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Objective: To determine if systemic administration of low-molecular-weight heparin impacts venous compromise in loco-regional flap reconstruction for head and neck subsites. Methods: This prospective study was conducted on patients who had developed features of venous compromise of the flap. The case group received low-molecular-weight heparin (dalteparin). Results: Of the 73 patients who developed venous congestion, low-molecular-weight heparin was administered in 47 patients. In the low-molecular-weight heparin subset, 23 patients had either reversal or non-progression of venous compromise (48.9 per cent). Of the patients who had no response to low-molecular-weight heparin rescue, complete necrosis was seen in 4 and partial flap necrosis was observed in 19. The corresponding numbers in the control group were 13 and 12, respectively (odds ratio 23.9, p = 0.002). Additionally, the low-molecular-weight heparin arm had a lower incidence of partial or complete flap necrosis (p = 0.002). Conclusion: Low-molecular-weight heparin salvage, when instituted early, is likely to result in a significant reduction in flap-related morbidity. [ABSTRACT FROM AUTHOR]

Background: There exists a lacuna in the structured reporting of swallowing dysfunction and quality of life (QoL) outcome following major glossectomy. Methods: Prospective cohort study to assess the swallowing dysfunction and QoL following STG (subtotal glossectomy) or NTG (near total glossectomy) over a 6‐month period using FEES and PAS scale, MDADI, and FACT‐HN. Results: Twenty‐four patients were available for analysis. The pre‐ and post‐adjuvant evaluation revealed a statistically significant improvement in the composite MDADI and FACT‐HN scores. Subscale analysis of FACT‐HN scores revealed maximum deficit in the head and neck cancer‐specific score domain followed by functional domain and social well‐being domain, with serial improvement noted in the post‐adjuvant setting. Conclusion: This study showed serial improvement in terms of swallowing dysfunction although social and functional well‐being domains related to QoL continued to reveal major deficits. Better outcomes were seen with preservation of bilateral base of tongue and mandible. [ABSTRACT FROM AUTHOR]

Background: "Depth of invasion" is an additional index incorporated in 8th AJCC staging system for oral cavity squamous cell carcinoma based on its prognostic significance. Pre‐operative assessment by clinical palpation and imaging modalities has been used with limitations. The aim of the study is to compare different techniques including clinical palpation, ultrasound, and magnetic resonance imaging with histopathology for assessment of depth of tumor invasion. Materials: Fifty patients of carcinoma tongue (T1–T3) were enrolled. Clinical palpation, Ultrasound tongue, and Magnetic resonance imaging were used to assess depth of tumor invasion. Microscopic depth of invasion was considered as reference. Statistical analysis was done to assess the level of agreement, reliability, and internal consistency. ROC analysis was done to find the "Area Under Curve" for microscopic depth versus ultrasound, MRI, and gross histopathological "depth of invasion". Results: Ultrasound tongue showed highest "area under curve", Intra class correlation (ICC:0.786) with a good consistency (Cronbach's Alpha:0.880) with histological reference compared to MRI(ICC:0.689;CA:0.816). Clinical palpation showed weak agreement (Kappa:0.43) for assessing depth. To observe the concordance between ultrasound and microscopic depth, Lin's Concordance Correlation Coefficient (CCC = 0.782) was calculated with 95% limits of agreement. Lin's concordance correlation between ultrasound and microscopic depth showed a good agreement. Conclusions: Ultrasound tongue is a reliable imaging modality for pre‐operative T staging by assessing tumor "depth of invasion" in carcinoma tongue patients with good internal consistency as per 8th AJCC staging system. Level of Evidence: 2 (CEBM‐Level of Evidence‐2.1) Laryngoscope, 134:215–221, 2024 [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to identify factors predicting outcomes following pectoralis major myocutaneous flap reconstruction in complex oromandibular defects. Methods: A prospective cohort study was conducted at a tertiary care oncology center in South Asia from January 2020 to May 2022 to include consecutive cases of complex oromandibular defects reconstructed with pectoralis major myocutaneous flap. During pectoralis major myocutaneous flap harvest surgical modifications were incorporated to preserve the choke vessel from the fourth intercostal perforator and lateral pedicle supply apart from the main pedicle from acromiothoracic artery. Results: In our series of 196 patients, overall flap compromise was noted in 17.6% with the most common pattern of failure being partial fullthickness necrosis (n = 23) and complete flap loss was identified in only 3 cases. The factors that showed statistically significant correlation with flap outcome in the univariate model were female sex (42.9% vs. 14.9%) associated with a higher incidence of flap compromise, while bipaddle pectoralis major myocutaneous flap (2.2% vs. 17.3%) and larger surface area of skin paddle (>49 cm²) (20.2%, 16%, and 0% in <49 cm², 50-96 cm², and >96 cm², respectively) were factors favoring a better outcome. Factors that emerged as independent prognostic variables in the multivariate model were female sex (odds ratio: 9.801, P = .001) and high body mass index (odds ratio: 1.19, P = .03) signifying a higher incidence of flap compromise. Conclusion: Pectoralis major myocutaneous flap is still the "workhorse" of head and neck reconstruction. Nevertheless, the female sex and high body mass index may serve as deterrents to the success of this flap. [ABSTRACT FROM AUTHOR]