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Objective: To investigate the influence of MSG obesity and maternal periodontal disease on the mandibular bone loss of male offspring in adulthood. Methods: 60 neonatal Wistar females were used and randomly separated into two groups. During the first 5 days of life, half of the female pups received subcutaneous injections in the cervical region of monosodium glutamate (MSG), and the other half-received of hyperosmotic saline solution (CTL). All animals used in the experiments received water and standard feed. At 70 days of life, animals were distributed into four experimental groups: control with no ligature (CTL NL), control with a ligature (CTL WL), MSG with no ligature (MSG NL), and MSG with a ligature (MSG WL). The four groups of females reproduced with control rats (2:1). Offspring (F1) were classified into 4 groups, according to the mothers' treatment. Hemimandibles were collected for histological, morphological, and radiographic analysis and a portion of gingival tissue for analysis by enzyme-linked immunosorbent assay (ELISA) of cytokines IL-6, IL-10, IL-17, and TNF-alpha. Data were assessed using Two-way ANOVA and Tukey's test. Results: There were no changes related to maternal hypothalamic obesity associated with periodontal disease in alveolar bone loss in the male offspring of F1 rats at 120 days. Conclusions: Hypothalamic obesity and maternal periodontal disease did not affect the body and plasma parameters of their male offspring in the first generation, demonstrating that there was no effect of fetal programming on these parameters.

European archives of oto-rhino-laryngology and head & neck 279(8), 4147-4156 (2022). doi:10.1007/s00405-022-07304-y, Published by Springer, Berlin ; Heidelberg

Introduction Microvascular free tissue transfer is a technique for reconstruction of large defects in head and neck surgery. Failure due to microvascular thrombosis can lead to microvascular damage or flap loss. Recombinant tissue-type plasminogen activator (Alteplase) is still an off-label use but it can help to rescue free flaps when embedded in a salvage algorithm. Presentation of case A 39-year-old patient with received a tumor resection and reconstruction by a radial forearm flap of the left palate. Postoperatively a venous flap thrombosis occurred and immediate surgical revision was done. Initially eperfusion of the flap could not be achieved even after mechanical removal of the thrombus. Then a thrombolysis with Alteplase, which was applied directly into the radial artery, was done. The flap was salvaged and is now completely integrated into the mucosa. Flap salvage procedure was performed according to our free flap salvage algorithm. Discussion Thrombolysis with Alteplase for free flap salvage is not a common method. Pedicle thrombosis cannot be predicted. Important procedures during surgical intervention when thrombosis occurs are careful reopening, removal of thrombus, flushing with heparin. Since these procedures failed, surgeons decided to employ Alteplase to optimally rescue the flap. Conclusion The present case shows that pharmacological thrombolysis with Alteplase is an effective ultima ratio in free flap salvage with venous thrombosis, although it is still considered offlabel use. Early detection of flap failure and a clear salvage algorithm are important for successful surgical revisions.

HNO 70(1), 44-50 (2022). doi:10.1007/s00106-021-01029-w, Published by Springer, New York

Oral diseases (2022). doi:10.1111/odi.14280, Published by Wiley-Blackwell, Oxford [u.a.]

Background Recurrent and residual laryngeal cancer after organ-preserving radio- or radiochemotherapy is associated with a poor prognosis. Salvage surgery is the most important therapeutic option in these cases. Objective The study assessed rates of recurrence and residual tumor as well as survival and complication rates after salvage laryngectomy at the authors’ academic cancer center. Materials and methods A retrospective examination of all patients receiving laryngectomy between 2001 and 2019 due to tumor residuals or recurrence after primary radio- and radiochemotherapy was conducted. Results A total of 33 salvage procedures were performed. Defect reconstruction was performed by free flap surgery in 30.3% (n = 10) and regional flap surgery in 15.2% (n = 5) . One patient received regional flap surgery and free flap surgery simultaneously. Overall survival after 1, 2, and 5 years was 68.7, 47.9, and 24.2%, and disease-free survival was 81.6, 47.8, and 24.2%, respectively, with 48.5% (n = 16) postoperative tumor recurrences overall. Disease-free survival was significantly shorter for tumor extension into or onto the hypopharynx (p = 0.041). Postoperatively, 72.7% of patients developed a pharyngocutaneous fistula, of which 24.2% required surgical treatment. The hospital stay was 28.0 ± 16.1 days. Conclusion Salvage laryngectomy is associated with a high rate of treatable complications and high morbidity. Nevertheless, considering the advanced tumor stages treated, it allows for respectable oncological results.

Endomicroscopia confocale laser tramite sonda nel rilevamento delle lesioni maligne delle corde vocali.L’endomicroscopia confocale laser (CLE) tramite sonda è una tecnica innovativa per l’analisi in tempo reale non invasiva dell’epitelio di superficie. Mentre il suo uso diagnostico ha avuto successo tra gli specialisti, questo metodo non si è ancora affermato nella routine clinica, in parte anche per la mancanza di regole e criteri per la classificazione delle varie lesioni. Il nostro obiettivo era quello di determinare il valore diagnostico e l’affidabilità tra valutatori CLE nel rilevamento delle lesioni maligne delle corde vocali. Sono state estratte 58 sequenze video dagli esami CLE tramite sonda (sonda GastroFlex con un sistema laser CellvizioProbe-based confocal laser endomicroscopy (CLE) is an innovative technique for real-time, non-invasive analysis of the surface epithelium. While being successfully used for diagnosis by experts, this method has not yet been established in clinical routine, partly due to the lack of standards and criteria for classifying various lesions. Our aim was to determine the diagnostic value and inter-rater reliability of CLE in detecting malignant lesions of the vocal cords. 58 video sequences were extracted from the probe-based CLE (GastroFlex probe with a Cellvizio

European archives of oto-rhino-laryngology and head & neck 279(4), 2029-2037 (2022). doi:10.1007/s00405-021-06954-8, Published by Springer, Heidelberg

The aims of our study were to investigate the clinical and audiometric outcome of the surgical treatment of postinflammatory medial meatal fibrosis (PIMMF) and to review the histopathologic changes in the specimens of the fibrotic plug, in order to try to shed light on the pathogenesis of the disease.The clinical records and the histopathologic specimens of all patients who underwent tympanomeatoplasty for PIMMF at the ENT Clinic of the University of Erlangen between 2006 and 2020 were evaluated retrospectively.Thirty-four patients (41 primary surgical procedures) made up our study cohort. Of this, 28 cases were managed by means of meatoplasty and 13 cases with tympanomeatoplasty. The mean preoperative air-bone gap (ABG) was 27.8 dB (10-44 dB). Postoperative ABG was significantly improved compared to preoperative values at both short- and long-term follow-ups (The moderate long-term outcome of surgical management and the identification of histologic changes with therapeutic implications might pave the way for alternative nonsurgical treatment options.

European archives of oto-rhino-laryngology and head & neck 278(11), 4433-4439 (2021). doi:10.1007/s00405-021-06659-y, Published by Springer, Berlin ; Heidelberg

Near-Infrared (NIR) fluorescence imaging is a novel technique for intraoperative sentinel lymph node (SLN) identification. It has demonstrated promising results in several surgical specialties. The study aims to evaluate the feasibility of identifying the SLN by indocyanine green (ICG) enhanced NIR endoscopy in squamous cell carcinoma of the oral cavity (OCSCC).Seven patients with (cT1-3 N0) OCSCC were included. We injected 1-1.25 ml of ICG (5 mg/ml) at four to five points around the primary. After the elevation of a platysma flap and posterior retraction of the sternocleidomastoid muscle, fluorescence images were taken via IMAGE1 STM NIR/ICG system to define the SLN(s). We sampled fluorescence marked SLN(s) stratified to lymph node levels, followed by level-specified elective neck dissection.The detection of at least one unilateral or bilateral SLN (range 1-5) was possible in every case. The fluorescence signal occurred, on average, 5.0 ± 2.2 minutes after injection. A total of 22 SLN could be identified. Among 331 histologically examined lymph nodes we could detect one micrometastasis, which was correctly defined as SLN (1/22). There were no false-negative findings. No adverse reactions to ICG occurred.Our first results are indicating the concept of SLN concerning OCSCC after the application of real-time NIR fluorescence endoscopy. However, this has to be verified by more extended studies.

Purpose Free flap reconstruction is a valuable technique to preserve function in oncological head and neck surgery. Postoperative graft thrombosis is a dreaded risk. This study aims to compare low-dose unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) in perioperative thrombosis prophylaxis. Methods This is a retrospective analysis of 266 free flaps performed at our academic center. A comparison was made between 2 patient groups, based on their respective postoperative prophylaxis protocols either with UFH (n = 87) or LMWH (n = 179). Primary endpoints were the frequency of transplant thrombosis and the number of flap failures. Secondary endpoints were the occurrence of peri- and postoperative complications. Results The flap survival rate was 96.6% and 93.3% for the groups UFH and LMWH, respectively (P = 0.280). The rate of postoperative bleeding requiring revision was 4.6% and 6.7% for each group, respectively (P = 0.498). We found a hematoma formation in 4.6% and 3.9% (P = 0.792). Conclusion The free-flap survival rate using low-dose UFH seems to be equivalent to LMWH regimens without compromising the postoperative outcome. Consequently, for risk-adapted thrombosis prophylaxis, either LMWH or UFH can be administrated.