In general, it is known that readmitted patients are older and have more medical comorbidities [11 – 13]. Being from a low socioeconomic class and having had previous unplanned visits to hospital also increase the risk for readmissions [11, 12, 14]. Moreover, the causes for readmission differ based on the specific patient population [15, 16]. Studies on surgery patients have identified risk factors for unplanned readmission that differ from medical patients . Within the field of Otolaryngology – Head and NeckSurgery, the surgical procedures performed are diverse in nature. A single
Pectoralis Major Myocutaneous Flap in Head and Neck Surgery Med J Malaysia Vol 40 No 2 June 1985 PECTORALIS MAJOR MYOCUTANEOUS FLAP IN HEAD AND NECK SURGERY IMRAN GURBACHAN A C GOMEZ NAZIM NOOR SUMMAR[.]
The pamphlets were created using a systematic review of the current informational landscape in adenoton- sillectomy peri-operative care. A review of traditional literature was done and pertinent information was in- cluded in the pamphlets. Multiple search strategies in Ovid MEDLINE were utilized and four review papers were selective as information sources [8-10]. Additionally, an en- vironmental scan including online grey literature and similar pamphlets available at other Canadian otolaryngology-head and necksurgery clinics was done. Pamphlets created by McGill University  and the University of Mississippi  were included in the review process. Grey literature was reviewed using popular search mediums available to patients. Utilizing multiple search strategies, google.com, yahoo.com, and bing.com were searched. Websites providing lay information on adenotonsillectomy were reviewed. The pamphlets were written to be inclusive of individuals with minimal educational background as per the recommendations of McAllister et al. . All the information was reviewed to create draft pamphlets which were audited by an experienced community otolaryngologist-head and neck surgeon before pro- ceeding to Phase 2.
The Surgical Exploration and Discovery (SEAD) program provides more experiential learning opportunities for pre- clerkship medical students interested in surgical careers, through operating room (OR) observerships, career discus- sions, and simulation-based workshops . The program was founded at the University of Toronto in 2012 and has run successfully there for three years . In June of 2014, the University of Ottawa Skills and Simulation Centre (uOSSC) collaboratively with the University of Ottawa Fac- ulty of Medicine, Department of Otolaryngology – Head and NeckSurgery and Department of Surgery, initiated the first Canadian expansion of the SEAD program. At the University of Ottawa, the program maintained the overall structure of the program as implemented in Toronto, with some variation in specialties included and the workshop content.
lag time. In the immediate future, a new focus must be directed toward transitioned retirements, protection of current resources, and very possibly the sharing of current resources. Introducing new graduates into established OTO-HNS practices could allow these graduates to maintain their skills, benefit from the mentorship of an experienced colleague, and ensure succession planning for busy community OTO-HNS practices. Those transitioning into retirement could benefit from decreased on-call responsibilities and the potential to bridge retirement through the provision of non-operative OTO-HNS care. This strategy could be implemented at a national level through the Canadian Society of Otolaryngology – Head and NeckSurgery (CSO-HNS) or more locally through academic training centres and their alumni network. The significance of the current employment problems and the substantial role OTO-HN Surgeons play in improving the quality of life of Canadians must be highlighted at a national level. While other areas of surgical care may provide improved reim- bursement opportunities, Canadians rely on Otolaryn- gology – Head and Neck Surgeons and, thus, hospital resources must remain stable for the continued care of communities. To this end, hospital based OTO-HNS re- sources (i.e., OR time) must be viewed collectively ra- ther than individually. OTO-HNS groups should ensure balanced and appropriate operating room resource allo- cation amongst all members of the group and consider- ation must be made to the potential of hiring new graduates should an abundance of resources exist. Fi- nally, ABOTO eligibility as a buffer to Canadian em- ployment should be considered. This would certainly improve current and immediate rates of under- and unemployment, but is largely a Band-Aid™ solution as workforce planning should ensure that investments in the training of Canadian OTO-HNS Surgeons are met with Canadian opportunities for these Surgeons.
that there is significant variability in opioid prescribing practices across all elective procedures for both adult and pediatric patients in Otolaryngology - Head and NeckSurgery in Canada. There is an ongoing epidemic of opioid use with associated dangers such as addiction and overdose, yet there is a lack of established procedure-specific and age-specific standards or guide- lines for physicians to follow. This is evidenced by the similar opioid prescribing amounts across a range of dis- similar procedures with expectantly differing amounts of pain, as seen in our results. Physicians and surgeons often estimate appropriate and safe dosing for their pa- tients and may not receive feedback from their patients regarding how many pills were actually consumed and whether their pain management was adequate. This vari- ability is not unique to Otolaryngology - Head and NeckSurgery. Recent studies in the areas of upper extremity surgery, Maxillofacial surgery, hand surgery, Urology and General surgery consistently show wide variability
Objective: New method to use magnet for localization and extraction of shell during head and necksurgery. Method: Series of 3 cases study all are boy’s 17_15_5 years old respectively. All are with penetrating shell injuries to head and neck in Salahaden General Hospital-Tikrit city-Iraq from 25-Oct.-2016 to 30 March 2017. This hospital is a central general governmental hospital that receives referral cases from region distal to the center of Salahaden province at north of Baghdad city (capital of Iraq) and plays a major rule in management of injured patient during war. The cases are selected after explanation of this new method to the patients, it is expected result, risk, possible complication, and unexpected sequelae that may happen after surgery. Prior consent from pa- tients and their families about this sort of surgery has been got. These patients are from families of low socio economic group except the last one he is medium class. All are undergoing surgical management with the aid of magnet. Result: we have 3 cases of shell injuries to head and neck magnet is used successfully for identification of shells and helps in their extraction. Our trial is limited for metallic objects and limited depth. Conclusion: These results suggest that magnet aid removal of shell during head and necksurgery, is less invasive tech- nique, minimal trauma to the surrounding tissues and reducing time of surgery.
operation, the electrodes were placed on the remaining right base of the tongue and the most posterior aspect of the left oral tongue. Remarkably, the right hypoglossal nerve responded to the stimulation by moving the base of the tongue to the ipsilateral side. The left nerve was intact and therefore a left hemiglossectomy was performed, and a radial forearm free flap (RFFF) was used to reconstruct the excised tongue. Surgical margins were cancer-free, and there were no intraoperative or post- operative complications. The patient was decannulated 12 days after surgery, and was able to eat, speak and move the flap with significant improvement in phonation compared to preoperative conditions. He completed his radiation therapy and was disease-free 9 months after surgery.
Most patients with adenoid cystic carcinomas (86%) had negative margins on final pathology, and all received postoperative radiation. One of these patients with a clinical T4, pathological T2 adenoid cystic carcinoma involving the base of tongue and floor of mouth was resected by TORS, found to have positive margins on final pathology, underwent postoperative radi- ation therapy, and was alive with no evidence of disease at 12.8 months of follow-up. Another patient with a T2 ade- noid cystic carcinoma of the tonsil and soft palate devel- oped distant disease in the lungs after surgery with negative margins received postoperative radiation therapy; this patient was alive with known pulmonary metastatic disease at 24 months of follow-up.
From a review of medical records, 21 patients were iden- tified whose surgical defects were reconstructed with cer- vicofacial or cervicothoracic rotation flaps (Table 1). The patients ranged in age from 46 to 87 years, with a mean age of 64.5 years. These patients included 12 men and 9 women. The patients exhibited a myriad of comorbid- ities, including 9 patients with hypertension, 5 patients with diabetes mellitus, 1 patient with cardiac disease, and 3 patients with two conditions. The most frequently encountered surgical defect site was the cheek (n = 7), and the most common histologic diagnosis was squa- mous cell cancer (n = 10). The size of the defects ranged from 1.5 cm × 1.5 cm to 16 cm × 7 cm. Ten patients were reconstructed with cervicofacial rotation flaps, and 11 patients were reconstructed with cervicothoracic flaps. Neck dissections were performed in 12 cases (57%), ran- ging from selective nodal dissections to radical neck dis- sections. There were 4 patients who suffered through- and-through cheek defects, with skin defects ranging from 4 cm × 4 cm to 6 cm × 4 cm and cheek mucosal defects ranging from 2 cm × 1.5 cm to 4 cm × 3 cm. They were all reconstructed with combined cervicothor- acic rotation flaps and PMMF (Figure 2). The PMMF were used to repair the cheek mucosa, and the cervi- cothoracic flaps were used to repair the cheek skin. All of the chest donation sites were able to be closed primarily.
The EORTC Head and Neck cancer module (QLQ-H&N35) is a module which is designed to be used in conjunction with the EORTC QLQ C30 64 . This consists of scales including pain, swallowing, senses, speech, social eating, social contact and sexuality. 11 papers used the EORTC QLQ C30 in conjunction with QLQ-H&N35, 7 used EORTC QLQ C30 without the Head and neck module and 3 used the QLQ-H&N35 without the EORTC QLQ C30 (Table 4). The focus the papers was in the comparison of different treatment regimes, particularly chemotherapeutic agents which was the case for 7 of the 11 papers.
There are number of other new robots in development that offer potential to improve energy delivery to the head and neck during TORS. These innovations are still at early stages in their development but already show great pro- mise in overcoming existing challenges in energy delivery. Johnson and Johnson have made multiple announce- ments surrounding the launch of its new surgical robot, the Verb. 63 They claim to have miniaturized existing robotic technology to a machine 20% of the size of current plat- forms, allowing the surgeon to get closer to the target tissue. Exactly what this will entail for head and necksurgery remains unclear, but a smaller machine with com- patibility for a variety of energy devices would be an area of interest to further overcome ongoing physical chal- lenges in energy delivery.
In the early 1990s, scholars began to apply CAD and 3D printing techniques to the diagnosis and treatment of com- plex head and neck and maxillofacial diseases. These two techniques improved diagnostic accuracy by 29.60%, pro- cedural precision by 36.23%, and shortened operative time by 17.63% . In the twenty-first century, CAD and 3D printing techniques have been widely used for reconstruc- tion of complex defects in head and necksurgery [4, 5]. These techniques provide an accurate preoperative simula- tion and intraoperative surgical ablative plan. Additionally, enhanced imaging provides a reference for the length and shape of fixed titanium plates and screw positions for osse- ous reconstruction. In recent years, some scholars have pio- neered the comprehensive application of CAD combined with 3D printing technology to guide free vascularized fib- ula free flap reconstruction of maxillary defects [6, 7]. Some scholars have also taken the lead in introducing VR tech- nology in the development of operative planning and pre- operative simulation .
Venous thromboembolism is a major source of peri- operative morbidity and mortality that is largely pre- ventable. It accounts for approximately 10 % of hospital deaths annually , and patients that survive are at risk for further complications. Although both surgery and cancer are major risk factors for VTE, compliance with chemoprophylaxis guidelines has traditionally been low in head and necksurgery. This is largely driven by the historically perceived low risk of VTE in head and neck patients and potential for significant complications with anticoagulation. Recent studies have demonstrated that even though most otolaryngology patients are considered to be at low risk for VTE, head and neck cancer patients consti- tute a unique group with different VTE risks (sum- marized in Table 4). Specifically, the rate of VTE in head and neck cancer patients is much higher than has been reported in previous retrospective studies, particularly in the highest-risk patients. Identification of patients at the highest risk of VTE is vital to appropriately direct surveillance and prevention re- sources. As such, risk assessment models like the Caprini RAM may be useful to identify those most likely to benefit from chemoprophylaxis. However, while chemoprophylaxis may reduce the risk of VTE in high-risk groups, the risk is not eliminated, and there is an associated increase in bleeding risk. Fur- ther large-scale prospective trials will be necessary to make definitive recommendations on risk stratification and VTE prophylaxis in head and neck cancer patients.
Scientific data on the effects of IN in head and necksurgery is much less definite, primarily due to the lim- ited number of large prospective randomized controlled trials . Moreover, several of the so far published trials reported significant problems with compliance to the prescribed diets [20, 22]. In their systematic review of 10 trials investigating the effect of arginine-based IN on postoperative outcomes in head and neck cancer, Stable- forth et al.  report that LOS was reduced by 3.5 days in groups receiving IN compared to standard formula or control. The reasons for this reduction remain unclear since it does not necessarily correlate with the complica- tion rates of the analyzed trials. Several trials reported a lower rate of infectious complications [20, 22], wound infections/complications [22, 36], and fistula formation [29–31, 37]. These findings are contested by other trials which found no differences in postoperative complica- tions at all [32, 38]. None of these studies report results Table 3 Number and grading of complications according to the Buzby  and Dindo  classifications
Simultaneous neck dissection has been recommended in the literature because of neck recurrence in previously unsuspicious neck [11,12]. However, the oncological value of simultaneous neck dissection in the absence of suspect lymph nodes has also been questioned . Te- mam et al.  found lymph nodes metastases only in one of the 30 patients undergoing salvage surgery for local recurrence of initially irradiated carcinoma of the head and neck with cN0 necks. They therefore recommend li- mitation of neck dissection according to the initial N sta- tus. In our series, mostly, the N status after salvage surge- ry for local recurrences including neck dissection was congruent with the N status before chemoradiotherapy in cases while in one case an initial cN2b stage turned into a pN0 stage after salvage surgery. This data suggest a coherence of initial clinical lymph nodes status with that in case of local recurrence after CRT in most cases. Thus, less radical necksurgery in absence of initial and preop- erative lymph nodes metastases has to be discussed.
Interventions in the head and neck can be performed via percutaneous, endovascular, or a combination of these ap- proaches. Procedures that predominantly require percutane- ous access include biopsies and aspirations, sclerotherapy, and newer techniques like radio-frequency ablation and cryoabla- tion. On the other hand, a transarterial (or endovascular) ap- proach forms the mainstay of treatment for head and neck bleeding as well as for transarterial chemotherapy for head and neck neoplasms. A combination of percutaneous and transar- terial approaches may be needed in the embolization of high- flow craniofacial vascular malformations (VMs) and hypervascu- lar tumors. This article provides a review of the current clinical applications of a variety of percutaneous and endovascular inter- ventional procedures of the extracranial head and neck.
On the other hand, there are also paper that do not confirm the correlation between herpes virus infection and the risk of head and neck cancer, but those studies are more related with HHV-2 infection. Maden et al.  found a non-significant level of risk of oral cancer associated with HHV- 2 infection. The lack of significant association of HSV1 and HSV2 infection in patients with head and neck cancers was also confirmed by Parker et al. . Similarly, insignificant were the results of patients with OSCC, toombak and non-toombak users . Moreover, no correlation between OSCC development and the presence of HSV-1 was detected  and yet the question is still unanswered, whether HSV-1 and HSV-2 play an active role in head and neck cancer’s development, or are just a bystanders in the decreased local immune-deficient tumor area.