Episode 69: Head and neck surgery with Alexandra Kejner
Jan 3, 2024
auto_awesome
Dr. Alexandra Kejner, an otolaryngologist specializing in head and neck surgery, discusses advancements in minimally invasive procedures, free flap surgery, and managing complications post-surgery. Topics include precision surgeries for aggressive cancers, balancing vasopressors for optimal perfusion, and emotional support for patients undergoing head and neck surgery.
Transoral robotic surgery offers effective treatment for head and neck cancers with less morbidity.
Vasopressors in pre-flap reconstruction and tranexamic acid intraoperatively improve outcomes in free flap surgeries.
Close monitoring, collaboration between surgical and ICU teams, and balanced use of vasopressors are essential in postoperative care for complex head and neck cancer surgeries.
Deep dives
Surgeries for Head and Neck Cancers
Head and neck cancers, although less common than other types, such as breast or prostate cancers, require specialized procedures. With around 65,000 to 70,000 cases in the US annually, there is a growing occurrence of HPV-related head and neck cancers. Advanced procedures like transoral robotic surgery offer effective treatment options with less morbidity. Dr. Alex Keckner highlights the complexities of treating cancers affecting the mouth, nose, throat, and surrounding areas.
Innovative Surgical Techniques and Considerations
In surgical interventions for head and neck cancers, innovative techniques like transoral robotic surgery provide minimally invasive but effective treatment options. The use of free flaps for reconstruction involves harvesting tissue from the patient and attaching it to the affected area. Recent studies suggest that employing vasopressors during pre-flap reconstruction can improve outcomes and reduce hospital stays. Additionally, using tranexamic acid intraoperatively can minimize blood loss and decrease the need for transfusions.
Postoperative Care and Critical Care Challenges
Postoperatively, patients receiving complex head and neck cancer surgeries require meticulous care and monitoring, especially within the initial 72 hours. Close monitoring of flap perfusion, oxygen levels, and signs of hematoma is crucial. Collaboration between surgical and ICU teams is vital to address potential complications like airway swelling, hematomas, or flap compromise. Balancing pain management, anticoagulation therapy, and fluid resuscitation while ensuring flap viability are key aspects of caring for these complex surgical patients.
Use of Vasopressors in Free Flap Surgeries
Balanced use of vasopressors is essential in free flap surgeries to support heart function and overall body perfusion. Data supports their use in maintaining hemodynamic stability, especially in prolonged surgeries. Judicious administration helps prevent kidney damage and optimizes outcomes by ensuring adequate blood flow to tissues.
Postoperative Management and Complications in Free Flap Surgeries
Postoperative care in free flap surgeries involves monitoring for complications like vessel clotting, saliva fistulas, and infections. Late flap failures due to vascular compromise highlight the importance of vigilance in postoperative healing. Reconstruction of disfigurement post-surgery involves advanced techniques like liposuction, prosthetics, and temporary prostheses to aid in patient recovery and psychological well-being.
We discuss head and neck surgery with Dr. Alexandra Kejner, otolaryngologist at the Medical University of South Carolina specializing in transoral robotic surgery, reconstructive surgery including microvascular free tissue transfer, salivary neoplasms, and sialoendoscopic procedures. Find us on Patreon here! Buy your merch here! Takeaway lessons References
Remember Everything You Learn from Podcasts
Save insights instantly, chat with episodes, and build lasting knowledge - all powered by AI.
