Unilateral Neck Dissection Research Articles

Extent of central neck dissection among thyroid cancer surgeons: Cross-sectional analysis.

It is unclear if surgeons are performing comprehensive central neck dissections for well-differentiated thyroid cancer. The purpose of this study was to determine mean lymph node retrieval in central neck dissection as well as variability across surgeons and institutions. A prospectively collected database identified 18 surgeons performing 425 central neck dissections, 313 unilateral and 112 bilateral. Demographics, perioperative, and pathologic factors were analyzed. Mean lymph node yield was 7.4 and 11.9 for unilateral and bilateral central neck dissection, respectively. Although 224 central neck dissections were prophylactic, both total and pathologic lymph node yields were significantly higher in therapeutic central neck dissection. There was a significant variation in lymph node yield across individual surgeons, institutions, and regions. High-volume central neck dissection surgeons have significantly lower lymph node yield compared to low-volume surgeons. Central neck dissection seems to be performed adequately; however, there is a significant variation in lymph node yield. Future initiatives should try to standardize the central neck dissections performed, with emphasis on obtaining a sufficient yield. © 2015 Wiley Periodicals, Inc. Head Neck 38: E328-E332, 2016.

Prognostic value of level IV metastases from head and neck squamous cell carcinoma

The purpose of this study was to evaluate the prognostic value of level IV metastases in head and neck squamous cell carcinoma (HNSCC). The clinical and histopathological data of 111 patients with HNSCC with pN+ neck who underwent a primary tumor resection with unilateral or bilateral neck dissection were analyzed. Level IV metastases were histopathologically proven in 33 patients (29.7%). Pulmonary metastases were observed in 12 of 33 patients (36.4%) with level IV metastases, and in 13 of 78 patients (16.7%) without level IV metastases (p = .04). Multivariate analyzes revealed a significant association between level IV metastases and pulmonary metastases (p = .038). However, an influence on overall (p = .65) or disease-free survival (p = .66) was not observed. Level IV metastases seem to be a predictive factor for pulmonary metastases but not for overall and disease-free survival in patients with HNSCC.

Application of CT angiography in design of anterolateral thigh perforator flap for reconstruction of defect after head and neck cancer resection

To evaluate the benefits of CT angiography (CTA) in preoperative mapping of anterolateral thigh perforator flap (ALTPF) for reconstruction of defect after head and neck cancer resection. Twenty-four patients underwent reconstruction of postoperative defect with ALTPF from March 2011 to March 2014 were retrospectively reviewed. According to the imaging methods used for examining perforating artery, these patients were divided into two groups: color Doppler flow imaging (CDFI)-group and CTA-group, 12 patients in each group. The surgical results of all patients were evaluated for consistency in number of perforating artery, operation time and flap-related complications. Only one of all patients had complete flap necrosis, with an overall flap survival rate of 95.83%. All perforating branches showed with preoperative CTA were found in operation (12/12), significantly higher than CDFI-group (8/12). The mean operation time of CTA-group was significantly shorter than that of CDFI-group (Unilateral neck dissection: (6.80±0.53) vs (8.39±0.75) h, bilateral neck dissection: (8.79±0.97) vs (10.96±0.26) h, both P<0.05). Flap-related complication occurred in one case in CTA-group, but in 5 cases in CDFI-group. CTA can accurately provide anatomical information of perforator vessels and guide preoperative design of ALTPF to improve operative outcomes, including the decrease in operation time and surgical injury.

Papiller tiroid kanserinde santral ve lateral lenf nodu metastazı gelişimine etkili klinikopatolojik faktörler

Objective: Regional lymph node metastases are common in papillary thyroid cancer. In this study we aimed to evaluate the factors affecting central and lateral neck lymph node metastasis in patients with papillary thyroid cancer. Material and Method: The clinical and pathological findings of 32 patients with papillary thyroid cancer who had undergone total thyroidectomy plus central and lateral compartment dissection were retrospectively analyzed between March 2012 and December 2013. The affect of age, gender, T stage, extrathyroidal extension, multifocality and lymphovascular invasion on central and lateral lymph node metastasis were evaluated. Results: 12 of patients underwent total thyroidectomy and unilateral central neck dissection, 20 of patients underwent total thyroidectomy and bilateral central neck dissection. 12 of them underwent additional therapeutic unilateral lateral neck dissection. T stage was T1:23, T2:6, T3:3. In twenty patients (62.5%) lymphovascular invasion, in 22 patients (68.5%) multifocality, in 16 patients (50%) extrathyroidal extension were identified. Central lymph node metastasis on 19 of 32 patients (59.4%) and lateral metastasis on 9 of 32 patients (28.1%) were identified. Central neck lymph node metastases were significantly higher in patients with extrathyroidal extention (p

Papillary Thyroid Carcinoma in Children and Adolescents: Long-Term Follow-Up and Clinical Characteristics.

The aim of this study was to analyze the clinical features and clinical outcomes of papillary thyroid carcinoma (PTC) in the pediatric and adolescent population treated in our institution. The subjects were 227 PTC patients 20 years of age or under treated initially between 1979 and 2012. Their mean age at diagnosis was 18-year old (range 7-20 years). Patient characteristics and outcomes in the period before 1999 and the period after 2000 were compared. Cause-specific survival (CSS) rates and disease-free survival (DFS) rates were calculated by the Kaplan-Meier method. Two patients died of their disease and 45 patients had recurrent disease (36 in lymph node, seven in a remnant thyroid, and 11 in the form of distant metastasis). The 10-, 20-, and 30-CSS rates were 99.3, 99.3, and 96.5%, respectively, and the 10-, 20-, and 30-DFS were 83.6, 70.7, and 64.0%, respectively. Gender and preoperative lymph node metastasis were identified as significant factors related to DFS in the multivariate analysis. After the year 2000, there were significantly more patients with a small primary tumor size, significantly more patients without distant metastasis at presentation and significantly more patients without extrathyroidal invasion. The number of patients with advanced cancer has been declining in recent years. Lobectomy with prophylactic unilateral central neck dissection is considered acceptable for patients without the risk factors for recurrence.

Selective Neck Dissection (IIa, III): A Rational Replacement for Extended Supraomohyoid Neck Dissection in Patients with N0 Supraglottic and Glottic Squamous Cell Carcinoma.

OBJECTIVESTo evaluate the effectiveness of selective neck dissection of sublevel IIa and level III in cases of glottis and supraglottic laryngeal carcinoma in the absence of lymph node metastasis and to show if there is value in dissecting the sublevel IIb or level IV in these cases.PATIENTS AND METHODSTwenty-five patients with N0 glottic or supraglottic cancer were subjected to unilateral or bilateral selective neck dissection according to the site and the extent of the tumor, and the specimens were histopathologically examined for metastasis.RESULTSTwenty-five patients (23 males and 2 females) with mean age of 55.72 years were included in the study. Lymph node metastasis to sublevel IIa and level III was found in 6/25 (24%) cases with glottic or supraglottic carcinoma, while to sublevel IIb and level IV was found in 1/25 (4%) with P-value of 0.05, which is statistically significant.CONCLUSIONSelective neck dissection of level IIb is not required in cases of the supraglottic laryngeal cancer. Dissection of sublevel IIa and level III takes less time and is effective. Dissection of level IV is not needed in the case of supraglottic cancer.

Increasing Thyroid Cancer Rate and the Extent of Thyroid Surgery in Korea

BackgroundIt is evident that the rate of thyroid cancer is increasing throughout the world. One reason is increased detection of preclinical small cancers. However, it is not clear whether the increase in thyroid cancer rate is reducing the extent of thyroid surgeries. The purpose of this study was to evaluate the thyroid cancer rate and analyze recent changes in the extent of thyroid cancer surgeries in Korea.MethodsAn observational study was conducted using data from Korea’s Health Insurance Review and Assessment Service (HIRAS) for thyroidectomy with/without neck dissection, with 228,051 registered patients between 2007 and 2011. Data were categorized by the extent of surgery: unilateral thyroidectomy without neck dissection (UT), bilateral thyroidectomy or radical thyroidectomy without neck dissection (TT), any thyroidectomy with unilateral selective neck dissection (SND), any thyroidectomy with unilateral modified radical neck dissection (MRND), any thyroidectomy with unilateral radical neck dissection (RND), and any thyroidectomy with bilateral neck dissection (BND). Annual rate difference for each surgery was analyzed with a linear by linear association.ResultsThe absolute numbers of total thyroid surgeries (UT+TT+SND+MRND+RND+BND) were increased from 28539 to 61481. The proportion of patients who underwent only thyroidectomy without neck dissection (UT+TT) decreased from 67.30% to 60.50%, whereas the proportion of patients who underwent neck dissection (SND+MRND+RND+BND) increased from 32.70% to 39.50% during the 5-year study period.ConclusionDespite the increase in rate of thyroid cancer due to earlier detection, increased rate of neck dissection was noted.

Analyses of functional and oncologic outcomes following supracricoid partial laryngectomy.

To review the functional and oncologic outcomes of patients who received supracricoid partial laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP) or cricohyoidopexy (CHP) in our institution. A total of 208 patients who received SCPL with CHEP or CHP from our institution from 1995 to 2007 were involved. Among them, 190 cases were patients with squamous cell carcinoma of the larynx (T1-T4, N0-N2), 14 cases were patients with recurrent larynx cancer and 4 cases were patients with laryngeal stenosis. Forty-four patients also received unilateral neck dissection, and 41 patients received a bilateral neck dissection. All patients were assessed at functional outcome and complications of their treatment. Also, the oncologic outcomes, such as disease-specific survival, total survival, and local recurrence, were measured for patients with tumor. Decannulation was achieved in nearly all patients, with the average time to decannulation being 20 ± 11.52 days in CHEP patients and 28 ± 8.92 days in CHP patients (P < 0.05). The average nasogastric tubes were removed, days postoperation, was 18 ± 7.39 days in CHEP patients and 25 ± 13.87 days in CHP patients (P < 0.05). The 5-year local recurrence rate was 5.77%, the 5-year disease-specific survival was 82.7%, and the 5-year overall survival was 84.1%. The patients with CHEP had a better recovery than the patients with CHP. SCPL was a well-tolerated procedure with generally good functional outcomes for patients with advanced laryngeal cancer, also for some patients with laryngeal stenosis.

PET‐CT for Detecting Nodal Metastasis in cN0 Early‐Stage Oral Cavity Squamous Cell Carcinoma

Objectives: To determine if positron emission tomography (PET)-computed tomography (CT) offers any diagnostic advantage over traditional CT neck in assessing the clinically N0 neck in patients with T1 and T2 squamous cell carcinoma (SCC) of the oral cavity. Methods: We performed a retrospective review of patients in the Alberta Cancer Registry who were diagnosed with cT1 or T2N0M0 disease who underwent elective unilateral or bilateral neck dissections. Results of preoperative PET-CT and CT necks were reviewed for number of “suspicious” lymph nodes. Surgical pathology reports were reviewed to obtain the total number of nodes sampled and number of malignant nodes. Results: Between 2009 and 2011, 148 patients were diagnosed with cT1 or T2N0M0 SCC of the oral cavity. Of these, 62 patients underwent elective neck dissections. Fourteen patients underwent preoperative PET-CT while 48 patients underwent CT neck alone. Based on final surgical pathology, 6 nodes out of 499 nodes sampled were falsely fludeoxyglucose-avid in the PET-CT group while 3 nodes out of 1800 were falsely identified as suspicious on CT neck alone. The overall false positive rate of PET-CT was significantly higher than CT alone (1.2% vs 0.2%, P &lt; .001). Both modalities had excellent specificity of &gt;98% for benign nodes in these patients. Conclusions: In patients with cT1 and T2 of the oral cavity and no palpable lymphadenopathy, PET-CT is no better than CT alone for ruling out nodal metastasis and may have a higher false positive rate.

Routine prophylactic central neck dissection for low-risk papillary thyroid cancer is not cost-effective.

The role of routine prophylactic central neck dissection (CND) in papillary thyroid cancer (PTC) remains controversial. The aim of this study was to evaluate the cost utility of the addition of routine CND in patients with low-risk PTC compared with total thyroidectomy (TT) alone. A Markov model for low-risk PTC was constructed with a treatment algorithm based on the American Thyroid Association guidelines for well-differentiated thyroid carcinoma. Utilities and outcome probabilities were derived from published medical literature. US 2010 costs were examined from a society perspective using Medicare reimbursement rates and opportunity loss based on published US government data. Monte Carlo simulation and sensitivity analysis were used to examine the uncertainty of probability, cost and utility estimates. Initial TT alone is more cost-effective than TT with CND, resulting in a cost savings of US $5763 per patient with slightly higher effectiveness per patient (0·03 QALY) for a cost savings of $285 per QALY. Sensitivity analysis shows that TT alone offers no advantage when radioactive iodine (RAI) becomes more detrimental to a patient's state of health, when the incidence of non-neck recurrence increases above 5% in patients undergoing TT alone or decreases below 3·9% in patients undergoing TT with CND or when the rate of permanent hypocalcaemia rises above 4%. TT with CND is not a cost-effective strategy in low-risk PTC. Initial TT alone is favourable because of the low complication rates and low recurrence rates associated with the initial surgery. Alternative strategies such as unilateral prophylactic neck dissection require additional study to assess their cost-effectiveness.

A systematic review and meta-analysis comparing outcomes between robotic-assisted thyroidectomy and non-robotic endoscopic thyroidectomy

BackgroundDespite its feasibility, using the da Vinci robot in remote-access thyroidectomy remains controversial. This meta-analysis compared surgical and oncological outcomes between robotic-assisted thyroidectomy (RT) and non-robotic endoscopic thyroidectomy (ET). MethodsA systematic review was performed to identify studies comparing outcomes between RT and ET. Outcomes included operating time, drain output, complications, number of central lymph nodes retrieved, and preablation stimulated thyroglobulin level. A random-effects model was used. ResultsSix studies were eligible. Of the 3510 patients, 2167 (61.7%) underwent RT whereas 1343 (38.3%) underwent ET. Despite a higher drain output (185.8 mLs versus 173.3 mLs, P = 0.019), RT had fewer temporary recurrent laryngeal nerve injury (2.6% versus 3.3%, P = 0.035) and shorter length of hospital stay (3.4 d versus 3.5 d, P = 0.030). In terms of oncological outcomes, despite higher incidence of multicentricity and larger tumors, the number of central lymph nodes retrieved during unilateral central neck dissection in RT was significantly greater than ET (4.5 ± 2.6 and 3.4 ± 2.5, P < 0.001) whereas the preablation stimulated thyroglobulin was comparable (0.8 ng/mL versus 1.1 ng/mL, P = 0.456). However, follow-up data were relatively scarce. ConclusionsAdding the robot in remote-access thyroidectomy was associated with a significantly lower risk of temporary recurrent laryngeal nerve injury and shorter length of hospital stay. However, despite achieving a comparable level of surgical completeness for low-risk differentiated thyroid carcinoma between RT and ET, this study highlighted the limitations with the current literature and the need for more prospective studies with adequate follow-up.

Measurement of the trapezius muscle volume: A new assessment strategy of shoulder dysfunction after neck dissection for the treatment of head and neck cancers

The purpose of this study was to determine the actual degree of shoulder muscle change and its relation to symptoms after neck dissection for head and neck cancers. Forty-two patients who underwent unilateral neck dissection were selected. Data obtained from each subject were trapezius muscle volume ratio and a Shoulder Disability Questionnaire (SDQ) score. Patients who had undergone neck dissection with spinal accessory nerve (SAN) preservation were compared with those who had received radical neck dissection. The preservation group was further separated into subgroups by the extent of neck dissection. Trapezius muscle volume ratio was higher and SDQ score was significantly lower in the SAN preservation group compared to the radical neck dissection group. However, the SAN preservation subgroups did not differ from each other. In addition, a good correlation between the muscle volume ratio and SDQ score was observed. With trapezius muscle volume ratio, clinicians may be able to diagnose shoulder dysfunction after neck dissection. Further research on the subject is warranted. This suggests a novel strategy for assessing the degree of shoulder dysfunction.

Outcome of transoral robotic surgery for stage I–II oropharyngeal cancer

Traditionally T1-2N0 oropharyngeal carcinoma is treated with a single treatment modality, being either radiotherapy or surgery. Currently, minimally invasive surgery, such as transoral robotic surgery (TORS), is gaining popularity. The aim of this study is to assess whether T1-2N0 oropharyngeal cancer can be safely and effectively resected with TORS, and to determine the oncologic and functional outcomes. In addition, the long-term quality-of-life outcomes are reported. Between 2007 and 2012, 18 patients with early stage oropharyngeal cancers underwent transoral resection with the da Vinci robot system in the Netherlands Cancer Institute. All surviving patients filled out the self-report assessments of quality-of-life questionnaires. Median robot-assisted operating time was 115 min (range 43-186 min), while median estimated blood loss was 5 ml (range 0-125 ml). In three cases the exposure was insufficient to obtain clear tumor margins because of tumor extension and local anatomy. Fourteen patients had clear surgical margins. Four patients received adjuvant radiotherapy. Nine patients underwent an elective unilateral neck dissection. The oropharyngeal cancer recurred in two patients. Regarding the quality of life, patients who needed postoperative radiotherapy had a worse outcome and patients treated with transoral resection only did quite well. TORS seems to be an oncologically safe surgical treatment for early stage T1-2N0 oropharyngeal cancer based on this relatively small group of patients. Selecting patients in whom sufficient surgical exposure can be obtained, should be performed with the greatest care to avoid the need for adjuvant radiotherapy. Comparing radiotherapy and TORS or CO2 laser should be the next step in finding the optimal treatment for patients with T1-2N0 oropharyngeal carcinoma.

The Relationship between the Localization, Size, Stage and Histopathology of the Primary Laryngeal Tumor with Neck Metastasis.

In this study we aimed the investigate the laryngectomy (partial and total) and neck dissection (functional, radical) in patients undergoing larynx identified as a result of the operation of primary tumour localization, size, stage and histopathology of the relationship between neck metastasis. The files of 118 patients who has had operation of laryngectomy (partly, total) and neck dissection (functional, radical) because of larynx cancer in the Ear Nose and Throat (ENT) Clinic in the last ten years (1997-2007) have been evaluated retrospectively. 116 of them were male and 2 of them were female. Age average was 56+/-22. 189 neck dissections have been applied to 118 patients. While in supraglottic tumours, 55.2% cervical metastasis and 28.9% occult metastasis have been determined, in transglottic tumours 35.1% cervical metastasis and 18.9% occult metastasis have been determined. It has been seen that while the cervical metastasis ratio of tumours bigger than 4 cm is 55.8%, the tumours smaller than 4 cm is 27.27% (p=0.002). The cervical metastasis rate has been determined as 26.3% in T1 cases, 25.8% in T2 cases, 40.6% in T3 cases and 58.3% in T4 cases. In tumours with advanced T stage, the rate of cervical metastasis has been seen more than the ones with early T stage (p=0.027). Cervical metastasis has been determined as 27.3% in good differential (G1) tumours, 53.4% in medium differential (G2) tumours, and 74.1% in bad differential (G3) tumours (p=0.005). Considered in the light of clinical parameters specified in the cervical lymph node metastasis, N0 patients with laryngeal cancer, tumour, according to the anatomical location as unilateral or bilateral elective neck dissection should be performed and histopathological specimens taken in the event of a positive detection of metastases concluded that postoperative radiotherapy should be performed.

Response to “Sentinel lymph node biopsy versus elective neck dissection in patients with cT1-2N0 oral tongue squamous cell carcinoma”

Objective This study aimed to compare the value of sentinel lymph node biopsy (SLNB) with that of elective neck dissection (END) for the prediction of cervical lymph node metastasis in patients with clinically diagnosed T1-2N0 (cT1-2N0) oral tongue squamous cell carcinoma (OTSCC), and it aimed to examine the prognostic value of individualized treatment in sentinel lymph node (SLN)-negative patients. Study Design The study entailed a retrospective review of 82 patients with cT1-2N0 OTSCC. Thirty patients underwent SLNB, and 52 patients underwent END. Results There was a significant difference between the SLNB and END groups in the incidence of occult cervical lymph node metastasis in initial specimens (30% vs 11.5%; P = .037). However, there were no significant differences between the groups for 10-year overall and cervical recurrence-free survival rates and 10-year overall survival rate. Conclusions SLNB is superior to END for the prediction of cervical lymph node metastasis in patients with cT1-2N0 OTSCC. Neck dissection may be reduced for SLN-negative patients, owing to the comparable prognosis of SLNB.

Eyelid Lymphedema Following Neck Dissection and Radiotherapy

Chronic eyelid lymphedema following neck dissection and radiotherapy is rare with 1 report in the literature. The authors report 3 cases and review the literature. Two cases had bilateral neck dissection and developed bilateral eyelid lymphedema and 1 case had unilateral neck dissection (left side) and developed ipsilateral lymphedema. Two patients underwent surgical debulking of lymphedema with significant improvement in symptoms. One patient declined surgical intervention, and the lymphedema remained unchanged. Chronic eyelid lymphedema following neck dissection and radiotherapy occurs where predominant lymphatic drainage to the submandibular and deep cervical lymph node basin is removed. Lymphedema tends to persist when it occurs and in selected cases appearance can be effectively improved by debulking and excision of festoons.

Treatments of oropharyngeal anterior wall cancer by transhyoid surgery radiotherapy

To evaluate the transhyoid resection of oropharyngeal anterior wall cancer and oncological outcomes of the surgery combined with radiotherapy. A total of 24 cases with carcinoma located in the anterior wall of oropharynx was reviewed. The TNM stages were as follows: T2 in 7 cases, T3 in 2 cases, T4 in 15 cases; NO in 7 cases, N1 in 4 cases, N2 in 12 cases and N3 in 1 case. Tumor resection was performed via transhyoid approach, including 9 cases with partial glossectomy + partial laryngectomy, 7 cases with partial glossectomy + total laryngectomy, 7 cases with total glossectomy + partial laryngectomy and 1 case with partial glossectomy alone pectoralis major myocutaneous flaps were applied to repair synchronously the defects of tongue and lateral pharyngeal wall in 16 cases and the defect of cervical skin in 1 case. Radial forearm free flap and sternohyoid myocutaneous flap were used to repair the defect of tongue and lateral and posterior pharyngeal wall in 1 case. Sternohyoid myocutaneous flap was applied to reconstruct the tongue base in 2 cases. Bilateral and unilateral neck dissections were performed in 20 cases and 4 cases respectively. Five cases received preoperative radiotherapy and 16 cases received postoperative radiotherapy. All cases had negative surgical margin. Pathological examination showed neck lymph metastasis in 17 cases (70.8%). Three patients had postoperative pharyngocutaneous fistula. Two of them who underwent partial glossectomy + total laryngectomy and pectoralis major myocutaneous flaps synchronously reconstruction suffered from pharyngocutaneous fistula 4 days after operation. The fistula was closed by re-suturation following debridement and 2 weeks dressing change. The other one who underwent partial glossectomy + partial laryngectomy suffered from pharyngocutaneous fistula during postoperation radiotherapy and healed by the pectoralis major myocutaneous repair. Tracheostomy tubes were removed within 1-6 months, with good voice and swallowing functions, in 16 of 17 cases who underwent partial laryngectomy. Another one failed to pull out tracheotomy tube because of dyspnea. Twenty one cases were followed up over 3 years and Kaplan-Meier survival analysis showed the 3-year overall survival rate was 72.6%. The transhyoid tumor resection is an effective surgical approach for oropharyngeal anterior wall cancer. The defect following tumor resection is commonly need repair synchronously with various flaps. Acceptable outcome could be received by surgery combined with radiotherapy.

En bloc resection of epiglottic tumors with transoral robotic approach - preliminary results

This study aimed to identify whether it would be possible to excise epiglottic laryngeal tumors en bloc with a transoral robotic approach (TORS), ensuring that basic principles of oncologic surgery are followed. TORS was performed on three patients at Umraniye Education and Research Hospital. All patients had T1 epiglottic tumors. Unilateral neck dissections were performed for node-positive patients (n = 2). Postoperative radiotherapy was administered to these two patients. None of the patients had positive surgical margins. The follow-up period on average was 14 months, no recurrences were observed in this follow-up period. Normal food intake was possible in all cases. Tracheostomy was not performed on any patient. No postoperative complications were observed. These preliminary results indicate that application of the da Vinci robotic surgical system for en bloc resection of supraglottic partial cancers is technically feasible and safe, with satisfactory oncological outcome and postoperative laryngeal function.

PP182: 17 Years – Reconstruction of mandible with microvascular fibula flap and extension of surface contact through stumps fenestration of the posterior surface of the fibula: Variable VI

Resection of face’s tumors which involve the face of the maxilla and mandible has left major sequelae. Objective To demonstrate a new technique of reconstruction with the Microvascular fibula flap in mandibular body. Method Study describes a new variation of the technique of reconstruction of the mandible with the microvascular fibula flap by increasing the contact surface between the remaining stump and the bone graft from the fibula in the region of the mandibular angle, which facilitates bone formation.The proposed technique used the osteomyocutaneous microvascular flap from the fibula to reconstruct the mandible. We performed a fenestration in the cortical surface of the end of the fibula, and another in the thickness and width of the ascending branch which is the remainder of the mandible. The ascending branch of the mandible was introduced in the fenestration and fixed with two titanium miniplates and screws respecting the anatomy of the jaws.The external surface of the anterior mandible was accomplished niche compatible with the width and thickness graft of the fibula, which was introduced at the end prepared (1.5 cm in the niche of the remaining stump of the jaw) and fixed with two miniplates and screws. The patient JMK (Erasto Gaertner Oncology Hospital) male, 43 years, caucasian, clinical examination showed an ulcerated lesion infiltrating and floor of mouth and body of the mandible to the left of midline, with histopathological report of squamous cell carcinoma. After submission to pelveglossomandibulectomia and unilateral neck dissection with immediate reconstruction. Results using panoramic radiographs and clinical evaluation, and 10 months after surgery showed function, aesthetics and anatomy of the jaw was restored and released to oral rehabilitation with dental implants. Conclusion It is believed that the described technique can contribute to the return of the function, anatomy of the jaw, conversation and aesthetics.

PP168: Should TP3 form part of the surgical algorithm for treatment of chyle leaks in the neck?

Introduction Chylous leakage is not an uncommon complication after neck dissection. It occurs in 1–2.5% of radical neck dissection, with the majority (75–92%) on the left side. There is currently no recognised surgical algorithm for the treatment of chyle leak in the neck. Conservative treatment protocols have been established and include closed vacuum drainage, nutrition modification and somatostatin analog1. We present a case of right sided chyle leak treated successfully with a sternocleidomastoid muscle flap and TP3. Case History A 57 year old female with SCC was treated with right sided partial glossectomy, mandibulotomy, unilateral selective neck dissection and radial forearm free flap reconstruction. A right sides neck swelling was noted 12 days post operatively. Radiological investigation revealed an 8 × 3 cm heterogenous noncompressible collection with no signs of infection. This swelling gradually increased in size over the next 48 h. Therefore, the decision was made for surgical exploration and a right sided chylous leak was found but there was no obvious source of leakage. TP3 was used in conjunction to a sternocleidomastoid muscle flap to help tissue adhesion. The chylous leak was successfully treated through this surgical approach with dietary modification without compromising the viability of her original free flap reconstruction. Conclusions The use of TP3 forms to form an air/blood and fluid tight barrier can assist the muscle flap in containing a chylous leak. The authors will use intra surgical and radiological imaging to illustrate the surgical usage of TP3. We would recommend TP3 to be used an adjunct in the surgical algorithm in the treatment of such conditions.