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To determine the frequency at which patients with osteocutaneous free flap reconstruction of the head and neck develop long-term complications and identify predisposing perioperative factors.A prospectively maintained database of free flaps performed at a single institution over a 10-year period was queried.Single tertiary care referral center.In total, 250 osseous or osteocutaneous free flaps (OCFFs) for mandibular or maxillary reconstruction were analyzed. Data were collected on demographics, preoperative therapy, resection location, adjuvant treatment, complications, and subsequent surgeries, and multivariate analysis was performed. Subgroup analysis based on perioperative factors was performed.The median follow-up time was 23 months. In 185 patients with at least 6 months of follow-up, 17.3% had at least 1 long-term complication, most commonly wound breakdown, fistula or plate extrusion (13.5%), osteoradionecrosis or nonunion (6.5%), and infected hardware (5.9%). Prior chemoradiotherapy and cancer diagnosis predisposed patients to long-term complications. At the 5-year follow-up, 21.7% of patients had experienced a long-term complication.Long-term complications after OCFF occurred in 17% of patients. In this series, a preoperative history of chemoradiation and those undergoing maxillary reconstruction were at high risk for the development of long-term complications and thus warrant diligent follow-up. However, OCFFs can often enjoy long-term viability and survival, even in the case of perioperative complications and salvage surgery.

In this prospective nonrandomized multicenter trial, we analyze the incidence of early and late complications after parotidectomy in correlation to the extent of dissection.A total of 148 patients underwent a parotidectomy for a benign lesion in the superficial lobe. The number of intraoperatively dissected main facial nerve branches was photo-documented and defined the extent of tissue dissection. Early postoperative complications including sialocele were evaluated until 4 weeks after surgery. Late complications as facial nerve palsy, Frey's syndrome (FS) and the outcome of the scar and substance loss were furthermore assessed after 6 and 12 months.Early complications occurred in 22 patients (14%) and did not depend on the extent of facial nerve dissection (all P .05). However, patients with higher number of intraoperatively dissected facial nerve branches showed significantly higher palsy scores on the first postoperative day (P = .026). FS occurred with incidence of 69% and correlated significantly to the extent of dissection (P = .003). Appearance of the scar and substance loss improved significantly during the follow-up (P .001 and P ,005, respectively) without significant correlation to the extent of dissection (P .05 for both variables after 12 months).Less extensive tissue dissection resulted in better postoperative facial nerve function on the first postoperative day and in lower incidence of FS after 12 months. However, incidence of early complications did not depend on the extent of surgery. The study was registered in the German Clinical Trials Register prior to conducting the research.DRKS00008967, URL:http://apps.who.int/trialsearch/.

Hypoparathyroidism (HypoPT) is associated with an increased risk of various complications, but only few data are available on risk factors. Using a case-control design, we assessed associations between biochemical findings and risk of different complications within a subpopulation of our previously identified Danish patients. We retrieved all biochemical data available on 431 (81% women) patients from the Central Region of Denmark, covering approximately 20% of the Danish population. Average age of patients was 41 years at time of diagnosis. Most patients (88%) had HypoPT due to surgery, mainly due to atoxic goiter and more than 95% were on treatment with calcium supplements and activated vitamin D. On average, time-weighted (tw) plasma levels of ionized calcium (Ca2+tw ) was 1.17 mmol/L (interquartile range [IQR], 1.14 to 1.21 mmol/L) and the calcium-phosphate (CaxPtw ) product was 2.80 mmol2 /L2 (IQR, 2.51 to 3.03 mmol2 /L2 ). High phosphatetw levels were associated with increased mortality and risk of any infections, including infections in the upper airways. A high CaxPtw product was associated with an increased mortality and risk of renal disease. Compared to levels around the lower part of the reference interval, lower Ca2+tw levels were associated with an increased risk of cardiovascular diseases. Mortality and risk of infections, cardiovascular diseases, and renal diseases increased with number of episodes of hypercalcemia and with increased disease duration. Treatment with a relatively high dose of active vitamin D was associated with a decreased mortality and risk of renal diseases and infections. In conclusion, risk of complications in HypoPT is closely associated with disturbances in calcium-phosphate homeostasis. © 2018 American Society for Bone and Mineral Research.

Aims The present study evaluates the effect of antenatal lamotrigine exposure, on short- and long-term paediatric outcome. Methods The study included the children of 83 epileptic women treated with lamotrigine during pregnancy, at a tertiary medical centre between 2004-2014. All newborns were monitored for vital signs, congenital malformations and Finnegan score. In addition, the parents completed a questionnaire regarding their child's development and health up to the age of 12 years. Results No major malformations were found in the newborns. None of the newborns had significant withdrawal symptoms by Finnegan score. The children were followed-up to the age of 12 years (56.6% were 6-12 years at the time of evaluation). There were no significant findings in the incidence of neurodevelopmental disorders. Conclusions According to our experience, lamotrigine is generally safe for pregnancy use, associated with minimal short-term complications with no long-term effects on the outcome.

Key content A review of hysteroscopic sterilisation for permanent birth control. The history and development of hysteroscopic sterilisation. The best possible management of any complications. The evidence relating to complications associated with the Essure Essure® device. Learning objectives To learn about the incidence of the long-term risk of hysteroscopic sterilisation. To be able to counsel women who are seeking this procedure. To gain an overview of the management of long-term complications. Ethical issues Women need to be informed of the long-term risks to be able to make an informed choice. Detailed discussion and awareness is needed to allow selecting the right method of contraception, covering both the positive and negative aspect of the method. Medico-legal implications.

Aim The incidence of non-obstetrical complications after cervical conization is low, and women receive minimal postsurgical attention. In this study, we investigated whether women felt any discomfort after undergoing conization by harmonic scalpel, one of the hot-knife devices widely used in Japan. Methods Eighty-eight women aged 20–47 years who were still experiencing menstrual cycles and had undergone harmonic conization participated in a questionnaire survey regarding perisurgical complications and postsurgical changes in gynecological issues. Correlations between the occurrence of postoperative complications and clinical characteristics were analyzed. Results Regarding the complications immediately after the surgery, 37 women (45.1%) complained of postoperative bleeding that was heavier than their usual menstrual bleeding, and 14 (18.2%) reported that the postsurgical bleeding was greater than they had expected. Regarding long-term gynecological changes after conization, 27 women (30.7%) reported that the duration of menstrual bleeding had increased after the surgery, 20 (22.7%) indicated that pain during menstruation had changed, and 40 (45.5%) stated that the amount of menstrual bleeding had changed. Irregular genital bleeding outside of menstruation appeared in 23 women (26.4%). Additionally, 24 (27.6%) of the women reported that the conization procedure negatively impacted their quality of life. Finally, the occurrence of long-term atypical bleeding after the surgery was significantly correlated with the thickness and circumference of the tissue specimen. Conclusion Several women experienced a significant change in quality of life after harmonic conization. Women who undergo conization should receive a comprehensive preoperative overview of the procedure and attentive postsurgical care.

Long-term biliary complications after living donor liver transplantation (LDLT) are not well described in the literature. This study was undertaken to determine the long-term impact of biliary complications after adult right-lobe LDLT.This retrospective review analyzed an 11-yr experience of 344 consecutive right-lobe LDLTs with at least two yr of follow-up.Biliary leaks occurred in 50 patients (14.5%), and strictures occurred in 67 patients (19.5%). Cumulative biliary complication rates at 1, 2, 5, and 10 yr were 29%, 32%, 36%, and 37%, respectively. Most early biliary leaks were treated with surgical drainage (N = 29, 62%). Most biliary strictures were treated first with endoscopic retrograde cholangiography (42%). There was no association between biliary strictures and the number of ducts (hazard ratio [HR] 1.017 [0.65-1.592], p = 0.94), but freedom from biliary stricture was associated with a more recent era (2006-2010) (HR 0.457 [0.247-0.845], p = 0.01). Long-term graft survival did not differ between those who had or did not have biliary complications (66% vs. 67% at 10 yr).Biliary strictures are common after LDLT but may decline with a center's experience. With careful follow-up, they can be successfully treated, with excellent long-term graft survival rates.

Purpose The purpose of this retrospective investigation was to present the incidence of biological and technical complications in patients treated with implant-supported, immediately loaded full-arch restorations. Materials and Methods Clinical data of all patients treated with full-arch, immediately loaded rehabilitations supported by a combination of upright and tilted implants were screened. Data on both technical and biological complications (such as peri-implant mucositis and peri-implantitis) and their onset and frequency of occurrence were recorded and analyzed. Results The clinical records of 86 patients (95 prosthetic rehabilitations) were included in this study. There were 61 mandibular rehabilitations and 34 maxillary ones, all of them immediately loaded within 8 to 48 hours of the surgical intervention. The follow-up time varied from 16.3 to 112 months of function (mean 65.36 months). The most common biological complications were hygiene-related (n = 81; 30.2% of patients displayed peri-implant mucositis and 10.4% peri-implantitis). Among all prosthetic complications, the detachment of an element of the definitive prosthesis was the most frequent event (n = 20; 23.2% of patients). The total number of prosthetic complications was 42. Most complications were reversible and did not affect the overall implant/prosthesis survival rate. Conclusions The occurrence in well-maintained patients of technical and biological complications in full-arch rehabilitations supported by a combination of tilted and upright implants in the medium to long term is lower than previously reported by the pertinent literature. Further studies are needed to confirm this result.

Background Device closure of atrial septal defect (ASD) and patent foramen ovale (PFO) are both associated with short- and long-term complications. Our knowledge of the complication rates of ASD and PFO closure is limited. Our objective was to review the peri-procedural and long-term complications of ASD and PFO closure. Methods Medline, EMBASE, and Scopus databases were searched between 1973 and 2012. A total of 28,142 patients from 203 case series were included. Of these 203 articles, 111 were reporting ASD closure, 61 were reporting PFO closure, and 31 were reporting both. Pooled incidence rates of cardiac complications were calculated separately for peri-procedural and at follow-up. Results Peri-procedural major complications were reported from 0% to 9.4%, with a pooled estimate rate of 1.4% (95% CI: 1.3–1.6%). It was 1.6% (95% CI: 1.4–1.8%) in ASD group, 1.1% (95% CI: 0.9–1.3%) in PFO group, and 1.3% (95% CI: 0.9–1.9%) in ASD/PFO group. The most common major complication was the device embolization requiring surgery. Peri-procedural minor complications were reported with a pooled estimate rate of 1.4% (95% CI: 1.2–1.7%). It was 1.6% (95% CI: 1.2–2.1%) in ASD group, 1.3% (95% CI: 1.0–1.7%) in PFO group, and 1.5% (95% CI: 1.1–1.2.1%) in ASD/PFO group. The most frequent major complications at follow-up were cerebrovascular events [1.3% (95% CI: 1.1–1.6%)] and device thrombosis [1.2% (95% CI: 1.0–1.4%)]. Both were more frequent in PFO group. Conclusion Device closure of ASD and PFO are associated with non-negligible serious complications, both in early and long-term. © 2013 Wiley Periodicals, Inc.

Objectives A novel double opposed helical (DH) biodegradable stent was designed and fabricated for CHD applications. The primary objective was to evaluate the feasibility of DH stent delivery and deployment in rabbit external iliac arteries (EIA). Secondary objectives were to assess stent patency, thrombosis and inflammation at 1-week and 1-month follow-up. Background Biodegradable stents have largely been designed for adult cardiovascular indications, to avoid long term complications of permanent implants. A growing child with congenital heart disease (CHD) would especially derive substantial benefit from this technology. Methods DH stents were manufactured to 3, 4, 5, and 6-mm diameter with poly-l-lactic acid (PLLA) fibers. Bench test analysis was performed. Six DH stents were implanted in rabbit EIA. Vessel patency was assessed at 1-week and 1-month follow-up with repeat angiography, intravascular ultrasound (IVUS). Histopathological evaluation was performed. Results The elastic recoil and collapse pressure of DH stents were comparable to conventional metal stents. All DH stents were successfully delivered and implanted with good apposition to the vessel wall and no collapse of the proximal, mid or distal ends. All stented vessels remained patent. No acute or early stent thrombosis was noted. Histopathology showed minimal inflammatory response and mild neointimal proliferation at 1 month follow-up. Conclusions In vitro results of DH PLLA biodegradable stents are comparable to conventional metal stents. The pilot animal study confirms the delivery and deployment of the DH stents to the desired location. The DH design can be used to fabricate larger diameter stents needed for CHD. © 2013 Wiley Periodicals, Inc.

Background This prospective randomized study evaluated complications related to long-term totally implantable catheters in oncologic children and adolescents by comparing venopunction performed either in the jugular or subclavian vein. Methods A total of 83 catheters were implanted from January 2004 to April 2006 and followed-up until March 2008. Patients were randomly allocated to the subclavian or jugular vein group. The endpoint was complications that led to catheter revision or catheter removal. Results Six patients were excluded, 43 had the catheter implanted in the subclavian and 34 in the jugular vein. Subclavian catheters were used for up to 12.6 months, while jugular catheters were kept in place for up to 14.8 months (P = 0.38). No statistical differences were found between the groups concerning age, sex, leukocyte count, platelet count, type of admission (in or outpatient), or previous chemotherapy regimens. When analyzed individually, long-term complications did not present statistically significant differences either. Infection occurred in 20 and 11% (P = 0.44), while catheter embolism took place in 23 and 8% (P = 0.11) of patients with subclavian and jugular catheters, respectively. A statistical difference was seen in the total number of complications, which occurred in 48 and 23% (P = 0.02) of patients in the subclavian and in the jugular groups, respectively. Conclusions Catheters implanted by puncture in the subclavian vein were more prone to late complications than those implanted in the jugular vein. Pediatr Blood Cancer 2012; 58: 274–277. © 2011 Wiley Periodicals, Inc.

Fifty patients who underwent open carpal tunnel release (OCTR) surgery at least 12 months earlier for carpal tunnel syndrome were reviewed, focusing on scar tenderness, pillar pain, and symptoms of neuroma. A total of 55 hands were studied. At an average of 20.2 months of follow-up, 5.5% had Tinel's sign, 7.3% had scar tenderness, 12.7% had pillar pain, and 18% had burning discomfort. Pillar pain was elicited in a much higher fraction of patients by using the "table test" (provocation of pillar pain by having the patient lean with his/her weight on the hands placed on the edge of a table), even when traditional tests were negative. Symptoms and signs are present in a substantial number of patients after OCTR, even after almost 2 years of follow-up. Patients should be informed of the incidence of long-term symptoms and signs after OCTR surgery.

This report describes the clinical and investigative findings in a 31-year-old man with Hunter's syndrome, showing evidence of severe multisystem involvement. Papilloedema has been present for at least 8 years with no evidence of progressive visual impairment. His most serious and life-threatening complications are laryngeal oedema and tracheal narrowing, which both compromise his respiratory function and constitute a major anaesthetic risk.

The long term morbidity and mortality of two consecutive groups of patients undergoing successful shunt surgery for bleeding oesophageal varices has been studied. Twenty-seven patients with a non-selective shunt in the form of a mesocaval Dacron 'H' graft and 21 patients with selective variceal decompression via a distal lienorenal shunt, all of whom had a patent shunt on discharge from hospital, were included in the study. Shunt associated encephalopathy was documented in 77% of the patients following mesocaval shunts and only 19% of patients following distal lienorenal surgery. Other postoperative morbidity was largely related to problems with the synthetic Dacron graft. Late shunt blockage, often resulting in recurrent variceal bleeding, was documented in 25% of these patients and shunt infection was responsible for complicating fatal disseminated sepsis in 18.5%. Long term survival, as assessed by life table analysis, following distal lienorenal shunt surgery was consistently better than that following mesocaval shunts. This was largely due to specific problems which could be directly related to the synthetic nature of the Dacron graft. It is concluded that the mesocaval Dacron interposition graft carries the potentially lethal long term complications of shunt blockage and infection rendering it unsuitable as a portasystemic shunt. Provided that successful surgery can be performed the distal lienorenal shunt may be a more appropriate alternative due to its reduced shunt related morbidity and, possibly, mortality.

Childhood craniopharyngiomas are histologically benign tumours arising from remnants of Rathke's pouch in the hypothalamic-pituitary region. The two common treatment approaches are primary total resection or limited resection followed by radiotherapy. To study the outcome after a primary surgical approach, we followed 25 consecutive patients (10 females, 15 males) under 16 years of age who were treated in a single institution with a management policy of radical tumour excision (mean age at diagnosis 9 years 2 months, SD 4 years 3 months; range 2 years 9 months to 15 years 11 months). Mean follow-up after primary surgery was 11 years 3 months (SD 7 years 7 months). Tumour control, and neurological, endocrine, and hypothalamic complications and their impact on health-related quality of life were assessed (medical follow-up, semi-structured interview, and questionnaires). Results of tumour control were generally good, however, local failure was observed in 6 of 25 patients, and severe late-treatment complications decreased quality of life for many long-time survivors. Endocrine deficiency occurred in 24/25, visual complications in 16/24, neurological complications in 8/24, obesity in 14/23, increased daytime sleepiness in 6/21, and significant school problems in 10/20. Patients with craniopharyngioma rated their health-related quality of life as considerably lower than healthy controls; the domains of social and emotional functioning were particularly affected. Parents' ratings were considerably lower than those of the patients. Poor functional outcome was associated with large tumours infiltrating or displacing the hypothalamus, the occurrence of hydrocephalus, and young age at diagnosis, but also with multiple operations due to tumour recurrence. Alternative treatment strategies should be considered, especially in very young patients with large tumours.

Zusammenfassung: Der Aufschwung der Transplantationsmedizin durch die verbesserte immunsuppressive Therapie hat dazu gefuhrt, dass die Patienten- und Transplantatuberlebenszeiten betrachtlich zugenommen haben. Mit diesem Erfolg und der zunehmenden Anzahl an Nierentransplantationen steigt aber auch die Rate an Spatkomplikationen, die unter anderem das Skelettsystem betreffen konnen. Der Knochenstoffwechsel vor einer Transplantation weist bereits in vielen Fallen (pathologische) Veranderungen auf. Bei Patienten mit chronischer dialysepflichtiger Niereninsuffizienz treten in der Regel zwei typische Knochenveranderungen auf, einerseits eine „Low-turnover bone disease”, zu der die Osteomalazie und die adyname Knochenkrankheit gehoren, oder eine „High-turnover bone disease” im Rahmen eines sekundaren Hyperparathyroidismus. Viele PatientInnen zeigen Manifestationen beider Erkrankungen (gemischte Osteodystrophie). Vor allem in den ersten Monaten nach der Transplantation ist ein starker Knochenmasseverlust zu beobachten. Einer der dafur verantwortlich gemachten Grunde ist die relative starke Immunsuppression in diesen Zeitraum, insbesondere Glukokortikoide scheinen hier eine zentrale Rolle zu spielen. Inwieweit andere Medikamente Einfluss auf den Knochenstoffwechsel haben, ist nicht vollstandig geklart. Derzeit gibt es kaum Studien uber eine standardisierte Therapie gegen diesen Knochenabbau, und die Behandlung stutzt sich vor allem auf Erfahrungen mit anderen Osteoporoseformen. Immunosuppressive Therapy and Bone Metabolism after Kidney Transplantation Summary: The success of transplant medicine due to improvements of immunosuppressive therapy has led to a significant increase of patient and organ survival. With the increasing number of transplantations, however, long term complications, often affecting the skeletal system, are becoming more frequent. Bone alterations often exist prior to transplantation in patients with chronic renal failure. There are two types of renal osteopathy, including “low-turnover bone disease”, consisting of osteomalacia, and adynamic bone disease, and “high-turnover bone disease” due to the development of secondary hyperparathyroidism. Many patients show evidence of both disorders (mixed bone disease). During the first months after transplantation patients lose bone mass rapidly. One of the major factors responsible for the development of osteoporosis is thought to be the intensive immunosuppressive therapy during that period, steroids in particular seem to play an important role. To what extent other medications influence bone metabolism has not been established. Currently there are no studies about a standardized therapy and treatment relies mainly on experience with other forms of osteoporosis.

Background. The purpose of this study was to determine the long-term outcome after an appendectomy during pregnancy, especially focusing on fertility. Methods. The Danish National Registry of Patients identified 117 pregnant women who had had an appendectomy during the period 1980 to 1985. One hundred-and-one of these women answered a questionnaire designed to focus on long-term complications, including infertility, during a 4 to 9 year period after the appendectomy. More than a 2-year attempt to conceive was defined as infertility. Results. Of the 101 women 15 with a normal appendix had a new intraperitoneal operation due to different indications. Three of these women had intraperitoneal adhesions. In one patient, adhesions were located on the Fallopian Tube but the location did not influence fertility. Five of the 101 women complained of infertility as defined; all had a normal appendix and none had intraperitoneal surgery during the observation period. Two of these five women conceived later during the observation period; one had confounding female and male infertility factors and two were not examined. Conclusions. Appendectomy during pregnancy of a normal, inflamed or perforated appendix does not seem to cause clinically significant intraperitoneal adhesions or infertility later in life.

BACKGROUND. In the curative treatment of Hodgkin's disease, many institutions give doses above 40 Gray (Gy). To assess the effectiveness of treating patients with 35 Gy, data from a single institution regarding survival, prognostic factors, patterns of failure, and secondary complications were reviewed. METHODS. Data for a total of 172 patients with Hodgkin's disease were reviewed. All patients received definitive irradiation between 1971 and 1994. Median follow-up was 110 months. Kaplan-Meier methods were used to estimate survival, relapse-free survival, and complication rates. RESULTS. Relapse-free survival was 83% at 5 years and 76% at 10 years. The only two prognostic factors related to relapse-free survival were the stage of disease and the number of sites. The involved infield control rate was 96%. The 10-year estimates of hypothyroidism and second malignancies were 14% and 10%, respectively. CONCLUSIONS. Doses of 35 Gy are adequate for treating Hodgkin's disease. The stage of disease and the number of sites are predictive of relapse-free survival. The incidence of late complications necessitates long term surveillance of these patients.

Objective To report the case histories of two patients who presented with haematometra and haematosalpinx 18 and 24 months after endometrial ablation. Design This is a retrospective case note analysis. Subjects A 51-year-old woman, who had undergone endometrial ablation 18 months previously, presented with acute abdominal pain. She was known to be taking continuous combined hormone replacement therapy. Pelvic ultrasound scan showed a large cystic mass, and diagnostic laparoscopy revealed a right haematosalpinx. She underwent right salpingectomy and was pain-free after the operation. A 48-year-old woman presented with lower abdominal pain 2 years after endometrial balloon ablation. The ultrasound scan of the pelvis showed a haematometra (4.4 × 2.6 × 3.3 cm). She underwent examination under anaesthesia (EUA), dilation and drainage of the haematometra. A few weeks later she had a recurrence and underwent hysterectomy. Conclusion As more ablation procedures are performed, more delayed complications will arise.

As the chemistry of saccharides and related molecular species plays a significant role in the metabolic pathways of living organisms, detecting the presence and concentration of biologically important sugars in aqueous solution is necessary in a variety of medicinal and industrial contexts. The recognition of d-glucose is of particular interest, for example in the monitoring of diabetics. Recent research provides clear evidence that tight control of blood sugar levels in diabetics sharply reduces the risk of long term complications, which include blindness, kidney failure, heart attacks and even gangrene and amputation of the limbs. Current enzymatic detection methods of sugars offer specificity for only a few saccharides; additionally, enzyme based sensors are unstable in harsh conditions. Phenylboronic acid has been known for 120 years. However, it took until 1959 for the first quantitative evaluation of saccharide boronic acid interactions. Boronic acids react with 1,2 or 1,3 diols of saccharides to form five- or six-membered cyclic esters in non-aqueous or basic aqueous media. The stable boronic acid-based saccharide receptors offer the possibility of creating saccharide sensors ‘chemosensors’ which are selective and sensitive for any chosen saccharide.

This study examines long term efficacy and saftey of “birds nest” filters (Cook), and the use of doppler ultrasound to assess patency. Of the seventeen “birds nest” filters inserted twelve were available for study. All patients were reviewed for evidence of recurrent pulmonary emboli or filter complication. Mean length of follow up was 10 months, (7 had follow up of > 12 months). Three have had further episodes of deep venous thrombosis, with probable recurrent pulmonary embolism in one. No patient had evidence of thrombosis of the inferior vena cava. No fracture or migration of the “birds nest” filters was found. Ten of the twelve filters studied with ultrasound could be visualized within the cava. In all, turbulent flow was detected with colour and duplex doppler study. We conclude that insertion and use of the “birds nest” filters is safe, with a high long term patency rate and few initial or long term complications. Doppler ultrasound is a simple and rapid method of assessing venous patency.

Purpose: Varian Eclipse treatment planning system (TPS) used for large volumes (>14 cm) IMRT always creates split‐fields that produces excessive MLC segments, match‐line dose inhomogeneity and higher treatment time compared to a non‐split field. A new method using fixed jaw technique (FJT) is proposed to reduce problems associated with split‐fields. Dosimetric comparisons between split‐field technique (SFT) and FJT used for IMRT treatment is presented. Method and Materials: Five head and neck patients with extensive target volume are studied and compared with both techniques. Treatment planning was performed on Eclipse planning system using beam data generated for Varian 2100C linear accelerator. The proposed FJT method is studied that forces the jaw to stay at a fix position during optimization. A standard, coplanar, 9‐fields equally spaced gantry angles arrangement was used in both techniques. The institutional dose‐volume constraints used in head and neck cancer were kept the same for both techniques. Results: The dosimetric coverage for the target volumes between SFT and FJT for head and neck IMRT plan is identical within ±1%. Similarly the organ at risks (OAR) such as parotids, spinal cord and brain stems have dose‐volume coverage within ±1% for all patients. When the total MU and segments were analyzed, SFT produces statistically significant higher segments (13.9±9.9%) and higher MU (13.7±4.4%) compared to the FJT. There is no match line in FJT and hence dose uniformity in the target volume is superior to the SFT. Conclusion:Dosimetrically, SFT and FJT are similar for dose‐volume coverage; however, the FJT method provides better logistics, lower MU and treatment time and better dose uniformity. The number of segments and MU have been correlated with the whole body radiation dose with long term complications and hence it is concluded that FJT should be preferred option compared to the SFT for large target volumes.