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Article ; Online: Percutaneous tracheostomy in the surgical management of oral malignancy: an emerging standard of care.

Sato, Takaaki / Alimadadian, Matin / Schache, Andrew / Shaw, Richard

The British journal of oral & maxillofacial surgery

2023 Volume 61, Issue 10, Page(s) 696–703

Abstract: Percutaneous tracheostomy insertion is commonly performed in the critical care setting. However, its applicability and safety in head and neck (H&N) surgery remains uncertain. This study aimed to compare complications and postoperative recovery for ... ...

Abstract	Percutaneous tracheostomy insertion is commonly performed in the critical care setting. However, its applicability and safety in head and neck (H&N) surgery remains uncertain. This study aimed to compare complications and postoperative recovery for percutaneous tracheostomy versus surgical tracheostomy in H&N surgery. A total of 66 patients undergoing percutaneous tracheostomy as part of H&N microvascular surgery were identified retrospectively. A control cohort of 70 consecutive surgical tracheostomy cases performed by another surgical team in the same department was similarly determined. Generally, the complication rates in the percutaneous and surgical tracheostomy groups were similar, with overall rates being 42% and 31%, respectively. The percutaneous group experienced a higher rate of airway obstruction (15%), primarily due to tube displacement. Time to decannulation and duration of inpatient stay were similar in both groups. Notably, an analysis of tracheostomy tube displacement identified high body mass index (BMI) and bilateral neck dissection as potential risk factors, and all cases occurred on postoperative day one. To mitigate this risk we recommend implementation of a percutaneous tracheostomy management protocol, precise tube selection using preoperative imaging, and careful passage of the stoma intraoperatively. In conclusion, this study found that the percutaneous technique exhibited a similar complication profile. It remains unclear whether the rates of longer-term complications, such as delayed stoma healing and tracheal stenosis, differ between techniques. A future prospective study with appropriate elimination of selection and reporting bias would help address this and similar pertinent issues, including patients' perspectives.
MeSH term(s)	Humans ; Tracheostomy/adverse effects ; Tracheostomy/methods ; Retrospective Studies ; Prospective Studies ; Standard of Care ; Mouth Neoplasms/surgery ; Mouth Neoplasms/etiology ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology
Language	English
Publishing date	2023-10-13
Publishing country	Scotland
Document type	Journal Article
ZDB-ID	605685-4
ISSN	1532-1940 ; 0266-4356
ISSN (online)	1532-1940
ISSN	0266-4356
DOI	10.1016/j.bjoms.2023.10.006
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Article ; Online: Head and neck reconstruction in the vessel depleted neck using robot-assisted harvesting of the internal mammary vessels.

Kerai, Ashwin / Modi, Paul / Shackcloth, Michael / Schache, Andrew G / Shaw, Richard J

The British journal of oral & maxillofacial surgery

2023 Volume 61, Issue 5, Page(s) 368–372

Abstract: We report a novel technique of robot-assisted harvesting of the internal mammary vessels to provide effective recipient vessels in a patient with bilateral vessel depleted neck (VDN). A 44-year-old with a Notani grade III osteoradionecrosis (ORN) of the ... ...

Abstract	We report a novel technique of robot-assisted harvesting of the internal mammary vessels to provide effective recipient vessels in a patient with bilateral vessel depleted neck (VDN). A 44-year-old with a Notani grade III osteoradionecrosis (ORN) of the anterior mandible underwent robot-assisted (Da Vinci® Surgical System, Intuitive Surgical) harvesting of the left internal mammary vessels (LIMA, LIMV). Reconstruction of the mandibular defect was done with a virtually planned composite fibular free flap and microvascular anastomosis of the peroneal vessels to the LIMA and LIMV. Successful reconstruction of the anterior mandible was achieved with excellent recipient arterial diameter and length, devoid of any significant thoracic morbidities resulting from robot-assisted harvesting of the internal mammary vessels. Robot-assisted harvesting of internal mammary vessels is a viable alternative to an open approach. The advantages in tissue handling, vessel length, and favourable profile of complications may extend the indications for this otherwise 'niche' solution in the VDN.
MeSH term(s)	Humans ; Adult ; Robotics ; Neck/surgery ; Neck/blood supply ; Head ; Free Tissue Flaps/blood supply ; Mandible/surgery
Language	English
Publishing date	2023-04-25
Publishing country	Scotland
Document type	Journal Article
ZDB-ID	605685-4
ISSN	1532-1940 ; 0266-4356
ISSN (online)	1532-1940
ISSN	0266-4356
DOI	10.1016/j.bjoms.2023.04.004
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Article ; Online: Health-related quality of life, functional outcomes, and complications after sentinel lymph node biopsy and elective neck dissection in early oral cancer: A systematic review.

McDonald, Christopher / Kent, Samuel / Schache, Andrew / Rogers, Simon / Shaw, Richard

Head & neck

2023 Volume 45, Issue 11, Page(s) 2754–2779

Abstract: Background: Elective neck dissection improves survival in early oral cancer. Sentinel lymph node biopsy may also do this with less morbidity. This systematic review compared health-related quality of life, functional outcomes, and complications after ... ...

Abstract	Background: Elective neck dissection improves survival in early oral cancer. Sentinel lymph node biopsy may also do this with less morbidity. This systematic review compared health-related quality of life, functional outcomes, and complications after sentinel lymph node biopsy and elective neck dissection in early oral cancer. Methods: PRISMA guidelines were followed. Thirteen studies met inclusion criteria. Results: Results favoring sentinel lymph node biopsy were found in complications, scar length and appearance, length of hospital stay, time to drain removal, and objective shoulder measures at timepoints up to 12 months. Where differences in health-related quality of life were found, methodological issues make their clinical significance questionable. Conclusions: Sentinel lymph node biopsy was associated with fewer complications and statistically better outcomes in a number of physical measures. There is as yet no strong evidence to suggest it is associated with better health-related quality of life outcomes. While a number of health-related quality of life outcome measures show promise, their interpretation is hampered by methodological concerns. Further rigorous research is required to address this.
MeSH term(s)	Humans ; Sentinel Lymph Node Biopsy/adverse effects ; Neck Dissection/adverse effects ; Neck Dissection/methods ; Quality of Life ; Lymphatic Metastasis/pathology ; Neoplasm Staging ; Mouth Neoplasms/surgery ; Mouth Neoplasms/pathology ; Lymph Nodes/pathology
Language	English
Publishing date	2023-08-29
Publishing country	United States
Document type	Systematic Review ; Journal Article
ZDB-ID	645165-2
ISSN	1097-0347 ; 0148-6403 ; 1043-3074
ISSN (online)	1097-0347
ISSN	0148-6403 ; 1043-3074
DOI	10.1002/hed.27495
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Article ; Online: Reviewing the epidemiology of head and neck cancer: definitions, trends and risk factors.

Gormley, Mark / Creaney, Grant / Schache, Andrew / Ingarfield, Kate / Conway, David I

British dental journal

2022 Volume 233, Issue 9, Page(s) 780–786

Abstract: Introduction Head and neck cancer appears to be increasing in incidence, with potential changes in aetiology proposed. This paper aims to provide a narrative overview of the epidemiological literature to describe the disease burden and trends in terms of ...

Abstract	Introduction Head and neck cancer appears to be increasing in incidence, with potential changes in aetiology proposed. This paper aims to provide a narrative overview of the epidemiological literature to describe the disease burden and trends in terms of incidence and mortality both in the UK and globally and to review the evidence on current risk factors.Methods A search was performed on multiple databases (PubMed and Epistemonikos), applying filters to identify systematic reviews and meta-analyses which investigated head and neck cancer incidence, mortality and risk factors. International and UK cancer registries and sources were searched for incidence and mortality data.Results Multiple definitions of head and neck cancer are employed in epidemiology. Globally, incidence rates have increased in recent decades, largely driven by oropharyngeal cancer. Mortality rates over the last decade have also started to rise, reflecting the disease incidence and static survival rates. Major risk factors include tobacco smoking alone and in combination with alcohol consumption, betel chewing (particularly in Southeast Asian populations) and the human papillomavirus in oropharyngeal cancer.Conclusions These epidemiological data can inform clinical and preventive service planning for head and neck cancer.
MeSH term(s)	Humans ; Head and Neck Neoplasms/epidemiology ; Head and Neck Neoplasms/etiology ; Oropharyngeal Neoplasms/epidemiology ; Risk Factors ; Papillomaviridae ; Incidence ; Papillomavirus Infections/complications ; Papillomavirus Infections/epidemiology
Language	English
Publishing date	2022-11-11
Publishing country	England
Document type	Journal Article
ZDB-ID	218090-x
ISSN	1476-5373 ; 0007-0610
ISSN (online)	1476-5373
ISSN	0007-0610
DOI	10.1038/s41415-022-5166-x
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Article ; Online: Accuracy of preoperative clinical examination and imaging for mandibular resection in oral cancer: a systematic review of diagnostic test accuracy studies.

Brown, James S / Crowder, Lauren P / Willcocks, Edward J / Bajwa, Mandeep S / Schache, Andrew G

The British journal of oral & maxillofacial surgery

2022 Volume 61, Issue 1, Page(s) 28–38

Abstract: The aim of this systematic review is not only to analyse the accuracy of clinical examination and radiological preoperative assessment of mandibular invasion reported in isolation, but to highlight those reports that have combined them. A total of 1636 ... ...

Abstract	The aim of this systematic review is not only to analyse the accuracy of clinical examination and radiological preoperative assessment of mandibular invasion reported in isolation, but to highlight those reports that have combined them. A total of 1636 titles and abstracts published between 1995 - 2000 were screened following a literature search in PubMed. Keywords were "mandible" and "squamous cell carcinoma". A total of 90 full manuscripts were reviewed with 24 meeting defined inclusion/exclusion criteria and yielding the data reported. The most sensitive test was single photon emission tomography with eight out of the 10 studies reporting sensitivity higher than 95%. Magnetic resonance imaging (MRI) demonstrated superior sensitivity but was less specific than computed tomography (CT). A single report attempted to report the combined CT and MRI scans with a separate expert reporting but did not result in more reliable detection. Periosteal stripping was not reported, and there was insufficient data to establish the value of new technologies. This review confirms that, to our knowledge, there are no reliable data on the results of combining imaging techniques with or without clinical examination. It emphasises the lack of data for the combination of preoperative techniques to enhance safe oncological resection of the mandible. Based on the evidence gathered in this review an algorithm of assessment of possible mandibular invasion is proposed. With new technologies available and 3-dimensional models to help plan the mandibular resection and reconstruction, the potential of combining preoperative investigations should be fully realised through prospective research.
MeSH term(s)	Humans ; Diagnostic Tests, Routine ; Magnetic Resonance Imaging ; Mouth Neoplasms/diagnostic imaging ; Mouth Neoplasms/surgery ; Mouth Neoplasms/pathology ; Neoplasm Invasiveness ; Prospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed ; Mandible/surgery
Language	English
Publishing date	2022-10-25
Publishing country	Scotland
Document type	Systematic Review ; Journal Article ; Review
ZDB-ID	605685-4
ISSN	1532-1940 ; 0266-4356
ISSN (online)	1532-1940
ISSN	0266-4356
DOI	10.1016/j.bjoms.2022.10.005
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Article: Determining the Effectiveness of Fibrin Sealants in Reducing Complications in Patients Undergoing Lateral Neck Dissection (DEFeND): A Randomised External Pilot Trial.

Bajwa, Mandeep S / Jackson, Richard / Dhanda, Jagtar / Tudur Smith, Catrin / Shaw, Richard J / Schache, Andrew G

Cancers

2023 Volume 15, Issue 20

Abstract: Objectives: High-quality randomised controlled trials (RCT) to support the use of Fibrin Sealants (FS) in neck dissection (ND) are lacking. The DEFeND trial assessed critical pilot/feasibility questions and signals from clinical outcomes to inform a ... ...

Abstract	Objectives: High-quality randomised controlled trials (RCT) to support the use of Fibrin Sealants (FS) in neck dissection (ND) are lacking. The DEFeND trial assessed critical pilot/feasibility questions and signals from clinical outcomes to inform a future definitive trial. Patients and methods: The study design piloted was a blinded surgical RCT. All participants underwent unilateral ND for head and neck cancer. Interventional arm: ND with application of FS. Control arm: ND alone. Feasibility outcomes included recruitment, effectiveness of blinding, protocol adherence and evaluating administrative processes. Clinical outcomes included surgical complications (primary outcome), drainage volume, time to drain removal, length of hospital stay, pain and the Neck Dissection Impairment Index. Results: Recruitment completed ahead of time. Fifty-three patients were recruited, and 48 were randomised at a rate of 5.3 patients/month. Blinding of patients, research nurses and outcome assessors was effective. Two protocol deviations occurred. Two patients were lost to follow-up. The mean (SD) Comprehensive Complication Index in the interventional arm was 6.5 (12.8), and it was 9.9 (14.2) in the control arm. The median (IQR) time to drain removal (days) was shorter in the interventional arm (2.67 (2.42, 3.58) vs. 3.40 (2.50, 4.27)). However, this did not translate to a clinically significant reduction in median (IQR) length of hospital stay in days (intervention: 3.48 (2.64, 4.54), control: 3.74 (3.11, 4.62)). Conclusion: The proposed trial design was effective, and a definitive surgical trial is feasible. Whilst there was a tendency for FS to improve clinical outcomes, the effect size did not reach clinical or statistical significance. (ISRCTN99181100).
Language	English
Publishing date	2023-10-20
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers15205073
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Article ; Online: Academic Training in Oral and Maxillofacial Surgery - when and how to enter the pathway.

Payne, Karl F B / Higginson, James / Basyuni, Shadi / Goodson, Alexander M C / Chadha, Ambika / Elledge, Ross / Breeze, John / Goodson, Michaela / Bajwa, Mandeep S / Schilling, Clare / Shaw, Richard J / Fan, Kathleen / Dhanda, Jagtar / Schache, Andrew

The British journal of oral & maxillofacial surgery

2023 Volume 61, Issue 2, Page(s) 124–130

Abstract: Entering into surgical academia can seem a daunting prospect for an oral and maxillofacial surgery (OMFS) trainee. However, the streamlining of academic training by the NIHR to create the integrated academic training (IAT) pathway has simplified academic ...

Abstract	Entering into surgical academia can seem a daunting prospect for an oral and maxillofacial surgery (OMFS) trainee. However, the streamlining of academic training by the NIHR to create the integrated academic training (IAT) pathway has simplified academic training and more clearly defined academic positions and entry points for trainees. In this article we review the current NIHR IAT pathway and the various grades and entry points available to OMF surgeons, both pre- and post-doctoral. We highlight the unique challenges facing OMF trainees and provide advice and insight from both junior and senior OMFS academics. Finally, we focus on the planning and application for a doctoral research fellowship - discussing funding streams available to OMF surgeons.
MeSH term(s)	Humans ; Surgery, Oral/education ; Fellowships and Scholarships ; Surgeons ; Surveys and Questionnaires
Language	English
Publishing date	2023-01-26
Publishing country	Scotland
Document type	Journal Article ; Review
ZDB-ID	605685-4
ISSN	1532-1940 ; 0266-4356
ISSN (online)	1532-1940
ISSN	0266-4356
DOI	10.1016/j.bjoms.2023.01.003
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Article ; Online: ACTivity as medicine In Oncology for Head and Neck (ACTIOHN): Protocol for a feasibility study investigating a patient-centred approach to exercise for people with head and neck cancer.

Midgley, Adrian W / Levy, Andrew R / Rogers, Simon N / Brooker, Rachel C / Bryant, Valerie / Cherry, Mary Gemma / Lane, Steven / Nugent, Michael M / Price, Ruth / Schache, Andrew G / Young, Bridget / Patterson, Joanne M

PloS one

2023 Volume 18, Issue 8, Page(s) e0289911

Abstract: Background and aim: Attempts at personalisation of exercise programmes in head and neck cancer (HaNC) have been limited. The main aim of the present study is to investigate the feasibility and acceptability of introducing a remotely delivered, fully ... ...

Abstract	Background and aim: Attempts at personalisation of exercise programmes in head and neck cancer (HaNC) have been limited. The main aim of the present study is to investigate the feasibility and acceptability of introducing a remotely delivered, fully personalised, collaborative, and flexible approach to prescribing and delivering exercise programmes into the HaNC usual care pathway. Methods: This is a single arm, feasibility study. Seventy patients diagnosed with HaNC will be recruited from two regional HaNC centres in the United Kingdom. Patients will undertake an 8-week exercise programme designed and delivered by cancer exercise specialists. The exercise programme will start any time between the time of diagnosis and up to 8 weeks after completing treatment, depending on patient preference. The content of the exercise programme will be primarily based on patient needs, preferences, and goals, but guided by current physical activity guidelines for people with cancer. The primary outcome measure is retention to the study. Secondary quantitative outcomes are uptake to the exercise programme, different measures of exercise adherence, pre- and post-intervention assessments of fatigue (Multidimensional Fatigue Symptom Inventory-Short Form), quality of life (SF-36), physical activity levels (International Physical Activity Questionnaire-Short Form), and various components of physical fitness. The outcomes of the nested qualitative study are acceptability and feasibility of the intervention evaluated via interviews with patients, health care professionals, and the cancer exercise specialists. Intervention and participant fidelity will be determined using checklists and scrutiny of each patient's logbook and the cancer exercise specialists' meeting notes. Analysis of quantitative data will be via standard summary statistics. Qualitative data will be analysed using thematic analysis. Expected results: This feasibility study will inform the design and conduct of a future randomised controlled trial. Success will be defined according to a traffic light system for identifying the appropriateness of progression to a randomised controlled trial. Trial registration: International Standard Randomised Controlled Trial Number registry (ISRCTN82505455).
MeSH term(s)	Humans ; Feasibility Studies ; Quality of Life ; Head and Neck Neoplasms/therapy ; Exercise ; Fatigue ; Randomized Controlled Trials as Topic
Language	English
Publishing date	2023-08-25
Publishing country	United States
Document type	Clinical Trial Protocol ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0289911
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Article ; Online: Genetic variants associated with mandibular osteoradionecrosis following radiotherapy for head and neck malignancy.

Brooker, Rachel C / Antczak, Philipp / Liloglou, Triantafillos / Risk, Janet M / Sacco, Joseph J / Schache, Andrew G / Shaw, Richard J

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology

2021 Volume 165, Page(s) 87–93

Abstract: Background/aim: Utilising radiotherapy in the management of head and neck cancer (HNC) often results in long term toxicities. Mandibular osteoradionecrosis (ORN) represents a late toxicity associated with significant morbidity. We aim to identify a ... ...

Abstract	Background/aim: Utilising radiotherapy in the management of head and neck cancer (HNC) often results in long term toxicities. Mandibular osteoradionecrosis (ORN) represents a late toxicity associated with significant morbidity. We aim to identify a panel of common genetic variants which can predict ORN to aid development of personalised radiotherapy protocols. Method: Single nucleotide polymorphism (SNP) arrays were applied to DNA samples from patients who had prior HNC radiotherapy and minimum two years follow-up. A case cohort of mandibular ORN was compared to a control group of participants recruited to CRUK HOPON clinical trial. Relevant clinical parameters influencing ORN risk (e.g. smoking/alcohol) were collected. Significant associations from array data were internally validated using polymerase chain reaction (PCR) and pyrosequencing. Results: Following inclusion of 141 patients in the analysis (52 cases, 89 controls), a model predictive for ORN was developed; after controlling for alcohol consumption, smoking, and age, 4053 SNPs were identified as significant. This was reduced to a representative model of 18 SNPs achieving 92% accuracy. Following internal technical validation, a six SNP model (rs34798038, rs6011731, rs2348569, rs530752, rs7477958, rs1415848) was retained within multivariate regression analysis (ROC AUC 0.859). Of these, four SNPs (rs34798038 (A/G) (p 0.006), rs6011731 (C/T) (p 0.018), rs530752 (A/G) (p 0.046) and rs2348569 (G/G) (p 0.005)) were significantly associated with the absence of ORN. Conclusion: This is the first genome wide association study in HNC using ORN as the endpoint and offers new insight into ORN pathogenesis. Subject to validation, these variants may guide patient selection for personalised radiotherapy strategies.
MeSH term(s)	Cohort Studies ; Genome-Wide Association Study ; Head and Neck Neoplasms/genetics ; Head and Neck Neoplasms/radiotherapy ; Humans ; Mandible ; Osteoradionecrosis/genetics ; Retrospective Studies
Language	English
Publishing date	2021-10-30
Publishing country	Ireland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	605646-5
ISSN	1879-0887 ; 0167-8140
ISSN (online)	1879-0887
ISSN	0167-8140
DOI	10.1016/j.radonc.2021.10.020
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Article ; Online: Liverpool Opinion on Unfavorable Results in Microsurgical Head and Neck Reconstruction: Lessons Learned.

Brown, James / Schache, Andrew / Butterworth, Chris

Clinics in plastic surgery

2016 Volume 43, Issue 4, Page(s) 707–718

Abstract: This article annotates a philosophy toward achieving best results for the patient with head and neck cancer, in particular relating to oral, mandibular, and maxillary resection. At the same time are highlighted the pitfalls that, if not avoided, are ... ...

Abstract	This article annotates a philosophy toward achieving best results for the patient with head and neck cancer, in particular relating to oral, mandibular, and maxillary resection. At the same time are highlighted the pitfalls that, if not avoided, are likely to result in a poor outcome even with a successful flap transfer. There is a paucity of evidence to support clinical practice in head and neck reconstruction such that much of the discussion presented is opinion-based rather than evidence-based.
MeSH term(s)	Head and Neck Neoplasms/surgery ; Humans ; Microsurgery/adverse effects ; Microsurgery/methods ; Reconstructive Surgical Procedures/adverse effects ; Reconstructive Surgical Procedures/methods ; Surgical Flaps/adverse effects ; Surgical Flaps/blood supply ; Wounds and Injuries/surgery
Language	English
Publishing date	2016-10
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	193117-9
ISSN	1558-0504 ; 0094-1298
ISSN (online)	1558-0504
ISSN	0094-1298
DOI	10.1016/j.cps.2016.05.007
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