NSND patients with SCCHN are commonly young women with oral tongue cancer, elderly women with gingival/buccal cancer, or young to middle-aged men with oropharyngeal cancer. While several exposures studied may be important to the etiology of a subset of these cancers in NSND patients, it is likely that no single known factor is responsible for a majority of SCCHN in NSNDs.
In the Sunbelt Melanoma Trial, ulceration was the strongest predictor of overall survival in melanoma of the ear. Ulceration and SLN status correlated with poorer OS in nonear melanoma of the H&N, whereas increasing depth correlated with poorer DFS in those same patients. Recurrence and survival were not impacted by anatomic site, but the prognostic significance of ulceration, thickness, and SLN status in the H&N may vary with the site of the melanoma.
Dislocation of the mandibular condyle into the middle cranial fossa is a rare traumatic injury caused by transmission of upward force through the condyle onto the glenoid fossa resulting in fracture of the fossa and superior displacement of the condylar head. This type of injury occurs when the "safety mechanisms" of the mandible fail or are absent. The authors present the case of a 72-year-old female patient with multiple comorbidities who suffered a subcondylar fracture of the left mandible and dislocation of the right mandibular condyle into the middle cranial fossa after a fall. Bilateral external fixation of the mandible to the zygomatic arch was utilized to minimize operative time and provide definitive treatment. Many factors must be taken into account when determining the treatment modality for this type of injury, and the final decision should be tailored to each individual case based on several factors including the length of time between injury and presentation, concomitant neurologic deficit, age, and stability of the patient. The goals of treatment are reduction of the dislocation, avoidance of neurologic injury, and restoration of mandibular function. A multidisciplinary effort is necessary to optimize patient care.
Background
The hemostatic net, which was initially described as a method to decrease hematoma rates in face/neck lift procedures, has since increased in practice and applicability. However, despite its demonstrated safety and efficacy, there exists significant skepticism with regards to its necessity; in particular, there is concern that the transcutaneous sutures may restrict dermal perfusion.
Objectives
The goal of this study was to assess flap perfusion, both pre- and post- the application of the hemostatic net, to determine if there is an objective decrease in tissue perfusion in relation to application of the hemostatic net, as measured by laser-assisted angiography (LAA).
Methods
Eight patients underwent cervicofacial flap reconstruction of cutaneous malignancy defects, after which a hemostatic net was applied. All patients underwent evaluation with LAA both pre- and post- the application of the net. The average relative and absolute perfusion of different zones of the flap were calculated.
Results
The average absolute change in relative perfusion was +6.41%, +0.31%, and +3.28% for zones 1, 2, and 3, respectively, after application of the hemostatic net. There was no statistical difference in relative tissue perfusion after application of the net. There were no instances of delayed healing, infections, ischemia, necrosis, or hematoma. One patient developed a seroma after the net was removed. No patients had scarring or residual track marks from the transcutaneous sutures.
Conclusions
With the use of LAA, we were able to objectively demonstrate no significant decrease in tissue perfusion after the application of the hemostatic net.
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