Cave, Taylor B.

ABSTRACT Background Medial sural artery perforator (MSAP) flaps are favored in head and neck reconstruction for skin paddle pliability, pedicle length, and low donor site morbidity. We sought to characterize MSA vascular branching patterns based on the Dusseldorp et al. classification system using pre‐operative lower extremity computed tomography angiogram (CTA). Methods We conducted a retrospective review of 153 scans from 78 patients who underwent CTA prior to head and neck reconstruction at our institution. Primary data points included MSA branching pattern, branch dominance, and vessel depth. Results The type IIa branching type was most prevalent and the MSA lateral branch most frequently dominant, and they were significantly related to one another. There was no significant difference in depth between branching patterns. Conclusions Lower extremity CTA provides valuable insight to vascular anatomy for MSAP flap harvest. The type IIa and IIb types may be associated with lateral and medial MSA dominance, respectively.

We present an interesting case of a 74‐year‐old female who presented with spinal accessory neuropathy following an ipsilateral right‐sided carotid endarterectomy 6 months after the initial injury. Subsequent surgical exploration revealed a surgical clip that had been placed directly across the spinal accessory nerve. Clip removal and neurolysis was subsequently performed, leaving the nerve intact. After surgical intervention, she immediately demonstrated increased bilateral shoulder shrug motion and continues to improve her function with physical therapy. This case demonstrates a fascinating case of cranial nerve recovery after delayed intervention in the context of existing literature. Laryngoscope, 135:2073–2075, 2025

AbstractThe study objective was to compare the length of stay (LOS) and the proportion of one-night admissions before and after the implementation of an endocrine monitoring protocol following endoscopic transsphenoidal surgery (ETSS) for pituitary adenoma.Patients who underwent transsphenoidal pituitary adenoma resection between July 1, 2018, and September 9, 2022, were identified, and divided into two cohorts before and after the implementation of the monitoring protocol. The overall LOS and number of nights of admission were recorded. Readmission within 30 days after surgery was also recorded. The number of outpatient laboratory tests performed and the time to the first test were also noted.Thirty patients were identified in the preprotocol group and 60 in the postprotocol group. The average admission length in the preprotocol group was significantly longer than the average admission length in the postprotocol group (2.4 vs. 1.7 days, p = 0.004). The percentage of one-night admissions increased from 13 to 57% (p < 0.001). There were no significant differences in readmission rates between the two groups (p = 0.681). The number of laboratory encounters increased from a mean of 1.38 to 2.40 (p = 0.030), while the time to the first test decreased from a mean of 3.43 to 2.36 days (p = 0.049).Patients admitted after ETSS for pituitary adenoma had shorter hospital stay and greater proportion of one-night admission with the implementation of an endocrine monitoring protocol. The all-cause readmission rate was not statistically different between the two groups. Through aggressive outpatient laboratory monitoring, one-night admission for ETSS may be feasible.

AbstractObjectiveFirst bite syndrome (FBS) is a rare complication of transoral surgery (TOS) for oropharyngeal cancer (oropharyngeal squamous cell carcinoma [OPSCC]). Risk factors for developing this complication are not well described. In this study, we attempt to identify risks for developing FBS in TOS.Study DesignRetrospective chart review.SettingTertiary care medical center.MethodsThis study was exempted by the Mayo Clinic institutional review board. We performed a review from January 2017 to November 2022 of all patients who underwent TOS for OPSCC by a single provider. Exclusion criteria included less than 6 months follow up, prior treatment of head and neck cancer, or incomplete records. Demographic data, comorbidities, tumor characteristics, surgical details, adjuvant treatment details, functional outcomes, and oncologic outcomes were assessed. Fisher's Exact test and Kruskal‐Wallis rank sum test were used to identify significant variables, and multivariable logistic regression was used to address confounding.ResultsOne hundred and one patients were identified. Eighty‐nine met the inclusion criteria. The mean follow‐up was 34 months (median 33). Seven patients (7.9%) developed FBS. Palatine tumor primary (P = .041), resection of styloglossus/stylopharyngeus (P = .039), and parapharyngeal fat manipulation (P = .015) were associated with the presence of FBS. After adjusting for tumor location, manipulation of parapharyngeal fat maintained significance (P = .025). T and N staging, tumor volume, adjuvant radiation, and ligation of lingual/facial arteries were not associated with the development of FBS. Eighty‐six percent (6/7) of patients had a resolution of FBS at an average of 11.3 months.ConclusionManipulation of the parapharyngeal space is independently associated with developing FBS in TOS in our cohort. Further confirmatory studies are warranted.

AbstractBackgroundVelopharyngeal insufficiency (VPI) is a known complication of transoral surgery (TOS) for oropharyngeal HPV‐mediated squamous cell carcinoma. Controversy exists regarding adequate resection margins for balancing functional and oncologic outcomes.MethodsThis retrospective study was exempted by the IRB. Patients who underwent TOS from January 2017 to October 2022 were included. Patient characteristics, treatment details, and oncologic and functional outcomes were evaluated.ResultsFifty‐five patients were included. Mean and median follow‐up was 34 months. 98% of patients were AJCC stage I/II. Recurrence‐free survival was 96% with no local recurrences.Univariate analysis demonstrated an association between VPI and pT stage (p = 0.035), medial pterygoid resection (p = 0.049), and palatal attachment sacrifice (p < 0.001). Multivariate analysis showed sacrifice of the palatal attachments remained a significant risk for VPI (p = 0.009).ConclusionLoss of soft palate pharyngeal attachments is an independent risk factor for VPI. When oncologically appropriate, the palatal attachments to the pharynx may be preserved.

AbstractThis is a comprehensive review of facial fillers including landmark studies and expert commentary spanning the years from 2003 (when the first hyaluronic acid [HA] dermal filler underwent Food and Drug Administration approval in United States) to present.

ObjectivesMicrovascular free tissue transfer is routinely used for reconstructing midface defects in patients with malignancy, however, studies regarding reconstructive outcomes in invasive fungal sinusitis (IFS) are lacking. We aim to describe outcomes of free flap reconstruction for IFS defects, determine the optimal time to perform reconstruction, and if anti‐fungal medications or other risk factors of an immunocompromised patient population affect reconstructive outcomes.MethodsRetrospective review of reconstruction for IFS (2010–2022). Age, BMI, hemoglobin A1c, number of surgical debridements, and interval from the last debridement to reconstruction were compared between patients with delayed wound healing versus those without. Predictor variables for delayed wound healing and the effect of time on free flap reconstruction were analyzed.ResultsTwenty‐seven patients underwent free flap reconstruction for IFS. Three patients were immunocompromised from leukemia and 21 had diabetes mellitus (DM). Patients underwent an average of four surgical debridements for treatment of IFS. The interval from the last IFS debridement to flap reconstruction was 5.58 months (±5.5). Seven flaps (25.9%) had delayed wound healing. A shorter interval of less than 2 months between the last debridement for IFS and reconstructive free flap procedure was associated with delayed wound healing (Fisher Exact Test p = 0.0062). Other factors including DM, BMI, HgA1c, and bone reconstruction were not associated with delayed wound healing.ConclusionPatients with maxillectomy defects from IFS can undergo microvascular‐free flap reconstruction with good outcomes while on anti‐fungal medication. Early reconstruction in the first 2 months after the last IFS debridement is associated with delayed wound healing.Level of Evidence4 Laryngoscope, 134:1642–1647, 2024