2018-19 Section 7-Neoplastic and Inflammatory Diseases of the Head and Neck eBook

VI. Complications

A. Free flaps complication rates Brady JS, Desai SV, Crippen MM, et al. Association of anesthesia duration with complications after microvascular reconstruction of the head and neck. JAMA Facial Plastic Surg . 2018; 20(3):188-195. EBM level 4.....................................................................................................................................184-191 Summary : This article specifically examines the contribution of anesthesia duration during head and neck free flap reconstruction to postoperative complications, using the American College of Surgeons National Surgical Quality Improvement Program database. It provides data showing that increasing anesthesia duration was associated with both medical and surgical complications as well as need for postoperative transfusion. Eskander A, Kang S, Tweel B, et al. Predictors of complications in patients receiving head and neck free flap reconstructive procedures. Otolaryngol Head Neck Surg . 2018; 158(5):839-847. EBM level 4...............................................................................................................................................192-200 Summary : This article assesses the complication rate in a large cohort of patients who underwent free flap reconstructive surgery of the head and neck and the contributing perioperative factors. It highlights the high incidence of both medical and surgical complications experienced by these patients in the postoperative period. The article also identifies potential areas for quality improvement initiatives to reduce these complications. Summary : In this study, the most common sources of infection were the submandibular glands, the parapharyngeal and retropharyngeal spaces, and odontogenic causes. Risk factors for the development of significant complications were diabetes mellitus and multiple neck space involvement. Submandibular and sublingual space infections had the highest incident of airway compromise. Microbacterial aspects, CT scan data, and laboratory and clinical data of these cases were analyzed. Surgical intervention may be most important in patients with such history. Antimicrobial therapy and considerations also are discussed, and the importance of CT scan from neck through to the mediastinum is noted. Cramer JD, Purkey MR, Smith SS, Schroeder JW Jr. The impact of delayed surgical drainage of deep neck abscesses in adult and pediatric populations. Laryngoscope . 2016; 126(8):1753-1760. EBM level 2c.............................................................................................................................................210-217 Summary : This is a multicenter, prospective cohort study of 1012 patients (347 adult, 665 pediatric) with deep neck abscesses who underwent incision and drainage within 7 days of admission. Days to drainage following admission were compared to clinical outcomes with regard to abscess-specific morbidity and mortality. Postoperative abscess-related indictors were sepsis, pneumonia, unplanned intubation, mechanical ventilation for > 48 hours, and death. Surgical site infections, stroke, return to OR, and length of stay also were analyzed. Infectious Disease A. Abscess/infection treatment regarding medical vs surgical therapy Boscolo-Rizzo P, Stellin M, Muzzi E, et al. Deep neck infections: a study of 365 cases highlighting recommendations for management and treatment. Eur Arch Otorhinolaryngol . 2012; 269(4):1241- 1249. EBM level 3..........................................................................................................................201-209

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