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Smith B, Rosko A, VanKoevering KK, Heft Neal M, Ellsperman S, Fenberg RB, Cho J, Vita A, Feng AL, Contrera KJ, Sridharan SS, Spector ME. 3D modeling of anterior 2/3rds glossectomy reconstruction: A volume based donor site evaluation. Oral Oncol 2024; 157:106960. [PMID: 39068767 DOI: 10.1016/j.oraloncology.2024.106960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 07/05/2024] [Accepted: 07/15/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE Anterior 2/3rds glossectomy results in significant patient morbidity due to speech and swallowing impairment. Microvascular free flap reconstruction compensates for large volume defects. Flap volume is based on the adipose content of the donor site and varies by patient body mass index (BMI) and donor site location. We sought to correlate flap thickness at different donor sites with patient BMI to determine optimal donor site selection. METHODS Patients with CT scans of the oral cavity, thorax and lower extremity were identified and included. The volumes of the anterior 2/3rds of the tongue were measured and recorded using computed tomography-generated modeling. Pre-muscular tissue thicknesses at anterolateral thigh (ALT), deep inferior epigastric artery (DIEP), latissimus dorsi, and parascapular donor sites were measured. The donor site adequency was defined as reconstructing the tongue volume within 10% of the ideal volume required and stratified based on patient BMI. RESULTS In 144 patients, the average anterior 2/3rds glossectomy defect was 100.3 cm3. Glossectomy defect size was highly correlated with BMI (p < 0.001). The DIEP flap had the largest volume (155.4 cm3), followed by latissimus (105.6 cm3), parascapula (97.8 cm3), and ALT (60.5 cm3). For patients with BMI ≤ 30, the DIEP flap best reconstructed native tongue volume (up to 113 % of native tongue volume). In patients with BMI > 30.1, native tongue volumes were approximated by the latissimus flap (89-92 % of native tongue) and parascapular flap (85-95 % of native tongue volume). In BMI > 30.1 the DIEP flap provided excess tissue bulk (129-135 % of native tongue volume). CONCLUSION The DIEP flap more closely approximates the volume needed to reconstruct anterior two-thirds tongue defects for BMIs ≤ 30. The subscapular system flaps provided the best volume match for BMIs > 30 and the DIEP flap provided excess tissue bulk which could be adjusted in the reconstruction process.
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Affiliation(s)
- Brandon Smith
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh, Medical Center, Pittsburgh, PA, USA
| | - Andrew Rosko
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan - Michigan Medicine, Ann Arbor, MI, USA
| | - Kyle K VanKoevering
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Molly Heft Neal
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan - Michigan Medicine, Ann Arbor, MI, USA
| | - Susan Ellsperman
- Department of Otolaryngology - Head and Neck Surgery, Veteran Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | | | - Joshua Cho
- Kresge Hearing Research Institute, University of Michigan, USA
| | - Alex Vita
- Department of Internal Medicine, University of Michigan, USA
| | - Allen L Feng
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, USA
| | - Kevin J Contrera
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh, Medical Center, Pittsburgh, PA, USA
| | - Shaum S Sridharan
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh, Medical Center, Pittsburgh, PA, USA
| | - Matthew E Spector
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh, Medical Center, Pittsburgh, PA, USA.
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Pu JJ, Atia A, Yu P, Su YX. The Anterolateral Thigh Flap in Head and Neck Reconstruction. Oral Maxillofac Surg Clin North Am 2024:S1042-3699(24)00042-6. [PMID: 39142949 DOI: 10.1016/j.coms.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
The anterolateral thigh (ALT) free flap has become a workhorse for head and neck reconstruction. This paper offers a thorough introduction to the ALT flap, covering its anatomy, surgical technique, adaptable designs, and use in a range of clinical settings along with case studies. With its long vascular pedicle and tissue versatility, the ALT flap is well-suited for matching varied defects. Still, understanding possible anatomic variances and managing complications are critical to its success. With this paper as a comprehensive guidance, surgeons can apply the ALT flap for difficult head and neck reconstructions and achieve the best possible results.
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Affiliation(s)
- Jingya Jane Pu
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, 34 Hospital Road, Sai Ying Pun, Hong Kong
| | - Andrew Atia
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peirong Yu
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yu-Xiong Su
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, 34 Hospital Road, Sai Ying Pun, Hong Kong.
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Pfister P, Speck NE, Gahl B, Muller L, Fürst T, Kappos EA, Schaefer DJ, Largo RD, Ismail T. Impact of adjuvant radiochemotherapy on free flap volume in head and neck reconstruction: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2024; 91:24-34. [PMID: 38401274 DOI: 10.1016/j.bjps.2024.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/08/2023] [Accepted: 02/04/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Limited data exist regarding the effect of adjuvant radiochemotherapy on free flap volume in head and neck reconstruction. However, an adequate free flap volume is an important predictor of functional and patient-reported outcomes in head and neck reconstruction. METHODS A systematic review of Medline, Embase, and the Cochrane Central Register of Controlled Trials was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. A total of 6710 abstracts were screened, and 36 full-text papers were reviewed. Nineteen studies met the inclusion criteria and were used to extract data for this analysis. RESULTS A meta-analysis of 14 two-arm studies comparing the impact of adjuvant radiotherapy versus no adjuvant radiotherapy was performed. The main analysis revealed that 6 months postoperatively, irradiated flaps showed a significant reduction of volume (average, 9.4%) compared to nonirradiated flaps. The average interpolated pooled flap volumes 6 months postoperatively were 76.4% in irradiated flaps and 81.8% in nonirradiated flaps. After a median postoperative follow-up of 12 months, the total flap volume was 62.6% for irradiated flaps and 76% for nonirradiated flaps. Four studies reported that chemotherapy had no significant impact on free flap volume. CONCLUSIONS Compared to nonirradiated flaps, irradiated flaps were significantly reduced in volume (range, 5% to 15.5%). Clinicians should take this into account when planning the surgical reconstruction of head and neck defects. Conducting large-scale prospective studies with standardized protocols and well-defined follow-up measurements could contribute to defining the ideal, personalized free flap volume for optimal function and patient-reported outcomes.
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Affiliation(s)
- Pablo Pfister
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Nicole E Speck
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Brigitta Gahl
- Surgical Outcome Research Center Basel, University Hospital Basel, Basel, Switzerland
| | - Laurent Muller
- Department of Ear, Nose and Throat Surgery, University Hospital Basel, Basel, Switzerland
| | - Thomas Fürst
- University Medical Library, University of Basel, Basel, Switzerland
| | - Elisabeth A Kappos
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Dirk J Schaefer
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Rene D Largo
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tarek Ismail
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland.
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4
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Thoenissen P, Najafi R, Sader R, Ghanaati S. Volume reduction of vascularized flaps in the field of cranio-maxillofacial surgery: A narrative-style review. J Craniomaxillofac Surg 2024; 52:203-211. [PMID: 38135647 DOI: 10.1016/j.jcms.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 10/15/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023] Open
Affiliation(s)
- Philipp Thoenissen
- Clinic for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Goethe University, University Hospital Frankfurt, Frankfurt/Main, Germany.
| | - Ramin Najafi
- Clinic for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Goethe University, University Hospital Frankfurt, Frankfurt/Main, Germany
| | - Robert Sader
- Clinic for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Goethe University, University Hospital Frankfurt, Frankfurt/Main, Germany
| | - Shahram Ghanaati
- Clinic for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Goethe University, University Hospital Frankfurt, Frankfurt/Main, Germany
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Liu MD, Xue XM, Al-Aroomi MA, Xiong JJ, Liu S, Sun CF, Liu FY. A novel flap design technique for subtotal tongue reconstruction with an "Individualized and Convenient Tongue Model". Oral Oncol 2023; 145:106531. [PMID: 37499327 DOI: 10.1016/j.oraloncology.2023.106531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/22/2023] [Accepted: 07/22/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND To achieve improved functional outcomes in subtotal tongue reconstruction, a flap design with sufficient volume and appropriate shape is necessary. In this study, we introduce an "Individualized and Convenient Tongue Model" (ICTM) for flap design in subtotal tongue reconstruction. METHODS By studying the anatomical morphology of the tongue, we found a similar geometry within the dorsum and body of the tongue as well as the mouth floor. This can be used to create an ICTM through folding and splicing. We can simulate tongue defects in the ICTM and transform defect shapes into guide plates for flap design. In this study, fifty-eight patients requiring subtotal tongue reconstruction were randomly divided into two groups: an ICTM group (35 patients) and a conventional group (31 patients). In the ICTM group, we individually designed profunda artery perforator flaps (PAPFs) or anterolateral thigh flaps (ALTFs) using the ICTM method. In the conventional group, the flap was designed according to the surgeon's clinical experience. Patient demographics, operative and follow-up data were recorded. Swallowing, speech intelligibility, and cosmetic results were assessed using appropriate scales. RESULTS All flaps survived, although there were no significant differences in tumor size, operation time, flap size, and complication rate compared to the conventional group. Patients in the ICTM group had significantly improved speech intelligibility (p = 0.019), cosmetic appearance (p = 0.009), and swallowing ability (p = 0.003). CONCLUSIONS The ICTM technique is an effective and convenient solution for subtotal tongue reconstruction that provides an individualized flap design and improves functional outcomes compared to the conventional design.
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Affiliation(s)
- Min-Da Liu
- Department of Oromaxillofacial-Head and Neck, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning 110002, PR China.
| | - Xiao-Meng Xue
- Department of Oromaxillofacial-Head and Neck, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning 110002, PR China
| | - Maged Ali Al-Aroomi
- Department of Oromaxillofacial-Head and Neck, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning 110002, PR China
| | - Jian-Jun Xiong
- Department of Oromaxillofacial-Head and Neck, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning 110002, PR China
| | - Sheng Liu
- Department of Oromaxillofacial-Head and Neck, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning 110002, PR China
| | - Chang-Fu Sun
- Department of Oromaxillofacial-Head and Neck, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning 110002, PR China
| | - Fa-Yu Liu
- Department of Oromaxillofacial-Head and Neck, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning 110002, PR China.
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Russo E, Alessandri-Bonetti M, Costantino A, Festa BM, Egro FM, Giannitto C, Spriano G, De Virgilio A. Functional outcomes and complications of total glossectomy with laryngeal preservation and flap reconstruction: A systematic review and meta-analysis. Oral Oncol 2023; 141:106415. [PMID: 37149955 DOI: 10.1016/j.oraloncology.2023.106415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/23/2023] [Accepted: 04/27/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To analyze the functional outcomes and complications of total glossectomy with laryngeal preservation and reconstruction with free or pedicled flaps. METHODS A search was conducted using Pubmed/MEDLINE, Cochrane Library, Scopus, and Google Scholar databases. A single arm meta-analysis was performed for feeding tube dependence (FTD), tracheostomy dependence (TD), and speech intelligibility (SI) rates. Peri-operative sequels and complications were evaluated as secondary outcomes. RESULTS A total number of 642 patients (median age: 54.2 years; 95% CI 52.1-58) were included. Functional assessment was performed after a median of 12 months (n = 623/642; 95% CI 10.6-12). Overall, the cumulative FTD rate was 22.9% (n = 188/627; 95% CI 10.2-38.7), the TD rate was 7.3% (n = 95/549; 95% CI 1.9-15.8), and the SI was 91.1% (n = 314/409; 95% CI 80.7%-97.8). The cumulative complication rate was 33.1% (n = 592/642). Eighteen patients (n = 18/592; 3.0%) experienced a major fistula, while aspiration pneumonia occurred in 17 cases (n = 17/592; 2.8%). CONCLUSIONS Total glossectomy with laryngeal preservation and pedicled/free flaps reconstruction may guarantee good functional results and an acceptable quality of life. Further prospective studies are advised to define clinical guidelines about proper patients' and flaps' selection.
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Affiliation(s)
- Elena Russo
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Mario Alessandri-Bonetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, Milan, Italy
| | - Andrea Costantino
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy.
| | - Bianca Maria Festa
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Francesco Maria Egro
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Caterina Giannitto
- Radiology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Giuseppe Spriano
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Armando De Virgilio
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
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Kim YC, Lee SJ, Park H, Choi YJ, Jeong WS, Lee YS, Choi KH, Oh TS, Choi JW. Swallowing analysis in hemi-tongue reconstruction using motor-innervated free flaps: A cine-magnetic resonance imaging study. Head Neck 2023; 45:1097-1112. [PMID: 36840932 DOI: 10.1002/hed.27309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 11/06/2022] [Accepted: 01/12/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND This study aimed to explore the outcomes of motor-innervated free flaps in hemi-tongue reconstruction by assessing the tongue mobility through midsagittal images from cine-magnetic resonance imaging. METHODS In this retrospective study, 47 patients who underwent tongue reconstruction following hemi-glossectomy and 10 control subjects without any surgical history were included. Patients were classified into two groups: the motor and no-motor innervation group. Various spatial parameters related to tongue mobility that were acquired from midsagittal sections were compared during consecutive swallowing phases. RESULTS Overall, the motor group showed improved functional swallowing scale compared with the no-motor group. In case of tongue base resection, the motor group showed improved mobility of the tongue base during pharyngeal phase, whereas the no-motor group showed increased laryngeal elevation for compensatory movement. CONCLUSION The tongue reconstruction with motor-innervated free flaps may facilitate swallowing capacity in patients with a hemi-tongue defect combined with tongue base resection.
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Affiliation(s)
- Young Chul Kim
- Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, South Korea
| | - Seok Joon Lee
- Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, South Korea
| | - Hojin Park
- Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, South Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Woo Shik Jeong
- Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, South Korea
| | - Yoon Se Lee
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kyoung Hyo Choi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Tae Suk Oh
- Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, South Korea
| | - Jong Woo Choi
- Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, South Korea
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Nguyen KA, Nguyen CQ, Nguyen TA, Ngo TX, Wein RO. Use of the double-paddle anterolateral thigh flap for locally advanced tongue carcinoma requiring second site reconstruction. Surg Oncol 2022; 44:101838. [PMID: 36055115 DOI: 10.1016/j.suronc.2022.101838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/02/2022] [Accepted: 08/11/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Advanced oral tongue carcinoma can present with extension beyond the oral cavity. Operative defects after resection may involve multiple anatomical sites and significantly impact speech and swallowing. Dependence on long-term enteral feeding is not uncommon for these patients. The anterolateral thigh (ALT) flap is one of the most reliable and flexible flaps used in the reconstruction of total and subtotal tongue defects. The double-paddle flap modification may be a more suitable option for complex oral tongue defects after advanced tumor ablation. METHODS Case series of 31 patients with oral tongue squamous cell carcinoma that were classified as stage IV. The age of patients ranged from 32 to 63 years. We designed the double-paddle ALT flaps to reconstruct the two-site surgical defects (tongue defect and pharynx or neck skin defect). Postoperative viability of the flap was checked by clinical observation. The last examination was performed at 3-months after the completion of adjuvant chemoradiotherapy. The functional capacity of our patients was evaluated by three physicians (Head and Neck Surgeon, Radiation Oncologist, and Physiatrist) using a Speech Intelligibility Score and the Functional Oral Intake Scale. RESULTS A total of 31 patients with surgical defects after total or subtotal tongue resection for cancer underwent double-paddle ALT flaps for reconstruction from March 2018 to December 2019. The dimension of flaps from 8 × 12 cm to 10 × 18 cm were divided into double-paddle from 8 × 5 cm to 10 × 10 cm. There was one case of pedicle thrombosis, one case of postoperative bleeding, three cases of neck infection, and six cases of salivary fistula. Our patients were seen in follow up from 6 to 36 months, with median follow-up of 23.5 months. The survival rate of ALT flap was 100%. All of our patients achieved an oral diet by 9 months after surgery. The mean score speech intelligibility was 2.74 ± 0.68 (4-point ordinal scale). The 2-year disease-free survival rate was 61.3%. CONCLUSIONS The double-paddle ALT flap is a reliable flap suitable for oral defects involving multiple subsites after ablative procedures. The majority of patients demonstrated acceptable functional rehabilitation. CLINICAL QUESTION/ LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Khoi A Nguyen
- Department of Oncology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam; Department of Head & Neck Surgery, Oncology Hospital, Ho Chi Minh City, Viet Nam.
| | - Can Q Nguyen
- Department of Head & Neck Surgery, Oncology Hospital, Ho Chi Minh City, Viet Nam
| | - Tuan A Nguyen
- Department of Head & Neck Surgery, Oncology Hospital, Ho Chi Minh City, Viet Nam
| | - Tham X Ngo
- Department of Head & Neck Surgery, Oncology Hospital, Ho Chi Minh City, Viet Nam
| | - Richard O Wein
- Division of Head and Neck Surgery, Tufts Medical Center, Boston, MA, USA
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Huang CC, Yang TL, Tseng WH, Lee TC, Ko JY. An alternative surgical technique for advanced tongue/tongue base cancer without free flap reconstruction. J Formos Med Assoc 2022; 121:2626-2632. [PMID: 35985885 DOI: 10.1016/j.jfma.2022.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/PURPOSE Locally advanced tongue or tongue base cancer is recommended to be treated by radical resection that is usually detrimental to physiological functions. This study reports the efficacy and treatment outcome of the patients who had received total glossectomy and laryngeal suspension without lip-split mandibulotomy and free flap reconstruction to preserve laryngopharyngeal function. METHODS From 2010 to 2018, 37 consecutive patients who had received the surgery were retrospectively recruited. RESULTS The overall five-year survival is 72%. The postoperative dependent rate of feeding tube and tracheostomy largely decreases within 1-year follow-up. Treated by this surgical method, these patients are free from facial disfiguration, donor site morbidity, and destructive mastication and occlusion. It is also feasible to perform this surgical technique in the recurrent cases previously treated by chemoradiation. CONCLUSION Total glossectomy with laryngeal suspension can be successfully applied to locally advanced tongue or tongue base cancer, and benefits the patients with improved survival and preserved physiological function. Especially surgeons for free flap reconstruction are understaffed at some regional or district hospitals.
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Affiliation(s)
- Chun-Chi Huang
- Department of Otolaryngology, Lotung Pohai Hospital, Yilan, Taiwan
| | - Tsung-Lin Yang
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Hsuan Tseng
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tzu Chiang Lee
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jenq-Yuh Ko
- Department of Otolaryngology, Lotung Pohai Hospital, Yilan, Taiwan; Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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10
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Choi JW, Kim YC, Park HJ, Oh TS, Jeong WS. The impact of dynamic tongue reconstruction using functional muscle transfer: A retrospective review of 94 cases with functional outcome analysis for various glossectomy defects. J Craniomaxillofac Surg 2022; 50:719-731. [DOI: 10.1016/j.jcms.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 07/09/2022] [Accepted: 07/16/2022] [Indexed: 10/16/2022] Open
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11
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Utility of a palatal speech appliance combined with the five-point eight-line segment technique in total tongue reconstruction. Int J Oral Maxillofac Surg 2022; 51:1016-1021. [DOI: 10.1016/j.ijom.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 10/20/2021] [Accepted: 01/05/2022] [Indexed: 11/19/2022]
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12
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Wang SM, Yin SC, Su XZ, Xu Q, Liu YH, Xu ZF. Magnitude of radial forearm free flaps and factors associated with loss of volume in oral cancer reconstructive surgery: Prospective study. Head Neck 2021; 43:2405-2413. [PMID: 33847445 DOI: 10.1002/hed.26704] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/23/2021] [Accepted: 03/30/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Adequate flap volume is key to maintaining oral function after oral cancer surgery. This study aimed to evaluate changes in radial forearm free flap (RFFF) volumes after 1 year of follow-up following ablative tumor surgery in the head and neck. METHODS A prospective study that recorded the clinical data of 20 patients with head and neck cancer who underwent RFFF reconstruction. Magnetic resonance (MR) and Mimics Research 19.0 software were used to measure the RFFF volumes at 1, 3, 6, and 12 postoperative months. RESULTS Compared with one postoperative month, the RFFF volume decreased by 15.5%, 29.4%, and 42.0% at 3, 6, and 12 months, respectively, after surgery. A significant positive correlation between postoperative radiotherapy and RFFF volume changes was detected. CONCLUSION The volume of RFFF decreases with time. It is recommended to use overcorrection, with a 40% increase in RFFF volume, to reconstruct head and neck tumor-related defects.
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Affiliation(s)
- Si-Min Wang
- Department of Oral Maxillofacial-Head and Neck Surgery, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, Liaoning, China
| | - Shou-Cheng Yin
- Department of Oral Maxillofacial-Head and Neck Surgery, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, Liaoning, China
| | - Xing-Zhou Su
- Department of Oral Maxillofacial-Head and Neck Surgery, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, Liaoning, China
| | - Qiang Xu
- Department of Oral Maxillofacial-Head and Neck Surgery, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, Liaoning, China
| | - Yi-Hao Liu
- Department of Oral Maxillofacial-Head and Neck Surgery, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, Liaoning, China
| | - Zhong-Fei Xu
- Department of Oral Maxillofacial-Head and Neck Surgery, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, Liaoning, China
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13
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Heredero S, Falguera-Uceda MI, Sanjuan-Sanjuan A, Dean A, Solivera J. Chimeric profunda artery perforator - gracilis flap: A computed tomographic angiography study and case report. Microsurgery 2020; 41:250-257. [PMID: 33332622 DOI: 10.1002/micr.30694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/07/2020] [Accepted: 12/03/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND The possibility of harvesting the profunda artery perforator (PAP) flap in a chimeric configuration together with the innervated gracilis muscle may be a good option for dynamic reconstruction following total glossectomies. In this paper, we present a retrospective radiological study, which evaluates the presence and characteristics of the anatomical variation of the chimeric PAP - gracilis flap. METHODS The study sample comprised 66 patients (132 legs), 38 men, and 28 women with an average age of 56 ± 2 years old, who underwent head and neck reconstruction with a free flap. Preoperative computed tomographic angiography (CTA) was used for morphologic analysis. We present a case report of a patient with a total glossectomy reconstructed with this flap. RESULTS A perforator in the PAP area joining with the main pedicle of the gracilis muscle was found in 38 legs (28.8%). Mean length of the pedicle from the profunda femoral artery to the point where the perforator in the PAP area and the pedicle of the gracilis joined was 3.0 ± 0.3 cm. Differences in the existence of this vascular configuration were not significant comparing groups by sex, BMI, height, side or source vessel. Motion of the new tongue was documented clinically and with electromyography. The patient achieved an intelligible speech and normal diet. CONCLUSIONS Preoperative evaluation is necessary to assess the existence of a perforator in the PAP area joining with the main pedicle of the gracilis muscle. This chimeric flap has been demonstrated useful for dynamic reconstruction of a patient with a total glossectomy.
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Affiliation(s)
- Susana Heredero
- UGC de Cirugía Maxilofacial, Hospital Universitario Reina Sofía, Córdoba, Spain
| | | | | | - Alicia Dean
- UGC de Cirugía Maxilofacial, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Juan Solivera
- UGG de Neurocirugía, Hospital Universitario Reina Sofía, Córdoba, Spain
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14
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Patient-specific soft tissue reconstruction: an IDEAL stage I report of hemiglossectomy reconstruction and introduction of the PANSOFOS flap. Br J Oral Maxillofac Surg 2020; 58:681-686. [DOI: 10.1016/j.bjoms.2020.04.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/13/2020] [Indexed: 01/05/2023]
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15
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Kim MS, Oh KH, Cho JG, Baek SK, Woo JS, Jung KY, Kwon SY. Assessment of Chronological Volume Changes in Radial Forearm Free Flaps for Tongue Cancer. ORL J Otorhinolaryngol Relat Spec 2020; 82:1-7. [PMID: 31905363 DOI: 10.1159/000504196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/17/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The radial forearm free flap (RFFF) is a commonly used free flap for tongue cancer. Postoperative changes in the volume of free flap are known to influence the functional restoration of the resected tongue. This study aimed to estimate chronological volume changes in RFFFs for tongue cancer and to determine the clinical factors affecting these changes. METHODS Clinical data for 19 patients who underwent RFFF reconstruction for tongue cancer between May 2004 and September 2013 were retrospectively reviewed. The flap volume was measured 3, 6, 12, 24, and 36 months after surgery using CT and the Picture Archiving and Communication System software. RESULTS Relative to volumes at 3 months, median flap volumes decreased to 98.55, 70.16, 62.86, and 58.84% at 6, 12, 24, and 36 months, respectively. None of the evaluated parameters were correlated with volume changes. CONCLUSIONS Over time, the volume of RFFF in the tongue decreased. Considering this, free flap reconstruction should be carried out in tongue cancer surgery.
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Affiliation(s)
- Min-Su Kim
- Department of Otorhinolaryngology - Head and Neck Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Kyoung Ho Oh
- Department of Otorhinolaryngology - Head and Neck Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Jae-Gu Cho
- Department of Otorhinolaryngology - Head and Neck Surgery, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Seung-Kuk Baek
- Department of Otorhinolaryngology - Head and Neck Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jeong-Soo Woo
- Department of Otorhinolaryngology - Head and Neck Surgery, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Kwang-Yoon Jung
- Department of Otorhinolaryngology - Head and Neck Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Soon Young Kwon
- Department of Otorhinolaryngology - Head and Neck Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea,
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16
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De Virgilio A, Iocca O, Di Maio P, Malvezzi L, Pellini R, Mercante G, Spriano G. Head and neck soft tissue reconstruction with anterolateral thigh flaps with various components: Development of an algorithm for flap selection in different clinical scenarios. Microsurgery 2019; 39:590-597. [DOI: 10.1002/micr.30495] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/21/2019] [Accepted: 06/28/2019] [Indexed: 01/13/2023]
Affiliation(s)
- Armando De Virgilio
- Otorhinolaryngology ‐ Head and Neck SurgeryHumanitas Clinical and Research Hospital‐IRCCS, Rozzano (MI) Italy
- Department of Biomedical SciencesHumanitas University, Pieve Emanuele (MI) Italy
| | - Oreste Iocca
- Otorhinolaryngology ‐ Head and Neck SurgeryHumanitas Clinical and Research Hospital‐IRCCS, Rozzano (MI) Italy
| | - Pasquale Di Maio
- Giovanni Borea Civil HospitalDepartment of Otolaryngology‐Head and Neck Surgery Sanremo Italy
| | - Luca Malvezzi
- Otorhinolaryngology ‐ Head and Neck SurgeryHumanitas Clinical and Research Hospital‐IRCCS, Rozzano (MI) Italy
| | - Raul Pellini
- Department of Otolaryngology‐Head and Neck SurgeryRegina Elena National Cancer Institute Rome Italy
| | - Giuseppe Mercante
- Otorhinolaryngology ‐ Head and Neck SurgeryHumanitas Clinical and Research Hospital‐IRCCS, Rozzano (MI) Italy
| | - Giuseppe Spriano
- Otorhinolaryngology ‐ Head and Neck SurgeryHumanitas Clinical and Research Hospital‐IRCCS, Rozzano (MI) Italy
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17
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Baskin RM, Seikaly H, Sawhney R, Danan D, Burt M, Idris S, Shama M, Boyce B, Dziegielewski PT. Tongue reconstruction: Rebuilding mobile three-dimensional structures from immobile two-dimensional substrates, a fresh cadaver study. Head Neck 2019; 41:3693-3699. [PMID: 31347741 DOI: 10.1002/hed.25889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/13/2019] [Accepted: 07/11/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To determine the two-dimensional (2D) characteristics of flaps necessary to create three-dimensional (3D) tongue anatomy. METHODS Dissection of 11 fresh, nonpreserved human cadavers was performed. Six defects in each were created: total tongue, total oral tongue, hemiglossectomy, oral hemiglossectomy, total base of tongue, and hemi-base of tongue. The resections were debulked to create flat, 2D mucosal flaps. The dimensions and shapes of these flaps were determined. RESULTS Each specimen showed consistent dimensions and geometry between cadavers. The total tongue was pear-shaped, the total oral tongue was egg-shaped, the oral hemi-tongue was bullet-shaped, the hemi-tongue resembled a dagger, the total base of tongue was rectangular, and the hemi-base of tongue was hour-glass shaped. CONCLUSION Typical dimensions and shapes of common tongue defects were determined. It is conceivable that customizing reconstructive flaps based on these data will increase the accuracy of neo-tongue reconstruction, and thus, improve functional outcomes.
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Affiliation(s)
- R Michael Baskin
- Department of Otolaryngology, University of Florida, Gainesville, Florida
| | - Hadi Seikaly
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Raja Sawhney
- Department of Otolaryngology, University of Florida, Gainesville, Florida
| | - Deepa Danan
- Department of Otolaryngology, University of Florida, Gainesville, Florida
| | - Martha Burt
- Department of Otolaryngology, University of Florida, Gainesville, Florida
| | - Sherif Idris
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Mohamed Shama
- Department of Otolaryngology, University of Florida, Gainesville, Florida
| | - Brian Boyce
- Department of Otolaryngology, University of Florida, Gainesville, Florida
| | - Peter T Dziegielewski
- Department of Otolaryngology, University of Florida, Gainesville, Florida.,Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada.,University of Florida Health Cancer Center, Gainesville, Florida
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18
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Long-Term Serial Measurement of Muscle Volume in TRAM Flaps Using the Eclipse Treatment Planning System. Plast Reconstr Surg 2019; 143:1137e-1141e. [DOI: 10.1097/prs.0000000000005609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Quinsan IDCM, Costa GC, Priante AVM, Cardoso CA, Nunes CLS. Functional outcomes and survival of patients with oral and oropharyngeal cancer after total glossectomy. Braz J Otorhinolaryngol 2019; 86:545-551. [PMID: 30956152 PMCID: PMC9422732 DOI: 10.1016/j.bjorl.2019.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 06/10/2018] [Accepted: 02/11/2019] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Cancer of the oral cavity and oropharynx presents aggressive behavior and its diagnosis is, in most cases, performed in advanced stages. Total glossectomy is a therapeutic option in locally advanced cancer, and the only one in the recurrent or residual disease, after chemoradiotherapy. OBJECTIVE To evaluate the clinical-epidemiological profile, postoperative complications, survival rates and functional aspects of patients with oral cavity and oropharynx cancer after total glossectomy. METHODS It was a retrospective study where 22 patients were included with oral cavity and oropharyngeal cancer after total glossectomy at the Hospital Regional do Vale do Paraíba, em Taubaté, São Paulo. RESULTS All patients were male, with a median age of 57 years, most of tumors are located in the tongue and floor of the mouth and classified as stage IVa. Total glossectomy as initial treatment was performed in 18 and as salvage in four patients. The major pectoralis myocutaneous flap was used for reconstruction in all cases. The main postoperative complication was wound infection and salivary fistula. CONCLUSION Overall survival was 19% and cancer-specific survival was 30.8% in five years. Eight patients were rehabilitated for exclusive oral feeding without the dependence tracheostomy and enteral tube, all with an overall survival greater than 15 months.
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20
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Fan S, Zhang H, Li Q, Liang F, Bai Z, Chen W, Sun S, Yu P, Li J. A novel anatomy-based five-points eight-line-segments technique for precision subtotal tongue reconstruction: A pilot study. Oral Oncol 2019; 89:1-7. [DOI: 10.1016/j.oraloncology.2018.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/10/2018] [Accepted: 12/08/2018] [Indexed: 12/30/2022]
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21
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Fan S, Li QX, Zhang HQ, Liang MJ, Tian T, Wang YY, Lin ZY, Chen WX, Pan GK, Ahn MHY, He L, Sun S, Wu BH, Yu P, Li JS. "Five-point eight-line" anatomic flap design for precise hemitongue reconstruction. Head Neck 2018; 41:1359-1366. [PMID: 30561069 DOI: 10.1002/hed.25571] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 02/25/2018] [Accepted: 11/21/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Reconstruction of hemiglossectomy defects requires careful flap design to avoid adverse functional and aesthetic outcomes. METHODS Hemitongue specimens were obtained from minipigs to study the three-dimensional anatomy and to define anatomic landmarks for precise measurements of flap requirement. The concept developed in animal models was then applied to hemiglossectomy reconstruction in clinical practice. Sixty-one patients were randomly enrolled into the following two groups: a "five-point eight-line segment" (FIPELS) flap design group (28 patients) and a conventional group (33 patients). Functional and aesthetic outcomes were compared between the two groups. RESULTS All flaps designed with the FIPELS technique matched the hemiglossectomy defects without the need for flap trimming, thus reducing the operating time (P = .03). Swallowing functions, speech intelligibility, and aesthetic outcomes were superior in the FIPELS group than that in the conventional group (P < .05). CONCLUSIONS The FIPELS flap design for hemiglossectomy reconstruction yields improved functional and aesthetic outcomes compared to a conventional flap design.
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Affiliation(s)
- Song Fan
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Oral & Maxillofacial-Head & Neck Digital Precision Reconstruction Technology Research Center of Guangdong Province, Guangzhou, China
| | - Qun-Xing Li
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Han-Qing Zhang
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Mao-Jin Liang
- Department of Otorhinolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,Institute of Hearing and Speech-Language Science, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Tian Tian
- Department of Neurobiology, Nanjing Medial University, Nanjing, China
| | - You-Yuan Wang
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhao-Yu Lin
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Wei-Xiong Chen
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Guo-Kai Pan
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Michael Ho-Young Ahn
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lile He
- Department of Orthopaedic Surgery, The Second Xiangya Hospital, Central South University, Hunan, China
| | - Sheng Sun
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Bing-Hao Wu
- Cutaneous Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts
| | - Peirong Yu
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jin-Song Li
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,Oral & Maxillofacial-Head & Neck Digital Precision Reconstruction Technology Research Center of Guangdong Province, Guangzhou, China
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22
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Baus A, Culie D, Duong LT, Ben Lakhdar A, Schaff JB, Janot F, Kolb F. Primary clear cell sarcoma of the tongue and surgical reconstruction: About a rare case report. ANN CHIR PLAST ESTH 2018; 64:98-105. [PMID: 30262251 DOI: 10.1016/j.anplas.2018.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/03/2018] [Indexed: 01/03/2023]
Abstract
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.
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Affiliation(s)
- A Baus
- Institut Gustave-Roussy, department of plastic surgery, Gustave-Roussy, 114 rue Édouard-Vaillant, 94805 Villejuif, France.
| | - D Culie
- Institut Gustave-Roussy, department of head and neck oncology, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - L T Duong
- Institut Gustave-Roussy, department of head and neck oncology, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - A Ben Lakhdar
- Institut Gustave-Roussy, department of biopathology, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - J-B Schaff
- Institut Gustave-Roussy, department of plastic surgery, Gustave-Roussy, 114 rue Édouard-Vaillant, 94805 Villejuif, France
| | - F Janot
- Institut Gustave-Roussy, department of head and neck oncology, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - F Kolb
- Institut Gustave-Roussy, department of plastic surgery, Gustave-Roussy, 114 rue Édouard-Vaillant, 94805 Villejuif, France
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23
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Molteni G, Ghirelli M, Molinari G, Presutti L. Microvascular reconstruction two years after subtotal glossectomy: Is it worth it? JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 120:49-54. [PMID: 30196005 DOI: 10.1016/j.jormas.2018.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/17/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
Abstract
We ought to report an unusual case of a 49-year-old patient who underwent delayed reconstruction of the oral cavity defect, with an anterolateral thigh flap, two years after surgical demolition and adjuvant chemo-radiotherapy. At the end of oncologic treatment, he could not eat through oral route and presented evident speech articulation difficulties. After surgical reconstruction, swallowing assessment showed an improvement of swallowing with no gross signs of airways inhalation. His understandability of speech improved as well. Delayed reconstruction by a microvascular free flap with exclusive functional rehabilitation intent is feasible and may have satisfactory functional outcomes.
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Affiliation(s)
- G Molteni
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Verona, AOUI Borgo Trento, Piazzale Aristide Stefani, 1, 37126 Verona, Italy
| | - M Ghirelli
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Policlinico, Largo del Pozzo, 71, 41125 Modena, Italy.
| | - G Molinari
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Policlinico, Largo del Pozzo, 71, 41125 Modena, Italy
| | - L Presutti
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Policlinico, Largo del Pozzo, 71, 41125 Modena, Italy
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24
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3D computer simulation analysis of the flap volume change in total tongue reconstruction flaps. J Craniomaxillofac Surg 2018; 46:844-850. [DOI: 10.1016/j.jcms.2018.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 02/05/2018] [Accepted: 02/27/2018] [Indexed: 11/29/2022] Open
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25
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Speech and swallowing outcomes following oral cavity reconstruction. Curr Opin Otolaryngol Head Neck Surg 2017; 25:200-204. [DOI: 10.1097/moo.0000000000000359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Hamada K, Ishihara R, Yamasaki Y. The Very First Changes in the Tongue with the Development of Cancer. Eur J Case Rep Intern Med 2017; 4:000577. [PMID: 30755939 PMCID: PMC6346765 DOI: 10.12890/2017_000577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 01/20/2017] [Indexed: 11/10/2022] Open
Abstract
We describe the case of an elderly man with a 3-month history of pain at the tip of his tongue due to a lingual cancer. The lesion appeared slightly depressed and reddish. Our images show the very first changes in the tongue with the development of cancer. Patients with tongue pain often visit the internal medicine department first, so highlighting this case will help physicians detect lingual cancer quickly.
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Affiliation(s)
- Kenta Hamada
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Yasushi Yamasaki
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
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27
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Fernández-Riera R, Hung SY, Wu JCW, Tsao CK. Free profunda femoris artery perforator flap as a first-line choice of reconstruction for partial glossectomy defects. Head Neck 2016; 39:737-743. [DOI: 10.1002/hed.24675] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 11/01/2016] [Accepted: 11/08/2016] [Indexed: 11/09/2022] Open
Affiliation(s)
- Ricardo Fernández-Riera
- Division of Reconstructive Microsurgery; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University and Medical College; Taoyuan Taiwan
| | - Shao-Yu Hung
- Division of Reconstructive Microsurgery; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University and Medical College; Taoyuan Taiwan
| | - Jerry Chih-Wei Wu
- Division of Reconstructive Microsurgery; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University and Medical College; Taoyuan Taiwan
- Center for Tissue Engineering; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Chung-Kan Tsao
- Division of Reconstructive Microsurgery; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University and Medical College; Taoyuan Taiwan
- Center for Tissue Engineering; Chang Gung Memorial Hospital; Taoyuan Taiwan
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