Ménière’s Disease: A Diagnosis of Exclusion with Controversial Therapies

The investigators performed a retrospective chart review of all cases involving ablative head and neck surgery, IORT, and immediate flap reconstruction in one medical center over a seven-year period. Wound healing was graded excellent, satisfactory, or poor by the reconstructive surgeon. All but one of the patients had received prior treatment and presented with locoregionally recurrent disease requiring salvage therapy.

In total, 25 flap reconstructions were performed in the 21 patients at the time of IORT. Of these, 11 were free tissue transfers and 14 were pedicled tissue transfers. All flaps were inset directly into the field of IORT. None of the patients developed any flap sequelae or wound complications. Wound healing was described as excellent (uncomplicated) in 17 cases, satisfactory in two cases, and poor in three cases. All patients in the group with poor healing required surgical revisions and were considered to have major complications.

The researchers point out a number of advantages of IORT over traditional fractionated external beam radiation therapy (EBRT). Tumor margins can be assessed at the time of surgery, and the surgeon and radiation oncologist can accurately define the borders of the tumor bed. Shielding can be used to protect sensitive organs adjacent to the radiation field, thus increasing the allowable radiation dose. IORT can also be used in conjunction with adjuvant EBRT to lower the postoperative radiation dose required. These factors all contribute to minimizing complications of radiation therapy while providing the highest possible dose.

The investigators observed that morbidity of perioperative radiotherapy was significantly decreased after the introduction of the deltopectoral and pectoralis major pedicled flaps for head and neck reconstruction. Microvascular reconstructive techniques have expanded reconstructive options, with concomitant improvement of functional and aesthetic results. The investigators feel that head and neck flap reconstruction can be performed in conjunction with IORT with the expectation of good wound healing in most cases.

(Laryngoscope 2008;118:69-74)

©2008 The Triological Society