Reconstruction with different free flaps in oro-facial cancer patients.

In 75 patients following ablative surgery of head and neck cancer, reconstruction was attempted with free tissue transfer techniques under magnification. It was possible to do free tissue transfers in 69 cases. In 6 cases it was not possible to harvest free flaps successfully and alternative reconstructive procedure was carried out due to unavoidable circumstances and various reasons: 1. unsuitable venous drainage, as in Anterior Rib Osteomyocutaneous Composite Flap, AROCF (2 cases), 2. injury to vessels during flap harvest, as in parascapular flap (1 case), 3. residual disease unable to excise (2 cases) and 4. unsuitable proposition (1 case), due to emergency curfew imposed suddenly. These 6 cases were not included in the study. Free tissue transfer was successful in 64 cases (92.7%) and there was a total failure in 5 cases where delayed secondary salvage surgery was performed. Out of 69 cases, in 65 cases reconstructions were carried out immediately, primarily as one-stage operative procedure. Their functional, cosmetic results and complications during the operative and post-operative period are analyzed and discussed. Inter-maxillary fixation was never used to maintain the bite alignment. All cases were given a bite guide prosthesis in the early post-operative period, to improve the bite alignment when it was necessary.

Differentiated thyroid cancer invading the hypopharynx: A case report.

Most thyroid cancers (90-95%) are well differentiated. Well differentiated cancers of the thyroid are usually confined to the thyroid capsule, making them amenable to isolated thyroid resection. Invasion of the upper aerodigestive tract by these cancers is infrequent and hypopharyngeal invasion is still rare. We report a 51 year old man with thyroid cancer invading the hypopharynx, who was successfully managed with complete resection along with a partial pharyngectomy. He is asymptomatic and disease free eighteen months after surgery. We advocate aggressive surgical extirpation of thyroid carcinoma invading the upper aerodigestive tract.

Carotid body tumors.

A retrospective study of 20 patients treated at the Tata Memorial Hospital over a period of 50 years, 1941-1991, is presented. Seventy-five percent (15/20) of the patients presented before their fifth decade with a male-to-female ratio of 2:1. The commonest presenting symptom was a painless lump in the neck. Twenty-five percent (5/20) had an incisional biopsy done elsewhere prior to referral to our institute. We performed a subadventitial excision of the tumor in 17 patients, 3 of whom were given postoperative radiation therapy. Three patients underwent complete excision of the carotid system without a vascular replacement, one of whom developed hemiparesis secondary to a cerebral infarct. There was no operative/postoperative mortality. Cranial nerve palsy was seen in 45% (9/20) of patients; the hypoglossal nerve was most commonly affected. One patient had a recurrence, 6 years after surgery, whereas 60% of patients operated on before 1987 have completed a 5-year disease free survival. Forty percent of patients have yet to have a 5-year follow-up period. Reports of newer diagnostic and therapeutic modalities are discussed.

Moderate-dose methotrexate in head and neck cancer.

200 mg/m2 methotrexate given intravenously in a running drip for 6 h has been used as an initial adjuvant therapy in 38 patients with advanced head and neck cancer. The response rate is as high as 80%, with 21% achieving complete remission. Histologically, specimens were tumor free in 3 patients. Toxicity in 38 patients included leukopenia (4), mucositis (6) and diarrhea (1). This particular dose of methotrexate appears to be safe and usually does not need leucovorin rescue. Also, when given as initial treatment, it is effective in reduction of tumor bulk. A prolonged randomized trial is essential to determine its role in improving long-term survival.