Reconstruction of through-and-through cheek defects with folded free anterolateral thigh flaps.

PURPOSE: The purpose of this study was to assess the clinical application and therapeutic efficacy of through-and-through cheek defects reconstructed with folded anterolateral thigh (ALT) flaps. PATIENTS AND METHODS: From January 2009 to May 2012, 10 patients with through-and-through cheek defects resulting from resection of cheek tumor underwent reconstruction with the folded ALT flap at Sun Yat-Sen University Cancer Center, Guangzhou, China. Surgical procedures in harvesting the ALT flap, as well as the surgical anatomy, are described, and the success rate is reported. RESULTS: All ALT flaps were fasciocutaneous flaps. One patient with a thrombotic event required operative exploration in the perioperative period. All 10 flaps were based on a single perforator for reconstruction of defects. In all 10 cases, the donor site was closed primarily for the ALT flap, leaving only a linear scar that was inconspicuous with normal clothing, and the thigh had no functional deficit. CONCLUSIONS: The free ALT flap has good pliability and can be folded for the reconstruction of both the inner and outer lining of through-and-through cheek defects. This flap presents good functional results at the recipient site with the additional advantages of minimal donor-site morbidity, a very acceptable esthetic result, and a high level of patient satisfaction.

Postoperative hypoparathyroidism after thyroid operation and exploration of permanent hypoparathyroidism evaluation.

Background: To investigate the risk factors for hypoparathyroidism, discuss the prevention of postoperative hypoparathyroidism, and explore permanent postoperative hypoparathyroidism evaluation (PPHE). Methods: A total of 2,903 patients with thyroid nodules were treated between October 2012 and August 2015. Serum calcium and intact parathyroid hormone (iPTH) levels were measured at 1 day, 1 month, and 6 months postoperatively. The incidence and management of hypoparathyroidism were analyzed. The PPHE was established based on the risk factors and clinical practice. Results: A total of 637 (21.94%) patients developed hypoparathyroidism, and 92.15% of them had malignant nodules. The incidence rates of transient and permanent hypoparathyroidism were 11.47% and 10.47%, respectively. The iPTH level was lower in patients with malignant nodules who underwent total thyroidectomy (TT) and central-compartment neck dissection (CND). These factors were independently associated with the recovery rate of parathyroid function. The formula for PPHE is as follows: {iPTH} + {sCa} + {surgical procedure} + {reoperation} + {pathologic type}. A scoring system was developed, and we scored low, middle, and high risk of permanent postoperative hypoparathyroidism as 4-6, 7-9, and 10-13, respectively. The differences in the recovery rates of parathyroid function in several risk groups were statistically significant (p < 0.001). Conclusion: Simultaneous TT and CND is a risk factor for hypoparathyroidism. The reoperation is not associated with hypoparathyroidism. Identification of parathyroid glands in situ and preservation of their vascular pedicles are key factors in managing hypoparathyroidism. PPHE can forecast the risk of permanent postoperative hypoparathyroidism well.

A "watch window" technique for monitoring buried free jejunum flaps during circumferential pharyngolaryngectomy reconstruction.

The free jejunum flap approach is the optimal option for circumferential pharyngolaryngectomy reconstruction. In this study, we designed a "watch window" for monitoring buried free jejunum flaps, thereby allowing us to assess graft viability. From 2007 to 2011, 14 patients with hypopharyngeal cancer underwent circumferential pharyngolaryngectomy that was reconstructed using a free jejunum flap at the Sun Yat-sen University Cancer Centre. During the closing of the neck incision, a "watch window" was designed for postoperative monitoring. Two patients experienced thrombosis of the pedicle. One was detected early and successfully rescued by removal of the thrombosis, the other one managed with a second free jejunum flap. The success rate of the buried flaps was 92.9%. No pharyngocutaneous fistulas or strictures occurred. All patients eventually resumed oral feeding and swallowing. The "watch window" technique for monitoring buried free jejunum flaps is simple, reliable and useful for finding vascular problems. Level of evidence Case series.

Planned neck dissection before combined chemoradiation in organ preservation protocol for N2-N3 of supraglottic or hypopharyngeal carcinoma.

OBJECTIVE: To investigate the clinical therapeutic outcomes and neck node control of a pretreatment neck dissection in the chemoradiation protocol of organ preservation for N2-N3 of supraglottic and hypopharyngeal carcinoma. METHODS: Forty-six patients (group A) with untreated N2 or N3 squamous cell carcinoma of the supraglottis or hypopharynx underwent pretreatment neck dissection in a chemoradiation protocol, while 39 patients (group B) did not undergo pretreatment neck dissection in a chemoradiation protocol. Salvage surgeries were used for local or cervical node residual tumor or recurrence after chemoradiotherapy. RESULTS: In group A, the mean time between neck dissection and chemoradiation was 21 days (range 15-29). Only 3 patients (6.5%) experienced wound complications. A 'boost' of radiation of 12 Gy was delivered after 33 neck dissections (64.8%) in patients with extracapsular spread. The Kaplan-Meier 5-year overall survival rate was 42.5%. The 5-year overall survival rate and disease-specific survival rate in group A was 42.5 and 46.4%. The rate of neck node control in group A was better than that in group B (86.3 vs. 65.9%, p = 0.02). CONCLUSIONS: Pretreatment neck dissection in a chemoradiation protocol for supraglottic or hypopharyngeal carcinoma showed low complication rates, no delay for radiation, optimal radiation doses, and a high nodal disease control.

Reconstruction of soft-tissue defects of the head and neck: radial forearm flap or anterolateral thigh flap?

This study compared the reliability, practicability and impact to donor site functionality of radial forearm (RF) and anterolateral thigh (ALT) flaps used for the reconstruction of head and neck soft-tissue defects. The clinical data of patients who underwent reconstruction using RF flaps (n = 53) and ALT flaps (n = 21) after tumour ablation were reviewed. Pedicle length, skin area harvested and flap survival rate were compared between the two flap types. A questionnaire was used to compare the patients' perceptions of donor site functionality. Pedicle length did not significantly differ between RF and ALT flaps (7.5 vs. 9 cm, p = 0.733). A significantly larger mean area of skin was harvested in the ALT group than in the RF group (65 vs. 38 cm(2), p = 0.001). Flap survival rates did not differ between the two groups (p = 0.554). Patients in the ALT group were more satisfied with the appearance of the donor sites than were those in the RF group (p = 0.029). Significantly more patients in the RF group complained of donor site numbness than in the ALT group (p = 0.014). No ALT group patients complained of movement impairment or weakness at the donor sites, but 10% of RF group patients experienced impairment (p = 0.014) and 35% felt weakness (p = 0.001). The ALT and RF flaps showed similar practicability and reliability for the reconstruction of soft-tissue defects, but ALT flaps had fewer impacts to donor site functionality than RF flaps.

Long-term survival of induction chemotherapy plus surgery and postoperative radiotherapy in patients with stage IV hypopharyngeal cancer.

This study was conducted to evaluate the safety, efficacy, and tolerability of induction chemotherapy plus surgery and postoperative radiotherapy in patients with stage IV hypopharyngeal cancer. The patients received two to three cycles of induction chemotherapy before surgery, with cisplatin (100 mg/m(2)) by rapid intravenous (i.v.) infusion over 15-20 min on day 1, bleomycin (10 mg/m(2)) on days 1 and 5, and 5-fluorouracil (800 mg/m(2)/day) by continuous i.v. infusion on days 1 through 5, repeated every 21 days. Adjuvant radiotherapy was begun 4-6 weeks after surgery. From July 1999 to December 2004, a total of 52 patients were enrolled. After completion of two to three courses of induction chemotherapy, 22 cases of CR (complete response) and 16 cases of PR (partial response) in the primary site were confirmed, giving an overall response rate (ORR) of 73.1% [95% confidence interval (CI), 61.1-85.2%]. There were 17 CRs and 19 PRs in neck lymph nodes, giving an ORR of 69.2%. The combined primary tumor site and lymph node response was 17 CRs and 16 PRs, giving an ORR of 63.5% (95% CI, 50.4-76.6%). The median time to progression and overall survival for all the patients were 32 months (95% CI, 7.6-56.4 months) and 36 months (95% CI, 22.3-49.7 months), respectively. The estimate of time to progression and overall survival at 5 years was 24.5% (95% CI, 12.5-36.5%) and 35.9% (95% CI, 23.2-48.6%), respectively. In conclusion, induction chemotherapy plus surgery and postoperative radiotherapy is a treatment modality that is tolerated with encouraging activity and survival outcome in patients with stage IV hypopharyngeal cancer.

Surgery for isolated regional failure in nasopharyngeal carcinoma after radiation: Selective or comprehensive neck dissection.

OBJECTIVE: To compare survival effects of comprehensive neck dissection (CND) and selective neck dissection (SND) for patients with nasopharyngeal carcinoma (NPC) with only regional failure. METHODS: A total of 294 recurrent T0N1-3M0 NPC patients who underwent neck dissection in Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China, between January 1984 and February 2014, were enrolled in the survival and interaction analyses. Using propensity scores to adjust for potential prognostic factors, an additional well-balanced cohort of 210 patients was constructed by matching each patient who received SND with one patient who underwent CND (1:1); the differences were then compared between SND and CND in terms of overall survival (OS), local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), and distant metastasis-free survival (DMFS). RESULTS: Both univariate and multivariate analyses showed that SND was not inferior to CND (P > 0.05) but demonstrated that extracapsular spread (ECS) (hazard ratio [HR] 3.49, 95% confidence interval [CI] 2.30-5.29, P < 0.001), recurrent N stage (rN stage) (HR 1.96, 95% CI 1.29-2.97, P = 0.002), and positive margins (HR 3.67, 95% CI 2.40-5.62, P < 0.001) were independent poor prognostic factors for OS. The interaction effects between the dissection style and each independent factor were not significant for OS, LRFS, RRFS, or DMFS (P > 0.05). Furthermore, no survival differences were found between SND and CND in the case-matched cohort in terms of OS, LRFS, RRFS, or DMFS (P = 0.550, 0.930, 0.214, and 0.146, respectively). CONCLUSION: With a similar radical dissection extent around the tumor rather than dissection of extensive lymph region distal to the lesion, SND is not inferior to CND for patients with NPC with only cervical failure. ECS, rN stage, and positive margins were adverse independent prognostic factors for patients with NPC. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:387-395, 2019.

Trends in clinical features and survival of oral cavity cancer: fifty years of experience with 3,362 consecutive cases from a single institution.

BACKGROUND: Global data demonstrate minimal improvement in the survival rate for oral cavity cancer (OCC) patients. We wished to know whether or not clinical features and survival rate have changed over time for OCC patients receiving initial treatment and follow-up at a large cancer center in China. METHODS: Clinical features and survival data were collected on patients diagnosed during the successive decades of 1960-1969 (n=253), 1970-1979 (n=497), 1980-1989 (n= 659), 1990-1999 (n=793), and 2000-2009 (n=1,160) at the Sun Yat-sen University Cancer Center. RESULTS: Over time, the overall 5-year survival rate for OCC patients was 52.0%. According to tumor localization, this rate was 71.4% for lip cancer, 56.3% for oral tongue cancer, and 42.7% for other parts of the oral cavity. From the 1960s to the 2000s, the 5-year survival rate steadily improved from 47.8% to 55.6% (P<0.001). Survival steadily decreased with age and was higher for women than for men in the 3 most recent decades. The survival rate for male patients was constant over time, while the rate for female patients improved dramatically. Obvious trends in clinical features over time included the following: increasing age of patients, increasing proportions of localized disease at diagnosis, decreasing proportions of diagnoses of lip cancer, decreasing proportions of diagnoses of squamous cell carcinoma, and decreasing proportions of non-surgical treatment approaches. CONCLUSION: The survival rate has steadily improved for OCC patients at this cancer center.

A novel classification system for the evaluation and reconstruction of oral defects following oncological surgery.

Accurate evaluation of oral tissue defects following oncological surgery is necessary for the subsequent reconstruction. However, there is currently no effective classification system for oral defects in the clinical setting. The present study therefore developed a clinical classification system for the evaluation and reconstruction of oral defects. A retrospective cohort study was performed. A two-dimensional classification system based on coronal computed tomography/magnetic resonance imaging was developed and validated by 145 cases with oral defects. Oral defects could be classified into 6 types (I-VI) horizontally and 2 classes (a and b) vertically. The proportion of the various types was as follows: Type I, 35.9%; type II, 21.4%; type III, 23.4%; type IV, 4.8%; type V, 2.1%; and type VI, 12.4%. Among them, 91 cases (62.8%) were class a and 54 cases (37.2%) were class b. Type Ia-Va represented the unilateral 1-5 subsites involving superficial oral defects without mandibular continuity destruction (88 cases, 60.7%). Type Ib-Vb (+M) represented the unilateral 1-5 subsites involving deep oral defects with segmental mandibular continuity destruction (38 cases, 26.2%). Type I-V (+S) represented the unilateral through and through oral defects with cheek skin involvement (10 cases, 6.9%). Type VI represented bilateral oral defects (18 cases, 12.4%). The present classification system for the evaluation of the oral defects was simple and practical, and could identify the common types of oral defects and guide the reconstruction.

Radiation-induced osteosarcoma of the maxilla and mandible after radiotherapy for nasopharyngeal carcinoma.

BACKGROUND: The increasing incidence of radiation-induced osteosarcoma of the maxilla and mandible (RIOSM) has become a significant problem that can limit long-term survival. The purpose of this study was to analyze the association of clinicopathologic characteristics with treatment outcomes and prognostic factors of patients who developed RIOSM after undergoing radiotherapy for nasopharyngeal carcinoma (NPC). METHODS: We reviewed the medical records of 53,760 NPC patients admitted to Sun Yat-sen University Cancer Center during the period August 1964 to August 2012. Of these patients, 47 who developed RISOM and met inclusion criteria were included in this study. Two of these 47 patients refused treatment and were then excluded. RESULTS: For all patients treated for NPC at Sun Yat-sen University Cancer Center during the study period, the total incidence of RIOSM after radiotherapy was 0.084% (47/53,760). Two patients (4.4%) had metastases at the diagnosis of RIOSM. Thirty-nine of the 45 (86.7%) patients underwent surgery for RIOSM; most patients (24/39; 61.5%) who underwent resection had gross clear margins, with 15 patients (38.5%) having either a gross or microscopic positive margin. All patients died. The 1-, 2-, and 3-year overall survival (OS) rates for the entire cohort of 45 patients were 53.3%, 35.6% and 13.5%, respectively. The independent prognostic factors associated with high OS rate were tumor size and treatment type. CONCLUSIONS: RISOM after radiotherapy for NPC is aggressive and often eludes early detection and timely intervention. Surgery combined with postoperative chemotherapy might be an effective treatment to improve patient survival.

A Meta-analysis of Carbon Nanoparticles for Identifying Lymph Nodes and Protecting Parathyroid Glands during Surgery.

OBJECTIVE: To investigate the ability of carbon nanoparticles (CNs) to identify lymph nodes and protect parathyroid glands during thyroid cancer surgery. DATA SOURCES: English and Chinese literature in PubMed, ClinicalTrials.gov, EMBASE, the Cochrane Database of Systematic Reviews, the China Biology Medicine Database, the China Master's and Doctoral Theses Full-Text Database, the China National Knowledge Infrastructure, the WANFANG database, and the Cqvip database (from January 2009 to July 2014). REVIEW METHODS: Studies were included if they were randomized controlled trials or nonrandomized controlled trials for thyroidectomy and central neck dissections that compared the use of CNs with methylene blue or a blank control in patients undergoing initial thyroid cancer surgery. The primary outcomes were the number of retrieved central lymph nodes and the accidental parathyroid removal rate. RESULTS: This meta-analysis identified 11 randomized controlled trials and 4 nonrandomized controlled trials comprising 1055 patients. Compared with the outcomes of the blank controls, the use of CNs resulted in an average of 2.71 more lymph nodes removed per patient (weighted mean difference = 2.71, 95% confidence interval [CI] = 1.68-3.74, P < .001), a 23% lower rate of accidental parathyroid removal (odds ratio = 0.23, 95% CI = 0.10-0.54, P = .0008), and similarly reduced rates of transient hypoparathyroidism and hypocalcemia. Compared with methylene blue, the use of CNs resulted in an average of 1.50 more lymph nodes removed per patient (weighted mean difference = 1.50, 95% CI = 0.11-2.89, P = .03) and a 5% reduction in the rate of accidental parathyroid removal (odds ratio = 0.05, 95% CI = 0.01-0.29, P = .0007). CONCLUSION: CNs partially improve the extent and accuracy of neck dissection and preserve the normal anatomic structure and physiologic function of the parathyroid glands during thyroid cancer surgery.

[Effect of p53 expression in the primary lesion and the surgical margin on the postoperative radiotherapy for laryngeal squamous carcinoma].

OBJECTIVE: To analyze the correlation between prognosis and p53 expression in primary lesion and the surgical margin of laryngeal squamous cell carcinoma (SCC) as an indication of postoperative radiotherapy. METHODS: Sixty-seven laryngeal SCC with pathological negative margin were analyzed retrospectively. Immunohistochemical method was used to detect the expression of p53. RESULTS: The p53 positive rates in the primary tumor and the surgical margin were 19.4% (13/67) and 50.7% (34/67). In p53 positive primary tumor group, the survival rate was higher in patients who received postoperative radiotherapy than those without (60.6% vs 20.0%, P = 0.000 5) and the recurrent rate was just the reverse (42.1% vs 93.3%, P = 0.002), though these differences were not significant in p53 negative primary tumor group (87.5% vs 94.1%, P = 0.409 6; 25.0% vs 5.9%, P = 0.175). The recurrent rate and survival rate between patients with and without postoperative radiotherapy did not show any significant difference either in p53 positive surgical margin group (47.4% vs 20.0%, P = 0.378 1; 62.5% vs 80.0%, P = 1.0) or p53 negative ones (84.9% vs 66.6%, P = 0.074 3; 20.6% vs 40.7%, P = 0.248). CONCLUSION: Postoperative radiotherapy should be given to patients with p53 positive primary laryngeal cancer. But those who are pathologically margin negative but p53 positive should not be taken, at least for the present, as candidates for postoperative radiotherapy.

Reconstruction of Wide-apart Double Defect Using a Branch-based Chimeric Anterolateral Thigh Flap.

SUMMARY: Wide-apart double defect in head and neck region is rare and difficult to reconstruct at one time. Double free flaps are normally used for this scenario and often tedious and technically complicated. This study presented a technique using branch-based anterolateral thigh free flap to simultaneously reconstruct the 2 defects separated wide apart. The concept, indications, surgical technique, and anatomical variations are discussed. Branch-based anterolateral thigh flap is a safe technique and the dissection will be easy when the oblique branch is present.

Sentinel lymph node biopsy versus elective neck dissection in patients with cT1-2N0 oral tongue squamous cell carcinoma.

OBJECTIVE: This study aimed to compare the value of sentinel lymph node biopsy (SLNB) with that of elective neck dissection (END) for the prediction of cervical lymph node metastasis in patients with clinically diagnosed T1-2N0 (cT1-2N0) oral tongue squamous cell carcinoma (OTSCC), and it aimed to examine the prognostic value of individualized treatment in sentinel lymph node (SLN)-negative patients. STUDY DESIGN: The study entailed a retrospective review of 82 patients with cT1-2N0 OTSCC. Thirty patients underwent SLNB, and 52 patients underwent END. RESULTS: There was a significant difference between the SLNB and END groups in the incidence of occult cervical lymph node metastasis in initial specimens (30% vs 11.5%; P = .037). However, there were no significant differences between the groups for 10-year overall and cervical recurrence-free survival rates and 10-year overall survival rate. CONCLUSIONS: SLNB is superior to END for the prediction of cervical lymph node metastasis in patients with cT1-2N0 OTSCC. Neck dissection may be reduced for SLN-negative patients, owing to the comparable prognosis of SLNB.

Notch-1 and Ki-67 receptor as predictors for the recurrence and prognosis of Kimura's disease.

Kimura's disease (KD) is a rare chronic disease with unknown origin. It remains controversial in KD's diagnosis, treatment, transformation and need further research. The aim of this study is to investigate the clinicopathologic features of KD and the relationship between the expression of Notch-1, Ki-67 receptor and the recurrence of KD. The hematoxylin and eosin sections and clinical data of 40 patients diagnosed with KD were examined retrospectively. Specimens were available in these 40 cases. Notch-1 and Ki-67 expression were examined using IHC (immunohistochemistry staining) analysis. Of 40 cases of KD (average age, 38.4 years; median age, 36.0 years), 34 cases (85.0%) were clinically seen to involve swelling of the head and neck region. Notch-1 and Ki-67 have a high expression in recurrent patients. High expression of Notch-1 receptor and Ki-67 tended to be found in patients who relapsed. This is the first study to discuss the correlation among Notch-1, Ki-67 and recurrent KD. These results suggest both of the markers may act as promising predictors for the recurrence and prognosis of KD. However, Notch-1 immunoexpression had no statistically significant association with the Ki-67 proliferation index.

Survival impact of cervical metastasis in squamous cell carcinoma of hard palate.

OBJECTIVE: Evaluate the impact of cervical metastasis on the survival of patients with squamous cell carcinoma (SCC) of the hard palate. METHODS: 155 cases of SCC of the hard palate hospitalized in Cancer Center, Sun Yat-sen University, from 1964 to 2008 were reviewed retrospectively. RESULTS: The 5-year DSS rates for N+ and N0 patients were 21.54% and 47.36% (P = .048). The 5-year DSS rates were 47.36%, 27.48%, 15.55% and 0 for N0-N3 lesions, respectively (P = .041). Cervical metastasis was detected in 40% patients for initial consultation. After therapy, those individuals who presented with clinically negative necks had a 9.03% rate of cervical metastasis. Ultimately, 49.03% of patients manifested disease to the cervical lymph nodes. CONCLUSION: The presence of cervical nodal disease in patients is associated with the decreased survival rates. SCC of the hard palate should be treated aggressively, and elective neck dissection should be considered because of the high rate of cervical metastasis.

Influence of pathologic complete response to neoadjuvant chemotherapy on long-term survival of patients with advanced head and neck squamous cell carcinoma.

OBJECTIVE: The aim of this study was to analyze whether pathologic complete response (PCR) to neoadjuvant chemotherapy (NAC) affected long-term survival in advanced head and neck squamous cell carcinoma (HNSCC) patients. MATERIALS: All patients with advanced HNSCC were previously untreated and underwent NAC followed by surgery. The 5-year overall survival, disease-free survival, local control rate, and reasons for treatment failure were analyzed. RESULTS: A total of 101 cases were included, and the response rate to NAC was 67.3%, including 17 patients (16.8%) who achieved PCR. The 5-year overall survival (OS) of the PCR group (82.4%; histologically complete response group [HCG]) was higher than that of the pathologic incomplete responder group (45.4%; histologically incomplete response group [HICG]) (P = 0.045). No statistically significant difference was noted between the two groups in terms of local recurrence and nodal recurrence, but the local control rate in HCG (88.2%) was higher than that in HICG (62.7%) (P = 0.034). CONCLUSIONS: Achieving PCR could improve locoregional control and long-term survival in patients with advanced HNSCC.

[Fine-needle aspiration with measurement of parathyroid hormone levels in thyroidectomy].

OBJECTIVE: Hypoparathyroidism is one of the most serious complications of thyroidectomy. It is important to identify the parathyroid glands during thyroidectomy. In order to find an economic, simple and less traumatic way to identify the parathyroid glands and testify its feasibility, fine-needle aspiration of suspected parathyroid tissue was used to measure the parathyroid hormone (PTH) levels during the surgical procedure. METHODS: From Nov. 2011 to Apr. 2012, 50 patients were recruited for thyroid surgery in the Sun Yat-sen University Cancer Centre. During surgery, fine-needle aspiration of suspected tissues, including parathyroid gland, thyroid gland, muscle, fat tissue, and lymph node, was performed, the PTH levels were measured. In addition, the tissues above-mentioned were taken to pathological examination. Statistical processing was adopted to determine the sensitivity and specificity of intraoperative fine-needle aspiration with measurement of PTH level in finding the pathology of the parathyroid gland. RESULTS: There were 237 tissues from 50 patients in total, and 45 of them were certified as the parathyroid glands by pathology. Intra-operative PTH (ioPTH) of the tissues in forty-four cases were higher than 600 ng/L, ioPTH of the tissues in one case was lower than 600 ng/L, and it was 160 ng/L. The highest ioPTH in other cases was 537.7 ng/L. The sensitivity was 97.8%. The specificity was 100%. The difference between the sensitivity and the specificity of two groups was not statistically significant, and P > 0.05. The level of PTH of parathyroid gland were much higher than other tissues, and P < 0.001. CONCLUSIONS: The level of ioPTH of parathyroid gland were far higher than thyroid, muscle, fat, lymph node. It is an economic, fast and less traumatic way to identify the parathyroid gland by using the fine-needle aspiration of the parathyroid tissue with measurement of PTH levels. The sensitivity and the specificity are high. It can be used in the thyroidectomy to identify the parathyroid glands.

[Laryngeal reconstruction by complex hyoid bone flap after frontal partial laryngectomy].

OBJECTIVE: The aim of this study was to describe a new technique of combined hyoid bone and thyrohyoid membrane flap in laryngeal reconstruction after tumor resection, and to evaluate outcome. METHODS: Six patients requiring an frontal partial laryngectomy for cancer were enrolled between September 2008 and August 2012. RESULTS: Nasogastric feeding was initiated within 24 hours. The mean times to swallow batter, ability to drink water and removal of the nasogastric tube were 2.6, 5.5 and 6.3 days. All patients had good respiratory function. There were no deaths, and no reports of postoperative dyspnea or dysphagia. The vocal quality was satisfactory, slightly deeper and raspy, and the volume was weak when calling. The final follow-up assessment was in August 2012, and the overall mean follow-up period was 29.5months, range 14 to 47 months. Case two subsequently underwent total laryngectomy for recurrence in the paraglottic space, but there was no evidence of further tumor recurrence at the final assessment. CONCLUSIONS: The combined muscle-pedicle hyoid bone and thyrohyoid membrane flap is a reliable graft for one-stage repair of laryngotracheal defects, providing effective repair of the mucosa and cartilage support. Vocal quality, swallowing function and ventilation after the procedure were favorable.

Immediate reconstruction of maxillectomy defects using anterolateral thigh free flap in patients from a low resource region.

OBJECTIVES/HYPOTHESIS: To report the reliability and reconstructive outcome of using anterolateral thigh (ALT) flap with or without titanium mesh to repair maxillectomy defects in a patient from a low resource region (LRR). STUDY DESIGN: Retrospective review. METHODS: Clinical data of patients with oral-maxillofacial cancers who underwent maxillectomy and reconstruction using ALT flap in two tertiary cancer centers in southern China were retrospectively reviewed. Reconstructive techniques, flap survival, postoperative oral functions, and surgical complications were reported. RESULTS: Apart from one total flap loss, 18 of the 19 free ALT flaps survived. Titanium mesh was used in two patients with total maxillectomy defects. Eighteen of the 19 patients resumed a normal oral diet. Fourteen patients had good speech, except one patient with poor pronunciation, and four patients had average speech. One patient presented with postoperative palatal fistula. No other complications were observed. CONCLUSIONS: The application of ALT flaps with or without titanium mesh to repair maxillectomy defects is straightforward and reliable and has an acceptable reconstructive outcome. It might be a suitable procedure for patients from an LRR.