Surgical side infections of the tracheostomy – A retrospective cohort study of patients with head and neck cancer in intensive care

This study was conducted to reveal the relevant risk factors for surgical site infections (SSI) of the tracheostomy in ICU tracheostomy patients with oncologic history. Retrospectively, medical and ICU records of patients who received open tracheostomy in a uniform manner were investigated. Of 187 consecutive patients in total, patients with a peri/post-operative antibiotic prophylaxis (POABP) experienced significantly more Organ-Space SSI, whereas patients with a POABP developed less Superficial Incisional SSI and Deep Incisional SSI. Neck Dissection (p = 0.025), especially the more levels are included, and POABP (p = 0.005) have a significant impact on the occurrence of an SSI of the tracheostomy. Deep incisional SSI significantly prolonged a patient’s dependency on a ventilator (p = 0.045, M = 3.92, SD = 4.718). The difference between Superficial Incisional, Deep Incisional and Organ-Space SSI should be taken in consideration regarding risk evaluation and treatment. Furthermore, a gram-negative facultative anaerobic biofilm should be taken into consideration in treatment options and thus an escalation regarding antibiotic treatment as a POABP. For fulminant SSI of the tracheostomy the use of piperacillin/tazobactam or 3rd generation cephalosporines or carbapenems is recommendable.     

Is nicotine still the bad guy? Summary of the effects of smoking on patients with head and neck cancer in the postoperative period and the uses of nicotine replacement therapy in these patients

Smoking has long been implicated in the development and progression of numerous postoperative complications. The cause is largely thought to be the presence of reactive oxygen species (ROS) in cigarette smoke, which attenuates inflammation and affects neutrophil function. Wound healing is further compromised by deficiencies in vitamins C and E, which result from a higher vitamin turnover secondary to the oxidative stress produced by smoking. However, studies recently have found that the effects of nicotine may benefit healing if used in isolation. We summarise the effects that smoking and abstaining from smoking can have on inflammation and wound healing, and describe the possible benefits that nicotine replacement and antioxidant supplements can give.     

Evolution assessment of head and neck infections in diabetic patients – A case control study

This research aimed to assess the occurrence and progression of head and neck infections in diabetic compared to non-diabetic patients.A retrospective study was carried out over a period of 10 years in 899 patients with head and neck infections. The patients who met the inclusion criteria were divided into cases and controls according to the presence/absence of diabetes.Seventy-three patients (8%, 95% CI [6.45%–10.12%]) were included in the case group and 826 (92%, 95% CI [89.87%–93.55%]) were assigned to the control group. The extension of the infection proved to be significantly (p < 0.001) higher in diabetic patients compared to non-diabetic patients. The difference between the two groups was statistically significant (Mann–Whitney U statistics = 18205.500, p < 1.56·10⁻⁸). A more than 10 year history of diabetes was statistically related to a wider extent of head and neck infections (p < 0.001).Diabetes proved to be associated with large necrotic areas and the spread of head and neck infections to more than two cavities.     

Exploring the relation between patients’ resilience and quality of life after treatment for cancer of the head and neck

Resilience, which is a measure of a patient's ability to recover from a traumatic event, varies among the general population, and previous studies have suggested that it has an important influence on a patient's quality of life. We conducted a study of patients treated for cancer of the head and neck to investigate the relation between scores for resilience and quality of life (QoL). A total of 98 patients, who had been treated with curative intent, completed the University of Washington quality of life questionnaire (UW-QoL) and the Connor-Davidson resilience scale (CD-RISC). Retrospective analysis of patients’ records identified demographic data, stage of disease, and treatment. The Mann-Whitney U-test, Kruskal-Wallis test, and Spearman’s rank correlation were used to assess the significance of differences between the groups. The mean (SE) QoL score after treatment was 61 (2.081), and the mean CD-RISC score 0.427 for QoL in the last seven days. There was a significant correlation between overall scores for QoL and resilience (Spearman's Rho = 0.427, p < 0.005). As higher resilience scores had a significant correlation with a better QoL, strengthening a patient’s resilience might in turn help to improve their quality of life.     

Clinical performance of different types of dental prosthesis in patients with head and neck tumors—a retrospective cohort study

Clinical Oral Investigations - To investigate how different types of dental prosthesis perform in patients with head and neck tumors. In this retrospective clinical cohort study, the impact of...     

Components of socioeconomic risk associated with head and neck cancer: A population-based case–control study in Scotland

The complex associations between socioeconomic circumstances and risk for head and neck cancer are under-explored. We investigated components of social class and their relative influence on the risk of head and neck cancers by studying 103 patients (age range 24–80 years) who had been diagnosed with cancer of the head and neck between April 2002 and December 2004, and 91 controls who were randomly selected from general practitioners’ lists. Information about occupation, education, smoking, and alcohol consumption was collected at personal interview. Socioeconomic circumstances were measured at an individual level (education, occupational social class, unemployment), and by area-based measures of deprivation. Odds ratios (OR) and 95% confidence intervals (CI) were computed using unconditional logistic regression and multivariate analyses. People living in the most deprived areas (OR = 4.66, 95% CI 1.79–12.18); and those who were unemployed (OR = 2.27, 95% CI 1.21–4.26) had a significantly higher risk of cancer than those with high levels of educational attainment (OR = 0.17, 95% CI 0.05–0.58). Significance was lost for all measures of social class when adjustments were made for smoking and consumption of alcohol. Smoking was the only significant risk factor (OR = 15.53, 95% CI 5.36–44.99) in the multivariate analysis. A high risk of head and neck cancer was consistently associated with poor socioeconomic circumstances, and there were strong links for specific components however smoking dominated the overall profile of risk. We propose a framework for future socioeconomic analyses.     

Can we assess quality of life in patients with head and neck cancer? A preliminary report from the American Academy of Maxillofacial Prosthetics

Survival statistics alone may no longer be valid when used as evidence of effective outcomes. Patient satisfaction is an end point that needs further evaluation and should be included in the outcomes assessment. A 133-item questionnaire has been designed by a special committee of the American Academy of Maxillofacial Prosthetics (AAMP) to assess the quality of life of patients with head and neck cancer impacting the orofacial region. This survey will be distributed to the entire population of 7 geographically dispersed treatment centers in the United States for a 2-year period. Patients will be stratified into several subgroups, including radiation/nonradiation, maxillary/mandibular, and surgical reconstruction/prostheses. Separate analyses will be conducted for each subgroup, and comparisons will be made within subgroups to test the sensitivity of the questionnaire to a known difference. A revised version of the AAMP questionnaire, limited to 50 items of interest to patients, will be validated against 2 established head and neck cancer questionnaires. This article provides background on previous quality-of-life studies and reviews the need for and aims of the AAMP assessment instrument.     

Chemical analysis of in vivo–irradiated dentine of head and neck cancer patients by ATR-FTIR and Raman spectroscopy

Objectives

To evaluate the effect of in vivo radiotherapy on the chemical properties of human dentine by Fourier-transform infrared spectroscopy (FTIR) and Raman analysis.

Materials and methods

Chemical composition was evaluated comparing control and irradiated group (n = 8). Irradiated teeth were obtained from radiotherapy patients subjected to fractionated X-ray radiation of 1.8 Gy daily totaling 72 Gy. The teeth were sectioned according to the type of dentine (crown or root dentine), obtaining 3-mm dentine cervical slices. The analyzed parameters by FTIR and Raman spectroscopies were mineral/matrix ratio (M:M), carbonate/mineral ratio (C:M), amide I/amide III ratio, and amide I/CH₂ ratio. Raman also calculated the phosphate and carbonate crystallinity.

Results

FTIR revealed that M:M had a decrease in both factors (p = 0.008; p = 0.043, respectively) and root dentine showed a lower C:M in the irradiated group (p = 0.003). Raman revealed a higher phosphate crystallinity and a lower carbonate crystallinity in crown dentine of irradiated group (p = 0.021; p = 0.039). For amide I/amide III, the irradiated showed a lower ratio when compared to the control group (FTIR p = 0.002; Raman p = 0.017). For amide I/CH₂, the root dentine showed a higher ratio than the crown dentine in both methods (p < 0.001).

Conclusions

Radiotherapy altered the chemical composition of human dentine. The exchange of phosphate-carbonate ions in the hydroxyapatite and higher concentration of organic components was found after radiotherapy.

Clinical relevance

The increased risk of radiation-related caries in patients undergoing head and neck radiotherapy is due not only to salivary, dietary, and microbiological changes but also to changes in tooth chemical composition.

     

Subjective and objective appearance of head and neck cancer patients following microsurgical reconstruction and associated quality of life─A cross-sectional study

Purpose

Depending on the site and size of head and neck cancer, the disease affects patients' appearance and subsequently their quality of life. The aim of this study was to correlate subjective and objective evaluation of facial appearance and associated quality of life following ablative tumor surgery and microsurgical reconstruction.

Evaluation of oral prophylaxis during and after intensity-modulated radiotherapy due to head and neck cancer—a retrospective study

Objectives

The aim of this study was to retrospectively analyze the influence of a prophylaxis protocol of head and neck tumor (HNT) patients during and after intensity-modulated radiotherapy (IMRT).

Material and method

In this 5-year retrospective study (2009–2013), 70 (m 55, f 15; age range 28–8 years; median 58.7 years) out of 248 HNT patients of the Clinic of Cranio-Maxillofacial and Oral Surgery at the University of Zurich, Switzerland, fulfilled the inclusion criteria. Parameters of investigation were the salivary flow rates, possible dental foci and the dental status, oral side effects of radiotherapy, the prophylaxis protocol, and patient’s compliance to this protocol. The following time points before during and after IMRT (6 weeks) were analyzed: prior to IMRT, 2–4 weeks, 6 weeks and 3, 6, and 12 months after the onset of radiotherapy.

Result

Unstimulated salivary flow rate, pH value of unstimulated salivary, and stimulated salivary flow rate showed a significant reduction over time (p < 0.001). One year after IMRT, both unstimulated and stimulated salivary flow showed a statistically significant lower salivary flow. The number of caries-affected sites per patient was significantly higher for patients with low compliance to the prophylaxis protocol (mean: low compliance 1.36, high compliance 0.26). Almost 75 % of the evaluated patients suffered immediate gustatory change, and 47.1 % showed signs of radiostomatitis through IMRT.

Conclusions

High compliance to the prophylaxis protocol during and after radiotherapy is a key factor for the reduction of radiation side effects on dental hard tissue.

Clinical relevance

High compliance to a monitored prophylaxis program is crucial for patients after head and neck surgery.

     

Radiotherapy-induced xerostomia: a randomised,double-blind,controlled trial of Visco-ease™ oral spray compared with placebo in patients with cancer of the head and neck

Radiotherapy-induced xerostomia (RIX) is a common and untreatable side effect of radiotherapy to the head and neck. Visco-ease? mouth spray (Lamellar Biomedical Ltd), a new product that is made from lamellar body mimetics, reduces the viscosity of saliva ex vivo. The purpose of this study was to evaluate its safety and effectiveness in the treatment of RIX in 43 patients with cancer of the head and neck. They were randomised into the Visco-ease? or placebo groups, and asked to complete the Groningen radiotherapy-induced xerostomia (GRIX) questionnaire each week. The primary endpoint was a change in GRIX score from baseline to end of treatment. There was no difference in scores between the two groups, and none of the patients had device-related serious adverse events. Visco-ease? oral spray was safe and tolerable but no better than placebo in reducing RIX in this group of patients.     

Patients’ views of physical activity whilst living with and beyond head and neck cancer

Exercise is an important component of recovery following cancer. Head and neck cancer (HNC) patients typically report low levels of engagement in exercise initiatives. The aim of this study was to give insight into HNC patients’ reflections on how and why they would be interested in participating in an exercise programme. A stratified sample of 51 patients based on age, gender and initial interest in an exercise programme was selected from 430 postal survey respondents. Twenty-five took part in a semi-structured telephone interview. There was responder bias with females, younger patients, and those already participating in or interested in an exercise programme being over-represented. The responders in this study highlighted issues related to physical activity levels, perceived ability to meet physical activity guidelines for cancer survivors, perceived exercise benefits, perceived exercise barriers, and advice to others diagnosed with cancer. The findings support the premise of personalized interventions tailored towards the specific needs of the patient, supported by patient peers to emphasize the benefits and help motivate patients to take part. In order to promote engagement in exercise there needs to be collaborative, culturally sensitive and individualized approaches, in order to address the specific barriers experienced by HNC patients.     

Implant survival or implant success? Evaluation of implant-based prosthetic rehabilitation in head and neck cancer patients—a prospective observational study

Objectives

Definition of implant success is unclear in prosthetic implant-based rehabilitation of head neck cancer patients.

Materials and methods

Fifty-two patients with 309 inserted implants were included in this prospective observational study. Implant survival (in situ and loaded) and implant success (modified Albrektsson criteria) at 2-year follow-up were evaluated under the influence of patient- and implant-specific variables.

Results

Thirty-nine patients with 234 implants finished the study. Overall implant survival after 2 years was 92.3% (216/234) with an osseointegration rate of 94% (220/234). Implant success was 78.6% (184/234). Main reasons for failure were “bone resorption > 1.7mm” (n = 27, 11.5%) and “implant not in situ or not loaded” (n = 18, 7.7%). Smoking (OR 3.1, p = 0.034), bone grafts (OR 2.4, p = 0.021) and radiation dose > 60 Gy (OR 3.8, p = 0.025) revealed as significant predictors for implant failure.

Conclusion

Implant survival differs significantly from implant success in head and neck cancer patients. Implant success is mainly determined by radiographic peri-implant bone resorption.

Clinical relevance

Dealing with head and neck cancer patients a higher amount of peri-implant bone resorption must be taken into account and warrants for intensified implant monitoring.

     

Squamous cell carcinoma of the head and neck – screening in patients who misuse alcohol and tobacco in Switzerland: a prospective pilot study

Squamous cell carcinoma (SCC) of the head and neck is the sixth most common cancer worldwide. It is preceded by early asymptomatic lesions which, if identified early enough and removed, would prevent malignant transformation or avoid delaying diagnosis to advanced stages. Our aim was to evaluate the feasibility of a screening programme for SCC of the head and neck in a group of high-risk patients, and to investigate their addiction profile. Patients admitted to an inpatient alcohol addiction centre (n = 101) were prospectively enrolled and asked to fill in a questionnaire about their use of tobacco and alcohol, and the presence of warning symptoms for SCC of the head and neck from 23 June 2014 to 21 January2016. Participants in the study had a physical examination by an alcohol addiction physician followed by a full examination of the head and neck by an otorhinolaryngologist to rule out premalignant or malignant lesions of the upper aerodigestive tract. Of the 101 patients, 62 (60%) had at least one warning symptom. Alcohol addiction physicians identified leukoplakia in six (6%) and erythroplakia in two. No pre-malignant or malignant lesions were confirmed on examination by the otolaryngologist.We were unable to draw conclusions about the cost-effectiveness or the yield of the screening programme. Despite our negative findings, we may need further investigation to clarify the relevance of such a programme on health-related outcome given the high compliance rate and minimal delay that was achieved by taking advantage of an in-patient alcohol rehabilitation centre.