Tracheoesophageal fistula and pharyngoesophageal stenosis repair by double skin paddle radial forearm flap.

Tracheoesophageal fistula (TEF) constitutes a rare, but serious complication in laryngectomized patients, usually occurring after radiotherapy. TEF may occur spontaneously or may be due to enlargement of the TEF created for placement of a voice prosthesis. Surgical treatment of TEF can be complex, especially in the presence of a concomitant pharyngoesophageal stenosis (PES), and is associated with a high failure rate. In this article, we describe the surgical reconstruction technique for TEF associated with PES using a double skin paddle fasciocutaneous radial forearm free flap. The key points of this technique consist of correct positioning of the 2 skin paddles in order to reconstruct the anterior pharyngoesophageal wall and posterior tracheal wall, as well as de-epidermization of the intermediate part of the flap, which is then placed in the tracheoesophageal space.

Primary clear cell sarcoma of the tongue and surgical reconstruction: About a rare case report.

Clear cell sarcomas (SCC), also called "soft-tissue melanoma", are rare and aggressive tumors that preferentially affect the lower limbs (tendons and fasciae) and which have also been described in head and neck localizations. Their clinical and immunohistochemical mimicry with melanoma makes it difficult to diagnose sarcomas. SCC treatment is mainly focused on large-scale resection surgery with adjuvant radiotherapy because of their low chemo-sensitivity and extreme lymphophilia. In case of head and neck localization, these treatments may lead to function and aesthetic sequelae thus requiring the use of modern techniques of reconstructive surgery. The authors describe the diagnosis, treatment and follow-up of large lingual SCC case using a DIEP free flap reconstruction according to an original technique developed in the department. Given the characteristics of patients with SCC (a high proportion of women between 20 and 40 years old) and its inherent qualities (low morbidity of the donor site, volume delivered and excellent plasticity), the fascio-cutaneous free flap type "DIEP" "taken according to the design of the" Cathedral triptych seems to be a viable choice among the range of reconstruction solutions.

Ambulatory surgery for primary hyperparathyroidism: A 67-case series.

INTRODUCTION: Surgery for primary hyperparathyroidism, targeted by ultrasound and scintigraphy, satisfies the theoretical criteria allowing ambulatory surgery. The purpose of this study was to validate this strategy on a homogeneous case series assessed by this imaging strategy. MATERIAL AND METHODS: All patients operated for primary hyperparathyroidism by ambulatory surgery from 01/01/13 to 30/04/15 were included in this retrospective study. The usual endpoints of ambulatory surgery were evaluated. RESULTS: A total of 144 patients were operated for primary hyperparathyroidism during the study period. Ambulatory surgery was possible in 67 patients, who all had a preoperative diagnosis of parathyroid adenoma. All patients were assessed by ultrasound and 66 patients were assessed by sestamibi scintigraphy, resulting in targeted unilateral neck surgery in 98.5% of cases. Two patients had to be hospitalised overnight due to minor complications. CONCLUSION: Surgery for primary hyperparathyroidism can be performed with short operating times in carefully selected patients with a low complication rate, thereby allowing ambulatory surgery.

Virtual planning and guided surgery in fibular free-flap mandibular reconstruction: A 29-case series.

INTRODUCTION: Virtual planning and guided surgery (VPGS) has been recently developed for mandibular reconstruction, but benefit remains to be assessed. The aim of this study was to analyze the impact of VPGS on operative time and postoperative course. MATERIAL AND METHODS: All patients who underwent fibula free-flap mandibular reconstruction between 2013 and 2014 in our institution were included in a retrospective study. Operative times and postoperative course were compared between patients who underwent conventional surgery in 2013 and those who underwent VPGS in 2014. RESULTS: A total of 29 patients were included: 11 in 2013 and 18 in 2014. Taking all types of mandibular defect together, ischemia time was significantly decreased by VPGS (75min, vs 150min for conventional surgery; P<0.001), whereas overall operative time was not significantly reduced (481 and 516min, respectively; P=0.4). VPGS had no impact on postoperative course: local or general complications, time to decannulation and nasogastric tube removal, or length of stay. CONCLUSION: VPGS significantly reduced fibula free-flap ischemia time. Long-term functional and esthetic benefit remains to be evaluated.

Spontaneous intra-parotid pseudoaneurysm of the external carotid artery.

INTRODUCTION: The authors report a case of spontaneous intra-parotid pseudoaneurysm of the external carotid artery, never previously described in the literature. CASE REPORT: A 59-year-old woman presented with a palpable, non-pulsatile, 2 cm retromandibular left parotid mass with no triggering factors. This mass was considered to be a mixed tumour, although it did not present the typical features on MRI. At surgery, the lesion in the lower pole of the parotid gland was found to be pulsatile, in favour of pseudoaneurysm of the external carotid artery. The external carotid artery was ligated to remove the lesion. Definitive histological examination confirmed the diagnosis of pseudoaneurysm. DISCUSSION: Pseudoaneurysms of extracranial arteries are rare, most commonly involve the internal carotid artery and are essentially secondary to trauma. Review of MRI images demonstrated hyperintense arterial blood flow within the hypointense mass on T2-weighted sequences. The presence of this sign must therefore be investigated in the context of atypical images of a parotid mass. Although rare, and despite the absence of trauma, the diagnosis of pseudoaneurysm of the external carotid artery or one of its branches should therefore be considered in the presence of an atypical parotid mass.