Head and neck surgery

A technical note describing the use of a carotid artery bypass graft in the management of head and neck cancer with carotid artery involvement and review of literature (2019)

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Type of publication:
Conference abstract

Author(s):
*Hamps C.; *Pilkington R.; *Merriman C.; *Thomas S.; *Bhatia S.

Citation:
British Journal of Oral and Maxillofacial Surgery; Dec 2019; vol. 57 (no. 10)

Abstract:
Introduction Carotid blowout syndrome (CBS) refers to rupture of the carotid artery and is an uncommon but often catastrophic complication of head and neck cancer when arterial wall integrity is compromised,
particularly where surgical procedures and radiotherapy are involved. Rupture occurs most commonly in the common carotid artery in proximity to the furcation, often within 10-40 days post surgery. Methods We present the use of a great saphenous vein carotid artery bypass graft in the management of a 47-year-old woman with recurrent squamous cell carcinoma (T2 N1 M0 RO V1) utilizing the Pruitt F3 carotid shunt system to minimize cerebral perfusion compromise. We explore pre and post-operative surgical considerations including suggested graft-monitoring protocols. Results The body of evidence supporting the use of carotid bypass grafts is limited. Despite data paucity, case series are available demonstrating variable mortality. A systematic review of PubMed was conducted revealing three English language case series. One series reported a 2-year survival of 82% with carotid sacrifice and autogenous venous graft where distant metastatic disease is absent. 96% of patients experienced no neurologic sequela whilst 3.9% suffered CVA post-operatively. Our own patient remains free of neurologic symptoms and graft patency has been confirmed at 3 months. Clinical Relevance Tumour resection involving in the carotid artery presents an array of surgical management possibilities including tumour shaving, artery ligation or resection. The long-term survival of carotid bypass graft is unknown and reported complications vary, it remains a promising technique in the prevention of carotid blowout syndrome.

Current trends in head and neck surgery: Use of recurrent laryngeal nerve monitoring (RLNM) (2014)

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Type of publication:
Conference abstract

Author(s):
Babatola O., *Karamchandani D., *Ahsan S.F.

Citation:
International Journal of Surgery, November 2014, vol./is. 12/(S39)

Abstract:
Introduction: Aim is to understand the patterns of use of nerve monitoring in UK surgical practice. Methods: An electronic questionnaire was sent to the 434 members of the ENT-UK expert panel in 2012. 86 members (22.4%) of the panel identified themselves as having an interest or subspecialty related to thyroid surgery. The survey contained 8 questions on their current practice in thyroid or parathyroid surgery, their typical use of the recurrent laryngeal nerve stimulator and any patient selection criteria that they may have. Demographic data on the surgeon's year of gaining consultancy and number of procedures performed per annum was also obtained. Results: Of 100 respondents (23.04% response rate) of this panel, 50 of these surgeons performed thyroid and/or parathyroid surgery on a regular basis and the following results pertain to this group. 58.3% use the RLNS in almost all cases that they perform. A further 12.5% used it in fewer than half of their cases. 29.2% did not use the stimulator at all. Conclusions: Currently there appears to be no true consensus among the surgeons performing thyroid surgery on use of RLNS in thyroid surgery.

Link to more details or full-text:
http://www.journal-surgery.net/article/S1743-9191(14)00373-2/pdf