Neck Tumor Resection Research Articles

Image fusion of thallium-201 SPECT and MR imaging for the assessment of recurrent head and neck tumors following flap reconstructive surgery.

The aim of this study was to assess the value of fused MR and Tl-201 single photon emission computed tomography (SPECT) images in the diagnosis of recurrent head and neck tumors in patients after flap reconstruction surgery. Twenty-four patients after resection of primary head and neck tumors with flap reconstruction were suspected of having recurrent tumor by follow-up MR examination. Both MR examination and Tl-201 SPECT were prospectively performed to produce fused images. For qualitative analysis, two independent readers separately evaluated the existence of tumor recurrence in the fused images. The Tl-201 uptake of the lesion (Tl index) was also quantitatively compared with that of the normal nuchal muscles. Eighteen patients were histologically proved as having recurrence. The remaining 6 patients, false positive on MRI alone, had non-recurrence. Using the fused images, false positive was found in 1 case for one reader and 2 cases for the other reader. The Tl index of recurrent tumors was significantly higher (p < 0.001) than that of non-recurrent mass lesions. In the assessment of recurrent tumors following flap reconstruction surgery in the head and neck, the use of fused MRI and Tl-201 SPECT images can reduce the number of false positives.

Tracheal autotransplantation as a new and reliable technique for the functional treatment of advanced laryngeal cancer.

Tracheal autotransplantation allows for reconstruction of extended hemilaryngectomy defects (including half of the cricoid cartilage) after resection of laryngeal or hypopharyngeal cancer. A series of 38 patients underwent the operation. The technique involved a two-stage procedure (stage 1, tracheal revascularization; stage 2, hemilaryngectomy and tracheal autotransplantation) because the trachea requires at least 2 weeks for revascularization. The objective was to improve the oncological reliability of the procedure by performing a one-stage tumor resection. Five patients who underwent a one-stage tumor resection are presented. They had T2 (n = 3) to T3 (n = 2) N0 laryngeal tumors. Neck dissection, tumor resection, and tracheal revascularization were all performed during the first operation. The radial forearm fascia flap was designed with a distal fascial paddle and a proximal skin paddle. A 4-cm segment of cervical trachea was wrapped with the fascial paddle for revascularization, and the skin paddle was used for temporary closure of the extended hemilaryngectomy defect. The definitive reconstruction consisted of tracheal autotransplantation and was performed 4 months after the first procedure. Medical records were reviewed to determine time to oral intake, time to decannulation, length of hospital stay, and postoperative complications. After the first operation the skin paddle of the radial forearm flap succeeded in a restoration of the sphincteric function. The mean time to oral intake for solids was 9.0 days (SD = 2.6 d) and the mean length of hospital stay was 11.2 days (SD = 2.2 d). All patients were able to speak with the tracheal cannula in place. All laryngeal functions were restored after the second operation. The mean time to oral intake for solids was 8.2 days (SD = 5.2 d). The mean time to oral intake for liquids was 16.6 days (SD = 6.3 d), and the mean length of hospital stay was 9.6 days (SD = 2.3 d). The mean time to closure of the tracheostomy and removal of the gastric tube was 27.0 days (SD = 5.8 d). Tracheal autotransplantation allows for a functional treatment of advanced laryngeal cancers and is compatible with a one-stage tumor resection.

Effects of Nafamostat Mesilate on Hypercytokinemia after Head and Neck Tumor Resection

Effects of Nafamostat Mesilate on Hypercytokinemia after Head and Neck Tumor Resection

Anterior belly of digastric muscle transfer: a useful technique in head and neck surgery.

Permanent loss of the marginal mandibular branch of the facial nerve (MMBFN) may result from an inadvertent injury or an intentional sacrifice during tumor resection. This may occur in isolation or as a part of total facial nerve palsy. The loss of the MMBFN results in paralysis of the depressors of the ipsilateral lower lip with troublesome cosmetic and functional deficits. A series of 14 patients with permanent loss of the MMBFN during resection of head and neck tumors were treated with the anterior belly of digastric muscle transfer (ABDMT). The loss of the MMBFN occurred in isolation in five patients and formed a part of total facial nerve palsy in nine. Immediate reconstruction was performed on nine patients, and it was done as a secondary procedure in the remainder. Two patients in the latter group had prior facial reanimation, although the paralyzed lower lip was not reconstructed. The average follow-up period was 23.2 (range, 3-48) months. Satisfactory results were achieved in all of the patients, although revision of the ABDMT was required in one patient. ABDMT is a simple and reliable reconstructive technique for restoring the depressor function of the lower lip resulting from MMBFN palsy. It is the treatment of choice during primary extirpative surgery for head and neck tumors when the MMBFN requires sacrifice for tumor clearance or is inadvertently injured. The reconstructive options for MMBFN palsy, particularly in the absence of the anterior belly of digastric muscle, are discussed.

Hyoid bone position change after neck dissection for oral cancer: A preliminary report

Purpose: The study goal was to evaluate the change in hyoid bone position after neck dissection and tumor resection for oral cancer. Patients and Methods: Twenty-seven patients who underwent surgery were retrospectively evaluated. The hyoid bone position was measured before and after the surgery using a topogram of computed tomography scans. Results: There was a statistically significant difference in the hyoid bone position between preoperative and postoperative images in anteroposterior direction (Wilcoxon signed rank test, P <.05), but there was no significant difference in the superoinferior direction. The hyoid bone moved anteriorly when the submandibular region was resected. In cases in which the submental region was resected, it was variably displaced depending on the type of suspension or reconstruction of the resected suprahyoid muscles. Conclusion: This limited study suggests that the hyoid bone is displaced after surgery for oral cancer. The hyoid bone was displaced anteriorly if the submandibular region was resected, and it was displaced severely if the submental region was resected. © 2002 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 60:636-641, 2002

Radial forearm and fibula free flap reconstruction after radical resection of head and neck malignancies

The incidence of head and neck cancer has been rapidly increasing in Hungary during the last decade. Most of these tumors are discovered in advanced stage, consequently, surgical removal of the tumor results in large complex defects in the soft tisses and bone elements of the face and neck. For optimal anatomical and functional reconstruction we perform free flap transfer in increasing number of cases. Between December 1993 and March 2001 in the Head and Neck Surgery Department of the National Institute of Oncology the defects after resection of head and neck tumors were reconstructed with free flaps in 85 cases. Radial forearm flap in 64 cases, fibula osteoseptocutaneous flap in 14 cases were used. In 87% of the patients the postoperative period was uneventful, the surgical complications were not more numerous than following traditional reconstructions. The average duration of operations became shorter by 2.5 hours during the last two years than before. In most of the cases we achieved good functional and esthetic results. The quality of life of the patients was excellent in 14%, almost normal in 73% and bad with serious problems of social life in 13%. It is surprising that there was no significant difference between the survival of neck node positive and negative patients. In our practice the replacement of large defects in the head and neck region with free flaps is a reliable and useful method for reconstruction.

頭頚部悪性腫よう摘出後の１期的再建術

頭頚部悪性腫よう摘出後の１期的再建術

ADVANCED SURGICAL TECHNOLOGIES FOR PLASTIC AND RECONSTRUCTIVE SURGERY

Virtual reality creates a simulated world in which the surgeon can practice and plan complex surgical procedures. This simulated world can be especially valuable in head and neck surgery, including congenital craniofacial surgery, facial trauma, and resection and reconstruction of head and neck tumors, whereby the complexity of the anatomy and the difficulty of the problems test the surgeon's abilities. The author presents a brief history of simulations and surgery, a background to plastic surgery simulators, and discuss the problem of limited human body models in past systems. Computer-aided surgery and virtual reality technologies are also reviewed.

Resection of Benign Head and Neck Tumors with an Ultrasonic Surgical Aspirator

Resection of Benign Head and Neck Tumors with an Ultrasonic Surgical Aspirator

Resection of benign head and neck tumors with an ultrasonic surgical aspirator

Otolaryngology–Head and Neck SurgeryVolume 117, Issue 2 p. P191-P191 Original Article Resection of Benign Head and Neck Tumors with an Ultrasonic Surgical Aspirator Jeffery S. Magnuson MD, Jeffery S. Magnuson MD Birmingham, Ala.Search for more papers by this authorBrian J. Wiatrak MD, MD, FAAP, FACS, Brian J. Wiatrak MD, MD, FAAP, FACS Birmingham, Ala.Search for more papers by this authorGlenn E. Peters MD, Glenn E. Peters MD Birmingham, Ala.Search for more papers by this author Jeffery S. Magnuson MD, Jeffery S. Magnuson MD Birmingham, Ala.Search for more papers by this authorBrian J. Wiatrak MD, MD, FAAP, FACS, Brian J. Wiatrak MD, MD, FAAP, FACS Birmingham, Ala.Search for more papers by this authorGlenn E. Peters MD, Glenn E. Peters MD Birmingham, Ala.Search for more papers by this author First published: 01 August 1997 https://doi.org/10.1016/S0194-59989780413-5Read the full textAboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume117, Issue2August 1997Pages P191-P191 RelatedInformation

Prosthetic-Surgical Collaborations In The Rehabilitation Of Patients With Head And Neck Defects

Resection of head and neck tumors often results in severe facial disfigurement and functional disabilities. Superior rehabilitation efforts rely on close collaboration between the resection surgeon, reconstructive surgeon, and the maxillofacial prosthodontist. Trauma patients are best rehabilitated surgically, whereas patients with head and neck tumors are best rehabilitated prosthetically in combination with specific surgical reconstruction procedures. This article describes these modifications. Surgical advancements such as microvascular free flaps and endosseous implants have greatly enhanced rehabilitative efforts.

Cinematographic functional diagnosis of swallowing after plastic reconstruction of large tumor defects of the mouth cavity and pharynx

Reestablishing good swallowing function after resection and reconstruction of head and neck tumors is very important for our patients' well-being. Today many different surgical concepts for reconstruction after tumor surgery are in common use. It is necessary to establish a good diagnostic procedure for postoperative assessment of the swallowing function. High-speed cineradiography at a minimum of 50 frames per second is well established for evaluating swallowing problems in head and neck patients. Thirty-six patients divided into three groups were examined using high speed cineradiography after surgical treatment of pharyngeal and oral cavity cancer. Group 1 (n = 12) included patients with a subtotal or total tongue resection and reconstruction with infrahyoid myofascial flap and jejunal flap; Group II (n = 8), patients with total resection of the oropharynx soft palate and velum and reconstruction with a free radial forearm flap; Group III (n = 15), patients with total laryngopharyngektomy and reconstruction with jejunal flap and siphon and with or without repair of the digastric muscle. Group I: All patients with tongue reconstruction were able to swallow normally from the oral cavity into the pharynx. All patients had normal bolus propulsion because of a good tongue volume and tongue motility. There was only one case of aspiration after total glossectomy with the larynx left in place. All patients could swallow with the head and neck in a normal position. Group II: All patients with reconstruction of the soft palate and velum were able to initiate proper bolus propulsion without nasal regurgitation or rhinolalia aperta. Only one patients suffered from chronic aspiration after hemiresection of the oropharynx and hypopharynx. Group III: All patients with pharynx reconstruction had no problems with bolus transfer through the reconstructed pharynx. Aspiration into the reconstructed pharynx was a major problem for those patients without repair of the digastric muscle (5/8 = 63%). Better results were observed in the patients who underwent repair of the digastric muscle. There was only one case (13%) of aspiration. By using high-speed cineradiography it is possible to make a detailed description of the swallowing function after extensive surgical treatment of pharyngeal and oral cavity cancer. We think that high-speed cineradiography is a very sensitive diagnostic procedure capable of detecting all functional aspects of swallowing. High-speed cineradiography should be one of the standard diagnostic studies performed surgery of the oral cavity and pharynx.

A reappraisal of the platysma myocutaneous island flap: A follow-up study of the functional outcome after reconstruction of the floor of the mouth

The functional results of primary reconstruction of the floor of the mouth after ablative surgery for oral cancer using a platysma myocutaneous island flap are reviewed. Seventeen patients who had simultaneous neck dissection, tumor resection, and reconstruction were evaluated. It appears from this study that primary reconstruction of the floor of the mouth with a platysma flap is not ideal. This is believed to be due partly to the high occurrence of direct, postoperative complications.

Re: Extended Anterior Thigh Flaps for Repair of Massive Cervical Defects Involving Pharyngoesophagus and Skin

"Mosaic" flaps, i.e., connected anteromedial thigh-groin flaps, and connected anterolateral thigh-medial thigh flaps, the pedicles of which are the perforators of the lateral circumflex femoral system, the superficial circumflex iliac vessels, and the perforators from the femoral vessels are used to repair cervical skin defects involving the pharyngoesophagus. Although they appear to be similar to "siamese" flaps, these mosaic flaps are a new concept because they consist of two adjacent flaps that are simultaneously elevated with double pedicles including the lateral circumflex femoral system. The pedicles of the groin or the medial thigh flaps are anastomosed to the muscle branch or the descending branch of the lateral circumflex femoral system, which is the pedicle of the anterior thigh flaps, and the system is joined to a single recipient vessel as a "bridge" flap. The main advantages of these mosaic flaps are (1) they offer single recipient vessels, (2) they offer a larger extension of the vascular territory of a skin flap, and (3) they offer the possibility of creating custom-made composite flaps such as musculocutaneous and osteocutaneous flaps, and (4) the elevation of the flaps simultaneous with head and neck tumor resection is possible. Based on cited cases, it is suggested that mosaic flaps are suitable to use for reconstruction of massive cervical defects involving the cervical skin and the pharyngoesophagus due to recurrent laryngeal carcinomas.

Extended Anterior Thigh Flaps for Repair of Massive Cervical Defects Involving Pharyngoesophagus and Skin: An Introduction to the "Mosaic" Flap Principle

"Mosaic" flaps, i.e., connected anteromedial thigh-groin flaps, and connected anterolateral thigh-medial thigh flaps, the pedicles of which are the perforators of the lateral circumflex femoral system, the superficial circumflex iliac vessels, and the perforators from the femoral vessels are used to repair cervical skin defects involving the pharyngoesophagus. Although they appear to be similar to "siamese" flaps, these mosaic flaps are a new concept because they consist of two adjacent flaps that are simultaneously elevated with double pedicles including the lateral circumflex femoral system. The pedicles of the groin or the medial thigh flaps are anastomosed to the muscle branch or the descending branch of the lateral circumflex femoral system, which is the pedicle of the anterior thigh flaps, and the system is joined to a single recipient vessel as a "bridge" flap. The main advantages of these mosaic flaps are (1) they offer single recipient vessels, (2) they offer a larger extension of the vascular territory of a skin flap, and (3) they offer the possibility of creating custom-made composite flaps such as musculocutaneous and osteocutaneous flaps, and (4) the elevation of the flaps simultaneous with head and neck tumor resection is possible. Based on cited cases, it is suggested that mosaic flaps are suitable to use for reconstruction of massive cervical defects involving the cervical skin and the pharyngoesophagus due to recurrent laryngeal carcinomas.

Parathyroid carcinoma: 50-year experience at The Cleveland Clinic Foundation.

Parathyroid carcinoma is rare, with a reported prevalence of 0.6% to 4.0% in patients presumed to have primary hyperparathyroidism. This study examines the long-term results of surgical therapy and combination chemotherapy. From 1938 to 1988, 1260 operations for primary hyperparathyroidism were performed; only six patients (0.47%) were subsequently found to have parathyroid carcinoma. A seventh patient was referred to our institution after the diagnosis of parathyroid carcinoma had been made. All patients had excessive hypercalcemia (serum calcium concentration > 12.0 mg/dL) with a range of 12.3 to 18.3 mg/dL. Locally recurrent tumors causing recurrent hypercalcemia were managed by repeated neck exploration and tumor resection. Six of the seven patients (85%) survived 5 years, while four patients (57%) survived 10 years. Diagnosis of parathyroid carcinoma rests upon postoperative surveillance of patients who have undergone previous neck exploration and resection of apparently benign adenomas. Long-term survival is possible with repeated resection of locally recurrent tumors.

A reliable reconstruction of the cranial base after the resection of head and neck tumors, using pedicled musculopericranial flaps

A reliable reconstruction of the cranial base after the resection of head and neck tumors, using pedicled musculopericranial flaps

微小血管吻合用スペーサーの臨床応用

The methods for reconstruction with a flap after resection of head and neck tumors have progressed since Bakamjian developed the D-P flap in 1965. During the intervening 21 years, such excellent flaps/organs as stalked muscle flaps, the free forearm flap, and the free jejunum flap have been devised.However, the fast progress of surgical techniques has brought with it a concomitant increase in the difficulty of training clinicians to apply said techniques.Therefore, we developed a spacer for use in performing microsurgical vascular anastomoses. We studied the difficulties involved in using it for patients undergoing oral reconstruction (with a forearm flap) in the treatment of oral cancer.Oral reconstruction by means of angiostomy featurs a free flap that includes anastomosis of the nourishing vessels with the transplanted vessels. This method obviously favors a more successful oral reconstruction than methods that use the conventional D-P flap or various muscle flaps.However, learning the operational technique presents a problem.This spacer is designed specifically for microsurgical vascular anastomoses. It was developed in 1983 at the Department of Head and Neck Surgery of the Cancer Institute Hospital, the 5leading author of this article.We introduced this spacer because it enhances the safety, simplicity, and reliability of microsurgical vascular anastomoses.

Pectoralis Major Musculocutaneous Flap and Splitthickness Skin Graft for The Reconstruction of Pharyngocutaneous Fistula After Total Laryngeal Resection

Background: Pharyngocutaneous fistula (PCF) is the most frequent complication in the early postoperative period after total laryngectomy. Most PCF respond well to conservative management, but when it fails and the fistula persists surgical closure in indicated. Patients and Methods: Sixty-five year-old male was consulted to our division following total laryngectomy by the Ear Nose Throat surgeons, with wound dehiscence and pharyngocutaneous fistula. We performed a pectoralis major musculocutaneous flap (PMMCF) to close the fistula after a failed conservative management. The skin island of PMMCF was used as an inner lining to close the laryngeal fistula, the exteriorized muscle part of the "ap was then covered by skin graft.Results: PMMCF is a technically simple and reliable distant musculocutaneous pedicled flap to cover defect on the neck area. The skin island of the flap provided an adequate air-thight cover and successfully closed the laryngeal fistula.Summary: PCF is a problematic complication resulting from the resection of head and neck tumor. Early diagnosis and proper multidisciplinary management is required to prevent further morbidity. PMMCF is a simple, easy to perform and reliable option for closure of PCF.