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Review
. 2013 Dec 13:12:Doc04.
doi: 10.3205/cto000096.

Surgical errors and risks - the head and neck cancer patient

Ulrich Harréus  1
Affiliations
Review

Surgical errors and risks - the head and neck cancer patient

Ulrich Harréus. GMS Curr Top Otorhinolaryngol Head Neck Surg. .

Abstract

Head and neck surgery is one of the basic principles of head and neck cancer therapy. Surgical errors and malpractice can have fatal consequences for the treated patients. It can lead to functional impairment and has impact in future chances for disease related survival. There are many risks for head and neck surgeons that can cause errors and malpractice. To avoid surgical mistakes, thorough preoperative management of patients is mandatory. As there are ensuring operability, cautious evaluation of preoperative diagnostics and operative planning. Moreover knowledge of anatomical structures of the head and neck, of the medical studies and data as well as qualification in modern surgical techniques and the surgeons ability for critical self assessment are basic and important prerequisites for head and neck surgeons in order to make out risks and to prevent from mistakes. Additionally it is important to have profound knowledge in nutrition management of cancer patients, wound healing and to realize and to be able to deal with complications, when they occur. Despite all precaution and surgical care, errors and mistakes cannot always be avoided. For that it is important to be able to deal with mistakes and to establish an appropriate and clear communication and management for such events. The manuscript comments on recognition and prevention of risks and mistakes in the preoperative, operative and postoperative phase of head and neck cancer surgery.

Keywords: head and neck surgery; oncology; prevention of surgical error; surgical mistakes; surgical risk.

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Figures

Table 1
Table 1. Obligatory und optional indications for tracheostomy placement in head and neck cancer cases
(cm: co-morbidity; nd: neck dissection)
Figure 1
Figure 1. Swiss cheese model (by Reason)
Figure 2
Figure 2. Inoperable situation of a hypopharyngeal metastasized cancer
Figure 3
Figure 3. Transoral approach using open mouth gags and the Stierlein retractor
Figure 4
Figure 4. Parastomal metastatic recurrence of a laryngeal cancer
Figure 5
Figure 5. Scarred interarytenoid region and hypopharynx after a laser procedure (during inspiration)
Figure 6
Figure 6. Selective neck dissection level II–Va with preservation of all vessel and nerve structures
Figure 7
Figure 7. Level Va and accessory-cervical plexus (arrow)
Figure 8
Figure 8. Modified radical neck dissection and pharyngotomy in a salvage situation. A transplant might be useful for reconstruction of the pharyngeal wall and to protect the exposed carotid artery.
Figure 9
Figure 9. Skin necrosis and fistula after salvage surgery
Figure 10
Figure 10. Skin island in the neck wound for easy flap supervision after reconstruction using a radial forearm transplant
See this image and copyright information in PMC

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