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Perioperative management of the head and neck cancer patient

The perioperative care of patients with head and neck cancer is complex and requires significant preoperative planning and patient education. The issues include analgesia, antibiotics, stoma and wound care, general and chest physiotherapy, thromboprophylaxis and nutrition. This article provides a...

When to treat a fractured mandible?

This is a prospective study from Brisbane of 215 patients with a total of 359 fractures of the mandible. Nine outcome variables were analysed with a further 19 included to adjust for potential confounding. Treatment delay was found not to...

Delirium post-op

This is a retrospective study from Japan analysing 102 patients who underwent oral cancer resection and free flap reconstruction. Postoperative delirium occurred in a third of these patients. An increased risk was identified in those with high preoperative albumin, postoperative...

One anastomosis or two

This is a cumulative meta-analysis from Hong Kong reviewing 27 articles and a total of 7,389 flaps. The authors, at the outset, acknowledge that the number of anastomoses is not the only factor of venous compromise and flap failure. Nonetheless...

SPECT scans not justified in growth of the mandibular condyle

This is a paper from Hong Kong of 200 patients between January 2011 and July 2013 who underwent SPECT bone scintigraphy for assessment of growth causing condylar hyperplasia and subsequent mandibular asymmetry. Thirty-four patients were found to have active growth...

Blindness after orthognathic surgery

This is a case report and review of the literature of this rare, but well recognised alarming complication. The authors discuss the possible mechanisms, suggesting that it does not arise from a direct injury to the optic nerve and is...

Obstructive sleep apnoea: Does maxillomandibular advancement work?

This is a paper from the Netherlands reviewing 62 patients who underwent maxillomandibular advancement for moderate to severe obstructive sleep apnoea. The authors observed a 71% success rate with mean apnoea hypopnea index (AHI) reduction of 69%. There was no...

Cinch suture: Does it work?

Flaring of the nostrils is a common side-effect of a maxillary osteotomy. At times flaring is minimal or of no significance. In some instances, it can be a significant postoperative concern to the patient, even to the extent of declining...

Risk factors in free flap failure

This is a retrospective analysis from China of 881 free flaps over nearly four years, 49 of which were ‘taken back’, 26 of which were lost, giving a 97% success rate. The commonest cause of flap failure was venous thrombosis....

What causes delays in head and neck cancer treatment?

This article identifies which factors are responsible for delays in cancer management by a retrospective case-control series study, statistically comparing two groups, each of 50 patients, one receiving timely treatment and the other breaching set targets. It was observed that...

Discharge planning

For a specialty such as ENT in which so many procedures are performed as day case surgery, there is a pressing need for objective discharge criteria to facilitate safe decision making post-op. This review strikes a good balance between prescriptive...

Surgery for class III malocclusions pharyngeal airway and sleep apnoea effects

Thirty-three patients from Brazil were assessed for obstructive sleep apnoea and hypopnoea syndrome pre- and six months postoperatively. The 33 patients were made up of nine having mandibular set back surgery, six maxillary advancement and 18 bi-maxillary surgery. They identified...