Reporting of Cosmesis in Head and Neck Reconstruction: A Systematic Review

Abstract

Objective To identify the method and rate at which cosmesis is reported after reconstruction from head and neck surgery among adults. Data Sources A medical librarian implemented search strategies in multiple databases for head and neck reconstruction, outcome assessment/patient satisfaction, and cosmesis/appearance. Review Methods Inclusion and exclusion criteria were designed to capture studies examining adults undergoing reconstruction after head and neck cancer surgery with assessment of postoperative cosmesis. The primary outcome was the method to assess cosmesis. Secondary outcomes were types of instruments used and the rate at which results were reported. Validated instruments used in these studies were compared and critically assessed. Results The search identified 4405 abstracts, and 239 studies met inclusion and exclusion criteria. Of these, 43% (n = 103) used a scale or questionnaire to quantify the cosmetic outcome: 28% (n = 66), a visual analog, Likert, or other scale; 13% (n = 30), a patient questionnaire; and 3% (n = 7), both. Of the 103 studies that used an instrument, 14% (n = 14, 6% overall) used a validated instrument. The most common validated instrument was the University of Washington Quality of Life (UWQOL) questionnaire (4%, n = 9). The most highly rated instruments were the UWQOL and the Derriford Appearance Scale. Conclusions Reporting of cosmetic outcomes after head and neck cancer reconstruction is heterogeneous. Most studies did not report patient feedback, and a minority used a validated instrument to quantify outcomes. To reduce bias, improve reliability, and decrease heterogeneity, we recommend the UWQOL to study cosmetic outcomes after head and neck reconstruction.

Leveraging the outcome of a frontal bone tumor facial reconstruction case by a multimodal approach

“…A case-controlled study has shown BSCC has a 6-times higher risk of distant metastasis compared to the usual type of squamous cell carcinoma. Treatment of choice is complete surgical excision and radiotherapy/adjuvant chemotherapy [ 8 ].…”

“…This case exemplifies that to maximize the success of multimodal cancer therapy involving surgery, radiation, chemo- and immunotherapy, a multimodal approach should also include reconstruction and rehabilitation phases [ 9–11 ]. Predisposition for local evolution and recurrence with a severe prognosis of sinusoidal basal squamous cell carcinoma justifies surgical approaches securing the quality of margins as the first objective of treatment with possible “worst-case scenarios” in mind [ 8 , 10 , 11 ]. Creation of a secure barrier between the nasal cavity and frontonasal duct is one of the key operative tasks in cranialization of the frontal sinus.…”

“…The overall course of the presented case supports the notion that the adequacy of margins and the quality of dural repairs separating the nasal cavity from the brain is essential. In general, endoscopic transnasal surgery or an unnecessarily conservative open approach are less predictable and appear to be oncologically less successful [ 8–11 , 13 ].…”

What Type of Incision for Anterior Cervical Spine Surgery Involving Long Segments Can Bring Better Cosmetic and Functional Outcomes?

“…As more patients return to the workforce and social activities after ACSS, cosmetic results may affect their quality of life [ 20 , 21 ]. Inferior skin scarring at the anterior neck negatively affects self-esteem and can lead to anxiety and depression [ 22 ].…”

“…The VSS may be susceptible to observer bias, underestimating skin scarring after surgery. In addition to surgeon’s bias, patients may be subject to a social desirability bias, as they may not want to disappoint the surgeon [ 20 ]. To control for these biases, skin scarring after multilevel ACSS was evaluated by the VSS and POSAS in this study.…”