Woody hardness classification impact on salvage laryngectomy functional outcomes

Djabali, Emma J.; Rotter, Jason; Chheda, Neil N.; Amdur, Robert J.; Hitchcock, Kathryn; Mendenhall, William; Dziegielewski, Peter T.

doi:10.1016/j.amjoto.2020.102877

Cited by 3 publications

(3 citation statements)

References 17 publications

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“…Radiation-induced fibrosis (RIF) is depicted clinically as a woody aspect ( 131 , 132 ). Mild to moderate RIF is frequent ( 133 ).…”

Section: Effects Of Postoperative Radiotherapy On Flapsmentioning

confidence: 99%

“…In addition to spontaneous and host-dependent atrophy (50), poRT further contributes to flap volume reduction (68, 129) (Figure 4). With an average flap volume loss of 34%, 39% was reported in patients with poRT versus 31% in patients without poRT (130), probably by muscle atrophy, which itself is related to innervation (37,39). This occurred despite efficient flap vascularization possibly through radiation endarteritis and chronic ischemia (39).…”

Section: Radiation-induced Atrophymentioning

confidence: 99%

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Reconstructive flap surgery in head and neck cancer patients: an interdisciplinary view of the challenges encountered by radiation oncologists in postoperative radiotherapy

Thariat,

Carsuzaa,

Beddok

et al. 2024

Front. Oncol.

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BackgroundMajor advances have been made in reconstructive surgery in the last decades to reduce morbidity in head and neck cancer. Flaps are now present in 80% of patients with oral cavity cancer to cover anatomic, functional, and cosmetic needs. However, gaps in interdisciplinary innovation transfer from surgery to postoperative radiotherapy (poRT) remain challenging. We aimed to provide an interdisciplinary view of the challenges encountered by radiation oncologists in planning head and neck postoperative radiotherapy.MethodsA systematic and critical review was conducted to address areas of optimization in surgery and radiology that may be relevant to poRT.ResultsDespite extensive surgical literature on flap techniques and salvage surgery, 13 retrospective series were identified, where flap outcomes were indirectly compared between surgery alone or poRT. These low-evidence studies suggest that radiotherapy accelerates flap atrophy, fibrosis, and osteoradionecrosis and deteriorates functional outcomes. Preliminary evidence suggests that tumor spread occurs at the flap–tissue junction rather than in the flaps. One prospective 15-patient study showed 31.3% vs. 39.2% flap volume reduction without or with poRT. In an international consensus, experts recognized the needs for optimized flap-sparing poRT against flap-related functional deterioration and bone damage. CT, MRI, and PET-CT modalities show potential for the delineation of the junction area between native tissues and flap for flap segmentation and to characterize flap-specific changes quantitatively and correlate them with patterns of relapse or complications.ConclusionFlap management in poRT is insufficiently documented, but poRT seems to damage flaps. Current gaps in knowledge underscore the need for prospective flap assessment and interdisciplinary trials investigating flap morbidity minimization by flap-sparing poRT planning.

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“…Radiation-induced fibrosis (RIF) is depicted clinically as a woody aspect ( 131 , 132 ). Mild to moderate RIF is frequent ( 133 ).…”

Section: Effects Of Postoperative Radiotherapy On Flapsmentioning

confidence: 99%

Section: Radiation-induced Atrophymentioning

confidence: 99%

Reconstructive flap surgery in head and neck cancer patients: an interdisciplinary view of the challenges encountered by radiation oncologists in postoperative radiotherapy

Thariat,

Carsuzaa,

Beddok

et al. 2024

Front. Oncol.

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“…57 Using this classification, a significant association was found between increasing degree of fibrosis and time to stricture development. 58 Strictures seem to be more common and severe depending on the severity of neck fibrosis/woodiness.…”

Section: Primary Versus Salvage Laryngectomymentioning

confidence: 99%

Neopharyngeal Stricture following Laryngectomy

2022

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Stricture formation is a serious complication following pharyngeal reconstruction. These strictures can be life-threatening and can severely impact quality of life. In this article, the existing literature on surgical risk factors linked to neopharyngeal stricture formation is reviewed. Intraoperative preventative measures reconstructive surgeons should consider are also discussed. Finally, this article will describe the evaluation and management of pharyngoesophageal strictures, including the challenges and options when dealing with refractory strictures.

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Extracorporeal Membrane Oxygenation (ECMO)-Assisted Tracheostomy in a Patient with a “Woody Neck” Due to Radiation Therapy and Complicated by Bilateral Internal Jugular Vein Occlusion: A Case Report

Bales,

Hamid,

Fadumiye

2024

IMCRJ

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Radiation for head and neck cancer (HNC) can lead to neck fibrosis, commonly known as "woody neck", limiting neck mobility. We report the case of a 46-year-old male with a history of tonsillar squamous cell carcinoma, with a "woody neck" following multiple radiation treatments. Facial swelling and impending airway loss prompted emergent intubation. Despite nasotracheal tube placement, bilateral internal jugular vein occlusion led to a difficult tracheostomy. An airway exchange catheter (AEC) facilitated multiple attempts at tracheal cannulation, but due to challenging anatomy, prolonged nasotracheal intubation was maintained. Tracheostomy was attempted again with extracorporeal membrane oxygenation (ECMO) support, which resulted in successful tracheal cannulation.

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Woody hardness classification impact on salvage laryngectomy functional outcomes

Cited by 3 publications

References 17 publications

Reconstructive flap surgery in head and neck cancer patients: an interdisciplinary view of the challenges encountered by radiation oncologists in postoperative radiotherapy

Reconstructive flap surgery in head and neck cancer patients: an interdisciplinary view of the challenges encountered by radiation oncologists in postoperative radiotherapy

Neopharyngeal Stricture following Laryngectomy

Extracorporeal Membrane Oxygenation (ECMO)-Assisted Tracheostomy in a Patient with a “Woody Neck” Due to Radiation Therapy and Complicated by Bilateral Internal Jugular Vein Occlusion: A Case Report

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