Modified visor approach applied to total or subtotal glossectomy and reconstruction: avoidance of lip splitting and mandibulotomy and cutting off mental nerve

A lower lip-splitting incision has traditionally been performed with different types of mandibulotomy approaches for obtaining wide access to total or subtotal glossectomy. However, lip splitting can be associated with unfavorable aesthetic and function results. We describe our new modification of a traditional visor approach without lip splitting, mandibulotomy, and reserve mental nerve to avoid these morbidities and to compare aesthetic, functional, and patient subjective outcomes between the two access procedures. Of the patients undergoing total or subtotal glossectomy and reconstruction with flaps, 99 were grouped according to a surgical access procedure performed (lip split and mandibulotomy [LSM] or modified visor approach [MVA]). Data on surgical morbidity and outcomes were compared. All the tumors were safely removed by means of our modified visor approach through the combined intraoral and transcervical routes with adequate resection margins. There were no troublesome difficulties in reconstruction of the surgical defects with various flaps. Recurrence rates, swallowing, chewing, and speech were similar for both groups. Rates of postoperative fistulae were 9.3 % (LSM) vs 0 % (MVA). There were significant differences between the two groups in the temporomandibular joint (TMJ) signs (p?=?0.000) and for appearance domains (p?=?0.01). Avoiding lip splitting and mandibulotomy reduces patient morbidity and hospital stay and gets excellent aesthetic consequences; reserve mental nerve can avoid lower lip numbness after surgery. In our experience, the lower lip-splitting and mandibulotomy procedure for surgical exposure is unnecessary for both oncologic resection and reconstruction of tongue cancers.     

Anti-infective locks for treatment of central line-associated bloodstream infection: a systematic review and meta-analysis

Central line-associated bloodstream infections (CLABSI) are associated with considerable morbidity, mortality and economic costs. In most cases, catheter removal is considered an essential component of managing CLABSI. However, in patients with poor access, catheter salvage may have to be attempted rather than removal and replacement of catheters. Anti-infective lock therapy (ALT) - instilling an antibiotic or antiseptic into the catheter lumen - is a novel way of treating CLABSI while attempting to salvage the catheter. However, data on the efficacy of ALT for catheter salvage is limited. In this systematic review, we critically review the evidence regarding the use of ALT for catheter salvage. We identified 8 studies including a total of 396 patients that compared ALT with systemic antibiotic therapy alone or an alternate method of catheter salvage (guidewire replacement). We found that the combination of systemic antibiotics and culture-guided lock therapy was superior to systemic antibiotics alone (OR: 0.20, 95% CI: 0.10-0.39), with 10% of locked patients requiring replacement compared to 33% of subjects without locks. There was a 20% relapse rate in the ALT group and a 30% relapse rate in the control group (OR: 0.43, 95% CI: 0.18-1.03). There was insufficient data on catheter exchange over a wire compared with ALT to permit conclusions. Our data support the use of ALT in conjunction with systemic antibiotics for catheter salvage. Large randomized controlled trials of ALT examining dose, dwell times and relapse rates stratified by infecting pathogen are needed.