Thai Journal of Otolaryngology Head and Neck Surgery

Accuracy of Near-infrared Spectroscopy for Detecting Postoperative Free Flap Failure in Head and Neck Tumor Surgery with Free Flap Reconstruction

Natchanon Panyayong — 2024-07-17

Abstract

Background Condition of loss of graft after head and neck tumor surgery with free flap
reconstruction. This affects the patient's quality of life after surgery and also increases the
risk of repeat anesthesia to recover tissue. Therefore, after surgical tissue transfer, accurate
and efficient methods for monitoring and monitoring the ischemic state of the grafted tissue are
required.

Objectives To study the accuracy of postoperative free flap monitoring with Near-infrared
spectroscopy (NIRS) compare with the pin-prick method. To study factors associated with the
postoperative graft loss and the association of the two methods of monitoring.
Materials and methods Diagnostic descriptive study in a group of patients with head and neck tumors
who received tumor surgery with free flap reconstruction and postoperative free flap monitoring
with NIRS compare with the pin-prick method within 72 hours in the Otolaryngology Department,
Rajavithi Hospital. The data was collected between October 2022 and December 2023.

Results A total of 34 patients were found to have a tendency to lose a graft after surgery in 5
cases, which could be detected by using NIRS, with tissue oxygen levels lower than 60% in all
cases. It is an accuracy value equal to 100% compared to pin-prick method, and found that smoking,
blood loss during surgery, and the tissue oxygen level after surgery are the factor that has a
statistically significant relationship with postoperative free flap failure, with p-values equal to
0.015, 0.018, and 0.000, respectively.

Conclusion The NIRS for measuring the tissue oxygen level after surgery has the potential to be
used for postoperative free flap monitoring.

Keywords Postoperative free flap monitoring, Postoperative free flap failure, Near-infrared
spectroscopy

Efficacy of rubber tube drain versus Penrose drain to decrease hospital stay in Ludwig’s angina with upper airway obstruction

Panuchporn Pluksa — 2024-07-17

Abstract
Background: Ludwig's angina is a life-threatening rapid progressive cellulitis resulting in upper
airway obstruction and death. Standard management includes securing the airway and surgical
decompression. A rubber tube (irrigating drain) or Penrose drain is commonly placed in surgical
wounds to facilitate fluid drainage and reduce pressure.

Objective: The objective of this study was to compare the efficacy of rubber tube drain versus
Penrose drain in terms of hospital stay in Ludwig's angina with upper airway obstruction patients.

Methods: This retrospective cohort study included the patients who were admitted to the
Otolaryngology Department, Khon Kaen Hospital, Thailand with Ludwig's angina with upper airway
compromise from January 2013 to August 2023. The demographic data, airway management received, type
of drain, and length of hospital stay were collected.

Results: 131 patients were included in this study. The rubber tube drain was placed in 60 patients
while 71 patients were placed with Penrose drain in the surgical site. There was no statistically
significant difference in age, sex, underlying diseases, cause of infection, duration of symptoms,
and type of airway management between groups (p > 0.05). The mean length of hospital stay in the
rubber drain group was 5.57 ± 2.42 days while the mean length of hospital stay in the Penrose drain
group was 6.83 ± 3.16 days (mean difference 1.26 days, 95% CI 0.28 to 2.25, p = 0.012). There was
no difference in terms of re-operation and re-intubation between groups (p > 0.05).
Conclusions: Rubber tube drain can reduce the duration of hospital stay in Ludwig’s angina
with upper airway compromise patients better than Penrose drain.

Keywords: Ludwig’s angina, airway obstruction, drain, hospital stay

Intraoperative near-infrared navigation with indocyanine green predicts negative margins at final pathology of oral cavity squamous cell carcinoma in Rajavithi Hospital

Somjin Chindavijak, MD — 2024-07-17

Background: Mainstay treatment of oral cavity squamous cell carcinoma is wide excision the tumor with adequate margin for decrease local recurrence and increase survival.

Objective: To compare tumor margin in pathology from tumor surgery by near infra-red spectroscopy (NIR spectroscopy) combine with indocyanine green (ICG) intravenous injection group with the conventional group . And to estimate efficacy of the tool.

Method: This is a Quasi-Experimental study of surgical treatment in squamous cell carcinoma of oral cancer by ICG injection 6-8 hrs before surgery with intraoperative NIR spectroscopy examined the tumor and tumor bed during January 2023 to November 2024 . And retrospective data collection of oral cancer patients surgery by conventional method which surgeon controlled the tumor margin
during January 2020 and November 2023.

Result. 30 patients were performed surgery with NIR spectroscopy combine with ICG and 120 patient records of conventional method surgery were reviewed. The pathological report of surgical margin between the tool and the conventional method demonstrated no statistically significant difference (p = 0.325) .The sensitivity and specificity of this tool for positive margin were 100 percent and
30.8 percent respectively.

Conclusions: The NIR spectroscopy combined with ICG injection method for surgical margin is high sensitivity but low specificity. The studied results of the tumor margin of both groups do not statistically significant difference.

Keywords: Surgical margin, Indocyanine green, Near-infrared fluorescence imaging, Oral cancer

The incident of thyroid gland invasion in carcinoma larynx and hypopharynx

Kittaya Lertnakorn — 2024-07-17

Introduction : Intraoperative management of thyroid gland in laryngeal and hypopharyngeal cancer is controversial.

Purpose : The object of this study were to determine the incidence of thyroid gland invasion in patients with advanced laryngeal and hypopharyngeal squamous cell carcinoma submitted to total laryngectomy.

Study design : Retrospective chart review

Method : Retrospective case series with chart review, from 1 September 2014 to 31 October 2022 was undertaken in Maharaj Nakhon Si Thammarat Hospital.26 patients who underwent surgery for carcinoma larynx and hypopharynx. Surgical specimens were examined to determine the incident of thyroid gland invasion and radiological assessment was done. The recurrent rate and the survival in patients with and without thyroid gland invasion were also analyzed.

Results : In all 25 patients underwent total laryngectomy (20 cases were treated with primary laryngectomy and 5 cases were treated with salvage laryngectomy). Hemithyroidectomy was performed in 13 patients and the total thyroidectomy was performed in 12 patients. The overall frequency of invasion of the thyroid gland was zero. In spite of thyroid cartilage invasion in 44% of cases were
detected in the preoperative radiological imaging, none case demonstrated microscopic thyroid gland invasion. The result indicated that overall survival rate was 3.50 years and recurrent rate was 3.31 years .There was no significant in overall survival between patients with or without thyroid cartilage invasion by radiographic imaging.

Conclusion : Invasion of thyroid gland by laryngeal and hypopharyngeal cancer is uncommon. Unnecessary thyroidectomy lead to hypothyroidism and hypoparathyroidism. We would like to suggest that thyroid gland need not be removed in all laryngectomy, unless there is advanced disease with thyroid cartilage invasion and gross thyroid gland involvement. This can save the patients from the burnt of unnecessary morbid hypothyroid and hypoparathyroidism.

Keywords : thyroidectomy, total laryngectomy, hypothyroidism

Associated factors for tracheostomy dependence in advanced hypopharyngeal cancer with (chemo) radiation

Naphorn Suksangpanya — 2024-07-17

Abstract

Objective: To study and compare factors associated with tracheostomy in locally advanced hypopharyngeal cancer patients treated with radiation therapy or concurrent chemoradiotherapy

Study design: This is a retrospective cohort analytic study conducted at Maharat Nakhon Ratchasima Hospital from January1, 2010, to December 31, 2022. A total of 131 patients with locally advanced hypopharyngeal cancer who underwent radiation therapy or concurrent chemoradiotherapy were included. The survival rate after tracheostomy was analyzed using Kaplan-Meier survival curves and Log-rank tests. Factors associated with the 1 -year tracheostomy-free rate were analyzed using Cox regression analysis, presenting Hazard ratios and 95% confidence intervals.

Results: Among the 131 patients, 34 (25.95%) required tracheostomy. The average patient follow-up is 91.1 individuals over one year. The tracheostomy rate is 3.1% during the 1-year follow-up period. The majority were male (93.1%), smokers (70.9%), and had tumors located in the pyriform sinus (77.8%). Factors significantly associated with tracheostomy included vocal cord immobility
(adjusted hazard ratio 46.69, 95% CI 6.27-347.47; p < 0.001), feeding tubes insertion during treatment (adjusted hazard ratio 4.44, 95% CI 1.83-10.77; p < 0.001), and palliative radiation therapy (adjusted hazard ratio 3.6, 95% CI 1.07-12.17; p = 0.039). The 1-year survival
tracheostomy-free rate was 64.3%, with an increasing trend in tracheostomy rate observed after 8 months.

Conclusion: In locally advanced hypopharyngeal cancer treated with radiation therapy or concurrent chemoradiotherapy, the 1-year tracheostomy-free rate was 64.3%, with an increasing trend in tracheostomy rates observed after 8 months. Factors significantly associated with tracheostomy included vocal cord immobility, feeding tube insertion during treatment, and palliative radiation
therapy, indicating statistically significant increase in tracheostomy risk.

Keywords: Malignant neoplasm of hypopharynx, tracheostomy dependence