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An anterior thorac-cervical approach to tumors of the thoracic inlet
Otolaryngology– Head and Neck Surgery Volume 131 Number 2
11:00 AM Hemorrhage in Abscess Tonsillectomy Roland Giger, MD (presenter); Basile Nicolas Landis, MD; Pavel Dulguerov, MD Chaux de Fonds Switzerland; Geneva Switzerland; Geneva Switzerland
Objectives: The goal of this study was to evaluate the incidence, side, and possible predictive factors of posttonsillectomy hemorrhage in abscess tonsillectomy. Methods: A retrospective study was performed on 150 patients who underwent abscess tonsillectomy under general anesthesia between 1995 and 2002. Nine patients were excluded from the study because only unilateral tonsillectomy was performed. Age, sex, recurrent tonsillitis, prior peritonsillar abscess history, bleeding disorders, current treatments (NSAID, aspirin, antibiotics), side of peritonsillar abscess, initial treatment (observation, needle drainage, surgical incision, tonsillectomy), surgeon’s experience, operative time, anti-inflammatory treatment peri- and postoperatively, bacteriology, systolic and diastolic blood pressure, side and postoperative day of hemorrhage, and management strategy were reviewed. Results: A total of 103 patients (73%) underwent abscess tonsillectomy within the first 24 hours. In the other 38 patients (27%), observation, needle aspiration or surgical drainage did
not show any improvement of symptoms, and tonsillectomy was performed on days 2 to 5. Bleeding occurred in 18 patients (12.8%). Ipsilateral hemorrhage was observed in 5 patients (3.5%), and contralateral hemorrhage in 13 patients (9.3%). This is a nonsignificant trend for bleeding on the contralateral side(P ⫽ 0.08). Posttonsillectomy hemorrhage occurred after the fourth day in all these cases. Only aspirin intake was associated with increased posttonsillectomy hemorrhage (P ⫽ 0.015). Conclusions: The risk of postoperative hemorrhage (12.8%) in abscess tonsillectomy seems higher than reported in elective tonsillectomy. The posttonsillectomy hemorrhage incidence could be reduced by excluding patients taking aspirin and by performing only ipsilateral abscess tonsillectomy.
11:08 AM An Anterior Thorac-cervical Approach to Tumors of the Thoracic Inlet Peter H Rhys Evans, MD (presenter) London United Kingdom
Objectives: Tumors arising in the thoracic inlet and superior mediastinum present a difficult problem of surgical access. Standard approaches from below offer limited exposure to the neurovascular structure superior to the tumor and other techniques involve thoracotomy and resection of part of the clavicle or manubrium with their associated increased morbidity. Our objective was to describe an approach with excellent access and minimal morbidity. Methods: A retrospective study of 9 years experience with 27 consecutive operations in 26 patients, the majority presenting with severe symptoms or life-threatening tumor. Sixteen patients had malignant tumors and 10 had benign pathology. Fifteen patients were either self-referrals or tertiary referrals from other hospitals where their disease was deemed inoperable with local facilities. Fourteen patients had presented with recurrent tumor after previous surgery elsewhere. All patients had advanced disease (stage III, IV). Results: Fifteen tumors were resected completely and a further 8 had near total clearance with equal relief of symptoms. Major complications consisted of 2 postoperative hemorrhages, 1 chylothorax, and 1 persistent pleural effusion requiring multiple drainage. None of our patients had acute respiratory distress syndrome or significant functional shoulder problems. The median in-patient stay was 6 days. Conclusions: The anterior thoraco-cervical approach offers excellent exposure for the resection of neurogenic, metastatic thyroid, or other tumors of the root of the neck and superior mediastinum. The procedure is associated with minimal morbidity and a short hospital stay.
WEDNESDAY
Methods: The charts of 80 consecutive patients seen between 1/1995 and 12/1997 were retrospectively abstracted. Patients underwent either partial (n ⫽ 24) or total laryngectomy (n ⫽ 56). Thirty of the 80 patients were previously radiated; 50% received wide field radiation. The occurrence of at least 1 of the following determined presence of a wound complication: fistula, abscess, cellulitis, or skin necrosis. Differences in complication rates between radiated and nonradiated patients were evaluated using a Student t test. Radiated patients were further evaluated based on wide versus narrow radiation exposure and total radiation dose. Results: The overall complication rate in this cohort was 33.8% (95% confidence interval ⫽ 23.6%-45.2%). The complication rates for radiated patients compared with nonradiated patients were 36.7% (95% CI ⫽ 19.9%-56.1%) and 32.0% (95% CI ⫽ 19.5%-46.7%) respectively (P ⫽ 0.669). However, among those radiated, the complication rates for those patients who underwent wide field radiation were significantly higher than those who received narrow, 53.3% (95% CI ⫽ 26.6%-78.7%) and 20% (95% CI ⫽ 4.3%-48.1%), respectively (P ⫽ 0.058). Conclusions: Wound complications following laryngectomy are associated with the extent of radiation field in the neck. The total radiation dose did not predict wound complications in this cohort. Results are being validated on a larger retrospective and a prospective study in progress.
Scientific Session—Wednesday P235
11:00 AM Hemorrhage in Abscess Tonsillectomy Roland Giger, MD (presenter); Basile Nicolas Landis, MD; Pavel Dulguerov, MD Chaux de Fonds Switzerland; Geneva Switzerland; Geneva Switzerland
Objectives: The goal of this study was to evaluate the incidence, side, and possible predictive factors of posttonsillectomy hemorrhage in abscess tonsillectomy. Methods: A retrospective study was performed on 150 patients who underwent abscess tonsillectomy under general anesthesia between 1995 and 2002. Nine patients were excluded from the study because only unilateral tonsillectomy was performed. Age, sex, recurrent tonsillitis, prior peritonsillar abscess history, bleeding disorders, current treatments (NSAID, aspirin, antibiotics), side of peritonsillar abscess, initial treatment (observation, needle drainage, surgical incision, tonsillectomy), surgeon’s experience, operative time, anti-inflammatory treatment peri- and postoperatively, bacteriology, systolic and diastolic blood pressure, side and postoperative day of hemorrhage, and management strategy were reviewed. Results: A total of 103 patients (73%) underwent abscess tonsillectomy within the first 24 hours. In the other 38 patients (27%), observation, needle aspiration or surgical drainage did
not show any improvement of symptoms, and tonsillectomy was performed on days 2 to 5. Bleeding occurred in 18 patients (12.8%). Ipsilateral hemorrhage was observed in 5 patients (3.5%), and contralateral hemorrhage in 13 patients (9.3%). This is a nonsignificant trend for bleeding on the contralateral side(P ⫽ 0.08). Posttonsillectomy hemorrhage occurred after the fourth day in all these cases. Only aspirin intake was associated with increased posttonsillectomy hemorrhage (P ⫽ 0.015). Conclusions: The risk of postoperative hemorrhage (12.8%) in abscess tonsillectomy seems higher than reported in elective tonsillectomy. The posttonsillectomy hemorrhage incidence could be reduced by excluding patients taking aspirin and by performing only ipsilateral abscess tonsillectomy.
11:08 AM An Anterior Thorac-cervical Approach to Tumors of the Thoracic Inlet Peter H Rhys Evans, MD (presenter) London United Kingdom
Objectives: Tumors arising in the thoracic inlet and superior mediastinum present a difficult problem of surgical access. Standard approaches from below offer limited exposure to the neurovascular structure superior to the tumor and other techniques involve thoracotomy and resection of part of the clavicle or manubrium with their associated increased morbidity. Our objective was to describe an approach with excellent access and minimal morbidity. Methods: A retrospective study of 9 years experience with 27 consecutive operations in 26 patients, the majority presenting with severe symptoms or life-threatening tumor. Sixteen patients had malignant tumors and 10 had benign pathology. Fifteen patients were either self-referrals or tertiary referrals from other hospitals where their disease was deemed inoperable with local facilities. Fourteen patients had presented with recurrent tumor after previous surgery elsewhere. All patients had advanced disease (stage III, IV). Results: Fifteen tumors were resected completely and a further 8 had near total clearance with equal relief of symptoms. Major complications consisted of 2 postoperative hemorrhages, 1 chylothorax, and 1 persistent pleural effusion requiring multiple drainage. None of our patients had acute respiratory distress syndrome or significant functional shoulder problems. The median in-patient stay was 6 days. Conclusions: The anterior thoraco-cervical approach offers excellent exposure for the resection of neurogenic, metastatic thyroid, or other tumors of the root of the neck and superior mediastinum. The procedure is associated with minimal morbidity and a short hospital stay.
WEDNESDAY
Methods: The charts of 80 consecutive patients seen between 1/1995 and 12/1997 were retrospectively abstracted. Patients underwent either partial (n ⫽ 24) or total laryngectomy (n ⫽ 56). Thirty of the 80 patients were previously radiated; 50% received wide field radiation. The occurrence of at least 1 of the following determined presence of a wound complication: fistula, abscess, cellulitis, or skin necrosis. Differences in complication rates between radiated and nonradiated patients were evaluated using a Student t test. Radiated patients were further evaluated based on wide versus narrow radiation exposure and total radiation dose. Results: The overall complication rate in this cohort was 33.8% (95% confidence interval ⫽ 23.6%-45.2%). The complication rates for radiated patients compared with nonradiated patients were 36.7% (95% CI ⫽ 19.9%-56.1%) and 32.0% (95% CI ⫽ 19.5%-46.7%) respectively (P ⫽ 0.669). However, among those radiated, the complication rates for those patients who underwent wide field radiation were significantly higher than those who received narrow, 53.3% (95% CI ⫽ 26.6%-78.7%) and 20% (95% CI ⫽ 4.3%-48.1%), respectively (P ⫽ 0.058). Conclusions: Wound complications following laryngectomy are associated with the extent of radiation field in the neck. The total radiation dose did not predict wound complications in this cohort. Results are being validated on a larger retrospective and a prospective study in progress.
Scientific Session—Wednesday P235