Marginal Mandibular Nerve Research Articles

Complications of Submentonian and Cervical Liposuction Surgery Associated With Platysmaplasty.

The aim of this study was to report a series of 3 cases of complications following submentonian and cervical liposuction associated with platysmaplasty. The complications include hemorrhage, Ludwig's angina, and paralysis caused by injury to the marginal mandibular nerve. The procedure was performed by the same operator using the same technique, and the patients were informed of the risks. It is important to emphasize that the surgeon must be prepared to manage any of these complications, and treatment should be immediate and appropriate. The management of complications following submentonian and cervical liposuction associated with platysmaplasty must be prompt and effective to prevent further risks and damage. The approaches are discussed and referenced by the authors. Submentonian and cervical liposuction surgery associated with platysmaplasty is a valuable tool for reducing neck fat and enhancing esthetic outcomes, but there is a possibility of postoperative complications, which, although rare, can occur. Proper patient selection and thorough explanation of risks are crucial to preventing some of these situations.

Endoscope-Assisted Transcervical Resection of Parapharyngeal Space Tumors.

We describe a novel technique for endoscope-assisted (EA) transcervical (TC) approach for resection of parapharyngeal space (PPS) tumors and compare perioperative outcomes of this approach to standard TC approaches. Retrospective chart review. Single tertiary care center. This was a single-institution, retrospective analysis of all patients undergoing TC approach for resection of PPS tumors over a 10-year period. We describe unique advantages of our surgical approach utilizing a 0° endoscope for improved surgical access, visualization, and efficiency. χ2 and Student's t test were used to compare perioperative outcomes between cases in which an endoscope was utilized EA for resection versus standard TC approach. Our cohort included 77 patients (n = 40 EA, n = 37 TC). There was no difference in patient age, sex, tumor laterality, tumor size, or tumor location between groups. The EA approach was associated with significantly shorter operative times (median [range] for EA 73 [33-270] minutes vs TC 112 [56-362] minutes, P < .01) and reduced rates of immediate postoperative marginal mandibular nerve paresis (EA: n = 5 [12.5%] vs TC: n = 16 [43.2%], P < 0.01). EA TC approach for resection of PPS tumors offers improved surgical access and is associated with reduced surgical time and rates of marginal mandibular nerve paresis compared to standard transcervical approaches.

Peripheral Nerve Injury After Deoxycholic Acid (ATX-101) Injection in an Experimental Rat Model.

Deoxycholic acid (ATX-101) is a drug administered by subcutaneous injection for local fat reduction. However, ATX-101 treatment has been reported to cause marginal mandibular nerve injury with noticeable functional deficits when targeting submental fat. As a cytolytic agent with some selectivity for adipocytes, ATX-101 may damage the lipid-rich myelin surrounding peripheral nerves. This study seeks to characterize the nerve injection injury from ATX-101 in an experimental rat model. Using a rat sciatic nerve injection model, intrafascicular and extrafascicular injections of deoxycholic acid (ATX-101) were compared to lidocaine (positive control) and saline (negative control). Nerves were harvested at a 2-week endpoint for histomorphometric analysis. Cross-sectional area of nerve injury was significantly increased by ATX-101 injection at 75±15% with intrafascicular ATX-101 (p<0.001), 41±21% with extrafascicular ATX-101 (p<0.01), and 38±20% with positive control lidocaine (p<0.01) compared to 7±13% with negative control saline. Demyelinating injury was a significant mechanism of injury in the affected nerve fibers compared to uninjured nerve fibers (p<0.04), but there was no difference in axon-to-myelin area ratio between the lidocaine and ATX-101 cohorts. After two weeks, Wallerian degeneration was evident with only small regenerating nerve fibers present in the ATX-101-injured groups compared to saline (2.54±0.26um vs 5.03±0.44um, p<0.001) in average width. Deoxycholic acid (ATX-101) is capable of extensive nerve injury in rats. The mechanism of action for ATX-101 does not preferentially target myelin more than other common neurotoxic agents. Appropriate knowledge of surgical anatomy and injection technique is necessary for any practitioners providing ATX-101 injections.

A Comparative Assessment of Outcomes Following Mandibular Distraction Osteogenesis and Tongue-Lip Adhesion in Pierre Robin Sequence.

The purpose of this study was to assess long-term outcomes of tongue-lip adhesion (TLA) and mandibular distraction osteogenesis (MDO) to resolve upper airway obstruction in patients with Robin sequence (RS). A retrospective cohort study was performed of subjects presenting to a tertiary care pediatric center who underwent either primary MDO or TLA for the treatment of RS between 2004 and 2020. N=59 subjects met inclusion criteria (n=34 MDO, n=25 TLA), and there were no significant differences in preoperative patient characteristics other than age at surgery (MDO 31d vs. TLA 17d, P=0.049). Preoperative apnea-hypopnea index (AHI) was similar between cohorts (33.9 and 46.7, P=0.38). Subjects who underwent MDO demonstrated improved AHI on initial postoperative polysomnogram performed at 2 weeks (3.4 vs. 11.6, P=0.014), however AHI at the second postoperative timepoint (270 vs. 142d, P=0.007) was no different between cohorts (2.8 vs. 2.6, P=0.89). No subject in either group required enteral nutrition or supplemental oxygen at last follow-up. In subjects undergoing MDO, 14.7% demonstrated temporary asymmetric marginal mandibular nerve dysfunction. Forty-seven percent of MDO patients had injury to first primary molars. MDO and TLA both ultimately achieved similar long-term resolution of upper airway obstruction and associated feeding difficulties in patients with Robin sequence. MDO offered a more immediate airway improvement, but the procedure carried a potential risk of neurosensory and dental injury when compared with TLA.

Perimarginal quadrangle dissection: Pushing the boundaries of neck dissection in gingivo-buccal complex cancer

ObjectivesPerimarginal nodes (PMN) lie in close relationship with marginal mandibular nerve (MMN), in the lymphatic drainage pathway of gingivo-buccal cancers (GBC), above the lower border of mandible and remain unaddressed in conventional neck dissection. We have aimed to define the boundaries of perimarginal node dissection, explore incidence of PMN metastasis and its correlation with histopathological characteristics. Materials and methodsA prospective study was conducted on 112 consecutive patients of GB carcinoma. PMN dissection was performed in an anatomically defined quadrangle. Prospective clinical characteristics included subsite, tumor and nodal stage, location of primary and clinical skin involvement. Histopathological characteristics analyzed included grade, size, pathological tumor, nodal stage, skin and/or bone involvement, depth of invasion, Brandwein Gensler histological risk score and lympho-vascular emboli. MMN function was graded at 3 and 6 months post-operatively. ResultsThe PMN were identified histologically in 75.89 % patients. 15.2 % patients harboured metastasis in PMN. 16.7 % patients had clinically occult metastasis with 11.7 % having isolated PMN metastasis. None of the pre-operative clinical factors was found to be significant in predicting incidence of metastasis. Higher nodal burden (p = 0.01) and pathological skin involvement (p = 0.03) were found statistically significant on multivariable analysis. At 6 months follow-up, none of the patients had any MMN functional deformity at rest. ConclusionThere is a high incidence of occult PMN metastasis from gingivo-buccal complex cancer. High nodal stage and pathological skin involvement are independent predictors for PMN metastasis. PMN dissection must be performed in all cases of GB cancer.

Perimarginal lymph node metastasis in gingivo-buccal complex carcinoma: Is it time to push the limits of neck dissection?.

6069 Background: Perimarginal nodes (PMN) are a group of perifacial lymph nodes that lie in close relationship with marginal mandibular nerve (MMN). They lie in the lymphatic drainage pathway of gingivo-buccal cancers (GBC), above the lower border of mandible which forms the superior limit of conventional neck dissection and thus remain unaddressed. With reported incidence of metastasis as high as 20.5%, we aimed to explore incidence of PMN metastasis in GBC, its correlation with histopathological tumor and nodal characteristics. Methods: A prospective study was conducted on 112 consecutive treatment naïve patients of GB squamous cell carcinoma. Patients with unresectable nodal disease, distant metastasis and prior radiotherapy or surgery to neck were excluded. PMN dissection was performed in the quadrangle bounded superiorly by the mandibular alveolar ridge, inferiorly by lower border of mandible, anteriorly by mental foramen and posteriorly by anterior border of masseter. On histopathological analysis, serial step sectioning and cytokeratin immunohistochemistry were performed. Prospective clinical characteristics analyzed were subsite, clinical tumor, nodal stage, location of primary and clinical skin involvement. PMN positivity was correlated with demographic, clinical, nodal status. Histopathological characteristics analyzed included tumor grade, pathological tumor, nodal stage, tumor size, skin and/or bone involvement, depth of invasion, Brandwein Gensler histological risk score and lympho-vascular emboli. MMN functional outcome was graded according to House-Brackman (HB) grading recorded at 3 and 6 months post-operatively. Results: Baseline characteristics are summarized in the table. The PMN were identified histologically in 75.89% (85/112) patients. Metastasis in these nodes were identified in 15.2% (17/112) patients. Our study revealed an occult PMN metastasis of 16.67% (13/78). None of the pre-operative clinical factors was found to be significant in predicting incidence of metastasis. Higher nodal burden (p=0.01) and pathological skin involvement (p=0.03) had statistically significant odds of having PMN metastasis on multivariable analysis. At 6 months follow-up, none of the patients had any MMN functional deformity at rest. Conclusions: There is a high incidence of occult PMN metastasis from gingivo-buccal complex cancer. High nodal stage and pathological skin involvement are independent adverse prognostic factors for PMN metastasis. The limits of conventional neck dissection should be expanded to include clearance of PMN in all cases of gingivo-buccal cancers. [Table: see text]

Deoxycholic Acid for Submental Convexity: A MAUDE Database Analysis

Study Design The study was a retrospective cross-sectional database analysis. Objective Deoxycholic acid (DOC) injections are a novel, in-office procedural alternative to submental liposuction or submentoplasty to address excess submental fat. Post-market safety data regarding this treatment is currently limited. The objective of this study is to analyze adverse events reported in the Manufacturer and User Facility Device Experience (MAUDE) database. Methods The MAUDE database was queried for all reports related to adverse events involving deoxycholic acid using the search terms “KYBELLA” and “deoxycholic acid.” Reports were individually reviewed by 2 reviewers and categorized with special attention to adverse events. Results A total of 34 medical device reports were identified from the database query. Thirteen of these reports (21 total events) were included in the analysis after excluding duplicates, unrelated adverse events, or events associated with the off-label use of DOC. Reported adverse events include excessive swelling (n = 5, 24%), marginal mandibular nerve weakness (n = 4, 19%), unsatisfactory aesthetic outcome (n = 4, 19%), numbness (n = 3, 14%), dysphagia (n = 1, 5%), infection (n = 1, 5%), and skin necrosis (n = 3, 14%). Two patients required hospitalization for skin necrosis management; both had underlying systemic diseases. Conclusions Adverse events following DOC injections included excessive swelling, dysphagia, numbness, infection, unsatisfactory aesthetic outcome, facial nerve weakness, and skin necrosis requiring hospitalization and/or surgery. Patient counseling regarding these adverse events should be discussed when offering DOC injections for submental convexity.

Management of Serious Adverse Events Following Deoxycholic Acid Injection for Submental and Jowl Fat Reduction: A Systematic Review and Management Recommendations.

Abstract Pivotal Phase 3 randomized control trials have demonstrated a favorable safety profile for ATX-101 in submental fat (SMF) reduction; however, in real-world settings, several serious adverse events (SAEs) have been reported, most of which are procedure related and avoidable. Current understanding of the management of uncommon AEs and SAEs is based on the aesthetic surgeon's discretion, and overzealous protocols for sclerosis agents are being applied for ATX-101-induced arterial injury. This review focuses on showcasing the management of SAEs reported previously and updating it with personal clinical experiences with ATX-101 for SMF and jowl fat reduction. Along with adherence to the standard procedures for ATX-101 administration, the authors recommend investigating other potential causes of SMF accumulation and jowling mechanism, appropriate demarcation of the surface area to determine the number of vials, and assessment of the fat pad thickness to determine the number of required treatment cycles for optimal therapeutic outcomes. Surgery is preferable for jowling caused by compartment displacement (ptosis), whereas fat-reducing treatments such as ATX-101 are contraindicated for jowling caused by subcutaneous tissue atrophy. Some proactive measures that can be employed to prevent AEs include avoiding intradermal injections to prevent skin ulceration/necrosis, injecting lidocaine to check for smile asymmetry as an indication of marginal mandibular nerve proximity, administering 1 to 2 mm deeper injections in males to prevent alopecia, employing good aseptic techniques to prevent abscess formation, injecting 1 product at a time using correctly labeled syringes, and confirming the diagnosis of pyoderma gangrenosum before treating it as an infection. Level of Evidence: 3

Surgically important neurovascular structures related to the submandibular gland. A cadaveric study

Introduction: The pathologies and procedures of the submandibular gland are numerous. Comprehensive knowledge of the anatomy and its relations of the SMG will avoid iatrogenic injuries within the submandibular triangle. This study assesses the presence and frequency of neurovasculature related to the SMG with special interest on the facial artery and the marginal mandibular nerve of cranial nerve (CN) VIIMethods: In twenty- five fresh cadavers, right and left side SMG (n=50) were dissected and observed in the department of Anatomy, faculty of Medicine, Ragama. Data were recorded on frequency of facial artery and postsynaptic sympathetic periarterial plexus and the marginal mandibular nerve of CN VII with relations to the SMG.Results: The majority 40/50 had the facial artery placed on the posterior surface of the SMG outside the capsule of the gland. Two of those specimens (2/10) had the e facial attires piercing through the parenchyma of the SMG. All facial artery anomalies were found to be present unilaterally, mostly on the right side and mainly among the females. 3/50 female cadaveric specimens had the marginal mandibular nerve of CN VII nerve traversing through the superficial part of the SMG. All of them were in the right side.Conclusions: The data indicate a higher rate of aberrant submandibular neurovasculature were on the right side with a female preponderance.

Comprehensive Long-Term Outcomes Following Mandibular Distraction Osteogenesis.

To describe long-term outcomes and complications following mandibular distraction osteogenesis (MDO) in a diverse patient cohort. Cross-sectional study. Single tertiary-care pediatric center. Forty-eight patients previously undergoing MDO with minimum 4-year follow-up. Respiratory outcomes, feeding patterns, dental development, motor/sensory nerve function, temporo-mandibular joint function, and postsurgical scarring. Forty-six patients with a median age of 7 years were evaluated. Of 20 nonsyndromic patients, none required additional airway procedures, none required continuous positive airway pressure (CPAP) during sleep, and 19 (95%) fed exclusively by mouth. Among 26 syndromic patients, 7 (27%) required CPAP and 8 (31%) were tube fed. Permanent first molar differences were seen in the majority of subjects; patterns of damage interfering with function were more common in syndromic (13/28, 46%) compared to nonsyndromic (5/24, 21%; P = .014) subjects. MDO prior to age two was associated with more frequent and worse dental damage (P = .001). Inferior alveolar nerve and marginal mandibular nerve function were fully intact in 37 (80%) and 39 (85%) of patients, respectively. Three patients (6%), all with associated genetic syndromes, demonstrated severe nerve impairment. By the Vancouver scar scale, ≥ 80% of surgical scars were rated in the most favorable category for each quality assessed. Temporomandibular joint dysfunction was rare. MDO shows highly favorable long-term respiratory, feeding, nerve, and scar outcomes in nonsyndromic patients, although permanent molar changes not precluding tooth viability are commonly seen. Patients with associated syndromes demonstrate respiratory and feeding benefits, but higher rates of dental and nerve abnormalities.

Education, Training & Research Track: Soft Tissue Landmarks for The Terminal Point of Marginal Mandibular Nerve: A Cadaver Study

Education, Training & Research Track: Soft Tissue Landmarks for The Terminal Point of Marginal Mandibular Nerve: A Cadaver Study

Why the Facelift Incision Should Be the Preferred Approach for Benign Parotid Neoplasms

Background: The modified Blair incision is the most utilized incision for parotidectomy. The facelift incision is a well described, but underutilized approach to parotidectomy. Objective: To demonstrate the exposure afforded by the facelift incision for parotidectomy and the excellent postoperative appearance. Materials and Methods: This approach was applied to 12 parotidectomies in 11 patients between January 2022 and December 2022. Result: There was one case of temporary marginal mandibular nerve weakness. There were no cases of permanent nerve weakness. Patient satisfaction was particularly high in young patients. Conclusion: This video demonstrates the exposure afforded by the rhytidectomy approach to the parotid gland. No competing financial interests exist. No funding was received for this article. Runtime of video: 2 mins 28 secs

Exploring patient values and perceptions with facial nerve palsy to help guide management: An Australian perspective

**Background**: Facial nerve palsy (FNP) leads to a combination of aesthetic and functional deficits with profound psychosocial consequences. Significant advances have been made in restoring dynamic function through a range of facial reanimation solutions. Patient-reported severity scales are predetermined metrics that provide limited insight into patient values and perceptions. A qualitative study was conducted to elicit the experiences of patients with FNP and explore their views and motivations for seeking therapy. **Methods**: Participants were sourced from the Sydney Head and Neck Cancer Institute Database, Australia. Eligibility for the study included age over 18 years and a diagnosis of complete FNP. Semi-structured interviews were conducted and the transcripts were subjected to thematic text analysis.**Results**: Nineteen patients consented to participate in the study. One was excluded due to an isolated marginal mandibular nerve palsy. Five main themes emerged: eye symptoms, fear of judgement and social withdrawal, aversion to further invasive surgeries, the need for multidisciplinary streamlined care and lack of public awareness.**Conclusion**: Eye symptoms and the social consequences of FNP carry significant impact on both patients’ personal and professional lives. There is a paucity of services that can support patients across the complex spectrum of problems seen in FNP.

Intra-oral Drainage of Submandibular Abscess: A Minimally Invasive Technique. A Prospective Study.

To evaluate the efficacy of intraoral drainage of isolated submandibular space abscess as a minimally invasive surgical technique compared to the standard trans-cervical approach. This prospective study included 40 subjects with isolated submandibular space abscesses. They were randomly divided into 2 equal groups: trans-cervical surgical drainage (group A) and intra-oral surgical drainage (group B). The included data were demographics, repeated surgery requirement, postsurgical hospitalization duration, formation of scar, and complications. Intraoral drainage (Group B) reduced the mean operative time by 15.25min (P < 0.001) compared with trans-cervical incision (Group A). No considerable difference was found between the 2 groups in regarding hospitalization postoperatively. No weakness in marginal mandibular nerve was found in both groups. Three patients only have a cervical scar in a group (B) who required external drainage due to recollection. No recurrence was detected in a group (A). The current study demonstrated that isolated submandibular abscesses can be successfully managed with an intraoral drainage modality, and it is a better option than the trans-cervical approach regarding better cosmetic outcome and shorter operative time.

Infinitesimal Periangular Pterygomasseteric Transectioning Approach for the Base Fractures of the Mandibular Condyle: A Technical Note and Quality of Life Outcome.

Purpose Infinitesimal Periangular Pterygomasseteric Transectioning Approach (IPPTA) is a minimal access surgical approach utilized for the management of base fractures of the mandibular condyle. The aim of the study was to evaluate and report the long-term post-operative functional outcomeusing this surgical access approach. Materials and method A prospective clinical study involving 20 patients was undertaken to evaluate the post-operative functional and aesthetic outcome for the patients that underwent surgery for base fractures of the mandibular condyle using IPPTA. The various parameters assessed were wound healing, marginal mandibular nerve injury, diet intake, mandibular function, and any other complications at twelfth post-operative month. Results IPPTA provided adequate exposure to the condylar base fracture for open reduction and internal fixation (ORIF) and was found to have an uneventful post-operative recovery phase in terms of functional and aesthetic outcomes. Conclusion IPPTA involves utilizing a smaller incision and provides adequate exposure to the condylar base region for ORIF to establish a satisfactory form and function with a predictable outcome.

Facial Nerve Morbidity after Superficial Parotidectomy in the Absence of Nerve Conductor: A Cross-Sectional Study from a Tertiary Centre in Pakistan

Objective: After superficial parotidectomy, the incidence of facial nerve injury for pleomorphic adenoma of the parotid gland remains the topic of interest despite different techniques to identify the nerve during surgery. We aim to evaluate the incidence of facial nerve injury in patients undergoing superficial parotidectomy without a nerve conductor. Material and Methods: After calculating the sample size, 101 patients, irrespective of age and gender, were included in this cross-sectional study at the Department of Surgery, for nine years, from 1st January 2012. The primary outcome was the incidence of temporary or permanent facial nerve injury with a follow-up period of 12 months. The data was calculated using SPSS version 23, where mean and standard deviation were calculated for continuous variables, and frequencies were calculated for categorical data. Results: Facial nerve injury was evident in 16/101 (15.8%) patients. Among these, the main truck of facial nerve was involved in 6(5.9%), temporary loss of function in 4(4.0%) and permanent injury in 2(2.0%). The most common branch of facial nerve affected was the marginal mandibular nerve (6, 5.9%), of which 4(4.0%) had a permanent loss. Additionally, four (4.0%) patients developed salivary fistula, whereas 2% developed Frey’s syndrome. Conclusion: Facial nerve injury should be clearly explained, in the consent, to the patient for a medicolegal purpose. Where the nerve stimulator is not available, identification of the proposed anatomical landmarks allows a safe recognition of the facial nerve Keywords: Pleomorphic adenoma, facial nerve, facial nerve injury, superficial parotidectomy

An Assessment of the Reduction of Submental Fullness With ATX-101 (Deoxycholic Acid Injection) in the Expanded Safe Zone.

Background and objective Facial aesthetics have a huge impact on how individuals view themselves and areviewed by society. The aesthetics of the face are tremendously influenced by the shape of the chin and neck. In this study, we aimed to observe the outcomes in individuals after the use of ATX-101(deoxycholic acid injection) in an expanded safe zone for submental fullness. To ensure optimal outcomes and reduce the risk of adverse events, appropriate patient selection is the key. ATX-101treatment may be administered in combination with hyaluronic acid fillers, botulinum toxins,cryolipolysis, and radiofrequency treatment. This is the first study of its kind to becarried out at the national level in Pakistan. Materials and methods This was a quasi-experimental study conducted at the Rawalian Burn and Reconstructive Surgery Unit, Holy Family Hospital, Rawalpindi, Pakistan for a period of nine months, from 10-1-2021 to 11-10-2021. A total of 62 patients who fulfilled the inclusion criteria were enrolled. We recordedif any complications had occurred or not. Moreover, the total number of treatment sessions, the volume of injectables used, and the interval between sessions were also documented. ATX-101 package was injected into the treatment area. Due care was taken to avoidthe region of the marginal mandibular nerve. After the procedure, outcomes and complications were observed. Results In this study, patient satisfaction was reported in 59 (95.2%) patients. After the fourth session,final improvement was observed in 59 (95.16%) patients. Tenderness was found in seven (11.3%) patients, bruising was noted in four (6.5%), edema was found in seven (11.3%), numbness was noted in one (1.6%), whereas paresis and alopecia were not found in any of the patients. Conclusion Our study concluded that ATX-101 is a very useful modality with fewer complication rates and is associated with significant improvement in the expanded safe zone for submental fullness.

Outcomes of the facelift incisional approach to neck dissection without endoscopic or robotic assistance

<h2>Abstract</h2><h3>Objective</h3> : The facelift incisional approach to neck dissection offers several advantages including improved cosmesis, increased patient satisfaction, and decreased morbidity. This approach has been previously described using robotic or endoscopic instrumentation, but the clinical outcomes of this approach using standard instrumentation have not been reported. The objective of this study was to determine if the facelift incisional approach to neck dissection can be performed without endoscopic or robotic assistance and achieve improved oncologic and cosmetic outcomes. <h3>Study Design</h3> : Retrospective cohort study over 4 years. <h3>Setting</h3> : A national comprehensive cancer center. <h3>Methods</h3> <b>:</b> 104 subjects received 113 oncologic neck dissections, of which 35 were performed using a facelift approach. Primary outcomes included rate of negative margins, recurrence, incidence of nerve weakness, and incidence of lymphedema. <h3>Results</h3> : The mean age of the cohort was 60.1 ± 12.7 years and 72.6% were male. Mean follow up was 23.1 ± 19.1 months (p=0.21). 104 subjects (92.9%) had negative margins on final pathology, with no difference between approaches (88.2% vs 94.9% respectively, p=0.24). 34 subjects (97.1%) in the facelift group had no evidence of disease at study conclusion. There was no difference in marginal mandibular nerve weakness (p=0.10) nor shoulder weakness (p=0.59) between groups. There was no difference between post-operative lymphedema (38.2% vs 29.2% for the facelift vs standard incision groups, p=0.35). <h3>Conclusion</h3> : A facelift approach to neck dissection using standard instrumentation without robotic or endoscopic assistance achieves acceptable clinical and oncologic outcomes compared to the standard incisional approach with an additional benefit of improved cosmesis.

Complications of neck dissection and their management: Retrospective study

Neck dissection (ND) is a surgical procedure performed in treating head and neck cancer patients with or without cervical nodal neck metastasis. The aim of neck dissection is to achieve loco-regional control thus optimizing the cancer cure rate. Various complications may potentially occur following this surgery. Previous studies done have documented the complication rate following neck dissection surgery to range between 5% to 15%. Most of the complications are inevitable and various efforts have been made to try and reduce complications by modifying the aggressive surgical procedure. The objective of this study is to report the various complications, its rate in various neck dissection procedures, their management and to seek improved patient care and outcome. : A systematic review of 73 patients who underwent neck dissection for various head and neck cancers from August 2017 to July 2020. These patients were studied for post-operative complications and their management.Out of 73 patients, Vascular injury observed in the current study was internal jugular vein (IJV) and was seen in 22.7%) cases and was repaired intraoperatively. Throracic duct injury was identified in 3(4.1%) and it was identified and ligated intraoperatively. Immediate post-operative complication being hemorrhage was seen among 2 cases, both the cases were re-opened. Marginal mandibular nerve and spinal accessory nerve injury was observed in 3 cases and they both came under the delayed type of complications.: A careful preoperative assessment, meticulous surgical technique, high quality postoperative care and appropriate rehabilitation are the cornerstone of preventing and managing complications.

Clinico-pathological profile of parotid gland tumors at a tertiary care center in North India.

The objective of this study was to know the various types of parotid tumors and their clinical presentations, surgical management, and post-operative outcome. Data of 102 patients assessed from hospital records who underwent parotid surgery between the years 2013 and 2018 were obtained. Parameters included age, sex, socio-demographic profile, presenting complaints, examination findings, and cytopathology. Surgical techniques, post-operative complications such as a facial scar, retro-mandibular and pre-auricular depression, facial palsy, Frey's syndrome, and numbness over the ear lobule were analyzed. Out of a total of 102 patients, 54.0% of patients were male, and 45.1% were female. The mean age of patients was 33.30 ± 13.87 years ranging from 7 to 65 years. The most common clinical presentation was swelling in the parotid region (95.1%), and associated symptoms with swelling were pain (17.5%), facial palsy (4.9%), discharging sinus (4.9%), and ulcerative lesions (1%) at the time of presentation. Pleomorphic adenoma was the most common benign neoplasm (76.5%), followed by Warthin's tumors (2.9%). Mucoepidermoid carcinoma was the most common malignant neoplasm (3.9%). After parotid surgery, 35% of patients had a sensory impairment or hypoesthesia of the ear lobule, and 23.28% had temporary facial nerve weakness. 5.0% of patients had permanent facial weakness, and 2.06% of patients had weakness of the marginal mandibular nerve. Pleomorphic adenoma and mucoepidermoid carcinoma are the most common benign and malignant tumors, respectively, and parotidectomy is the treatment of choice, depending on the tumor location. Successful treatment depends on early diagnosis and histopathological and radiological investigations. Sensory impairment and temporary facial nerve paralysis are the most common post-operative complications, which are minimized by proper knowledge of anatomy and meticulous dissection of the facial nerve during parotid surgery.