Sialoendoscopically assisted open sialolithectomy for removal of large submandibular hilar calculi.

PURPOSE: The management of large hilar calculi is a technically challenging issue during sialoendoscopic surgery. The aim of the present study was to evaluate the clinical efficacy of sialoendoscopically assisted open sialolithectomy for the removal of large submandibular hilar calculi to avoid sialoadenectomy. PATIENTS AND METHODS: The present study was undertaken among patients with sialolithiasis scheduled for sialoendoscopic surgery from August 2005 to October 2008. When we failed to remove large submandibular hilar stones intraductally, we performed sialoendoscopically assisted open sialolithectomy. The clinical characteristics, pre- and intraoperative data, and outcomes were documented in a prospective fashion. RESULTS: Of 78 consecutive patients with submandibular sialolithiasis, 18 were treated with sialoendoscopically assisted open sialolithectomy immediately after failure of intraductal removal of calculi by sialoendoscopy. For 17 patients, large hilar sialoliths were successfully removed using this surgical technique. The surgery failed in 1 patient with multiple sialoliths, and the procedure was converted to open sialoadenectomy. Temporary numbness of the tongue for 1 week postoperatively was documented in 3 patients. The patients were followed up for a median period of 18 months without any symptoms or signs of recurrence. CONCLUSION: Our results suggest that sialoendoscopically assisted open sialolithectomy is an effective and safe surgical technique to remove large submandibular hilar calculi.

[Reconstruction of the tongue with lateral arm free flap after hemiglossectomy].

OBJECTIVE: To investigate the value of microsurgical reconstruction of the tongue after hemiglossectomy with lateral arm free flaps in the treatment of tongue cancer. METHODS: From October 2006 to April 2007, ten patients underwent simultaneous reconstruction of the tongue and oral floor defects with lateral arm free flaps after resection of squamous cell carcinoma of tongue in our hospital. The flaps ranged from 8 cm x 5 cm to 9 cm x 6 cm in size, and were adjusted to the defect of the tongue. The vascular pedicle included the posterior radial collateral artery and the accompanying veins. The outcome of reconstruction was evaluated by follow-up examinations, including the contour and mobility of the reconstructed tongue, the swallowing function and the speech function. RESULTS: All patients recovered uneventfully from surgery, without any major postoperative complications. The transplanted flaps survived. During follow-up period the contour of the reconstructed tongues was satisfactory. The patients demonstrated good functional mobility of the reconstructed and remaining tongue. Postoperatively, the swallowing and speech function was nearly at normal levels and the patients could ingest a solid or semisolid diet. CONCLUSIONS: Microvascular reconstruction of the tongue with lateral arm free flaps after hemiglossectomy is an ideal and safe method, but long term results need to be further studied.

[Functional hemitongue reconstruction with free forearm flap].

OBJECTIVE: To investigate the clinical application of free forearm flap in the functional hemitongue reconstruction. METHODS: From July 2002 to November 2006, 40 patients with tongue cancer underwent hemiglossectomy and primary hemitongue reconstruction with free forearm flaps. In some cases, the lateral antebrachial cutaneous nerves of the flaps were anastomosed with the lingual nerve to restore the flap sensation. RESULTS: All patients recovered uneventfully after surgery with no morbidity in the donor site. All free flaps survived. The average follow-up period was 2 years and 6 months. The aesthetic and functional results were both satisfactory. The swallowing and speech function were almost normal. The flap sensation was partially restored. CONCLUSIONS: Good functional hemitongue reconstruction can be achieved with free forearm flaps.