How MRI and CT predict flap failure after head and neck reconstructive cancer surgery

Author: Noah Fromson Source: labblog.uofmhealth.org A composite picture from MR perfusion of a free flap demonstrating measurements made within the flap. Credit: Michigan Medicine When a patient with head and neck cancer has surgery to remove it, they often need reconstructive surgery in the form of a “free flap”, which is skin and tissue taken from a different part of the body and connected to the blood vessels of the wound in need of repair. This free flap method, called microvascular reconstruction, carries around a 10-40% risk of wound complications, with 10% of cases requiring another surgery. A Michigan Medicine study finds that early postoperative CT scans and MRIs can help predict whether a flap will fail, which could allow surgeons to intervene earlier. The results are published in the American Journal of Neuroradiology. “All patients who have this procedure can be investigated with non-invasive post-operative CT or MRI perfusion, and these two methods show a lot of promise as accurate biomarkers of predicting free flap viability,” said Ashok Srinivasan, M.D., FACR, senior author of the paper and neuroradiologist at University of Michigan Health. “By seeing how much blood is flowing in and out of the tissue, we may be able to predict if the flap will succeed and if the patient can be discharged earlier, or it may be able to tell us sooner that surgical intervention is needed to repair the flap. Radiologists have used CT and MRI perfusion with contrast to look at blood perfusion [...]

Rebuilding a jaw in a day

Source: www.eurekalert.org Author: Cedars-Sinai Medical Center Patients who lose a part of their jaw — whether from injury, infection, disease, or as a side effect of cancer treatment—can have the missing jawbone replaced through reconstruction. But most are left with a life-altering dilemma: Their new jaw is missing its teeth. That isn’t the case, however, for those treated by Cedars-Sinai’s “jaw-in-a-day” team. The team—a partnership between Cedars-Sinai and the Los Angeles Center for Oral & Maxillofacial Surgery—is one of just a handful across the country performing a relatively new procedure where patients receive a jaw replacement complete with dental implants in one surgery. “People who have a traditional jaw reconstruction get a new jawbone, but it isn’t very functional,” said oral/maxillofacial surgeon Steven Kupferman, DMD, MD. “The jaw is meant to talk and chew, and without teeth, it can’t do those things as well.” A Tricky Reconstruction In the traditional jaw-replacement procedure—called fibula free flap surgery—the surgeon replaces the damaged jawbone with a section of bone cut from the fibula, the outer bone in the lower leg, which can be removed without compromising the patient’s ability to walk. It is possible for patients to have dental implants added to the jaw in a separate procedure, but head and neck surgeon Jon Mallen-St. Clair, MD, PhD, who has performed many fibula free flap procedures, said that rarely happens. “The patient may be worn out from going through that major reconstruction operation,” Mallen-St. Clair said. “And the oral surgeon could be worried [...]

Team approach improves oral cancer outcomes

Source: www.drbicuspid.com Author: Donna Domino, Features Editor Providence Cancer Center in Portland, OR, is one of a growing number of facilities that is working to improve care for patients with oral cancer and head and neck cancers through a multidisciplinary program that brings together a spectrum of treatment providers. To illustrate the challenges many oral cancer patients face, R. Bryan Bell, MD, DDS, medical director of the Oral, Head and Neck Cancer Program at Providence, described the extreme effects the illness and its treatment had on one of his patients. The woman had undergone surgery, chemotherapy, and radiation for her oral cavity cancer. "This was a beautiful 32-year-old woman who had lost all her teeth and couldn't chew," Dr. Bell told DrBicuspid.com. "She had aged about 40 years during treatment, and she just looked awful. But she had no means of affording needed dental rehabilitation, which would have cost about $60,000. People need to see what happens when you don't restore these patients." Dr. Bell used the woman's case to convince officials at Providence Health, which oversees the medical center, of the need for a multidisciplinary approach for these patients. The new cancer treatment center, which opened last month, is a unique collaboration between dental and medical oncology specialists. The center provides coordinated care for oral cancer patients who often need expensive and complex dental rehabilitation, regardless of their ability to pay, according to Dr. Bell. His team includes head and neck surgical oncologists, radiation oncologists, medical oncologists, otolaryngologists, neuro-otologists, [...]

Go to Top