Study design: Retrospective review.
Explore this issue:December 2012
Setting: Department of Plastic Surgery, Department of Head and Neck Surgery, Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston.
Synopsis: The authors reviewed their own experience with temporal bone reconstruction, comparing outcomes between 27 patients with regional flaps and 90 patients with microvascular free flaps. They found that operative time was shorter for reconstruction with regional flaps, as were intensive care unit and hospital stays. However, the authors said they have steered away from using local flaps because of their poor reliability and cosmetic appearance. With the exception of the temporalis muscle flap, which is useful for small defects but is sometimes unavailable, the authors have also ceased using regional pedicled flaps, because temporal bone defects are at the very limit of the arc of rotation of these flaps. The authors said nerve repairs were performed in 19 patients, 17 of which were followed for about 12 months. Of these, 71.4 percent demonstrated signs of reinnervation and 42.9 percent achieved a House-Brackmann score of three or better. The mean time to reinnervation was 7.9 months.
Bottom line: Regional flaps, such as the temporalis muscle flap, are useful for small defects, while free flaps are indicated for large defects as well as in cases of prior surgery for radiation. Facial nerve repair should be attempted in every patient with less than 12 months of complete paralysis, even in the setting of advanced age, expected post-operative radiation or pre-existing facial nerve weakness.
Reference: Hanasono MM, Silva AK, Yu P, Skoracki RJ, Sturgis EM, Gidley PW. Comprehensive management of temporal bone defects after oncologic resection. Laryngoscope. 2012;122(12):2663-2669.
—Reviewed by Sue Pondrom
Pattern of Active HPV Expression Correlates to Disease Course
What is the behavior of primary and metastatic oropharyngeal squamous cell carcinoma (OPSCC) with respect to active human papillomavirus (HPV)?
Background: Carcinogens contributing to head and neck squamous cell carcinoma (HNSCC) have been thought to result in the progressive accumulation of adverse genetic modifications leading to loss of cell cycle control and/or derangements in DNA repair. Although the overall incidence of smoking has decreased over the last two decades, the incidence of HNSCC has remained stable, correlating with an increased incidence of squamous cell carcinoma in oropharyngeal subsites. This increase is thought to be due to oncogenic HPV.
Study design: Experimental study.
Setting: Department of Otorhinolaryngology, Department of Experimental Pathology, Department of Laboratory Medicine and Pathology and Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota.