JAMA otolaryngology-- head & neck surgery
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JAMA Otolaryngol Head Neck Surg · Jan 2016
Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea: A Meta-analysis.
Maxillomandibular advancement (MMA) is an invasive yet effective surgical option for obstructive sleep apnea (OSA) that achieves enlargement of the upper airway by physically expanding the facial skeletal framework. ⋯ Maxillomandibular advancement is an effective treatment for OSA. Most patients with high residual AHI and RDI after other unsuccessful surgical procedures for OSA are likely to benefit from MMA.
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JAMA Otolaryngol Head Neck Surg · Dec 2015
Factors Associated With Hospital Length of Stay Following Fibular Free-Tissue Reconstruction of Head and Neck Defects: Assessment Using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Criteria.
Cost containment is at the forefront of responsible health care delivery. One way to decrease costs is to decrease hospital length of stay (LOS). Data are lacking on factors contributing to LOS in patients with head and neck cancer (HNC) undergoing fibular free-tissue reconstruction (FFTR) of head and neck defects. ⋯ Evaluated by the ACS NSQIP criteria, FFTR of head and neck defects in patients with HNC was associated with LOS longer than 10 days for procedures lasting longer than 11 hours and for patients who are ventilator dependent for more than 48 hours.
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JAMA Otolaryngol Head Neck Surg · Dec 2015
Treatment Outcomes for T4 Oropharyngeal Squamous Cell Carcinoma.
Little is known about treatment outcomes for T4 oropharyngeal squamous cell carcinoma (OPSCC), particularly in the era of human papillomavirus (HPV)-related disease. ⋯ Primary surgical treatment may be associated with improved outcomes in patients with T4 OPSCC. p16 Immunohistochemical status remains a strong prognostic indicator even in patients with locally advanced disease.
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JAMA Otolaryngol Head Neck Surg · Dec 2015
Multicenter StudyEarly Oral Tongue Squamous Cell Carcinoma: Sampling of Margins From Tumor Bed and Worse Local Control.
Positive margins are associated with poor prognosis among patients with oral tongue squamous cell carcinoma (SCC). However, wide variation exists in the margin sampling technique. ⋯ The margin sampling technique affects local control in patients with oral tongue SCC. Reliance on margin sampling from the tumor bed is associated with worse local control, most likely owing to narrower margin clearance and greater incidence of positive margins. A resection specimen-based margin assessment is recommended.
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JAMA Otolaryngol Head Neck Surg · Dec 2015
Antibiotic Prophylaxis in Patients Undergoing Head and Neck Free Flap Reconstruction.
Evidence supports short courses of perioperative antibiotics for patients receiving minor head and neck procedures. Few studies have addressed antibiotic prophylaxis for patients undergoing free flap reconstruction of head and neck defects. ⋯ The choice of antibiotic appears to affect the rate of all postoperative infections and flap site infections more than the duration of antibiotics following head and neck free flap reconstruction. At our institutions, ampicillin-sulbactam is the preferred prophylactic antibiotic for major clean-contaminated head and neck procedures when possible.