皮瓣和肌皮瓣修复头颈组织缺损30例报告

目的：探讨皮瓣、肌皮瓣移植修复耳鼻咽喉科组织缺损的作用。方法：采用前臂皮瓣、胸大肌皮瓣、额正中皮瓣、鼻唇沟皮瓣、脐旁腹直肌皮瓣修复或重建耳鼻咽喉科组织缺损30例。结果：29例皮瓣存活，1例额正中皮瓣失败。结论：皮瓣、肌皮瓣应用于耳鼻咽喉科较大组织缺损的移植修复，安全可靠、成功率高，但应掌握一定的原则，预防并发症的发生。     

面颈部皮肤组织缺损修复32例

目的 探讨应用恰当皮瓣修复面颈部皮肤组织缺损的方法。方法 32例面颈皮肤组织缺损患者共采用了旋转皮瓣、菱形皮瓣、鼻唇沟皮瓣、翻转皮瓣及前臂带血管游离皮瓣等方法进行皮肤组织修复。结果 32例均一期修复成功,满足了患者美观及生理功能的需求。结论 旋转皮瓣、菱形皮瓣、鼻唇沟皮瓣在面颈部皮肤组织缺损中较为常用且术后恢复效果较满意,游离皮瓣需具备显微外科技术。     

局部皮瓣转移即刻修复急性外伤性耳廓缺损63例

目的：探讨局部皮瓣转移即刻修复急性外伤性耳廓缺损的疗效。方法：对63例急性外伤性耳廓缺损患者即刻行局部皮瓣转移修复缺损。结果：术后所有皮瓣无坏死，随访12～18个月，耳廓外形良好，无耳软骨膜炎发生。结论：局部皮瓣转移即刻修复急性外伤性耳廓缺损．尽快地恢复了耳廓的外形，其皮肤色泽与缺损区皮肤相近，是理想的修复耳廓缺损的材料。伤口污染严重者．术后常规静脉滴注抗生素及地塞米松5～10mg 7～10d，有助于防止耳软骨膜炎的发生。     

Efficacy and safety of a vessel sealing system in oral cancer resection and reconstructive surgery

Objective: Currently, many studies are being performed that focus on the efficacy and safety of the vessel sealing system (VSS) in various fields of surgery. However, in the field of oral cancer surgery, the efficacy and safety of VSS use have not been clarified.

Methods: One hundred and fifty-one patients underwent oral cancer resection and reconstructive surgery. They were divided into two groups: Ligasure vessel sealing system (LVSS) group and conventional surgery (CS) as control. Intra-operative blood loss, operating time, and incidence of post-operative complications and recurrence were analyzed.

Results: LVSS use significantly reduced intra-operative blood loss. The operating time was shortened only in mandibular gingiva cancer surgery. There were no differences between the two groups with regard to the incidence of post-operative complications and recurrence.

Conclusions: LVSS use was found to be effective and proved to be efficient and safe, and may be useful in oral cancer surgery.     

Free jejunal graft reconstruction after total pharyngolaryngeal resection for hypopharyngeal cancer

The free jejunal graft is a very useful procedure for hypopharyngeal reconstruction after total pharyngo-laryngectomy. Between 1985 and 1994 56 patients with squamous cell carcinoma of the hypopharynx were treated by this method. The median age was 54 (range 35–76). There were 54 men and 2 women. The mortality rate was 4% (2/56). The graft failure was 4% (2/56). Good swallowing function was achieved in 91% (49/54 assessable patients). Nine patients developed local recurrences, four patients had local and neck recurrences. Distant metastases occurred in six patients and five developed metachronous cancers. Follow-up analysis showed a 5-yr survival rate of 33%. After 10 yr, the free jejunal graft has become, for us, the method of choice for hypopharyngeal reconstruction after total pharyngolaryngectomy.     

Ipsilateral full-thickness forearm skin graft for covering the radial forearm flap donor site

OBJECTIVES/HYPOTHESIS: The technique of the ipsilateral full-thickness forearm skin graft for covering the defect of radial forearm free flap (RFFF) improves aesthetic impairment at the recipient and donor sites by split-thickness skin graft repair and omits the need to make an extraoperative site for harvesting the skin graft. However, in this technique, the RFFF is limited in size. In the present study, we considered a model of the forearm and calculated the possible size of the RFFF for using this technique. METHODS: The calculation was conducted under assumptions that the isosceles-triangle skin graft is elevated as its height is twice the RFFF length in the direction of the forearm axis and that the forearm skin defect can be primarily closed with a width shorter than one-fourth of the wrist circumference. The calculation revealed that this technique is feasible when the RFFF width, that is, the length vertical to the forearm axis, is shorter than half of the wrist circumference. We repaired the RFFF defect using this technique in 15 patients with head and neck cancer in whom the RFFF size conformed to the above-mentioned condition. RESULTS: When the RFFF width was shorter than half of the wrist circumference and the isosceles-triangle skin graft was elevated as its height was twice the RFFF length, the RFFF defect could be repaired using this technique in all 15 patients. CONCLUSION: The above-mentioned condition (that the RFFF width is shorter than half of the wrist circumference) is useful for determining whether or not the technique of ipsilateral full-thickness forearm skin graft can be used for covering the RFFF defect.     

Microdebrider removal under suspension laryngoscopy: An alternative surgical technique for subglottic hemangioma

Objective

To describe microdebrider removal of subglottic hemangiomas and evaluate the efficacy of this procedure.

Methods

This retrospective study was conducted at an otorhinolaryngology department. Seven consecutive patients with subglottic hemangiomas who failed to respond to pharmacologic treatment were treated by microdebrider removal under suspension laryngoscopy. Respiratory symptoms and hemangioma status were assessed preoperatively and postoperatively.

Results

The mean age of patients at disease onset was 68 days (range, 24–120 days), and their mean age at the time of surgical treatment was 132 days (range, 55–195 days). Their initial pharmacologic treatment included steroids, propranolol, and/or antibiotics. The mean percentage of airway obstruction was initially 36% (range, 30–50%), and this value changed to 61% (50–80) before surgery. Microdebrider removal of hemangiomas was successful in all patients without any intraoperative or postoperative complication. The mean operative time was 30 min (range, 21–47 min). Three patients required orotracheal intubation for 12 or 24 h after surgery, and no reintubation or tracheotomy was required in this series. Symptoms such as stridor and inspiratory retraction were resolved approximately 72 h after surgery, but wheezing was generally resolved at a later time point. One year later, no respiratory symptom was noted in these patients, and endoscopic examination revealed a sufficient glottis opening.

Conclusions

Surgical removal with a microdebrider is advantageous as a routine surgical technique for small and moderate pediatric subglottic hemangioma.     

Analysis of treatment results for oral tongue cancer

OBJECTIVE: The study reports the results of treatment of oral tongue cancer with five different treatment modalities with long-term follow-up. STUDY DESIGN: Retrospective study of 332 patients with oral tongue cancer treated in the Departments of Otolaryngology-Head and Neck Surgery and Radiation Therapy at Washington University School of Medicine (St. Louis, MO) from 1957 to 1996. METHODS: Patients with biopsy-proven squamous cell carcinoma of the oral tongue who were previously untreated and were treated with curative intent by one of five modalities and who were eligible for 5-year follow-up were included. The treatment modalities included local resection alone, composite resection alone (with neck dissection), radiation therapy alone, local resection with radiation therapy, and composite resection with radiation therapy. Multiple diagnostic, treatment, and follow-up parameters were studied using standard statistical analysis to determine statistical significance. RESULTS: The overall 5-year disease-specific survival rate (DSS) was 57% with death due to tumor in 43%. The 5-year cumulative disease-specific survival probability (CDSS) was 0.61 (Kaplan-Meier) with a mean of 17.5 years and a median of 30.1 years. The DSS by treatment modality included local resection (73%), composite resection (61%), radiation therapy (46%), local resection and radiation therapy (65%), and composite resection with radiation therapy (CR/RT) (44%). Overall, local resection had a significantly improved DSS and CR/RT had a decreased DSS that was related to the stage of disease being treated. In treating stage IV disease, CR/RT produced a more significantly improved CDSS than the other treatment modalities. Recurrence at the primary site was as common as recurrence in the neck. Eighty-nine percent of recurrences occurred within the first 60 months. Recurrence significantly decreased survival. DSS was significantly improved in patients with clear margins of resection. Metastasis to a distant site occurred in 9.6% of patients. Twenty-one percent of patients had second primary cancers, and 54% of these patients died of their second primary cancer. CONCLUSIONS: Significant improvement in DSS was seen in patients with clear margins, early stage grouping and clinical (pretreatment) tumor stage, and negative nodes. Significant decrease in DSS was seen in patients with close or involved margins, advanced stage grouping and clinical (pretreatment) tumor staging, positive clinical (pretreatment) node staging, and tumor recurrence. Obtaining clear margins of resection is crucial because it significantly affects survival. A minimum of 5 years of close monitoring is recommended because of the high incidence of second primary cancers.     

Advantages of superficial femoral vein grafts for carotid artery reconstruction following carotid artery resection in the treatment of head and neck cancer

Conclusion: Reconstruction of the carotid artery using the superficial femoral vein (SFV) is very effective due to the ease in harvesting the vessel and its optimal size and length for carotid artery replacement. Objectives: To evaluate the effectiveness of carotid artery reconstruction using the SFV. Methods: Ten patients with malignant tumors involving the carotid artery underwent carotid artery resection followed by reconstruction with the SFV. The SFV between the deep femoral vein and branches to the great saphenous vein and deep femoral vein at the popliteal region was used as a reconstructive vessel. Results: The mean length and diameter of the grafted SFVs were 13.9 cm and 11.2 mm, respectively. The mean time for acquisition of SFV was 18 min. Ultrasonography measurements indicated that the mean lumen diameter of the common carotid artery was 8.37 mm. None of the patients experienced any permanent neurologic complications. The 2-year and 5-year overall survival rates were 60% and 40%, respectively. En bloc resection of the cancer and involved carotid artery followed by reconstruction with the SFV provides effective locoregional control. Our results indicated no postoperative vascular graft thrombosis and no donor site complications.     

Creation of a quality of life instrument for nonmelanoma skin cancer patients

Objective: Malignancies of the skin are the most common cancers among humans. The cervicofacial region is most affected by cutaneous malignancies, with approximately 80% of nonmelanoma skin cancers (NMSC) occurring in the head and neck. Treatment of cervicofacial skin cancers also is more likely to result in significant patient morbidity, because of the functional and cosmetic importance of this region. Unlike other malignancies, skin cancer has not been well investigated in terms of patient quality of life (QOL) assessment. Furthermore, no validated disease‐specific QOL instrument currently exists for skin cancer. The aim of this study was to construct a new QOL instrument, The Facial Skin Cancer Index (FSCI), that captures the relevant QOL issues for NMSC patients. Study Design: Cross‐sectional study of patients presenting to a dermatologic surgery clinic with NMSC of the head and neck. Methods: For stage I, item generation, a sample of 20 patients with cervicofacial NMSC and six health care providers specializing in the care of NMSC patients completed semistructured interviews. For stage II, item reduction, a second sample (n = 52) of NMSC patients rated the items in terms of their importance for QOL among skin cancer patients. Domains of the FSCI were evaluated in terms of data quality, item variability, internal consistency, and range and skewness of scale score on aggregation and floor and ceiling effects. Results: A total of 71 distinct items were generated in stage I. After using the outlined item reduction techniques in stage II, the FSCI was reduced from 71 to 36 items, representing 6 domains. With the exception of Physical Functioning (alpha = 0.63) that suggested adequate reliability, all subscale scores showed excellent reliability coefficients, with Cronbach's alpha ranging from 0.78 (Lifestyle) to 0.87 (Social/Family). Conclusions: A new disease‐specific QOL instrument for patients with NMSC of the head and neck has been created. Validation studies are currently underway. Future directions will include sensitivity analysis to determine whether the FSCI is sensitive to change over time among patients undergoing treatment for NMSC.     

The expression of epidermal growth factor receptors in the oral mucosa of patients with oral cancer

Summary Representative tumor samples and mucosal samples were taken from three different groups of patients and were stained immunohistochemically for their expressions of epidermal growth factor receptors (EGFR). Patients in group 1 had oral squamous carcinoma, with specimens taken from the tumor as well as from the mucosa without tumor invasion. Patients in group 2 had no evidence of tumor but had heavy drinking and smoking habits. Tumor-free patients who do not drink or smoke served as the control group. The findings in the present study showed that the tumor and mucosal samples from groups 1 and 2 had increased EGFR expression while the control group showed significantly less EGFR. These results suggest that EGFR may play a role in the development of premalignant tissue changes, which are probably influenced by chronic toxic irritation.Presented at the XXI Pan American Congress of Otolaryngology, Head and Neck Surgery, Bahia-Salvador, Brazil, 2 November 1988     

Throat cancer surgery training in France

This article reviews the development of practical and theoretical teaching of surgical management of throat cancer, from the dialectic of the Middle Ages to computer simulation of the 21st century. This work is essentially based on original historical publications, analysed from secondary references relevant to the interpretation of the original texts. The literature search was essentially conducted in the “bibliothèque universitaire de médecine de Tours”, the “bibliothèque inter-universitaire de médecine de Paris”, the “Assistance publique–Hôpitaux de Paris archives” and the “bibliothèque nationale de France”. PubMed was used for the most recent references. The search terms focused on surgical training, the history of otorhinolaryngology and throat cancer. Up until the 19th century, throat cancer surgery training was provided by general surgeons. The otorhinolaryngology specialty was created at the turn of the 20th century: throat cancer surgery became a subspecialty, but certain university obstacles prevented the creation of formal throat cancer surgery training. In the 20th and 21st century, throat cancer surgery training was enhanced by technical innovations as well as ethical imperatives. The principle of mentoring, essential in surgical training, has remained a constant feature throughout the ages, regardless of the scientific progress described in this historical review.     

Quality of life assessment in nonmelanoma cervicofacial skin cancer

OBJECTIVES/HYPOTHESIS: Health-related quality of life (QOL) assessment of patients with nonmelanoma skin cancer is poorly understood. The objectives of the study were to determine the general QOL of patients with cervicofacial skin cancer and to identify patient, clinical, and preventive behavior variables associated with patients' QOL. STUDY DESIGN: Cross-sectional study of 121 consecutive patients (65 female and 56 male patients) presenting to a dermatological Mohs surgery clinic with nonmelanoma skin cancer of the head and neck. METHODS: Quality of life assessment was performed before counseling or treatment. Measures included the Medical Outcomes Study Short Form 36-item Health Survey (SF-36) and the Functional Assessment of Cancer Therapy-General (FACT-G). RESULTS: Both instruments demonstrated good internal consistency as measured by Cronbach's alpha (SF-36, alpha = 0.45-0.91; FACT-G, alpha = 0.61-0.90). The SF-36 scores were similar to historical norms. Bivariate analysis indicated significant correlation coefficients between QOL and patients' coexisting illnesses and medical risk factors. Sun-protective behaviors were associated with better QOL. The relationship appeared to be minimally influenced by patients' sociodemographic characteristics and disease-related variables (size, location, extent). CONCLUSIONS: Sun-protective behaviors were positively associated with certain QOL subscale scores in the population in the study. General QOL instruments demonstrated minimal impact of nonmelanoma skin cancer on patients at initial diagnosis. However, general measures may not be sensitive to the impact of nonmelanoma skin cancer. The development of a more disease-specific instrument may be necessary to evaluate this disease process.