[Possibilities and limitations of palliative surgery in head and neck cancer patients]. / Möglichkeiten und Grenzen der Palliativchirurgie im Kopf-Hals-Bereich.

BACKGROUND: Incurable head and neck cancer causes distressing symptoms that significantly reduce patients' quality of life. OBJECTIVE: The aim of this article is to present the surgical possibilities and their limitations in a palliative setting. MATERIALS AND METHODS: A literature review was performed and supplemented with the authors' own experiences. RESULTS: Smaller endoscopic procedures for tumor debulking or hemostasis are possible to reduce symptoms and improving quality of life, which should be the aim of palliative care. To preserve swallowing function and breathing, the insertion of stents is a feasible alternative to tracheotomy. However, even larger tumor resections with reconstruction by pedicled or free grafts may be justified. CONCLUSION: Especially in the palliative setting, patients and their individual complaints are the primary focus. Therefore, the indications for surgery should be discussed with the patient and his relatives, preferentially interdisciplinarily. Due to considerable progress, particularly in the field of systemic tumor therapy, extended surgical procedures with reconstruction are losing some of their importance in the palliative situation.

[Temporary cricothyrotomy in airway management]. / Passagere Koniotomie im Airway-Management.

BACKGROUND: Extended tumors of the oral cavity, pharynx or larynx can severely compromise the performance of a necessary endotracheal intubation. Both transnasal fiberoptic intubation under spontaneous breathing as well as tracheotomy under local anesthesia require a great deal of cooperation from the awake patient. In cases with dyspnea due to a recurrent tumor the situation is much more difficult. These patients are often in a reduced general condition, show a lack of cooperation and often have postoperative or radiogenic scars of the pharyngeal and laryngeal structures. METHODS AND PATIENTS: In response to these problems cricothyrotomy was performed in 16 selected patients under local anesthesia. Analgesia and sedation had been adapted to the needs of the individual patient. The cricothyrotomy was performed alternately by an anesthesiologist and an ENT surgeon. General anesthesia has been carried out immediately after secured ventilation and oxygenation had been determined. RESULTS: In all patients except one the airway was finally secured by tracheotomy and the larynx incision was closed in all cases. The possibility of conventional intubation was judged retrospectively by the anesthesiologist concerned and was found to be simple in one case and nearly impossible in 10 cases. There were no complications due to the surgical procedure apart from a brief episode of disturbance in wound healing and the potentially life-threatening situation of cannot ventilate-cannot intubate could be avoided. CONCLUSIONS: In selected cases with extended tumors of the upper airway, temporary cricothyrotomy is an effective and convenient procedure to secure the respiratory tract.

[Modification of the microvascular reanastomosed latissimus dorsi flap for reconstruction after extensive maxillary resection]. / Modifikation des mikrovaskulär reanastomosierten Latissimus-dorsi-Lappens zur Rekonstruktion nach erweiterter Oberkieferresektion.

Large defects after extended maxillectomy and orbital exenteration were immediately reconstructed using a modification of the revascularized musculocutaneous latissimus dorsi flap. Three skin islands were transplanted based on the muscular part of the flap. The first island replaced the hard palate, the second the lateral nasal wall and the third was used together with the preserved eyelids to reconstruct an eye socket. The muscular part of the flap was folded spirally so that each skin island reached the site to be reconstructed.