Extirpation of primary malignancies in the pterygopalatine and infratemporal fossa via modified maxillary swing approach / 中华口腔医学杂志

Five patients with primary malignancies in the pterygopalatine fossa (PPF) and infra temporal fossa (ITF) were enrolled in this retrospective study between January 2012 and January 2018. After malignancies proven by biopsy and evaluation with CT and MRI scan, all patients received modified maxillary swing (MMS) approach for extirpation of malignant tumors in the PPF and ITF under general anesthesia. En bloc resection with wide surgical margins was successfully performed in all cases. Negative margins were observed in 4 cases and positive margins were found in one patient with adenoid cystic carcinoma who received postoperative radiotherapy. The most common complication was facial numbness. During the follow-up period (range 12 to 57 months), one patient suffered from recurrence while others did not. The advantages of MMS include wide surgical field, full exposure and easy manipulation. The MMS approach is expected to become an standard method for monobloc resection of malignancies in the PPF and ITF.

[Clinical application of the combined radical operation without breaking lower lip and mandible for tongue and lingual root carcinoma].

OBJECTIVE: To investigate the clinical applicability and outcomes of the combined radical operation without breaking the lower lip and mandible with one-stage reconstruction using free anterolateral thigh flap for tongue and lingual root carcinoma. METHODS: The operation with or without breaking lower lip and mandible was performed respectively in 245 patients (experimental group) and 120 patients (control group). RESULTS: Removal of tumor and neck dissection were conducted successfully in all patients of two groups with no serious postoperative complication. With the follows-up of 6 to 36 months, in the patients of experimental group there was no recurrence for primary sites but 3 cases with neck lymphnode recurrence, the functions of chewing, swallowing and speaking were good, there was no damage to appearance, and no osteoradionecrosis occurred in the lymphnode positive cases after radiotherapy; in the patients of experimental group there was no recurrence for primary sites but 4 cases with neck lymphnode recurrence, the functions of chewing, swallowing and speaking were good, but there was apparent scar in neck and face, and osteoradionecrosis occurred in 11 of lymphnode positive cases. CONCLUSIONS: The combined radical operation without breaking the lower lip and mandible with one-stage reconstruction using free anterolateral thigh flap is feasible for tongue and lingual root carcinoma (T2-T3), which reduces the risk for osteoradionecrosis in lymphnode positive cases after radiotherapy and keeps good appearance for patients.

Modified pectoralis major myocutaneous flap in reconstruction of head and neck defects / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To report the experience of use of modified pectoralis major myocutaneous (PMMC) flaps in reconstruction of head and neck postoperative defects.</p><p><b>METHODS</b>A total of 107 patients who underwent head and neck defect reconstruction using modified PMMC flaps after tumor rescetion between Jan 2008 and Dec 2013 were analyzed retrospectively.</p><p><b>RESULTS</b>The success rate of reconstruction with modified PMMC flaps was 94.4% (101/107). Five patients had partial flap necrosis and their wounds healed with dressing change. One patient (0.9%) had total flap necrosis, followed by the second reconstruction using contralateral PMMC flap.</p><p><b>CONCLUSIONS</b>The modified falcate PMMC flap can obtain optimum quantity of the skin in the chest and decreasing the closing tension of the donnor site in favor of wound healing. The pedicle without muscle will not only maintain the partial function of the pectoralis major, but also help to avoid pressing the vascular pedicle within the subclavian tunnel. The muscular element the pedicled muscles of the PMMC flap can increase the ability of the flap to resist infection, which can use for covering an exposed carotid artery and improving the neck fibrosis of irradiated patients.</p>

Analysis of the causes of flap necrosis after head and neck reconstruction / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the causes of the vascular crisis and necrosis of free flaps used for reconstruction of defects following head and neck cancer resection and the managements of these issues.</p><p><b>METHODS</b>A total of 850 cases with head and neck tumors who underwent free flap reconstruction from October 2010 to April 2014 were studied retrospectively. The risks for vascular crisis and necrosis were analyzed with one-factor analysis and multivariate analysis.</p><p><b>RESULTS</b>The total success rate of 95.1% (808/850) for the free flap reconstruction was obtained. Twelve flaps due to poor blood supply indicated during operation were replaced by other free flaps. Among 73 flaps with vascular crisis, 31 flaps were salvaged by surgical exploration and subcutaneous injection of low molecular heparin calcium. Obesity, smoking, preoperative radiotherapy and surgeon's experience, rather than age, hypertension and diabetes, were the risk factors of skin flap necrosis. Two-vein anastomosis had a higher success rate than one-vein anastomosis.</p><p><b>CONCLUSIONS</b>The necrosis rate of free flaps can be reduced by the choice of suitable flaps, subtly preparation of flaps, carefully vascular anastomosis, and prompt perioperative managements. The two-vein anastomosis is recommended. Diabetes, hypertension and elderly patients are not the contraindications for free flap reconstruction.</p>

Application of improved submental island flap in hypopharyngeal cancer reserved laryngeal function surgery / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#This study aimd to evaluate the application and clinical effect of improved submental island flap in hypopharyngeal cancer reserved laryngeal function surgery.@*METHOD@#A retrospective review of clinical data was performed on 38 patients of hypopharyngeal cancer reserved laryngeal function using sumental island flaps, by the way of improving in design of vascular pedicle, reconstructive mode of laryngeal and hypopharyngeal function and closing of wound of neck following hypopharyngeal cancer resection. Meanwhile, the effect and prognosis was comprehensively assessed on patients with hypopharyngeal cancer reserved laryngeal function using improved submental island flaps.@*RESULT@#The submental flaps kept alive in all 38 cases. During the follow-up period, 18 cases were dead, and of them, 7 cases died of the second primary carcinoma, included 4 cases of esophagus cancer, 1 case of cancer of soft palate, 2 cases of nasopharyngeal carcinoma; and 5 cases died of cervical or parapharyngeal lymph nodes recurrence; 2 cases died of hepatic metastasis; and 4 cases died of pulmonary metastasis. The overall 5-years survival rate was 52.6%.@*CONCLUSION@#Improved submental island flap repairing postoperative defect of hypopharyngeal cancer reserved laryngeal function has many advantages including higher success rate, more security, easy and simple to operate as well as good clinical effects, and is worth to widespread using.

Surgical treatment of tremendous neurogenic tumors in the root of neck / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate surgical treatment outcomes in 6 cases with tremendous neurogenic tumors in the root of neck.</p><p><b>METHODS</b>Neck-chest-axil-arm "T" incision was used to remove huge tumor in the root of neck.</p><p><b>RESULTS</b>The tumors in the root of neck in 6 patients were removed successfully and no serious complication occurred. With postoperative follows-up for 2-6 years(median 4.5 years), only 1 case died due to the recurrence of lesion in vertebral canal in 11 months after surgery and the other cases survived with satisfying therapeutic outcomes.</p><p><b>CONCLUSION</b>Surgery is an effective method to remove advanced tumor in the root of neck and to improve the quality of life for the patients.</p>