Lettieri, Salvatore C.

Background: Acute postoperative major salivary gland adenitis is a rare complication characterized by swelling of the salivary glands, most commonly associated with skull base neurosurgical procedures. Its occurrence following supratentorial non-skull base craniotomies is uncommon and may be overlooked. Case Description: We report a 45-year-old man who developed ipsilateral parotid gland inflammation within 24 h after undergoing a frontal interhemispheric craniotomy for resection of a craniopharyngioma. The procedure was performed in the supine position with 90° head rotation and 45° neck flexion. Postoperative imaging confirmed acute parotitis without abscess or hematoma. The patient was treated conservatively with hydration, warm compresses, and empiric antibiotics, leading to complete resolution of swelling without airway compromise. Conclusion: Acute postoperative parotitis can occur after supratentorial non-skull base procedures, particularly in cases involving extreme and prolonged head positioning. Although we presented a rather mild case of postoperative parotitis following a non-skull base craniotomy, acute major salivary gland adenitis after craniotomy may cause significant morbidity and early recognition and conservative management are essential to prevent airway compromise and other complications. Awareness of this rare entity may help neurosurgeons implement preventive measures during surgery.

AbstractBackgroundSoft tissue management (STM) training programs for surgeons are largely tradition based, and substantial differences exist among different surgical specialties. The lack of comprehensive and systematic clinical evidence on how surgical techniques and implants affect soft tissue healing makes it difficult to develop evidence‐based curricula. As a curriculum development group (CDG), we set out to find common grounds in the form of a set of consensus statements to serve as the basis for surgical soft tissue education.MethodsFollowing a backward planning process and Kern's six‐step approach, the group selected 13 topics to build a cross‐specialty STM curriculum. A set of statements based on the curriculum topics were generated by the CDG through discussions and a literature review of three topics. A modified Delphi process including one round of pilot voting through a face‐to‐face CDG meeting and two rounds of web‐based survey involving 22 panelists were utilized for the generation of consensus statements.ResultsSeventy‐one statements were evaluated, and 56 statements reached the 80% consensus for “can be taught as is.”ConclusionsUsing a modified Delphi method, a set of cross‐specialty consensus statements on soft tissue management were generated. These consensus statements can be used as a foundation for multi‐specialty surgical education. Similar methods that combine expert experience and clinical evidence can be used to develop specialty‐specific consensus on soft tissue handling.

Background Small recalcitrant defects of the mandible and maxilla may be secondary to tumor, trauma, infection, and congenital origin. Vascularized bone grafting has been shown to effectively manage these defects; however, donor sites are limited. The vascularized medial femoral condyle (MFC) provides adequate cortical cancellous bone with the option of a skin island, consistent anatomy, and minimal donor site morbidity. This article outlines the use of the MFC flap for maxillomandibular reconstruction. Methods A retrospective chart review of patients who required segmental maxillomandibular reconstruction with the MFC flap was conducted. A total of 9 patients (5 men and 5 women) with an average age of 45.3 years were identified. The etiology of the defects, flap sizes, and postoperative outcomes were recorded. Results Three patients had osteoradionecrosis of the neomandible after irradiation of the free fibula reconstruction, 3 patients had defects after cancer extirpation (1 mandible, 2 maxillary), 1 patient had a maxillary defect from trauma, and 2 patients had a residual cleft palate defect. All defects failed initial treatment with nonvascularized bone grafts. The average dimensions of the MFC flaps were 1.2 × 2.5 × 4 cm. Two of 9 flaps included a skin island. Eight flaps survived completely, but 1 patient suffered from flap failure requiring debridement and resulted in an oroantral fistula. Four patients received endosseous dental implants. Average time to union was 6.7 months, and average time to implant was 6.75 months. The average follow-up time was 24.9 months. Conclusions The MFC flap is useful in the reconstruction of small segmental maxillomandibular defects and for the salvage of a neomandible after osteoradionecrosis. The MFC flap provides a reliable platform for endosseous dental implants and serves as an alternative source of vascularized bone reconstruction in the head and neck.