1
|
Mennes T, Vander Poorten V, Vermeulen F, Hens G. Comparison of treatment modalities for non-tuberculous mycobacterial cervicofacial lymphadenitis in children. Eur Arch Otorhinolaryngol 2024; 281:1463-1471. [PMID: 38085303 DOI: 10.1007/s00405-023-08376-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 11/23/2023] [Indexed: 02/10/2024]
Abstract
PURPOSE We aim to compare the different treatment modalities of non-tuberculous cervicofacial lymphadenitis in children, by means of a retrospective study conducted in the University Hospitals of Leuven of patients treated between 2012 and 2022. METHODS For this retrospective cohort study, data were collected and pseudonimised from 52 patients with non-tuberculous cervicofacial lymphadenitis, who were treated in our hospital between January 2012 and December 2022, either conservatively, antibiotically, surgically, or with a combination of these options. We only included patients who were considered immunocompetent. All of the included patients were below 10 years at time of treatment. We collected data regarding time to resolution and adverse effects, i.e., skin discoloration, excessive scar formation, fistula formation, persistence of adenopathies after treatment, need for additional treatment, facial nerve paresis/paralysis, or systemic side-effects due to antibiotic treatment. RESULTS The mean time to resolution (in days) when looking at primary treatments, was shortest in partial excisions (16), followed by complete excisions (19), antibiotic therapy (129), incision and drainage (153), curettage (240), and finally conservative management (280). Taking into account isolated treatments (i.e., both primary and adjuvant), we also observed consistently faster time to resolution in surgical and antibiotic treatments when compared to conservative treatment. Antibiotic therapy (p = 0.003), incision and drainage (p = 0,004) were associated with a significantly higher need for adjuvant treatment. Curettage was associated with a higher incidence of fistula formation (p = 0,006) and higher number of adjuvant treatments (p = 0,002). CONCLUSIONS This study shows a faster resolution of nontuberculous mycobacterial cervicofacial lymphadenitis in children when treated surgically, more specifically when treated with partial or complete lymph node excision. Antibiotic treatment also leads to faster resolution than conservative management. There was a low rate of complications, and no permanent facial nerve damage was reported.
Collapse
Affiliation(s)
- T Mennes
- UZ Leuven, Department of Otorhinolaryngology and Head and Neck Surgery, Leuven, Belgium.
| | - V Vander Poorten
- UZ Leuven, Department of Otorhinolaryngology and Head and Neck Surgery, Leuven, Belgium
| | - F Vermeulen
- UZ Leuven, Department of Paediatrics, Leuven, Belgium
| | - G Hens
- UZ Leuven, Department of Otorhinolaryngology and Head and Neck Surgery, Leuven, Belgium
| |
Collapse
|
2
|
Pollet N, Mennes T, Denys S, Loos E, Verhaert N, Vander Poorten V, Hens G. Otomicroscopic and functional outcomes after cleft palate repair via Sommerlad intravelar veloplasty vs. modified Veau-Wardill-Kilner push-back. Int J Pediatr Otorhinolaryngol 2022; 162:111283. [PMID: 35998528 DOI: 10.1016/j.ijporl.2022.111283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/18/2022] [Accepted: 08/11/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We aim to compare the modified Veau-Wardill-Kilner push-back technique (VWK) and the Sommerlad intravelar veloplasty (Sommerlad IVVP) in terms of middle ear outcomes and oronasal fistulae frequency in three years old children. METHODS For this retrospective cohort study, data were collected and anonymized from consecutive patients with cleft palate (with or without cleft lip) who underwent surgery in our hospital between January 2008 and December 2018. Patients with syndromic diagnoses and patients who underwent surgical treatment elsewhere were excluded. We collected data from 101 children (202 ears) regarding middle ear complications at the age of three, including acute otitis media, middle ear effusion, tympanic membrane retraction, tympanic membrane perforation, tympanic membrane atelectasis and chronic otitis media with cholesteatoma. In addition, the presence of oronasal fistulae and the number of ventilation tubes received by the age of three were recorded. RESULTS The odds of children having a normal middle ear evaluation were 3.07 (95% Confidence interval (95%CI): [1.52, 6.12]; p < 0.05) times higher when children received Sommerlad IVVP compared to modified VWK. With 40.7% compared to 26.7%, a significantly higher incidence of middle ear effusion was present in the modified VWK group compared to Sommerlad IVVP (X2(1) = 4.38, p < 0.05). Furthermore, this group needed significantly more ventilation tube reinsertions (X2(2) = 12.22, p < 0.05) and was found to have a significantly higher incidence of oronasal fistula (53.5% vs. 17.2%, X2(1) = 14.75, p < 0.05). The latter was significantly associated with a higher need for ventilation tube reinsertion (X2(1) = 7.34, p < 0.05). CONCLUSION This study shows superior middle ear outcomes and fewer oronasal fistulae after Sommerlad IVVP compared to modified Veau-Wardill-Kilner push-back at the age of three.
Collapse
Affiliation(s)
- Naomi Pollet
- Otorhinolaryngology, Head & Neck Surgery, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Tillo Mennes
- Otorhinolaryngology, Head & Neck Surgery, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Sam Denys
- Otorhinolaryngology, Head & Neck Surgery, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium; Department of Neurosciences, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Elke Loos
- Otorhinolaryngology, Head & Neck Surgery, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium; Department of Neurosciences, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Nicolas Verhaert
- Otorhinolaryngology, Head & Neck Surgery, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium; Department of Neurosciences, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Vincent Vander Poorten
- Otorhinolaryngology, Head & Neck Surgery, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium; Department of Oncology, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Greet Hens
- Otorhinolaryngology, Head & Neck Surgery, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium; Department of Neurosciences, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| |
Collapse
|
3
|
Meulemans J, Demarsin H, Debacker J, Batailde G, Mennes T, Laenen A, Goeleven A, Neyt P, Vanclooster C, Vauterin T, Delaere P, Huvenne W, Vander Poorten V. Functional Outcomes and Complications After Salvage Total Laryngectomy for Residual, Recurrent, and Second Primary Squamous Cell Carcinoma of the Larynx and Hypopharynx: A Multicenter Retrospective Cohort Study. Front Oncol 2020; 10:1390. [PMID: 32983968 PMCID: PMC7492266 DOI: 10.3389/fonc.2020.01390] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 07/01/2020] [Indexed: 11/25/2022] Open
Abstract
Background/Purpose: We analyzed complications and functional outcomes and aimed at identifying prognostic factors for functional outcomes and complications in patients who underwent salvage total laryngectomy (STL) for residual, recurrent, and second primary squamous cell carcinoma (SCC) of the larynx and hypopharynx after initial (chemo)radiation. Methods: Retrospective cohort study of patients who underwent STL in four major Belgian reference hospitals between 2002 and 2018. Prognostic factors for functional outcomes and complications were identified with uni- and multivariable analysis. Results: A total of 405 patients were included in the final analysis. STL was performed for residual tumor (40.2%), local recurrence (40.5%), or second primary laryngeal or hypopharyngeal SCC (19.4%). Early postoperative complications were experienced by 34.2% of patients: postoperative hemorrhage occurred in 5.4%, wound infection in 16.2%, and clinical pharyngocutaneous fistula (PCF) in 25.5% of patients. Early readmission proved necessary in 15.1% of cases, most often due to late PCF development (72.2%). Patients achieved total peroral intake in 94.2% of cases. However, subjective dysphagia was reported by 31.3% of patients during follow-up. Functional speech, defined as functional communication by speech without additional aids, was reported in 86.7% of cases and was most often achieved by tracheo-esophageal puncture (TEP) (94.1%). In a multivariable model, lower preoperative hemoglobin (<12.5 g/dl) was identified as an independent prognostic factor for higher overall complication rate. No risk factors were found significant for clinical fistula formation. Vascularized tissue augmentation did not significantly prevent clinical PCF. Patients with positive section margins, patients initially treated with surgery combined with adjuvant RT (vs. radiotherapy alone), and those developing PCF after STL were less likely to achieve total peroral intake. Postoperative dysphagia proved more likely in patients who developed a PCF postoperatively, and less likely in patients who underwent STL without partial pharyngectomy and in patients with myocutaneous pectoralis major (PM) flap reconstruction, compared to muscle onlay PM flap. Achieving postoperative functional speech proved most likely in patients with smaller tumors (lower pT classification) and free section margins. Conclusion: Substantial complication rates and favorable functional outcomes are reported after STL.
Collapse
Affiliation(s)
- Jeroen Meulemans
- Otorhinolaryngology-Head and Neck Surgery, University Hospital Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Hannelore Demarsin
- Otorhinolaryngology-Head and Neck Surgery, University Hospital Leuven, Leuven, Belgium
| | - Jens Debacker
- Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Gaël Batailde
- Otorhinolaryngology-Head and Neck Surgery, University Hospital Leuven, Leuven, Belgium
| | - Tillo Mennes
- Otorhinolaryngology-Head and Neck Surgery, University Hospital Leuven, Leuven, Belgium.,Otorhinolaryngology-Head and Neck Surgery, AZ Sint-Jan, Bruges, Belgium
| | - Annouschka Laenen
- Interuniversity Center for Biostatistics and Statistical Bioinformatics, Leuven, Belgium
| | - Ann Goeleven
- Otorhinolaryngology-Head and Neck Surgery, Swallowing Clinic, University Hospital Leuven, Leuven, Belgium
| | - Peter Neyt
- Otorhinolaryngology-Head and Neck Surgery, AZ Sint-Lucas, Ghent, Belgium
| | | | - Tom Vauterin
- Otorhinolaryngology-Head and Neck Surgery, AZ Sint-Jan, Bruges, Belgium
| | - Pierre Delaere
- Otorhinolaryngology-Head and Neck Surgery, University Hospital Leuven, Leuven, Belgium
| | - Wouter Huvenne
- Department of Head and Skin, Ghent University, Ghent, Belgium.,Otorhinolaryngology-Head and Neck Surgery, University Hospital Ghent, Ghent, Belgium
| | - Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery, University Hospital Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| |
Collapse
|
4
|
Meulemans J, Debacker J, Demarsin H, Vanclooster C, Neyt P, Mennes T, Vauterin T, Huvenne W, Laenen A, Delaere P, Vander Poorten V. Oncologic Outcomes After Salvage Laryngectomy for Squamous Cell Carcinoma of the Larynx and Hypopharynx: A Multicenter Retrospective Cohort Study. Ann Surg Oncol 2020; 28:1751-1761. [PMID: 32860174 DOI: 10.1245/s10434-020-09017-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/28/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We aimed to analyze oncologic outcomes and identify patterns of failure and negative prognostic factors in patients who underwent salvage total laryngectomy (STL) for residual, recurrent, and second primary squamous cell carcinoma (SCC) of the larynx and hypopharynx. METHODS This was a retrospective cohort study of patients who underwent STL in four major Belgian reference hospitals between 2002 and 2018 for residual/recurrent/second primary SCC in the larynx or hypopharynx after initial (chemo)radiation. Prognostic factors for oncologic outcomes were identified using univariable and multivariable analysis. RESULTS A total of 405 patients were included in the final analysis. Five-year overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS), and locoregional relapse-free survival (LRFS) estimates were 47.7% (95% confidence interval [CI] 42.0-53.2%), 68.7% (95% CI 63.7-73.7%), 42.1% (95% CI 36.7-47.4%), and 44.3% (95% CI 38.8-49.7%), respectively. In a multivariable model, increasing clinical tumor stage of the residual/recurrent/second primary tumor, increasing number of metastatic cervical lymph nodes retrieved during neck dissection, hypopharyngeal and supraglottic tumor location, positive section margin status and perineural invasion were independent negative prognostic variables for OS, DSS, DFS, and LRFS. The type of second tumor was identified as an additional independent prognosticator for DSS, with local recurrences and second primary tumors having a better prognosis than residual tumor. CONCLUSIONS AND RELEVANCE Favorable oncologic outcomes are reported after STL. Increasing clinical tumor stage, increasing number of metastatic cervical lymph nodes, hypopharyngeal and supraglottic tumor location, positive section margins, and perineural invasion are identified as independent negative prognosticators for all oncologic outcome measures.
Collapse
Affiliation(s)
- Jeroen Meulemans
- Otorhinolaryngology-Head and Neck Surgery, University Hospital Leuven, Herestraat 49, 3000, Louvain, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Louvain, Belgium
| | - Jens Debacker
- Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Hannelore Demarsin
- Otorhinolaryngology-Head and Neck Surgery, University Hospital Leuven, Herestraat 49, 3000, Louvain, Belgium
| | | | - Peter Neyt
- Otorhinolaryngology-Head and Neck Surgery, AZ Sint-Lucas, Ghent, Belgium
| | - Tillo Mennes
- Otorhinolaryngology-Head and Neck Surgery, University Hospital Leuven, Herestraat 49, 3000, Louvain, Belgium.,Otorhinolaryngology-Head and Neck Surgery, AZ Sint-Jan, Brugge, Belgium
| | - Tom Vauterin
- Otorhinolaryngology-Head and Neck Surgery, AZ Sint-Jan, Brugge, Belgium
| | - Wouter Huvenne
- Department of Head and Skin, Ghent University, Ghent, Belgium.,Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium
| | - Annouschka Laenen
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Louvain, Belgium
| | - Pierre Delaere
- Otorhinolaryngology-Head and Neck Surgery, University Hospital Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery, University Hospital Leuven, Herestraat 49, 3000, Louvain, Belgium. .,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Louvain, Belgium.
| |
Collapse
|
5
|
Reul M, Verschaeve M, Mennes T, Nijs S, Hoekstra H. Functional outcome and economic burden of operative management of patellar fractures: the pivotal role of onerous implants. Eur J Trauma Emerg Surg 2017; 44:697-706. [PMID: 28965219 DOI: 10.1007/s00068-017-0850-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 09/25/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The complication rate following operative treatment of patellar fractures remains high and is associated with a poor functional outcome. The primary goal of this study was to evaluate our functional outcome of patellar fracture osteosynthesis and define strategies to improve the outcome. The healthcare costs and utilization were calculated. METHODS All demographic, clinical, radiographic variables and hospital-related costs of 111 patients with 113 surgically treated patellar fractures between January 2005 and December 2014 were analyzed. Fractures were grouped as either simple or complex. Functional outcome was assessed using Knee Injury and Osteoarthritis Outcome Score (KOOS). RESULTS There were 67 simple fractures (59.3%) and 46 complex fractures (40.7%). The overall complication rate was 48.7%, including 19.5% implant-related complications. In 69 patients (61.1%), implants were removed. The outcome was rather poor, with considerable impairment in all KOOS subscales with the knee-related quality of life rated worst (median 62.5, IQR 37.5-81.25). Poor outcome correlated significantly with complex patellar fractures and extensive tension-band constructs. CONCLUSIONS The operative treatment of patellar fractures was associated with a high complication rate, functional impairment and reduced quality of life. Complex patellar fractures and extensive tension-band constructs were identified as the main determinants of poor outcome and increased economic burden due to higher reinterventions rates. Strategies to reduce complications and improve outcome should focus on less onerous implants.
Collapse
Affiliation(s)
- M Reul
- Department of Trauma Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - M Verschaeve
- Faculty of Medicine, KU Leuven-University of Leuven, 3000, Leuven, Belgium
| | - T Mennes
- Faculty of Medicine, KU Leuven-University of Leuven, 3000, Leuven, Belgium
| | - S Nijs
- Department of Trauma Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.,Faculty of Medicine, KU Leuven-University of Leuven, 3000, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven-University of Leuven, 3000, Leuven, Belgium
| | - H Hoekstra
- Department of Trauma Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. .,Faculty of Medicine, KU Leuven-University of Leuven, 3000, Leuven, Belgium. .,Department of Development and Regeneration, KU Leuven-University of Leuven, 3000, Leuven, Belgium.
| |
Collapse
|