Literature Review: A Roundup of Important Recent Studies

Bottom line: Spasmodic dysphonia is likely multifactorial and associated with several endogenous and exogenous factors.

References: Tanner K, Roy N, Merrill RM, et al. Case-control study of risk factors for spasmodic dysphonia: a comparison with other voice disorders. Laryngoscope. 2012;122(5):1082-1092.

—Reviewed by Sue Pondrom

 

Predictors of Complications of Free Flap Reconstruction

What are the predictors of complications following free flap reconstruction in the head and neck?

Background: Each year, more than 400,000 head and neck squamous cell cancers are diagnosed worldwide. Surgical resection is frequently required, necessitating reconstruction for appropriate wound closure, restoration of function and aesthetics. The significance of predictors of complication is a matter of debate.

Study design: Retrospective analysis.

Setting: Department of Medicine and Department of Otolaryngology-Head and Neck Surgery, University of Toronto; Sunnybrook Health Sciences Centre, Toronto, Canada.

Synopsis: The authors analyzed 304 consecutive free flap reconstructions performed over a seven-year period. Patient and procedure characteristics included age, sex, peripheral vascular disease (PVD), diabetes mellitus, pre-operative cerebrovascular accident, pre-operative myocardial infarction, alcohol history, smoking history, pre-operative chemoradiation, indication for reconstruction, T stage, N stage, defect classification, node dissection and flap type. Of the comorbid conditions assessed with univariate ordinal regression, only PVD was associated with statistically significantly different complication grades. With multivariate ordinal regression, however, PVD was not found to have a statistically significant relationship with complication grades.

Bottom line: Overall, the incidence of serious complications according to the Clavien-Dindo classification system was found to be low. The only statistically significant predictors of complication grades were increased tumor stage and pharyngoesophageal reconstruction.

Reference: le Nobel GJ, Higgins KM, Enepekides DJ. Predictors of complications of free flap reconstruction in head and neck surgery: analysis of 304 free flap reconstruction procedures. Laryngoscope. 2012;122(5):1014-1019.

—Reviewed by Sue Pondrom