1
|
Tiwari AV, Dangore-Khasbage S. Management of a Partially Treated Case of Chronic Osteomyelitis of the Hard Palate and Maxillary Sinus. Cureus 2024; 16:e58983. [PMID: 38800228 PMCID: PMC11127707 DOI: 10.7759/cureus.58983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
Osteomyelitis affects bones, including both cortex and medulla. It influences the mandible more frequently than the maxilla. Probable etiologic factors include foci of infection or trauma; however, the hematogenous spread of infection from a distant site is also a causative factor. Staphylococcus is the common organism involved in the causation. Clinical symptoms include signs of inflammation, pus drainage, fistulous or sinus tracts, wound disintegration, erythema, and raised local temperatures. Laboratory diagnosis with the evaluation of white blood cell count, rate of erythrocyte sedimentation, and C-reactive protein proves vitally significant. Radiographic evaluation reveals sequestra and bone destruction in the affected region. Histopathology of the lesion is confirmatory for the final diagnosis, which helps in the formulation of an appropriate management strategy. The treatment regimen usually focuses on thorough debridement of the necrotic material and an antibiotic regimen. This case report describes a male patient aged 45 years presenting with a palatal ulcer, severe halitosis, and speech difficulty. He has suffered from type II diabetes mellitus for four years. A radiological examination was carried out. Treatment was performed with surgical debridement of necrotic maxillary bone and curettage of bilateral maxillary and ethmoid sinuses under general anesthesia. Results of histopathological evaluation of the curetted material from the maxillary and ethmoid sinuses revealed osteomyelitis of the maxilla.
Collapse
Affiliation(s)
- Aakanksha V Tiwari
- Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Suwarna Dangore-Khasbage
- Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
2
|
Lech D, Matysek J, Maksymowicz R, Strączek C, Marguła R, Krakowczyk Ł, Kozakiewicz M, Dowgierd K. Maxillofacial Microvascular Free-Flap Reconstructions in Pediatric and Young Adult Patients-Outcomes and Potential Factors Influencing Success Rate. J Clin Med 2024; 13:2015. [PMID: 38610780 PMCID: PMC11012962 DOI: 10.3390/jcm13072015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 03/16/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Maxillofacial microvascular free-flap reconstructions are significant interventions in the management of congenital defects, traumatic injuries, malignancies, and iatrogenic complications in pediatric and young adult patients. Craniofacial disorders within this demographic can result in profound functional, cosmetic, and psychosocial impairments, highlighting the critical need for thorough investigation into factors that may influence procedural success and postoperative quality of life. This retrospective chart review aims to examine the outcomes and potential influencing factors, aiming to offer valuable insights into optimizing the effectiveness of these reconstructions and improving patient outcomes. Methods: A single head and neck surgical team performed all the included 136 procedures. Demographic and surgical patient data were recorded. Type of transfer performed in each recipient site and major complications were analyzed. Relevant influencing factors, such as age, gender, and etiology of defect were determined using the ANOVA test and χ2 test of independence. Results: The results indicate a 90% success rate. No significant relationship was found between the incidence of total flap loss and patient age, etiology, or graft source. The maxillary reconstructions showed a higher incidence of total flap loss compared to mandibular reconstructions (11 vs. 3 cases). Conclusions: Despite the high success rate, the findings underline the necessity for further research to validate these observations and enhance surgical methods for pediatric and young adult patients.
Collapse
Affiliation(s)
- Dominika Lech
- Department of Clinical Pediatrics, Head and Neck Surgery Clinic for Children and Young Adults, University of Warmia and Mazury, Żołnierska 18a Street, 10-561 Olsztyn, Poland; (D.L.); (J.M.); (R.M.); (C.S.); (R.M.)
| | - Jeremi Matysek
- Department of Clinical Pediatrics, Head and Neck Surgery Clinic for Children and Young Adults, University of Warmia and Mazury, Żołnierska 18a Street, 10-561 Olsztyn, Poland; (D.L.); (J.M.); (R.M.); (C.S.); (R.M.)
| | - Robert Maksymowicz
- Department of Clinical Pediatrics, Head and Neck Surgery Clinic for Children and Young Adults, University of Warmia and Mazury, Żołnierska 18a Street, 10-561 Olsztyn, Poland; (D.L.); (J.M.); (R.M.); (C.S.); (R.M.)
| | - Cyprian Strączek
- Department of Clinical Pediatrics, Head and Neck Surgery Clinic for Children and Young Adults, University of Warmia and Mazury, Żołnierska 18a Street, 10-561 Olsztyn, Poland; (D.L.); (J.M.); (R.M.); (C.S.); (R.M.)
| | - Robert Marguła
- Department of Clinical Pediatrics, Head and Neck Surgery Clinic for Children and Young Adults, University of Warmia and Mazury, Żołnierska 18a Street, 10-561 Olsztyn, Poland; (D.L.); (J.M.); (R.M.); (C.S.); (R.M.)
| | - Łukasz Krakowczyk
- Oncological and Reconstructive Surgery Clinic, Branch of National Oncological Institute in Gliwice, Maria Sklodowska-Curie Institute—Oncology Centre (MSCI), Ul. Wybrzeze Armii Krajowej 15, 44-100 Gliwice, Poland
| | - Marcin Kozakiewicz
- Department of Maxillofacial Surgery, Medical Univeristy of Lodz, 113 Żeromskiego Str., 90-549 Lodz, Poland;
| | - Krzysztof Dowgierd
- Department of Clinical Pediatrics, Head and Neck Surgery Clinic for Children and Young Adults, University of Warmia and Mazury, Żołnierska 18a Street, 10-561 Olsztyn, Poland; (D.L.); (J.M.); (R.M.); (C.S.); (R.M.)
| |
Collapse
|
3
|
Gulati A, Heaton CM, Park AM, Seth R, Knott PD. Outcomes Associated with Multiple Free Tissue Transfers Performed in a Single Day. Facial Plast Surg Aesthet Med 2023; 25:472-477. [PMID: 36848581 DOI: 10.1089/fpsam.2022.0392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Background: Although microvascular free tissue transfer (MFTT) remains technically challenging, surgeons may need to perform >1 MFTT operations in a given day. Objective: To compare MFTT outcomes in cases where surgeons completed one versus two flaps per day by measuring flap viability and complication rates. Methods: A retrospective review was conducted of MFTT cases from January 2011 to February 2022 with >30-day follow-up. Outcomes, including flap survival and operating room takeback, were compared using multivariate logistic regression analysis. Results: Of 1096 patients meeting inclusion criteria (1105 flaps), there was a male predominance (n = 721, 66%). Mean age was 63.0 ± 14.4 years. Complications requiring takeback were identified in 108 flaps (9.8%) and were greatest for double flaps in the same patient (SP) (27.8%, p = 0.06). Flap failure occurred in 23 (2.1%) cases and was also greatest for double flaps in the SP (16.7%, p = 0.001). Takeback (p = 0.06) and failure (p = 0.70) rates were not different between days with one versus two unique patient flaps. Conclusions: Among patients undergoing MFTT, those treated on days in which surgeons perform two unique cases compared with single cases will demonstrate no difference in outcomes, as measured by flap survival and takeback, whereas patients with defects requiring multiple flaps will experience greater takeback and failure rates.
Collapse
Affiliation(s)
- Arushi Gulati
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Chase M Heaton
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Andrea M Park
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Rahul Seth
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - P Daniel Knott
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
4
|
Tarle M, Čvrljević I, Raguž M, Lukšić I. Hemoglobin-Albumin-Lymphocyte-Platelet (HALP) Score as a Predictive Model for the Success of Reconstruction of Head and Neck Defects with Free Microvascular Flaps. J Clin Med 2023; 12:5314. [PMID: 37629355 PMCID: PMC10455496 DOI: 10.3390/jcm12165314] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Significant advances in reconstructive head and neck surgery with free microvascular flaps have had a positive impact on esthetic outcomes and quality of life. However, complications still occur in some patients. This study investigated the influence of the Hemoglobin, Albumin, Lymphocyte, and Platelet Score (HALP score), an immunonutritive marker, on complications and flap success. The retrospective analysis included 194 patients who underwent reconstruction of head and neck defects with free microvascular flaps. The HALP score correlated strongly with overall complications, including flap necrosis, infection, fistula, and hematoma. Hemoglobin, albumin, lymphocytes, and platelets individually showed associations with specific complications. HALP score was an extremely strong predictor of complications (AUC = 0.85). HALP score may be valuable for assessing patient status and predicting complications in microvascular free-flap reconstruction to allow timely interventions and improve outcomes. Further research is needed to investigate additional predictors and improve postoperative care.
Collapse
Affiliation(s)
- Marko Tarle
- Department of Maxillofacial Surgery, Dubrava University Hospital, 10000 Zagreb, Croatia; (M.T.); (I.Č.)
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Igor Čvrljević
- Department of Maxillofacial Surgery, Dubrava University Hospital, 10000 Zagreb, Croatia; (M.T.); (I.Č.)
| | - Marina Raguž
- Department of Neurosurgery, Dubrava University Hospital, 10000 Zagreb, Croatia;
- School of Medicine, Catholic University of Croatia, 10000 Zagreb, Croatia
| | - Ivica Lukšić
- Department of Maxillofacial Surgery, Dubrava University Hospital, 10000 Zagreb, Croatia; (M.T.); (I.Č.)
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| |
Collapse
|
5
|
Chiang SH, Ho MH, Wu SH, Lin CC. Postoperative recovery among head and neck cancer patients receiving microvascular free flap surgery with implementing nurse-protocolized targeted sedation: relationship of use of sedatives and mechanical ventilation to length of ICU stay. Support Care Cancer 2023; 31:317. [PMID: 37133641 DOI: 10.1007/s00520-023-07730-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/04/2023] [Indexed: 05/04/2023]
Abstract
PURPOSE Patients receiving microvascular free flap surgery are usually admitted to a high-dependency adult intensive care unit (ICU). Research is limited to investigate postoperative recovery among head and neck cancer patients in the ICU. This study aimed to evaluate a nursing-protocolized targeted sedation on postoperative recovery and to examine the relationship of demographic characteristics, use of sedation, mechanical ventilator to length of ICU stay in patients receiving microvascular free flap surgery for head and neck reconstruction. METHODS This retrospective study involves 125 ICU patients at a medical centre in Taiwan. Medical records were reviewed between 1 January 2015 and 31 December 2018 including surgery-related data, medications and sedations used, and ICU-related outcomes. RESULTS The mean length of ICU stay was 6.2 days (SD = 2.6), and the mean duration of mechanical ventilation was 4.7 days (SD = 2.3). The daily dosage of sedation used in patients who received microvascular free flap surgery was dramatically reduced since the postoperative day (POD) 7. Over 50% of patients switched to PS + SIMV ventilator mode on POD 4. Duration of sedation used (r = 0.331, p < 0.001), total dosage of sedation (r = 0.901, p < 0.001), clear consciousness (r = - 0.517, p < 0.001), and duration on mechanical ventilator (r = 0.378, p < 0.001) are correlated with the length of ICU stay. CONCLUSION This study provides an understanding of the use of sedation, mechanical ventilator, and length of ICU stay to inform the continued education for clinicians.
Collapse
Affiliation(s)
- Su-Hua Chiang
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
| | - Mu-Hsing Ho
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Szu-Hsien Wu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Chin Lin
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
- Alice Ho Miu Ling Nethersole Charity Foundation Professor in Nursing, Pokfulam, Hong Kong.
| |
Collapse
|
6
|
Li CX, Gong ZC, Pataer P, Shao B, Fang C. A retrospective analysis for the management of oromaxillofacial invasive mucormycosis and systematic literature review. BMC Oral Health 2023; 23:115. [PMID: 36810012 PMCID: PMC9942087 DOI: 10.1186/s12903-023-02823-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/17/2023] [Indexed: 02/24/2023] Open
Abstract
PURPOSE Mucormycosis is a type of fatal infectious disease, rarely involved in the oromaxillofacial region. This study aimed to describe a series of 7 cases with oromaxillofacial mucormycosis and to discuss the epidemiology, clinical features, and treatment algorithm thereof. METHODOLOGY Seven patients in the author's affiliation have been treated. They were assessed and presented as per their diagnostic criteria, surgical approach, and mortality rates. Reported cases of mucormycosis originally happened in craniomaxillofacial region were synthesized through a systematic review so as to better discuss its pathogenesis, epidemiology, and management. RESULTS Six patients had a primary metabolic disorder, and one immunocompromised patient had a history of aplastic anemia. The criteria for a positive diagnosis of invasive mucormycosis were based on clinical presentation of signs and symptoms, and a biopsy for microbiological culture and histopathologic analysis. Each patient used antifungal drugs and five of them also underwent surgical resection at the same time. Four patients died due to the unregulated spread of mucormycosis, and one patient died owing to her main disease. CONCLUSIONS Although uncommon in clinical practice setting, mucormycosis should be of great concern in oral and maxillofacial surgery, due to the life-threatening possibility of this disease. The knowledge of early diagnosis and prompt treatment is of utmost importance for saving lives.
Collapse
Affiliation(s)
- Chen-xi Li
- grid.412631.3Department of Oral and Maxillofacial Oncology and Surgery, The First Affiliated Hospital of Xinjiang Medical University, School/Hospital of Stomatology, Xinjiang Medical University, Stomatological Research Institute of Xinjiang Uygur Autonomous Region, No.137 Liyushan South Road, Ürümqi, 830054 People’s Republic of China ,grid.33199.310000 0004 0368 7223Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, 430022 People’s Republic of China
| | - Zhong-cheng Gong
- grid.412631.3Department of Oral and Maxillofacial Oncology and Surgery, The First Affiliated Hospital of Xinjiang Medical University, School/Hospital of Stomatology, Xinjiang Medical University, Stomatological Research Institute of Xinjiang Uygur Autonomous Region, No.137 Liyushan South Road, Ürümqi, 830054 People’s Republic of China
| | - Parekejiang Pataer
- grid.412631.3Department of Oral and Maxillofacial Oncology and Surgery, The First Affiliated Hospital of Xinjiang Medical University, School/Hospital of Stomatology, Xinjiang Medical University, Stomatological Research Institute of Xinjiang Uygur Autonomous Region, No.137 Liyushan South Road, Ürümqi, 830054 People’s Republic of China
| | - Bo Shao
- grid.412631.3Department of Oral and Maxillofacial Oncology and Surgery, The First Affiliated Hospital of Xinjiang Medical University, School/Hospital of Stomatology, Xinjiang Medical University, Stomatological Research Institute of Xinjiang Uygur Autonomous Region, No.137 Liyushan South Road, Ürümqi, 830054 People’s Republic of China
| | - Chang Fang
- grid.412631.3Department of Oral and Maxillofacial Oncology and Surgery, The First Affiliated Hospital of Xinjiang Medical University, School/Hospital of Stomatology, Xinjiang Medical University, Stomatological Research Institute of Xinjiang Uygur Autonomous Region, No.137 Liyushan South Road, Ürümqi, 830054 People’s Republic of China
| |
Collapse
|
7
|
Chan PYW, Patel E, Paulin E, Shah A. External tissue expansion to salvage failed scalp and forehead reconstruction: a case report. Case Reports Plast Surg Hand Surg 2022; 9:220-224. [PMID: 36118124 PMCID: PMC9481077 DOI: 10.1080/23320885.2022.2123809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/08/2022] [Indexed: 06/15/2023]
Abstract
The reconstruction of forehead and scalp defects is a difficult task. Common reconstructive methods are associated with multiple complications and may fail, requiring a difficult second surgery. We present the use of external tissue expansion as a method to achieve effective closure of a failed scalp and forehead reconstruction.
Collapse
Affiliation(s)
- Peter Y. W. Chan
- The Institute for Advanced Reconstruction, Shrewsbury, NJ, United States of America
| | - Elina Patel
- The Institute for Advanced Reconstruction, Shrewsbury, NJ, United States of America
| | - Ethan Paulin
- The Institute for Advanced Reconstruction, Shrewsbury, NJ, United States of America
| | - Ajul Shah
- The Institute for Advanced Reconstruction, Shrewsbury, NJ, United States of America
| |
Collapse
|