduce the unsightly retromandibular hollow left by total parotidectomy for cancer.

CASE DESCRIPTION

A 40-year-old Caucasian male with T3N1M0 temporal skin melanoma was managed by skin resection, conservative total parotidectomy and ipsilateral level II-IV selective lymph-node dissection. Two rotational muscle flaps were taken from the ipsilateral posterior belly of the digastric and sternocleidomastoid muscles. Postoperative course was uneventful, with 3 days' hospital stay, without facial or spinal palsy. At 3 days, 3 months and 9 months postoperatively, the appearance of the parotid region was similar to the non-operated contralateral region.

CONCLUSION

Easy to perform and without associated scars, the approach described here should be included in the armamentarium available to the head and neck surgeon to avoid an unsightly hollow after total parotidectomy for cancer, in an effort to improve quality of life.

Great auricular nerve conservation and parotidectomy for tumor

OBJECTIVE

To describe the key technical points for preserving the great auricular nerve during parotidectomy for tumor, and to discuss the literature regarding the benefits, limitations and indications for nerve-sparing surgery. Data suggested that great auricular nerve preservation should be discussed in the preoperative consultation, attempted intraoperatively and mentioned in the operative report once parotidectomy completed.

Is Prophylactic Cervical Drainage Effective in Patients Undergoing McKeown Esophagectomy Reconstructed Through the Retrosternal Route with Two-Field Lymphadenectomy?

BACKGROUND

McKeown esophagectomy with two-field lymphadenectomy is the treatment of choice for oncologic esophagectomy. A cervical drain is placed in cases after modern two-field lymph node dissection (M2FD) to provide information on anastomotic leakage. However, the necessity of prophylactic cervical drainage during surgery remains unknown. This study aimed to clarify the clinical significance of cervical drainage in patients who underwent McKeown esophagectomy with M2FD.

METHODS

A total of 293 patients underwent McKeown surgery with two-field lymphadenectomy at our institute between January 2013 and December 2019. We compared the day of drain removal, amount of drainage volume, and the appearance of drainage fluid between patients with and without anastomotic leakage.

RESULTS

McKeown esophagectomy reconstructed through the retrosternal route is 203 patients (69.3%) of all. Nineteen patients (6.5%) experienced anastomotic leakage. The amount of cervical drain discharge was comparable between patients with and without anastomotic leakage. In addition, no purulent or salivary discharge was observed in patients with anastomotic leakage. There was no difference in the median day of drain removal between the groups. The initial clinical findings for the diagnosis of anastomotic leakage were surgical site infection in 10 (52.6%), fever in 5 (26.3%), prolonged inflammation in a blood test in 3 (15.8%), and bloody discharge from the chest tube in 1 (5.3%). There was no mortality due to any cause.

CONCLUSION

A prophylactic cervical drain may not be mandatory in patients with esophageal cancer undergoing McKeown esophagectomy reconstructed through the retrosternal route with two-field lymphadenectomy.

[Prevention and relief of pain induced by otolaryngology procedures]

There are many types of pain induced in otolaryngology, stemming from medical acts, sinus drainage, packing of the nasal fossae, or complex bandaging after cancer surgery. In patients with impaired communication abilities resulting from impaired speech, greater attention must be paid to induced pain, sometimes requiring the use of behavioral evaluation scales. Preventing this pain means organizing medical acts and painful treatments by attempting to group them and informing the patient that the caregiver is listening to him and relieving his pain. Non-drug treatments should always be attempted, are based on a trusting relationship with the patient, a comfortable position, diverting his attention, and using bandaging that is less painful when removed. However, use of drug treatments often remains indispensable. The strong morphinics are used most often despite a pharmacokinetic profile that is poorly adapted and the undesirable side effects in case of repeated administration. Local anesthetics should be used whenever possible. Dissemination of nursing protocols for the use of MEOPA provides good pain relief providing that there are trained personnel in sufficient numbers. The intensity of pain induced by certain medical acts requires use of brief general anesthesia, which can often be done in the ambulatory situation and is preferable to deep sedation outside of the safety of the operating room.