RESUMEN
PURPOSE: The primary aim of this retrospective study was to analyze the progression of descending necrotizing mediastinitis (DNM), evaluate the impact of comorbidities on complications and mortality and to observe long-term consequences of DNM on dysphagia and measurements quality of life. DNM is a serious infectious disease that requires multimodal treatment. Current literature varies in conclusions of risk factors, management and outcome of DNM. In addition, little is known about persisting effects on quality of life. METHODS: Retrospective data analysis of 88 patients with DNM representing the largest single-center study. Recording data of patients and diseases as well as clinical progression from 1997 to 2018. Two questionnaires were sent to the participants to measure quality of life and to detect dysphagia. RESULTS: 88 patients were included. The most frequently found pathogen were Streptococcus spp. (52%). 75% of the patients underwent multiple surgeries, mean count of surgical procedures was 4.3 times. 84% received intensive care treatment. Median length of stay on the intensive care unit was 7 days. 51% had pre-existing comorbidities associated with reduced tissue oxygenation (e.g., diabetes). The most common complication was pleural effusion (45%). During the observation period, the mortality rate was 9%. 12 questionnaires could be evaluated. 67% of the participants were affected by dysphagia at the time of the survey. CONCLUSIONS: Descending necrotizing mediastinitis (DNM) is a severe disease requiring an immediate initiation of multimodal treatment. Although quality of life usually isn´t impaired permanently, dysphagia may often persist in patients after DNM.
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Trastornos de Deglución , Mediastinitis , Humanos , Mediastinitis/diagnóstico , Mediastinitis/etiología , Mediastinitis/terapia , Estudios Retrospectivos , Estudios de Seguimiento , Trastornos de Deglución/diagnóstico , Trastornos de Deglución/etiología , Trastornos de Deglución/terapia , Calidad de Vida , Drenaje/métodos , Necrosis/etiología , Necrosis/terapiaRESUMEN
CONCLUSIONS: Early diagnosis and aggressive antimicrobial and surgical treatment are essential to successfully treat extensive cervico-mediastinal abscesses of odontogenic origin. Patient management should be performed by experienced clinicians well trained in managing possible complications. We recommend close clinical and radiological postoperative follow-up investigations with early surgical re-intervention if necessary. OBJECTIVES: While neck infections affecting the perimandibular space have a high prevalence and their clinical aspects have repeatedly been discussed, further spread of the inflammation and life-threatening situations have rarely been described. The objective was to determine clinical, diagnostic, and therapeutic aspects of severe neck infections of odontogenic origin. Emphasis was placed on grave descending deep neck space infections, sometimes resulting in mediastinitis as a life-threatening complication. PATIENTS AND METHODS: We reviewed 10 patients with severe odontogenic abscesses treated during an 8-year interval in a single center. RESULTS: The submandibular space was the most frequently encountered location of deep neck space infections. Mediastinitis was found in five patients. The most frequent causative bacteria were Streptococcus and Bacteroides species. All patients underwent intravenous antibiotic treatment and surgical therapy. Mediastinotomy was inevitable in five cases and thoracotomy in one case. All patients survived.
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Absceso/etiología , Infecciones Bacterianas/etiología , Prótesis Dental , Perforación del Esófago/complicaciones , Esófago , Infección Focal Dental/complicaciones , Infección Focal Dental/etiología , Migración de Cuerpo Extraño/complicaciones , Angina de Ludwig/etiología , Mediastinitis/etiología , Cuello , Enfermedades Otorrinolaringológicas/etiología , Absceso Periodontal/complicaciones , Periodontitis/complicaciones , Absceso/diagnóstico , Absceso/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/cirugía , Infecciones por Bacteroides/diagnóstico , Infecciones por Bacteroides/etiología , Infecciones por Bacteroides/cirugía , Terapia Combinada , Femenino , Infección Focal Dental/diagnóstico , Infección Focal Dental/cirugía , Humanos , Angina de Ludwig/diagnóstico , Angina de Ludwig/cirugía , Masculino , Mediastinitis/diagnóstico , Mediastinitis/cirugía , Persona de Mediana Edad , Enfermedades Otorrinolaringológicas/diagnóstico , Enfermedades Otorrinolaringológicas/cirugía , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/etiología , Infecciones Estreptocócicas/cirugía , Tomografía Computarizada EspiralRESUMEN
OBJECTIVE: Three of four paraganglioma syndromes (PGLs) have been characterized on a molecular genetic basis. PGL 1 is associated with mutations of the succinate dehydrogenase subunit D (SDHD) gene, PGL 3 is caused by SDHC gene mutations, and PGL 4 is caused by SDHB gene mutations. The objective of this study was to investigate whether PGLs are associated with malignant head and neck paragangliomas (HNPs). STUDY DESIGN AND SETTING: Through November 2005, we screened 195 HNP patients for mutations of the genes SDHB, SDHC, and SDHD. RESULTS: We detected 5 SDHC, 13 SDHB, and 45 SDHD gene mutations. In seven SDHB mutation carriers, there were distant metastases. No signs of metastases were found in SDHC and SDHD patients. One patient with a sporadic HNP presented with locally metastatic disease. CONCLUSIONS: SDHB mutations are associated with a high rate of malignant HNPs. SIGNIFICANCE: In SDHB patients, a three-body region imaging and scintigraphy or DOPA-PET must be performed to exclude metastases.
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Neoplasias de Cabeza y Cuello/genética , Proteínas Hierro-Azufre/genética , Mutación/genética , Paraganglioma/genética , Succinato Deshidrogenasa/genética , Adulto , Anciano , Neoplasias Óseas/secundario , Tumor del Cuerpo Carotídeo/genética , Exones/genética , Femenino , Tumor del Glomo Yugular/genética , Humanos , Intrones/genética , Metástasis Linfática/diagnóstico , Masculino , Proteínas de la Membrana/genética , Persona de Mediana Edad , Mutación Missense/genética , Paraganglioma/secundario , Polimorfismo Conformacional Retorcido-Simple , Estudios ProspectivosRESUMEN
OBJECTIVES: The solitary fibrous tumor (SFT) is a potentially malignant spindle cell neoplasm of mesenchymal origin that was originally described as a thoracic lesion originating from pleural tissue. Recently, numerous extrapleural sites of origin have been described, frequently affecting the head and neck region. The purpose of this article is to focus on a formerly underestimated neoplasm and to highlight its appearance in the head and neck region. METHODS: The authors present 2 illustrative cases, including what is probably the first reported case of an SFT arising in the human tonsillar fossa, and give a clinical and pathological literature review. RESULTS: The clinical, histologic, and radiologic features are presented, and the surgical treatment is described. The international medical literature concerning SFTs in general and SFTs of the head and neck in particular is reviewed, and the changing concept of SFTs and hemangiopericytomas is discussed on the basis of the updated World Health Organization classification of soft tissue tumors. CONCLUSIONS: It is nowadays recognized that the large majority of lesions formerly classified as hemangiopericytomas are, in fact, variants of SFTs. Although still a rare occurrence, SFTs have become increasingly recognized, and clinicians should be aware of their presentation.
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Fibroma/diagnóstico , Fibroma/terapia , Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de Cabeza y Cuello/terapia , Adulto , Anciano , Angiografía de Substracción Digital , Terapia Combinada , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Ultrasonografía Doppler DúplexRESUMEN
BACKGROUND: Unclear cervicofacial masses are common presentations that often require tissue sampling to guide therapy. While open biopsy is invasive, fine-needle aspiration cytology includes a high rate of nondiagnostic samples. METHODS: A retrospective analysis on 181 core-needle biopsies in 88 patients was performed to determine the diagnostic efficacy of ultrasound-guided core-needle biopsies in the head and neck. RESULTS: We experienced 100% success in obtaining high-quality histopathologic specimens. The target tissue was correctly sampled in 80 of 88 patients. In these patients the sensitivity, specificity, and accuracy rate of core-needle biopsies in differentiating benign from malignant cervicofacial lesions was 98.1%, 100%, and 98.8%, respectively. CONCLUSIONS: Ultrasound-guided core-needle biopsies can be recommended as a safe and reliable technique in the diagnosis of cervicofacial masses with a high diagnostic yield. It obtains tissue samples of high quality and represents a sufficient alternative to open biopsy even in the diagnosis of lymphoma.
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Biopsia con Aguja/métodos , Carcinoma/patología , Neoplasias de Cabeza y Cuello/patología , Linfoma/patología , Cirugía Asistida por Computador , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma/diagnóstico por imagen , Estudios de Cohortes , Femenino , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Humanos , Linfoma/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Estudios Retrospectivos , UltrasonografíaRESUMEN
OBJECTIVE: Total or subtotal laryngectomy performed as surgical treatment of locally advanced laryngeal tumors requires a permanent laryngostomy or tracheostomy, and are both associated with severe and lifelong disability. The hitherto published reconstructive methods for the rehabilitation of patients after subtotal anterior laryngotracheal resection of extended laryngotracheal malignancies have not been thoroughly convincing. METHODS: We present a successful method of extended laryngotracheal reconstruction that combines modern surgical and biomedical techniques. RESULTS: A stable three-dimensional anterior neolarynx was prefabricated, including the use of vacuum-assisted prelamination and preconditioning of a composite radial forearm free flap, which was then transferred to the neck and vascularized by microvascular anastomosis to the cervical vessels. This reconstructive procedure permitted the restoration of a stable laryngotracheal conduit in two cases, with the subsequent successful closure of the tracheo-laryngostomy. CONCLUSION: In the reported cases the pre- or post-operative irradiation did not compromise the success of reconstruction. Not only did our technique facilitate the rehabilitation of patients suffering from drawbacks of the laryngo-tracheofissure, but it also assisted in avoiding total laryngectomy in cases of advanced anterior laryngeal cancer by extending the indications for subtotal anterior laryngeal resections followed by reconstructive surgery.
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Neoplasias Laríngeas/cirugía , Laringectomía , Colgajos Quirúrgicos , Neoplasias de la Tráquea/cirugía , Traqueostomía , Cartílago/trasplante , Humanos , Neoplasias Laríngeas/radioterapia , Masculino , Microcirugia , Persona de Mediana Edad , Radioterapia Adyuvante , Reoperación , Colgajos Quirúrgicos/irrigación sanguínea , Técnicas de Sutura , Tomografía Computarizada por Rayos X , Neoplasias de la Tráquea/radioterapiaRESUMEN
Leiomyosarcoma is a malignant mesenchymal tumor originating from smooth muscle cells, which most frequently develops in the myometrium and in the gastro-intestinal tract. Reviewing the international literature, radiation-induced sarcoma arise in 0.035 to 0.2% of all irradiated patients. Especially in the head and neck region, radiation-induced leiomyosarcoma is an extremely rare lesion. The authors report a case of a radiation-induced leiomyosarcoma of the tonsillar region of the oropharynx in a 51-year-old male patient, who had undergone radiation therapy of this region 38 years before. The lesion was treated by radical surgery. Diagnostic steps, histological presentation and therapy are described in detail and the literature concerning radiation induced malignancies in general as well as radiation induced leiomyosarcoma in particular is reviewed. The highlights of this case are an extremely uncommon location and a rare pathological entity of radiation induced malignancies.
RESUMEN
BACKGROUND: Primary Ewing sarcoma affecting the skull base in general and the petrous bone in particular is extremely rare with only 4 reports of Ewing sarcoma arising in the petrous temporal bone in the international medical literature. METHODS: The authors report for the first time a case of a primary Ewing sarcoma of the petrous temporal bone in a 5-month-old nursling, which became apparent with a complete peripheral facial palsy and ipsilateral surdity. RESULTS: The neoformation was treated by systemic chemotherapy and radiation of the tumor region. The diagnostic steps, therapy, and development of the child are described in detail; the literature concerning Ewing sarcoma originating from the skull in general and from the petrous temporal bone in particular is reviewed. CONCLUSIONS: The highlights of this case are an extremely uncommon location, an unusual age of presentation, as well as a unique set of symptoms.
Asunto(s)
Sordera/etiología , Parálisis Facial/etiología , Hueso Petroso , Sarcoma de Ewing/complicaciones , Neoplasias Craneales/complicaciones , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Preescolar , Terapia Combinada , Humanos , Masculino , Dosificación Radioterapéutica , Sarcoma de Ewing/diagnóstico , Sarcoma de Ewing/tratamiento farmacológico , Sarcoma de Ewing/radioterapia , Neoplasias Craneales/diagnóstico , Neoplasias Craneales/tratamiento farmacológico , Neoplasias Craneales/radioterapia , Resultado del TratamientoRESUMEN
BACKGROUND: Endolymphatic sac tumours (ELSTs) have been known as an individual tumour entity only since 1984. ELSTs may occur either solitarily and sporadically or as a hereditary manifestation associated with von Hippel-Lindau (VHL) disease. The latter association was first observed in 1992 and confirmed by molecular genetic analysis of the VHL gene. No consensual diagnostic and treatment strategy of ELST exists at present. METHODS: Based on imaging criteria in computed tomography, magnetic resonance imaging (MRI), and magnetic resonance angiography, we developed a staging system to classify ELST in a series of seven consecutive patients in an attempt to custom-tailor the surgical approach. Type A referred to tumours that were locally confined without temporal bone erosion or infiltration of the dura (n = 2); type B tumours showed evidence of bone infiltration of the osseous labyrinth and sensorineural hearing loss (n = 2); and in type C, the tumour further invaded the sigmoid sinus and jugular bulb (n = 3). Two patients suffered from VHL disease. RESULTS: In all patients, the tumour was completely removed. Stage-adapted surgical approaches included various transpetrosal procedures, from the translabyrinthine to the infratemporal approaches. The functional integrity of the facial nerve was maintained in all tumour stages, whereas the vestibulocochlear nerve could be preserved only in patients with type A tumours. Follow-up MRI demonstrated no local tumour recurrence during a postoperative observation period ranging from 4 to 38 months. CONCLUSION: Stage-based surgical strategy enables the complete removal of ELST with minor morbidity. Transmastoid approaches are most efficient for resection of the tumour matrix to prevent local recurrence.
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Neoplasias del Oído/patología , Neoplasias del Oído/cirugía , Saco Endolinfático , Estadificación de Neoplasias/métodos , Procedimientos Quirúrgicos Otológicos/métodos , Adulto , Diagnóstico por Imagen , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: To study the clinical course and outcome of deep neck infections (DNI), with special emphasis on microbiology and histopathology. STUDY DESIGN: Two hundred thirty-four patients with DNIs were included in this study. Patients with peritonsillar or dental infections, infections arising from salivary glands, as well as subjects with abscesses caused by neck trauma were excluded. METHODS: Clinical analysis of all patients with DNIs who were treated between January 1, 1997 and May 31, 2005 in a single center. RESULTS: In 13 patients, the DNI was the first manifestation of a malignant tumor. In 17 cases, the DNI was associated with cat-scratch disease (CSD). Six patients suffered from tuberculosis, and in another 7, an infected lateral cleft cyst was found. In 176 patients, the origin of DNI remained unclear. CONCLUSIONS: Our results demonstrate that CSD, tuberculosis, and malignant tumors must be considered as possible causes of DNIs. The current study represents one of the largest series of DNIs in the modern medical literature. EBM RATING: C.
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Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/terapia , Absceso Peritonsilar/epidemiología , Absceso Peritonsilar/terapia , Absceso Retrofaríngeo/epidemiología , Absceso Retrofaríngeo/terapia , Adulto , Distribución por Edad , Anciano , Antibacterianos/uso terapéutico , Infecciones Bacterianas/microbiología , Estudios de Cohortes , Terapia Combinada , Femenino , Alemania/epidemiología , Bacterias Gramnegativas/aislamiento & purificación , Bacterias Grampositivas/aislamiento & purificación , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Absceso Peritonsilar/diagnóstico , Pronóstico , Absceso Retrofaríngeo/diagnóstico , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Distribución por Sexo , Procedimientos Quirúrgicos Operativos/métodos , Tasa de Supervivencia , Resultado del TratamientoAsunto(s)
Neoplasias del Seno Maxilar/patología , Neurofibroma/patología , Paladar Duro/patología , Músculos Pterigoideos/patología , Adulto , Humanos , Masculino , Neoplasias del Seno Maxilar/cirugía , Invasividad Neoplásica , Neurofibroma/cirugía , Paladar Duro/cirugía , Músculos Pterigoideos/cirugíaRESUMEN
OBJECTIVE: The bacteria Bartonella henselae has been known as the principal causative agent of cat-scratch disease (CSD) since 1992. It is an important cause of infectious lymphadenopathies in the head and neck. Nevertheless, CSD often remains unrecognized in cases of cervicofacial lymph node enlargement. STUDY DESIGN: Between January 1997 and May 2003, we conducted a prospective clinical study including 721 patients with primarily unclear masses in the head and neck. RESULTS: CSD was diagnosed by serology and molecular investigations in 99 patients (13.7%; median age 33 years). Cervicofacial lymphadenopathy was the most common manifestation. Atypical manifestation of CSD including Parinaud's oculoglandular syndrome, swelling of the parotid gland and erythema nodosum were diagnosed in 8.1%, 8.1%, and 2.0% of cases, respectively. CONCLUSIONS: Our results demonstrate that CSD is a major cause of enlarged cervicofacial lymph nodes and should therefore be included in the differential diagnosis of lymphadenopathy in the head and neck region.
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Enfermedad por Rasguño de Gato/complicaciones , Enfermedades Otorrinolaringológicas/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad por Rasguño de Gato/diagnóstico , Enfermedad por Rasguño de Gato/tratamiento farmacológico , Niño , Preescolar , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
OBJECTIVE: Paragangliomas represent neoplasms of neural crest origin that arise from paraganglia. Mutations in the gene encoding succinate dehydrogenase subunit D (SDHD) are responsible for a percentage of hereditary paragangliomas. We previously described a group of 271 pheochromocytoma patients, 11 of whom had mutations of the SDHD gene. The objective of this study was to find out whether those 11 patients had additional paragangliomas. STUDY DESIGN: Ten patients participated in our clinical screening program that included MRI of the skull base and neck, thorax, and abdomen, as well as an 18 Fluoro-DOPA positron emission tomography (DOPA-PET). RESULTS: Five patients presented with head and neck paragangliomas, 1 patient with a thoracic paraganglioma, and 2 patients with intraabdominal paragangliomas. CONCLUSIONS: The screening for paragangliomas in patients with mutations of the SDHD gene offers the chance to diagnose those tumors in an early stage. SIGNIFICANCE: Because morbidity after surgical resection increases with tumor size, early surgery will minimize the potential risks.
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Neoplasias de las Glándulas Suprarrenales/genética , Proteínas de la Membrana/genética , Mutación , Neoplasias Primarias Múltiples/genética , Paraganglioma/genética , Feocromocitoma/genética , Adolescente , Adulto , Preescolar , Femenino , Humanos , Masculino , Succinato DeshidrogenasaRESUMEN
This cadaver study assessed the value of navigation in cochlear implant surgery. Cochlear implantation was simulated on a cadaver using a Stryker-Leibinger navigation system and a Nucleus 24 Contour implant. A conventional surgical strategy consisting of mastoidectomy, posterior tympanotomy, and cochleostomy was performed. The navigated surgical procedure was evaluated for accuracy, reliability, reproducibility, and practicability. The technology of computer-assisted surgery is applicable in cochlear implantation and beneficial in as much as the navigation-controlled implantation constitutes a non-invasive instrument of quality management. Nevertheless, in order to keep the point accuracy below one millimeter, a referencing method using concealed bordering anatomical structures may be further needed to perform the cochleostomy reliably under the guidance of a navigation system. More reproducible reference systems are needed if navigated lateral skull base surgery is to be fully relied upon.
Asunto(s)
Implantes Cocleares , Cirugía Asistida por Computador/métodos , Cadáver , Humanos , Neuronavegación , Calidad de la Atención de Salud , Reproducibilidad de los Resultados , Tomografía Computarizada por Rayos X/métodosRESUMEN
Burkitt's lymphoma is rare outside of Africa, and head and neck manifestations of this disease are even more uncommon. We report a case of Burkitt's lymphoma localized at the bifurcation of the right common carotid artery in a 64-year-old man. The presenting symptoms were recurrent syncopes that necessitated a pacemaker, followed by a rapid onset of cranial nerve palsies. The tumor had infiltrated cranial nerves IX, X, XI, and XII and was resected by selective neck dissection. The patient was subsequently treated with a chemotherapeutic regimen consisting of a combination of cytosine arabinoside, vincristine, ifosfamide, prednisone, and an intrathecal application of methotrexate. He also underwent external-beam irradiation of the neck. The patient has been followed up for a period of 42 months and has no evidence of recurrent disease. Repeated diagnostic testing and a coordination of multiple disciplines can speed diagnosis and therapeutic management. The current literature is reviewed and discussed.
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Linfoma de Burkitt/complicaciones , Enfermedades de los Nervios Craneales/etiología , Neoplasias de Cabeza y Cuello/complicaciones , Síncope/etiología , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Linfoma de Burkitt/terapia , Arterias Carótidas , Neoplasias de Cabeza y Cuello/terapia , Humanos , Escisión del Ganglio Linfático , Masculino , Persona de Mediana Edad , Radioterapia de Alta Energía , RecurrenciaRESUMEN
OBJECTIVE: Subacute haemorrhage is a common emergency in otorhinolaryngology. Rapid evaluation of the aetiology and localization is a precondition for suitable treatment. We demonstrate a rare case of primarily intractable epistaxis associated with occlusion of the circle of Willis (moyamoya disease). PATIENT: A 38-year-old man presented with a 24-h history of recurrent epistaxis. Anamnesis revealed long-term anticoagulation after heart valve transplantation and arterial hypertension. RESULTS: As a result of several re-bleedings after anterior nasal packing, a re-packing was followed by surgical treatment under general anaesthesia. Four days after discharge the patient presented to the intensive care unit with severe re-bleeding. After removal of a temporary Bellocq packing, interdisciplinary treatment was necessary. Emergency angiography revealed advanced moyamoya disease, with occlusion of both internal carotid arteries. The cerebral blood supply was sustained by an excessive collateral network originating from external carotid anastomoses. This complicated the endovascular treatment, which consisted of embolization of the infraorbital and maxillar arteries with liquid material and coils flanked by Bellocq packing. The patient was doing well at follow-up after 12 months. CONCLUSION: Epistaxis complicating moyamoya disease is rare, and endovascular treatment is difficult due to the high risk of cerebral embolism. Malformations of the cerebral arteries should be considered in the differential diagnosis of intractable epistaxis.
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Epistaxis/etiología , Enfermedad de Moyamoya/complicaciones , Adulto , Angiografía Cerebral , Diagnóstico Diferencial , Embolización Terapéutica , Epistaxis/diagnóstico , Epistaxis/terapia , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Humanos , Hipertensión/complicaciones , Angiografía por Resonancia Magnética , Masculino , Procedimientos Quirúrgicos Otorrinolaringológicos , Recurrencia , Tomografía Computarizada por Rayos XRESUMEN
Free microvascular flaps are an established method for soft tissue reconstruction following ablative oncological surgery in the head and neck. Functional reconstructions of the hypopharynx and the pharyngoesophageal segment (PES) are of particular relevance, as they are highly demanding surgical procedures. So far, the radial forearm free flap (RFFF) and the free jejunal transfer have been the transplants predominantly used for this purpose. The lateral upper arm free flap (LUFF) presents an alternative method for the fasciocutaneous tissue transfer. We report on our experience with the LUFF in a 56-year-old male patient with a pT3pN0M0 squamous cell carcinoma of the hypopharynx. A pharyngocutaneous fistula developed 5 days after pharyngolaryngectomy with bilateral neck dissection. The fistula was localized between the pharyngeal constrictor muscle and the esophagus and was closed with an LUFF from the left arm. Excellent flap adaptation to the remaining pharyngeal mucosa was observed. Although the length of the vascular pedicle and the diameter of the vessels in the LUFF are smaller than those in the RFFF, neither pedicle length nor vessel diameter proved to be a problem. The LUFF can be recommended as a well-vascularized, relatively safe and reliable flap for reconstruction of tubular structures such as the hypopharynx and the PES after tumor ablation and as an alternative to the RFFF. The flexibility of the LUFF allows surgeons to reconstruct the anatomy of the lost soft tissues as adequately as possible.
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Carcinoma de Células Escamosas/cirugía , Neoplasias Hipofaríngeas/cirugía , Faringe/cirugía , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos , Anciano , Fístula Cutánea/etiología , Fístula Cutánea/cirugía , Femenino , Humanos , Laringectomía , Masculino , Persona de Mediana Edad , Disección del Cuello , Enfermedades Faríngeas/etiología , Enfermedades Faríngeas/cirugía , Faringectomía , Complicaciones PosoperatoriasRESUMEN
Cervical thymic cysts are rare benign lesions that are hardly ever considered in the differential diagnosis of cystic neck masses. In the vast majority of cases, thymic cysts are found in infants and children. This article illustrates two cases of multilocular cervical thymic cysts in adults presenting as asymptomatic swellings in the neck. The clinical presentation, evaluation, surgical management and pathological findings are described. The possible pathogenesis as an acquired disease is reviewed and discussed. The authors recommend that, despite its rare occurrence, multilocular cervical thymic cysts should be considered in the differential diagnosis of all equivocal cases of unilateral cystic neck masses in adults.
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Quiste Mediastínico/diagnóstico , Adolescente , Adulto , Factores de Edad , Diagnóstico Diferencial , Humanos , Masculino , Quiste Mediastínico/patología , Quiste Mediastínico/cirugía , Procedimientos Quirúrgicos Operativos , UltrasonografíaRESUMEN
BACKGROUND: Our purpose was to evaluate different sonographic parameters of cervicofacial lymphadenopathy caused by cat-scratch disease (CSD) and toxoplasmosis. METHODS: By use of high-resolution B-mode sonography a total of 552 lymph nodes in the head and neck were detected between January 1997 and December 2001. There were 71 patients (422 lymph nodes) with CSD and 19 patients (130 lymph nodes) with toxoplasmosis. Sonographic variables, including 20 sonomorphologic features along with age and gender, were analyzed with multivariate logistic regression. RESULTS: Heterogenous lymph nodes were more often found in CSD (p =.003), and nonsharp nodal borders showed a significant association with CSD (p =.0005). Multivariate analysis identified sharpness of borders (p =.0001), S/L ratio (p =.0006), and type of lymphadenopathy (acute, abscessed, chronic) (p =.0006) as most significant for differentiating between CSD and toxoplasmosis. CONCLUSIONS: These results provide significant and useful criteria for ultrasonographic differentiation between CSD and toxoplasmosis.