No abstract

Our updated model continues to be clinically analogous to human mandibular ORN and improves the radiologic and histologic analysis of bony defects, providing a method for quantification of bone loss. Further cell-specific staining, including immunohistochemistry, can be used with this model to study potential cellular mechanisms of mandibular ORN and test any future therapeutic options.

4 Laryngoscope, 126:1440-1445, 2016.

Treatment with anti-Scl-Ab significantly increased mandibular bone mass and alveolar height in wild type mice and normalized mandibular bone mass and alveolar height in Ts65Dn mice. The anti-Scl-Ab therapy represents a novel method for increasing mandibular bone formation.

Background Immediate postprocedure extubation (cessation of mechanical ventilation) after free tissue transfer for head and neck reconstruction may improve outcomes, reduce intensive care unit and hospital length of stay, and reduce overall cost compared with delayed extubation in the intensive care unit. Methods Medical records of 180 consecutive patients undergoing free tissue transfer for head and neck reconstruction were reviewed. Patients immediately extubated in the operating room (immediate group, N = 63) were compared with patients who were extubated in the intensive care unit (delayed group, N = 117) by univariate and multivariate analysis. Results Medical complication rates and intensive care unit length of stay were significantly higher in the delayed extubation group (55.5 vs. 12.7%, p < 0.001, and 4.4 vs. 2.9 days, p < 0.001, respectively). Although the rate of preoperative alcohol use was similar between the two groups, significantly fewer patients underwent treatment for alcohol withdrawal or agitation in the immediate extubation group (3.2 vs. 27.4%, p = 0.001). There were no significant differences in surgical complication rates. Conclusion Immediate postprocedure extubation is associated with shorter intensive care unit length of stay, reduced medical complications, and reduced incidence of treatment for agitation/alcohol withdrawal for patients undergoing free tissue transfer for head and neck reconstruction.

No abstract

Similar to the mandible, the maxilla is susceptible to radiogenic bone injury as demonstrated by the significant decrease in bone volume of the radiated dental extraction socket. Despite radiologic similarities to mandibular ORN in the rat model, the maxilla demonstrated a more benign clinical course with a complete absence of bone exposure. Differences in the maxillary bone and microenvironment of the maxilla compared with the mandible may explain the subclinical response to radiation and lower incidence of maxillary ORN seen in patients. This maxillary model can be combined with our high-dose-rate mandibular ORN model to investigate these differences and better understand ORN.

IMPORTANCE Limited evidence is available to guide drain removal after selective lateral neck dissection (SLND). Patients may have drains left in longer than necessary, leading to patient discomfort, longer hospitalizations, and increased costs.OBJECTIVE To compare 2 output volume thresholds for drain removal after SLND. DESIGN, SETTING, AND PARTICIPANTSThis single-blind randomized clinical trial included a consecutive sample of all adult patients undergoing unilateral or bilateral SLND of levels I to III, I to IV, II to III, or II to IV from March 1, 2015, to December 1, 2016, at a tertiary academic medical center. Eligible patients had at least 30 days of follow-up. Patients undergoing a parotidectomy, a level V lymphadenectomy, or an SLND that communicated with the upper aerodigestive tract or who had a suspected chylous fistula on the first postoperative day were excluded from enrollment. Sixty-five patients were offered enrollment and 12 refused. Fifty-three patients who underwent 67 SLNDs were included in the final analysis, with no patients lost to follow-up. Analysis was based on intention to treat.INTERVENTIONS On the first postoperative day, patients were randomized to either a drain removal threshold of less than 30 mL or less than 100 mL during a 24-hour period.MAIN OUTCOMES AND MEASURES Duration of drain use, hospital length of stay, and wound complications for both groups.RESULTS Among the 53 patients with 67 SLNDs included in the analysis (45 men [85%] and 8 women [15%]; mean age, 58.5 years [95% CI, 53.2-64.5 years]), 32 SLNDs were randomized to the 100-mL group and 35 were randomized to the 30-mL group. No meaningful differences in preoperative characteristics were noted between groups. Two seromas occurred in the 100-mL group (2 of 32 [6.3%; 95% CI, 0%-13.5%]) and in the 30-mL group (2 of 35 [5.7%; 95% CI, 0%-14.6%]). No hematomas, chylous fistulas, or wound infections occurred. The 100-mL group had a 1.87-day reduction in mean hospital length of stay (95% CI, 0.66-3.10 days). CONCLUSIONS AND RELEVANCEA volume threshold for drain removal of 100 mL during a 24-hour period after SLNDs appears to be safe and may significantly reduce duration of drain use and hospital length of stay. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT03113526