The neurovascular infrahyoid muscle flap: a new method for tongue reconstruction.

OBJECTIVE: Description of a new neurovascular island flap derived from the infrahyoid muscles to reconstruct a total tongue or large defects of the tongue base. The surgical technique, anatomic findings, and the postoperative function tests with the patients' outcome are described. Eleven patients had tongue cancer, 5 at a T2 stage, 3 at a T3 stage, and 3 at a T4 stage. Four patients underwent total glossectomy, 3 patients underwent hemiglossectomy, and in 2 patients a half and in another 2 patients a quarter of the tongue base were resected. The tongue of the patients who underwent total glossectomy has been reconstructed with the infrahyoid myofascial neurovascular flap from both sides of the neck; in all the other patients this new flap has only been taken from one side of the neck. In one patient a glossectomy had to be combined with a laryngectomy. In 10 patients the tracheostoma could be closed in 4 weeks after the operation, and all patients could eat an oral diet. Electromyography showed voluntary innervation of the reconstructed tongues. With the neurovascular infrahyoid flap, defects of the tongue base can be reconstructed successfully after partial resections or total glossectomies. The main advantage is the voluntary innervation of this flap by means of the ansa cervicalis and the prevention of scarring and atrophy of the reconstructed tongue.

[Comparison of 2 endoscopic surgery techniques for reliable therapy of Zenker diverticulum]. / Vergleich zweier endoskopischer Operationstechniken für eine sichere Therapie des Zenkerschen Divertikels.

BACKGROUND: A mediastinitis or intraoperative bleeding are the most feared complications of the transoral laser assisted diverticulotomy of Zenker's diverticulum. To reduce these complications we developed a new endoscopic surgical technique and compared the results of this new method with the results of patients who we treated earlier. PATIENTS AND METHODS: At the department of Otorhinolaryngology, Head and Neck Surgery, University of Luebeck 68 patients suffering from a hypopharyngeal diverticulum have been treated since 1987. In 64 patients we performed an endoscopic diverticulotomy using a CO2-Laser and the Weerda distending diverticuloscope. Four of the Zenker's diverticulua had to be removed by an external approach. From 1987 to 1994 a five millimeter bar between pouch and hypopharynx after diverticulotomy was left and sealed with fibrin glue in the first 38 patients. From 1995 to 1999 the spur of the hypopharyngeal pouch of the other 26 patients was completely separated. Afterwards we sutured the mucosa between the pouch and the hypopharynx to close the opened mediastinal space and sealed the former spur with fibrin glue. RESULTS: Comparing both endoscopic methods we had to observe concerning our first method one mediastinitis, a rise of body temperature in 29 patients (76%) and we had to perform a revision diverticulotomy in three patients (8%). Our modified technique didn't cause any mediastinitis, a rise of body temperature did only occur in five patients (18%) and no patient had to undergo revision surgery. CONCLUSIONS: The transoral complete separation of the spur of the hypopharyngeal pouch with suturing the mucosa of the pouch and the hypopharynx causes good functional results and means a further reduction of complications and a further improvement of the endoscopic diverticulotomy. Our new instruments (Fa. K. Storz, Tuttlingen) will be demonstrated.