The infrahyoid myocutaneous flap for reconstruction after oral cancer resection: A retrospective single-surgeon study

ObjectiveTo review our experience with infrahyoid myocutaneous flap in reconstruction after oral cancer resection.MethodsChart reviews were completed for all patients who underwent oral reconstruction with an infrahyoid myocutaneous flap by a single surgeon in the Department of Otolaryngology at Chonburi Cancer Hospital from 2011 to 2017. Characteristics of the patients and postoperative complications were analyzed.ResultsOf the 34 patients in the study, 10 (29.4%) developed partial flap loss and 1 (2.9%) developed total flap loss. All cases of partial flap loss resolved with conservative treatment. Apparent cancer involvement of a cervical lymph node was significantly associated with flap failure (odds ratio: 5.0, 95% CI: 1.03–24.28).ConclusionsThe infrahyoid myocutaneous flap is a fairly reliable reconstruction method. The flap should be performed with caution in cases with gross lymph node involvement.     

影响口腔口咽癌广泛切除后吞咽功能恢复的因素

目的探讨影响口腔、口咽癌广泛切除后吞咽功能恢复的诸多因素。方法自2002年12月N2008年1月,共102例口腔或口咽癌患者经广泛切除手术治疗,其中男性77例,女性25例,年龄32N76岁,平均56．2岁。按照AJCC（2002）癌症患者分期标准,I期7例、II期39例、Ⅲ期44例、Ⅳ期12例。按照年龄大于或小于60岁、临床T分级、有否颈清扫、舌及舌根切除范围、下颌骨切除范围以及重建方法等因素进行多因素分析。结果102例患者术后7～47天去掉鼻饲管恢复经口进食功能。对于术后经口吞咽功能恢复期限的影响,年龄大于或小于60岁、T分级和临床分期、有否颈清扫、舌切除及下颌骨切除与否及其范围等均无统计学意义（P〉O．05）。而舌根切除或未切除（P=O．0164）,不同的重建方法（P=O．0011）,则有统计学意义。结论有否舌根切除及不同的重建方法是影响口腔及口咽癌切除术后恢复独立经口进食功能的主要因素。     

AO/ASIF plate for mandibular reconstruction in tumor surgery: results in 20 cases

Between May, 1983, and February, 1987, the authors performed mandibular reconstruction using an AO/ASIF plate in 20 patients. Apart from accurate modelling of the resected segment using a template, the key features of the technique include firm fixation and wrapping the plate with pectoralis major muscle. In 19 cases the plate was inserted at the same operation as the resection of a malignant neoplasm. In 10 cases the anterior mandibular osteotomy was placed on the far side of the midline, while in five the mandible was disarticulated through the temporomandibular joint. Eleven patients are alive (average survival 22 months) and nine have died (average survival 10 months). Two AO/ASIF plates have required removal because of exposure, while in three patients limited plate exposure was corrected with a minor surgical procedure. Seven patients had soft tissue complications that were managed conservatively. Nine of the patients had been irradiated previously. Five patients were fitted with dentures successfully. The authors believe that this technique provides a safe, rapid, functional and esthetically satisfactory method of mandibular reconstruction in the patient undergoing surgery for malignant disease.     

Use of free flaps for reconstruction in head and neck surgery: a retrospective study of 182 cases

OBJECTIVE: In order to clarify the factors affecting the survival of flaps, we performed a retrospective study on free flaps (187) used for reconstruction in head and neck surgery in 182 patients. METHODS: Free jejunum flaps were used on 68 occasions, rectus abdominus myocutaneous flaps on 67, radial forearm flaps on 49, scapular osteocutaneous flaps on 2 and latissimus dorsi myocutaneous flap on ones occasion, during the period from May 1996 to April 2003. Post-operative circulatory complications at the recipient site were analyzed mainly in relation to a history of previous surgery, radiotherapy and chemotherapy. RESULTS: Circulatory crisis was observed in seven cases and circulation was restored in two of them after emergency exploration, whereas the other five flaps failed to survive. The overall failure rate of free flaps was 2.7%. Wound infection at the recipient site was frequent in patients with a history of previous local cervical surgery. Flap failure was significantly more frequent in patients with a history of previous surgery and infection, except for 2 patients in whose case the microsurgical technique was inadequate. Flap failure was not observed in those patients whose irradiation field could be analyzed, or in the patients who received chemotherapy. Although the incidence of circulatory crisis as a consequence of inadequate microsurgical technique was observed in the early period of this retrospective study, their frequency has diminished in the last 2 years. CONCLUSION: The survival of flaps was affected by a history of previous surgery following wound infection, although a history of irradiation and chemotherapy would have no effects on flap failure. The appropriate choice of vessels and surgical skill are crucial for the success of free flaps from our experience. Emergency exploration was also crucial for the survival of the flap in the case of circulatory crisis.     

鼻内镜手术治疗首诊局部晚期鼻咽癌及放疗后严重并发症的作用

随着鼻内镜技术的不断提高,其已逐渐成为鼻咽癌综合治疗中的重要方式之一。就首诊局部晚期鼻咽癌的手术治疗、鼻咽癌放疗后严重并发症放射性骨坏死的内镜手术治疗及内镜手术在未来鼻咽癌治疗中可能的发展前景等方面进行综述。     

保留喉功能的梨状窝癌手术14例

目的 探讨保留喉功能的梨状窝癌手术方法和适应证。方法 梨状窝癌患者14例, Ⅰ期3例, Ⅱ期5例, Ⅲ期4例, Ⅳ期2例。行保留喉功能的手术治疗, 术后放疗40～55 Gy。结果 随访5年, 14例均恢复发音功能, 12例拔管。3年生存率为64.29%, 5年生存率为42.86%。结论 经严格术前评估, 大部分梨状窝癌患者可通过精细手术保留喉正常组织, 并通过多种修复方法恢复喉的全部或部分功能。     

Objective evaluation of gustatory function after surgery for vestibular schwannoma: A pilot study

ObjectiveTo evaluate the gustatory function before and after vestibular schwannoma (VS) surgery.MethodsIn this retrospective study, we evaluated the gustatory function of 12 patients who underwent VS surgery at Tsukuba University Hospital between 2012 and 2018. Gustatory function was examined using electrogustometry before VS surgery and 3 months, 6 months and 1 year after surgery. Electrogustometry was tested at the area mapped to the chorda tympani nerve, glossopharyngeal nerve and greater superficial petrosal nerve (GSPN). Intergroup mean comparisons of the threshold were performed using a one-way analysis of variance (ANOVA) followed by the Bonferroni post-hoc test.ResultsThe gustatory function mapped to the chorda tympani nerve was significantly disturbed 6 months after the surgery as compared with the preoperative function (p = 0.033) and that the dysfunction recovered at 1 year. However, gustatory function mapped to the glossopharyngeal nerve and greater superficial petrosal nerve (GSPN) was not impaired.ConclusionThe gustatory function mapped to the chorda tympani nerve is impaired after surgery for VS. The dysfunction peaked at 6 months after surgery, and recovered within 1 year.     

A phase II study of docetaxel and carboplatin with concurrent radiation therapy for locally advanced head and neck cancer

Objective

In this study we evaluate the clinical response and safety profile of a regimen of docetaxel + carboplatin concurrent with radiotherapy (RT) in locally advanced squamous cell carcinoma of head and neck (HNSCC).

Methods

Between January 2006 and December 2008, we enrolled 38 patients (stage IVA: 29 patients; stage III: 9 patients). Fourteen had oral cavity cancer (tongue 10, buccal mucosa 2, alveolar ridge 1, floor of mouth 1), 10 had oropharyngeal cancer (base of tongue 5, tonsil 5), 13 had laryngeal cancer, and 1 had maxillary sinus cancer. Patients received concurrent docetaxel 15 mg/m² 1-h infusion plus carboplatin AUC of 2, 30-min infusion on days 1, 8, 15, 22, 29, and 36. RT began on day 1 of concurrent chemotherapy with 2 cGy/fraction, 5 fractions/week (total dose: 66-70 cGy). Tumor was assessed by CT scan 3 months post-completion of concurrent chemoradiotherapy.

Results

Thirty-five patients were evaluated (2 refused to receive all treatments, 1 had serious adverse event [rash, wheezing] from docetaxel first dose). The primary study endpoint of clinical response was achieved in 26 (74.3%) patients, 6 (17.1%) had stable disease, and 3 (8.6%) had disease progression. The 2-year disease-free survival was 62.9% (CI: 45.85-79.95%). The 2-year overall survival was 64.1% (CI: 43.52-84.68%). The most common Grade 3 toxicities were mucositis, xerostomia and dysphagia (13.9% each) and dermatitis (11%). No Grade 4 toxicities were observed.

Conclusion

In conclusion, this study with a limited number of patients, docetaxel + carboplatin concurrent with RT appears to show acceptable activity and is generally well tolerated in patients with locally advanced HNSCC.     

喉部分切除喉功能重建87例的临床评价

目的评价喉部分切除喉功能重建术的疗效和喉功能的恢复状况.方法回顾分析喉癌87例的临床资料.结果实施喉部分切除喉功能重建的87例3年生存率为81%,5年生存率为78%,呼吸功能全部或部分恢复,拔管率81.4%;发声功能和吞咽功能恢复率均为100%.结论对喉癌患者施行喉部分切除术,既能彻底清除肿瘤,达到根治目的,又能重建恢复喉功能.     

Ileocolic free flap reconstruction,concomitant chemotherapy and radiotherapy and assessment of speech and swallowing function during management of advanced cancer of the larynx and hypopharynx: Preliminary report

Conclusion

The new technique of ileocolic free flap reconstruction provides a better quality of life in terms of swallowing and speech for patients who have undergone laryngopharyngectomy with concomitant chemotherapy and radiotherapy (CCRT).

Objectives

To compare and contrast the swallowing and speech outcomes of patients who underwent total laryngopharyngectomy with ileocolic free flap reconstruction and to analyze the survival rate after surgery and CCRT.

Material and methods

This was a follow-up study of 12 patients with advanced (stages III, IVA and IVB) laryngeal and hypopharyngeal cancer who underwent major surgery, CCRT (with one exception) and ileocolic free flap reconstruction.

Results

All patients were able to tolerate single-stage combined management comprising total laryngopharyngectomy with or without radical neck dissection plus ileocolic free flap reconstruction and postoperative CCRT (with one exception), without immediate morbidity or mortality. Eleven patients were diagnosed with hypopharyngeal cancer and one with laryngeal cancer. The mean interval between surgery and CCRT was 34.1 days. The mean follow-up period was 16.5 months. Four patients died during the follow-up period as a result of local recurrence (n=2), distant metastasis (n=1) and suicide (n=1). One patient was alive with disease despite neck recurrence.