Incisionless facial resection for Kadish stage C olfactory neuroblastoma: Transcaruncular approach with combined endonasal and skull base surgery.

This case report describes resection without facial incision for aggressive Kadish stage C olfactory neuroblastoma (ONB). We performed resection via transcaruncular approach with combined endonasal and skull base surgery. This multidisciplinary team surgical approach is expected to lead to a new strategy for this type of tumor in the future.

Functional outcomes and reevaluation of esophageal speech after free jejunal transfer in two hundred thirty-six cases.

Swallowing and communication are occasionally impaired after free jejunal transfer. Here, the relationship between surgical procedure and functional outcome was analyzed in 236 patients undergoing free jejunal transfer after total laryngopharyngectomy from 1992 through 2003. Swallowing and communication functions were also investigated with a questionnaire in 40 long-surviving patients. Although oral feeding could be resumed after surgery in most patients, anastomotic stricture and nasal regurgitation occurred in 12.7% and 29.7% of patients, respectively. Use of our standardized procedure, the tensed jejunal method, significantly reduced the incidence of stricture (P < 0.01) but increased the rate of nasal regurgitation; however, in most cases regurgitation gradually resolved. Of the 40 long-surviving patients, 17 attended a speech rehabilitation program at which 12 learned to perform esophageal speech without voice restoration procedures (11 of the 12 had received a tensed jejunal graft). Our standardized procedure helps prevent strictures and encourages esophageal speech.

Standardization of free jejunum transfer after total pharyngolaryngoesophagectomy.

OBJECTIVE: Our latest free jejunum transfer procedure was reviewed and compared with previous procedures to standardize the operation. METHODS: This was a retrospective study of 269 patients who had undergone total pharyngolaryngoesophagectomy and free jejunum transfer from 1992 through 2004. The patients were divided into two groups: a late group, in which surgery was performed with our latest standard procedure from 2000 through 2004, and an early group, in which various procedures had been used from 1992 through 1999. Surgical times, postoperative progress, and complications were evaluated. RESULTS: The mean surgical time was shortened from 3 hours 25 minutes in the early group to 3 hours 9 minutes in the late group, and ischemic time was shortened from 2 hours 44 minutes to 2 hours 20 minutes. For recipient vessels, branches of the external carotid artery and the internal jugular vein were more often used in the late group. Length of hospitalization decreased from 31.7 days in the early group to 24.4 days in the late group, although the start of drinking was similar (15.4 days versus 12.1 days). The rates of complications were significantly reduced in the late group, particularly those associated with the enteric anastomosis such as minor leakage (18.2-5.2%) and stenosis (17.6-3.0%). CONCLUSION: Our latest method of free jejunum transfer reconstruction has become reliable and expeditious through simple and stable minor revisions of procedures.

Versatile lotus petal flap for vulvoperineal reconstruction after gynecological ablative surgery.

OBJECTIVE: The objective of the present work was to assess the efficacy and complications of the use of the lotus petal flap in the vulvoperineal reconstruction among female patients treated for vulvar malignancies. METHODS: Between December 2000 and April 2003, five patients underwent vulvoperineal reconstructions with the fasciocutaneous skin flaps elevated from gluteal folds immediately after vulvoperineal ablative surgeries at National Cancer Center Hospital, Tokyo, Japan. RESULTS: The mean surface area of vulvoperineal tissue defects was 157.9 cm(2) (64.0-195.0 cm(2)), which could be filled completely by bilateral lotus petal flaps. The mean length of follow-up was 18 months (7-32 months). All flaps successfully survived without fatal necrosis. In postoperative follow-up, all patients had no complaint of pain and no abnormal sensation at the site of flap or at the donor site, and the lotus petal flap caused no severe damage to excretion, mobility of the hip, or the sensation in the vulvoperineal area. The gluteal fold could make the donor-site scar stand out in all patients. CONCLUSION: The lotus petal flap is thought to be one of the most ideal reconstructive procedures for vulvoperineal region from various viewpoints of oncology, function, wound healing, and cosmetic surgery.