Background Surgical site infection (SSI) in open surgical tracheostomy (ST) occurs in up to 33% of the cases. SSI can be reduced by a postoperative antibiotic prophylaxis (POAP). The effect of Clindamycin on SSIs in head and neck surgery (HNS) is discussed controversially in the literature. Methods An 8 year single-center retrospective comparative analysis of 441 STs (Visor-ST and Bjoerk-flap technique) performed within major HNS was evaluated due to the event of a SSI within 7 days and analyzed descriptively. Logistic regression model evaluated the impact of POAP with Clindamycin on SSIs. Results The use of Clindamycin showed twice the rate of ST-SSI as all patients that did not receive Clindamycin, treated with other perioperative antibiotics. (Fisher’s p = 0.008) The logistic regression model could not prove a statistically significant impact. (OR = 2.91, p = 0.04). Conclusion We recommend that Clindamycin should be reconsidered as a POAP regimen in ST. Further studies should evaluate alternatives for Penicillin-allergic patients. Level of evidence III Comparative retrospective monocentric study.

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Background: Autologous fat grafting (AFG) is evolving in both aesthetic and reconstructive applications, since the body of evidence for its use has expanded. The earliest controversies were evident in lipofilling for oncological breast reconstruction, and to this day, some countries do not allow it for fear of inducing tumourigenesis in an oncologically ablated field. Methods:We sought to review contemporary harvesting and processing techniques for AFG in the craniofacial region, therefore distributed a survey to evaluate the clinical impact of oncological risk across four European countries.Results: We found no significant geographical differences between the German-speaking and the English groups concerning their harvesting and processing technique. Half of our respondents discuss the possibility of pro-oncologic behavior of AFG. Conclusion:AFG harvesting and processing techniques do not considerably vary by geography. Further studies should evaluate oncologic risk potential of AFG in head and neck tumor sites, especially because there is no excellent article regarding this phenomenon.

Introduction Autologous fat grafting (AFG) has both aesthetic and reconstructive applications. Described by Neuber in 1893 there are numerous applications of AFG as the body of evidence for its use has expanded. The earliest controversies were evident in lipofilling for breast defects post-oncological treatment, and to this day some countries do not allow it for fear of inducing tumourogenesis in an oncologically ablated field. Adipose-derived stem cells (ASCs) have been shown pro-oncologic behaviour in xenografts, however, this has not been reproduced in clinical observations thus far. Material and Methods We sought to review contemporary harvesting and processing techniques for AFG in the craniofacial region, therefore distributed a survey to evaluate the opinion and clinical impact of oncological risk across four European countries with possibly differing clinical attitudes. Results In the craniofacial region AFG is mostly used for aesthetic indications, cannula hand-held aspiration and centrifugation seem to be the predominant harvesting and processing techniques. Half of our respondents tell patients about the possibility of pro-oncologic behaviour of AFG. We found no significant geographical differences between the German-speaking and the English groups concerning their harvesting and processing technique. German participants seem to perform AFG more often and mostly use it for cosmetic and post-cancer treatment sequelae, English participants homogenically use AFG for cosmetic reasons. Conclusion Theoretical pro-oncologic behaviour of craniofacial AFG does not deter surgeons. Perhaps, we shouldn’t consider discussing this complex area of oncogenesis with patients as there is no elevated risk from what we know.

The anatomy of the parapharyngeal space (PPS) is complex and the differential diagnosis of tumours in this area broad. Although primary tumours of the PPS account for only 0.5% of head and neck neoplasms and are benign lesions in 80% of the cases, the surgical management is crucial and needs specific planning and evaluation of CT and/or MRI scans. In literature, there are several ways to surgically deal with PPS tumours and due to location and differentiation, can reach from transparotid, submandibular transcervical and transoral approaches, extending in a mandibulotomy, further radiotherapy. Parapharyngeal cleft cysts are extremely rare and their management can be complex. We describe the presentation, the diagnosis and further management of a 71-year-old woman with a 6 cm first branchial cleft cyst in the PPS from puncture over emergency tracheostomy to elective excision via a combined transcervical/transparotid and transoral approach. We highlight the importance of the differential diagnosis and the and the correct clinical management of this rare entity.