Raskwagner6644

Many reconstruction possibilities exist and a choice depends on patient characteristics, tumour location and experience of the surgeon. The overall objective in patients with maxillary defects is to follow a prosthetic-driven reconstruction with the aim to restore facial form, oral function, and do so in accordance with the individual needs of the patient.PURPOSE OF REVIEW Chordomas of the clival region are challenging tumors to treat due to their location and infiltrative behavior. The primary goal of treatment remains a gross total resection (GTR). Advances in surgical techniques, especially the adoption of endoscopic endonasal techniques, provide improved rates of surgical resection while minimizing secondary surgical morbidities. RECENT FINDINGS Advances in the management of clival chordomas include further development of endoscopic endonasal approaches to the clivus and petroclival region, enhanced understanding of the biologic behavior of chordomas and prognostic value of molecular markers, and increased experience with newer radiation therapy modalities such as proton beam therapy. SUMMARY Improved surgical techniques enhance our ability to achieve a GTR while minimizing morbidity of surgery. Molecular markers may allow stratification of patients into prognostic groups and help direct further therapy. A combination of surgery with GTR and proton beam or intensity modulated radiotherapy currently offers the best potential for cure. Therapy with new immune system modulators is promising but is reserved for clinical trials.PURPOSE OF REVIEW Electrochemotherapy (ECT) is increasingly used in different settings in head and neck cancer patients when conventional treatment options are not available. RECENT FINDINGS Recent improvements of electroporation and ECT include new advanced electrode probes, the combination with intratumorally injected supraphysiological doses of calcium and an update of the standard operating procedures. SUMMARY ECT is a treatment modality that combines administration of a chemotherapeutic drug, for example, bleomycin, with electroporation therapy (EPT). EPT uses brief, high-intensity, pulsed electrical currents to enhance the uptake of cytotoxic drugs by producing a transient increase in cell wall permeability. ECT increases the effect of cytostatic drugs, is independent on histology of the lesion, enables treatment to previously treated areas, preserves healthy tissue, has no significant side effects (low-dose chemotherapy) and enables repeated treatments. ECT can be combined with other treatment modalities and is an addition to the current treatment options of head and neck cancer. ECT is not only able to palliate symptoms but can also provide complete responses and curation.PURPOSE OF REVIEW The vessel-depleted neck is the ultimate challenge for the head and neck reconstructive surgeon. In patients who have had previous neck dissections or radiotherapy, the arterial and venous options for future reconstruction can be very limited, and it is important for the surgeon to consider alternative options for vessels. RECENT FINDINGS Appropriate preoperative planning is crucial in these patients with a thorough history including previous operation notes, details of previous treatments, and previously used vessels for reconstruction. Clinical examination and a dual phase CT angiogram/MR angiogram can identify vessels available for reconstruction. Arterial options are discussed including tips on using the common carotid artery and the use of Corlett loops for utilizing contralateral arteries. Venous options are also discussed including cephalic vein transposition and Corlett loops. Novel options, such as use of extracorporeal perfusion of flaps have been shown to be effective when all other options have been depleted. SUMMARY Creative solutions are needed for these extreme circumstances, and reconstructive surgeons need to be aware of the options available to select the best one in each case. Proteases antagonist Careful planning and having multiple back-up choices is crucial to successful reconstruction in these cases.PURPOSE OF REVIEW The progressive growth of endoscopic and robotic-assisted procedures provided the tools for development of remote approaches to the neck, which could avoid a visible large neck scar usually necessary for neck dissections. This review explores the current experience with robotic neck dissection, looking for pros and cons in surgical, oncologic and aesthetic outcomes. RECENT FINDINGS Robotic neck dissection was shown to be feasible and well tolerated, with adequate oncological outcomes in different tumours. Although difficult to objectively analyse, cosmetic satisfaction seems to be significatively higher in patients submitted to this procedure when compared with those submitted to conventional neck dissection. The only consistently reported disadvantage was longer operative time. Other potential advantages beyond cosmesis such as improvements on oedema, fibrosis, neck movement, sensory loss and social interactions were not well explored so far. SUMMARY Surgical treatment of neck metastasis had several evolutions in the last decades. Robotic neck dissection emerged as an option to avoid extensive visible neck scars, improving cosmesis and probably other functional outcomes, although securing oncologic effectiveness. Technological innovation is increasingly dynamic, promising progressive evolution in robotic surgery. Together, the lack of objective data on functional outcomes warrants the need for further investigation on robotic neck dissection.BACKGROUND Increased operative volume has been associated with benefits in patient outcomes for a variety of surgical procedures. In autologous abdominally based breast reconstruction, however, there are few studies assessing the association between procedure volume and patient outcomes. The objectives of this study are to evaluate the associations between abdominal-based free flap breast reconstruction and patient outcomes. METHODS The 2013-2014 Healthcare Cost and Utilization Project National Inpatient Sample was queried for all female patients with a diagnosis of breast cancer who underwent mastectomy and immediate abdominally based breast reconstruction (deep inferior epigastric perforator or transverse rectus abdominus muscle free flaps). Outcomes included occurrence of major or surgical site in-hospital complications, hospital cost, and length of stay (LOS). High-volume (HV) hospitals were defined as the 90th percentile of annual case volume or higher (>18 cases/y). Multivariate regressions and generalized linear modeling with gamma log-link function were performed to access the outcomes associated with HV hospitals.