[Different surgical management of tumors in the anterior skull base: a report of 10 cases].

OBJECTIVE: To study the different surgical approach for the resection of tumors in the anterior skull base and to introduce an approach of the frontal mid-line incision with the nasal pyramid over-turned downward. METHOD: A review of 10 tumors in the anterior skull base employed unlike operative approach was presented. Of the 10 cases, 6 cases were benign tumors and 4 cases were malignant tumors. Two cases underwent the combined craniofacial approach, 3 cases the subfrontal approach, 3 cases the lateral rhinotomy approach, 2 cases the approach of the frontal mid-line incision with the nasal pyramid over-turned downward. RESULT: All tumors were totally resected. All patients were followed up from 1 to 5 years. In the benign tumors group, 6 cases achieved good results and no recurrence. Of the 4 cases with malignant tumors, 1 cases were followed up 1 year and is alive, 2 cases survived after 3 years and 1 case died after 5 years. Three cases died from local recurrence or invaded intra-cranial. CONCLUSION: According to the site, range and pathology of the skull base tumors, the best operative approach should been selected. The approach of the frontal mid-line incision with the nasal pyramid over-turned downward is closer to tumor and easy to repair duramater, has fine exposure of the anterior skull base, minimal retraction of the frontal lobe, and has better clinically worthy.

[The application of epiglottis and cervical anterior muscle to laryngeal reconstruction].

OBJECTIVE: To evaluate the methods of reconstruction of laryngeal function after the extended laryngectomy. METHODS: The laryngeal functions were reconstructed after the extended laryngectomy performed on 22 cases with the laryngocarcinoma of T2 and T3 stages of glottic type, using epiglottis and cervical anterior muscle to reconstruct the laryngeal cavity and larynx bracket, from September 1998 to October 1999. RESULTS: Twenty cases recovered normal swallow function in 20 days post-operation as well as the entire function of larynx was recovered, and the rate of decannulation was 90.9% (20/22). One case with pharyngeal fistula recovered a month later, but the other case recovered to normal diet by operation repaired. All the patients pronounced clearly and were able to keep the characteristics of their own voice. The fibred laryngoscope examination showed that the sphincter valves were formed at the larynx atrium in all postoperative cases. The rate of 3-year survival for T2 and T3 stages was 100% (9/9) and 92.3% (12/13), respectively. CONCLUSION: The laryngeal cavity could be enlarged and the laryngeal atrium was reconstructed by employing epiglottis ifraplacement and cervical anterior muscle to reduce the tension of epiglottis and minimize the injury of the membrane as well as to overcome the shortcomings of insufficient material if mere employing epiglottis. The application of combined methods to reconstruct the laryngeal cavity is a practical way to restore the larynx function and improve the life quality.

[Surgical management of hypopharyngeal cancer].

OBJECTIVE: To investigate the preservation of laryngeal function for the patients with hypopharyngeal cancer. METHODS: Two hundred and ninety-three cases of hypopharyngeal cancer with surgical management were reviewed retrospectively, and 222 cases were originated from pyriform sinus, 13 from post-cricoid, and 21 from posterior pharyngeal wall. Radiotherapy (37 cases), operation only (56 cases) and the combined treatment (operation plus radiation or chemotherapy, 200 cases) were adopted. 159 cases were treated with function preserved laryngectomy and 97 with total laryngectomy. RESULTS: The 5 year survival rates of patient with laryngeal function preserved and no laryngeal function preserved were 51.3%, 47.6% (for stage III); 40.4%, 43.3% (for stage IV), respectively. There were no significant differences in 5-year survival between the functionally preserved group and no functioned group (P > 0.05). The analysis of survival rates revealed a significant difference between combined therapy and radiotherapy. CONCLUSION: There is no significant difference between the survive rates of function preserved and non-preserved groups. Conservation laryngectomy improves the quality of patient's life, and combined therapy is the best choice for hypopharyngeal cancer.