radial forearm sensate free flap: an adjunct for laryngeal preservation in advanced posterior pharyngeal wall cancer surgery

Laryngeal preservation following advanced posterior pharyngeal wall [PPW] cancer resections can pose several reconstructive challenges. This study aimed to evaluate the efficiency of the sensate radial forearm free flap [RFFF] in primary reconstruction of PPW defects following advanced cancer resections with laryngeal preservation. The study included 11 patients with advanced [> 4 cm] PPW carcinomas, who were treated by surgical resection with laryngeal preservation and immediate reconstruction using a neurofasciocutaneous RFFF over a 4-year period. There were seven men and four women ranging in age from 43 to 69 years. The mean area of mucosal defects was 42 +/- 13.1 cm[2]. Reneurotization of free flaps was carried out in all cases. Two patients had preoperative radiotherapy and all previously untreated patients received postoperative irradiation. One free flap was lost due to venous thrombosis. This patient was salvaged by a pectoralis major myocutaneous flap without laryngectomy. Other postoperative complications were minor with no perioperative mortalities. All patients were decannulated after a median of 18 days and maintained their voice. Oral intake started after a median of 27 days [range 11-71 days]. Oral nutrition capabilities improved 6 and 12 months postoperatively as assessed by videofluoroscopy. One-year postoperatively, eight out of ten RFFF reconstructed patients managed a regular oral diet and two patients a soft diet with none requiring additional tube feedings or showing aspiration-related pulmonary changes. Six patients [54.5%] remain alive with no evidence of disease after a mean follow-up of 26 +/- 15 months. The unique properties of the RFFF, including its relatively thin, pliable nature, as well as its excellent sensate potential makes it a very suitable reconstructive choice for such defects, enabling laryngeal preservation with acceptable swallowing results thus offering patients a better quality of life

Surgical closure of postlaryngectomy pharyngocutaneous fistula: a defect-based approach

Postlaryngectomy pharyngocutaneous fistula [PCF] is a serious potentially life-threatening complication. Although most can be managed conservatively, some persist requiring surgical repair that can be sometimes challenging. Several studies describe separate reconstruction methods, however, only few address the variability in defect characteristics and hence appropriate flap selection. This study was conducted on 19 patients who underwent surgical repair of persistent PCFs, over a three-year period. Patients included 18 males [94.7%] and only one female [5.3%] with a mean age of 61 +/- 10 years. Nine patients had previous unsuccessful attempts for surgical closure. All patients had more than one comorbid condition predisposing to PCF development as ivell as preventing its healing. Previous neck irradiation was the most common [52.6%], followed by low hemoglobin level [47.4%], hepatic disease [36.8%] and diabetes mellitus [31.6%]. According to defect characteristics; 6 patients received a local cervical skin procedure [cervical skin turn-in [Z-plasty], 10 patients had reconstructions using the pectoralis major musculocutaneous flap with or without cervical skin turn-in hinge flaps for mucosal closure reinforcement and 3 patients required a radial forearm free flap repair in which its central part was de-epithelialized and the flap was folded on itself for both mucosal defect closure and external skin coverage. All PCFs were eventually successfully closed with no major complications. Acceptable oral swallowing results were achieved in all but one patient. This article describes the author's approach for surgical management of persistent PCFs with special emphasis on defect characteristics that affect reconstruction choice and hence closure outcome

Helicobacter pylori infection and chronic persistent cough: is there an association?

Chronic persistent cough is a common clinical problem that sometimes remains without an identifiable cause. To study a potential association between Helicobacter pylori infection and chronic persistent cough. A clinical observational study with symptom analysis, including 162 patients whose main presenting complaint was chronic persistent cough of an unidentifiable cause [study group] and 42 patients with chronic nonspecific laryngopharyngeal manifestations not including chronic cough [control group]. H. pylori active infection was present in 86.4 per cent [140/162] of patients in the chronic cough group opposed to 45.2 per cent [19/42] in the control group as confirmed by detection of H. pylori antigen in stool specimens. This difference was statistically significant [P < 0.001]. There was a significant improvement of chronic cough in 75.4 per cent [98/130] of patients after successful H. pylori eradication using appropriate medical therapy [P < 0.001]. H. pylori infection might lead to laryngopharyngeal irritation with several manifestations including chronic persistent cough; the exact mechanism of which still needs further research

Head and neck lipomas: presentation variability

Head and neck lipoma has seldom drawn attention in the literature except for separate case reports. Study presentation variability of head and neck lipomas as well as relative importance and efficiency of preoperative diagnostic methods used. Patients diagnosed as having head and neck lipomas presented to the Otolaryngology-Head and Neck Surgery Department, Alexandria Faculty of Medicine were included in this study. Preoperative clinical, laboratory and radiological evaluation was conducted peroperatively. Surgical excision was done and postoperative histopathological examination confirmed the diagnosis. Twenty-four patients had 26 lipomas. Males predominated [62.5%]. The posterior subcutaneous neck was the most common site. Three patients had deep lipomas affecting the hypopharynx, larynx and parotid gland; all were correctly diagnosed preoperatively. Computed tomography [CT] scans with specific radiodensity recording was the preferred preoperative investigation. Lipomas should be considered in the differential diagnosis of soft-tissue head and neck masses even in rare locations. CT or magnetic resonance imaging [MRI] scans can accurately diagnose a lipoma preoperatively thereby allow for better treatment planning