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Three cases of uncommon medication-associated osteonecrosis of temporal bone

World Journal of Otorhinolaryngology-Head and Neck Surgery 2024年第3期10卷 237-240页

作者： Hunter VanDolah jason r.crossley H.Jeffrey Kim Georgetown University School of Medicine Washington DCUSA Department of Otolaryngology–Head and Neck Surgery MedStar Georgetown University HospitalWashington DCUSA

Introduction:Medication-related osteonecrosis of the temporal bone is rare and has been reported to be associated with the use of anti-resorptive and biologic ***,we present the first case of tyrosine-kinase inhibitor-related external auditory canal(EAC)osteonecrosis as well as two cases related to anti-resorptive ***:A retrospective case ***:Case one:an 84-year-old female presented with chronic otitis externa and osteonecrosis of EACs *** had a history of osteoporosis treated with denosumab and risedronic *** successfully underwent left EAC reconstruction using an inferiorly-based pedicle periosteal flap while the right ear canal was managed *** two:a 69-year-old male presented with osteonecrosis of the right *** had a history of osteoporosis treated with alendronic acid and zoledronic *** osteonecrosis is conservatively managed with local debridement and antibiotic *** three:a 60-year-old male presented with osteonecrosis of the right inferior *** had a history of chronic myelogenous leukemia treated with a tyrosine-kinase inhibitor,*** failing conservative therapy,he underwent right ear canal reconstruction using a periosteal vascular pedicle flap without complication and experienced complete resolution to his ***:Anti-resorptive agents and/or tyrosine kinase inhibitors may lead to dysregulation of bone remodeling and result in rare cases of temporal bone *** a local debridement and antibiotic therapy fail,definitive surgical excision of necrotic bone with subsequent reconstruction of the EAC may offer patients a possible resolution in symptoms.

关键词： bisphosphonates denosumab external auditory canal imatinib medication-related osteonecrosis osteonecrosis temporal bone tyrosine-kinase Inhibitors

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A retrospective analysis of pain and opioid usage in head and neck free flap reconstruction

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2023年第2期9卷 153-159页

作者： Parhom Towfighi Alison Hill jason r.crossley Amanda Walsh James A.Leonard Jonathan P.Giurintano Matthew L.Pierce Michael J.reilly Georgetown University School of Medicine WashingtonDistrict of ColumbiaUSA Department of Otolaryngology-Head and Neck Surgery Medstar GeorgetownWashingtonDistrict of ColumbiaUSA

Objectives:Investigate opioid usage and postoperative pain in patients undergoing head and neck free flap ***:A retrospective review of 100 consecutive patients undergoing head and neck free flap reconstruction at two academic centers was *** captured included demographics,postoperative inpatient pain,pain at postoperative visits,morphine equivalent doses(MEDs)administration,medication history,and *** were analyzed using regression models,χ2 tests,and student’’***:Seventy-three percent of patients were discharged with opioid medication,with over half(53.4%)continuing to take opioids at their second postoperative visit,and over one-third(34.2%)continuing to take them around 4-month *** out of every five(20.3%)opioid-na?ve patients chronically took opioids *** was a poor association between inpatient postoperative pain scores and daily MEDs administered(r2=0.13,0.17,and 0.22 in postoperative Days 3,5,and 7,respectively).Neither preoperative radiotherapy nor postoperative complications were associated with an increase in opioid ***:For patients undergoing head and neck free flap operations,opioid medications are commonly used for postoperative *** practice may increase the chance an opioid-na?ve patient uses opioids *** found a poor association between MEDs administered and patient-reported pain scores,which suggests that standardized protocols aimed at optimizing analgesia while reducing opioid administration may be *** of Evidence:3(retrospective cohort study).

关键词： free flap reconstruction head and neck multimodal analgesia opioids postoperative pain

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