Head and Neck

Does tranexamic acid really matter in reducing blood loss? A critical evaluation of its efficacy in orthognathic surgery through a comprehensive systematic review and meta-analysis (2024)

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Type of publication:
Systematic Review

Author(s):
Mortada, Hatan; Hussain, Samar Ali; Liyanage, Dinithi Dilruvi; Zou, Yutong; Subbiah, Praveen; *George, Jefferson; Mansour, Hamid Reza Khademi; Khajuria, Ankur.

Citation:
British Journal of Oral & Maxillofacial Surgery. 2024 Jul 09.

Abstract:
Tranexamic acid (TXA) is acknowledged for reducing blood loss and transfusion requirements in various surgical specialties, yet its role in orthognathic procedures is less defined. Our study seeks to fill this knowledge gap by reviewing the available data and summarising the efficacy and clinical outcomes of TXA in orthognathic surgery. We performed a systematic review and meta-analysis, searching five databases for studies until 16 April, 2023. Our key outcome measures were intraoperative blood loss, postoperative bleeding, and transfusion rate. Previous weaknesses in systematic review and meta-analyses (SRMA) were identified using Assessing the Methodological Quality of Systematic Reviews-2 (AMSTAR-2). The risk of bias was evaluated with the RoB-2 tool. A total of 15 studies were included, involving a combined total of 1060 patients. Compared with the control, the TXA group demonstrated significant reductions in intraoperative blood loss (mean difference -135.60 mL; p < 0.00001; 95% CI, -177.51 to -93.70 mL), Hb level drop (mean difference: 2.67 [-0.63, 5.98]), and improved surgical field visibility [p < 0.00001. (MD -0.99) (CI -1.11 to -0.86)]. No significant differences were observed in postoperative haematocrit levels (mean difference: -0.42 [-2.19, 1.35]; p = 0.003; I2 = 75%), operation duration (p = 0.21), or duration of hospital stay (p = 0.63) between TXA and control groups. In orthognathic surgery, TXA effectively minimises blood loss, demonstrating both safety and efficiency. Well-designed, larger studies and comparisons with other haemostatic agents could solidify TXA evidence.

A Prognostic Model to Predict Hearing Recovery in Patients With Idiopathic Sudden Onset Sensorineural Hearing Loss (2024)

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Type of publication:
Journal article

Author(s):
Mandavia, Rishi; Joshi, Nikhil; Hannink, Gerjon; Ahmed, Muhammad Nayeem; *Parmar, Dilen; Di Bonaventura, Silvia; Gomes, Paola; Iqbal, Isha; Lyles, James; Schilder, Anne G M; Mehta, Nishchay

Citation:
JAMA Otolaryngology– Head & Neck Surgery. 2024 Sep 05. [epub ahead of print]

Abstract:
Importance: The prognosis of idiopathic sudden onset sensorineural hearing loss (iSSNHL) is uncertain, which creates challenges in clinical decision-making for ear, nose, and throat (ENT) physicians and adds to the burden of the condition experienced by patients. Objective: To develop and internally validate a prognostic model for hearing recovery among patients with iSSNHL to support ENT surgeons in making informed and individualized treatment decisions. Design, Settings, and Participants: This prognostic study and model used cohort data from the Sudden Onset Sensorineural Hearing Loss study, which included 812 patients (age >=16 years) diagnosed with iSSNHL at 76 National Health Service ENT departments in the UK from December 2019 to May 2022. Nine variables previously reported as independent prognostic
factors for complete recovery of patients with iSSNHL were selected for inclusion. The final model was internally validated using bootstrapping with 500 repetitions, then coefficients were adjusted for the degree of optimism in the model. The model intercept was reassessed after adjustment of model coefficients. Impact of individual predictors was evaluated by estimating odds ratios with corresponding 95% CIs. Model performance was re-evaluated after internal validation and expressed by discrimination, calibration, and clinical utility. Data analyses were performed from March 2022 to April 2024. Intervention: Routine treatment (per National Health Service standards), including oral steroids and intratympanic steroid injections. Main Outcome and Measures: Complete hearing recovery defined as a return to within 10 dB of the patient's before iSSNHL hearing levels at all frequencies in the affected ear at 6 to 16 weeks after iSSNHL symptom onset. Results: The study sample included 498 patients (mean [SD] age, 58.7
[16.0] years; 215 [46.9%] females and 243 [53.1%] males) who met the criteria for inclusion in the model. Of those, 210 (46%) were classified as having experienced complete hearing recovery. Five variables were found to be independent predictors for complete hearing recovery: steroid treatment within 7 days from symptom onset (OR, 5.23 vs no treatment ), lower severity of hearing loss at presentation (OR, 0.19 if loss is mild), absence of vertigo (OR, 0.56 vs no vertigo), younger patient age (OR, 0.64 per year), and a history of cardiovascular disease (OR, 1.84 vs no cardiovascular disease). The model showed good performance after internal validation with a c-index of 0.77 (95% CI, 0.7-0.81). Predictions for complete recovery aligned well with observed complete recovery rates, and greater clinical utility than treat all or treat none strategies was shown. Conclusion and Relevance: This prognostic model evaluated in this study
may be able to assist ENT surgeons in making informed treatment decisions for individual patients with iSSNHL. It is available online at no cost.

Novel case report of primary osteosarcoma of the maxilla in an adult: An important differential diagnosis (2023)

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Type of publication:
Journal article

Author(s):
*Venkatasami M.; *Harrison K.

Citation:
Advances in Oral and Maxillofacial Surgery. 2023. Article Number: 100423. Date of Publication: September 2023. [epub ahead of print]

Abstract:
Craniofacial osteosarcoma accounts for 10% of osteosarcoma malignancies, typically affecting the 4-5th decade of life, with the maxilla being the second-most common site. We report a 58-year-old male, non-smoker, with a lump of his upper jaw which occasionally bled during mastication. Clinical examination revealed an exophytic mass in the upper left tuberosity of the maxilla and no lymphadenopathy, where initial differential diagnosis was squamous cell carcinoma. Radiological investigations revealed a metabolically active left maxillary lesion with maxillary sinus destruction, representing primary malignancy. Histological analyses initially suggested a fibro-osseous lesion; further immunohistochemistry showed cytokeratin AE1/AE3/CK(MNF.116) positivity with 60% ki67 proliferation index; diagnostic of grade 2-3 osteosarcoma. Management included neoadjuvant chemotherapy prior to total maxillectomy and dental prosthetic rehabilitation. We report a novel case of primary osteosarcoma of the maxilla in an adult. Osteosarcoma is challenging to diagnose and an important differential to consider where the mainstay of treatment is early invention.

Link to full-text [open access - no password required]

Primary acinic cell carcinoma in an adolescent female (2023)

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Type of publication:
Journal article

Author(s):
Venkatasami M.; Harrison K.

Citation:
Advances in Oral and Maxillofacial Surgery. 10 (no pagination), 2023. Article Number: 100419. Date of Publication: June 2023. [epub ahead of print]

Abstract:
Acinic cell carcinoma (ACC) is a rare, low-grade tumour, accounting for about 17% of all primary salivary gland malignancies in adults. ACC most commonly affects the parotid gland, predominating fifth and sixth decades of life and a female predilection. In the paediatric population, mucoepidermoid carcinoma is the most common parotid malignancy, followed by ACC. We report a case of a 16-year-old female, presenting with a slow-growing right parotid lump. Clinical examination revealed a small right parotid nodule, grade I House-Brackmann score and cervical lymphadenopathy. Radiological investigations revealed a well-circumscribed lobulated lesion in the anterior right parotid gland and reactive lymph nodes. Surgical management included a right partial parotidectomy. Immunohistochemistry was negative for S100, positive with DOG-1 and widespread PAS-D-resistant granules throughout the tumour cells, confirming a diagnosis of ACC. ACC is an important differential diagnosis to consider in salivary gland pathology in the female adolescent patient.

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Addressing patients' concerns in speech and language therapy consultations following the diagnosis and treatment of head and neck cancer (2023)

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Type of publication:
Journal article

Author(s):
*Zuydam, Annette C; Rogers, Simon N; Roe, Justin W G.

Citation:
Current Opinion in Otolaryngology and Head and Neck Surgery. 2023 Volume: 31 Issue 3, p.159-164

Abstract:
PURPOSE OF REVIEW: Head and neck cancer (HNC) and its treatment impacts profoundly on patients' functional abilities, emotional well being and social interactions. Communication and swallowing are fundamental to everyday life, and the Speech and Language Therapist (SLT) has a critical role for both patients and their carers. In clinical practice, patient-reported outcome measures (PROMs) are a key part of the armamentarium of the SLT. The purpose of the review is to summarize how these measures can be beneficial in the context of time pressured SLT outpatient consultations. RECENT FINDINGS: Unmet needs in HNC are common and impact negatively on quality of life. There is an ever-increasing number of articles in this area, and it can be a challenge to identify, distil and summarize those specific to SLT. SUMMARY: In this review, we discuss the scope of holistic evaluation, strengths and limitations of PROMs, the Patient Concerns Inventory-Head and Neck, barriers to the use of outcome measures, the carers perspective and surveillance. SLT are uniquely placed members of the multidisciplinary team and provide expert advice and intervention. The inclusion of PROMs in routine consultations provides a model of follow up, which helps address patients and carers complex and unmet needs, ultimately promoting better outcomes.

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A Brief Clinical Study: The Use of a Custom Guide for Scapula Free Flap Harvest and Mandibular Reconstruction (2022)

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Type of publication:Journal article

Author(s):*Chundoo S; *Naredla P; *Thomas S

Citation:Journal of Craniofacial Surgery, 2022 Oct 01; Vol. 33 (7), pp. 2142-2145.

Abstract:Head and neck cancer can leave patients with significant defects requiring major reconstruction. The scapula free flap remains a relatively underused flap choice. This article examines the novel use of a custom guide for a scapula free flap in mandibular reconstruction following resection. A case file was created involving a consultant surgeon, KLS advisor, and technical team based in Belgium. A computed tomography scan of the mandible was sent electronically to render a 3-dimensional model. Custom cutting guides for resection and scapula graft harvest were fabricated. A custom plate for fixation was also developed. The scapula free flap was successfully placed using custom guides. In this case, the use of a custom guide enabled easier harvest, manipulation, and handling of the scapula free flap into the defect. The use of new technology and computer-generated guides represents a considerable shift forward into improving precision in complex surgical procedures and reducing intraoperative time. The use of a custom guide can provide an easier means to handle and manipulate one of the largest free flaps in surgery, the scapula free flap.

Establishing a large prospective clinical cohort in people with head and neck cancer as a biomedical resource: head and neck 5000 (2015)

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Type of publication:
Journal article

Author(s):
Ness A.R., Waylen A., Hurley K., Jeffreys M., Penfold C., Pring M., Leary S., Allmark C., Toms S., Ring S., Peters T.J., Hollingworth W., Worthington H., Nutting C., Fisher S., Rogers S.N., Thomas S.J., Rogers S., Thiruchelvam J.K., Abdelkader M., Anari S., Mehanna H., Sheehan T., Dyker K., McCaul J., Benson R., Stewart S., Hall C., Lester J., Homer J., Hamid A., Lamont A., Fresco L., Lester S., Cogill G., Roy A., Foran B., Bisase B., Balfour A., Evans A., Gollins S., Conway D., Gunasekaran S.P., Lees L., Lowe R., England J., Scrase C., Wight R., Sen M., Doyle M., Moule R., Goodchild K., Rowell N., Beaumont-Jewell D., Loo H.W., Jankowska P., Paleri V., Casasola R., Roques T., Tierney P., Hwang D., Dyson P., Andrade G., Tatla T., Christian J., Winter S., Baldwin A., Davies J., King E., Barnes D., Repanos C., Kim D., Richards S., Dallas N., McAlister K., Berry S., Cole N., Moss L., Palaniappan N., Evans M., Siva M., *Hari C. , Wood K., Simcock R., Waldron J., Hyde N., Ahmed I., Gahir D., O'Hara J., Carr R., Forster M., Thomas S., Wagstaff L., Mano J., Brammer C., Tyler J., Coatesworth A.

Citation:
BMC Cancer, December 2014, vol./is. 14/1, 1471-2407 (December 17, 2014)

Abstract:
Background: Head and neck cancer is an important cause of ill health. Survival appears to be improving but the reasons for this are unclear. They could include evolving aetiology, modifications in care, improvements in treatment or changes in lifestyle behaviour. Observational studies are required to explore survival trends and identify outcome predictors. Methods: We are identifying people with a new diagnosis of head and neck cancer. We obtain consent that includes agreement to collect longitudinal data, store samples and record linkage. Prior to treatment we give participants three questionnaires on health and lifestyle, quality of life and sexual history. We collect blood and saliva samples, complete a clinical data capture form and request a formalin fixed tissue sample. At four and twelve months we complete further data capture forms and send participants further quality of life questionnaires. Discussion: This large clinical cohort of people with head and neck cancer brings together clinical data, patient-reported outcomes and biological samples in a single co-ordinated resource for translational and prognostic research.

Link to full-text: http://europepmc.org/articles/PMC4301458