No abstract

We found a high predictive value of non-echo planar DW-MRI for the detection of primary and postoperative cholesteatoma. Given the moderate quality of evidence, we strongly recommend both the use of non-echo planar DW-MRI scans for the follow-up after cholesteatoma surgery, and when the correct diagnosis is questioned in primary preoperative cases.

Dutch otorhinolaryngologists are well aware of the available evidence-based guidelines, and many use these to support their clinical practice. The treatment by Dutch otorhinolaryngologists is in accordance with the Dutch guidelines. When guidelines, however, do not provide strict recommendations and allow flexibility in treatment, larger variations in chosen treatment occur. This may reflect that otorhinolaryngologists still may encounter difficulties when applying the current guidelines to an individual patient.

Background Free radial forearm flap (FRFF) reconstruction is a valuable technique in head and neck surgery, that allows closure of large defects while striving to maintain functionality. Anticoagulative drugs are often administered to improve flap survival, although evidence regarding effectiveness is lacking. Objective of review To investigate the effectiveness of postoperative anticoagulants to improve survival of the FRFF in head and neck reconstruction. Type of review Systematic review and multicenter, individual patient data meta-analysis. Search strategy MEDLINE, EMBASE, Web of Science and CINAHL were searched for synonyms of ‘anticoagulants’ and ‘free flap reconstruction’. Evaluation method Studies were critically appraised for directness of evidence and risk of bias. Authors of the highest quality publications were invited to submit their original data for meta-analysis. Results Five studies were of adequate quality and data from four studies (80%) were available for meta-analysis, describing 759 FRFF procedures. Anticoagulants used were: aspirin (12%), low-molecular weight dextran (18.3%), unfractioned heparin (28.1%), low-molecular weight heparin (49%) and prostaglandin-E1 (2.1%). Thirty-one percent did not receive anticoagulants. Flap failure occurred in 40 of 759 patients (5.3%) On univariate analysis, use of unfractioned heparin was associated with a higher rate of flap failure. However, these regimens were often administered to patients who had revision surgery of the anastomosis. In multivariate logistic regression analysis, anticoagulant use was not associated with improved flap survival or flap-related complications. Conclusions The studied anticoagulative drugs did not improve FRFF survival or lower the rate of flap-related complications. In addition some anticoagulants may cause systemic complications.