Changing trend in the management of head neck cancers during the COVID-19 pandemic

Abstract

Background In the present study, we have shared our experience in managing head neck cancers, especially the oral malignancies, during the crisis of COVID 19. Materials and methods Patients with oral cancers underwent pedicle/local flaps and free flaps reconstruction based on the availability of intensive care unit and comorbidities of the patients. The clinical outcomes were compared at the end of one week, one month, and three months after the primary surgery. Results Pedicle/local flaps were used in 25 cases and radial/fibular free flaps were used in 8 cases for the reconstruction of soft tissue defects. Patients with pedicle flap reconstruction had better clinical outcomes, including lesser ICU stay as compared to free flaps. Conclusion Pedicle flap can be a valid alternative to the free flap for the soft tissue reconstruction in advanced oral malignancies during the COVID pandemic period in the Indian subcontinent, especially with limited infrastructure of the hospitals.

A combination of two regional flaps for the complex reconstruction after head and neck cancer surgery as an alternative approach during the COVID‑19 pandemic: A case report

“…The COVID-19 pandemic outbreak has shattered the entire world, challenged the medical systems worldwide, and tested the speed of reaction of the scientific and medical community when facing unexpected aggression ( 20 ). At certain points, in different countries, heavy pandemic waves severely affected surgical departments, which are directly dependent on anesthetists as part of the medical team and intensive care units for patient management ( 12 , 19 ). The challenges related to the reconstruction of head and neck defects emerged once the first surgical procedures of head and neck tumor resections were performed ( 21 ).…”

“…In this context, complex, extended surgeries, including free flap reconstructive surgery for head and neck defects, could not be performed, forcing the maxillofacial surgeon to look for alternative solutions in order to provide the best medical care for the patients. Large defects, routinely reconstructed using free flap techniques, were reconsidered for reconstructive options with local or regional flaps, alone or in different combinations ( 19 ).…”

“…Reconstruction methods with local and regional flaps, widely used before the microsurgery era, were reintroduced as valid management alternatives for large head and neck defect reconstruction. Techniques using temporalis or pectoralis major muscles, submental or deltopectoral flaps, for the repair of a variety of oral defects ( 17 , 18 ), have been reported during the last years, in this pandemic context, as alternatives for free flap reconstructive methods ( 16 , 19 ).…”

Supraclavicular Artery Flap for Oral Reconstruction Prior to Esophagectomy During the COVID-19 Pandemic: A Case Report

“…However, our case achieved both pathologically negative tumor margins, decannulation, and had a thoracosopic esophagectomy with gastric tube reconstruction performed during the COVID-19 pandemic. Pedicle flaps including SAF in the management of head and neck cancer during the COVID-19 pandemic were recently reported as both a valid alternative to free flap (12) and the workhorse of reconstruction (13).…”

Simultaneous Orbital and Intracranial Abscesses in 17 Cases

“…8,9 The demographics, treatment, and outcomes of patients with severe orbital cellulitis and its subsequent intracranial complications are limited to case reports and small case series. [10][11][12][13][14][15] Management of these patients differ significantly from case to case.…”