Application of free anterolateral thigh flap in head and neck surgery / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the results of reconstruction by free anterolateral thigh flaps (ALT) after operation of head and neck tumors.</p><p><b>METHODS</b>Forty-three cases underwent the reconstruction of postoperative defects with free anterolateral thigh flaps after head and neck cancer surgeries between November 2007 and June 2010 were reviewed. Ages of the patients ranged from 40 to 81 years, with a median of 56 years; 32 males and 11 females; 23 cases of oral carcinoma, 7 cases of tonsil carcinoma, 11 cases of hypopharyngeal carcinoma, and 2 cases of head skin cancer. TNM classified as follows: no case of distant metastasis; T1 9 cases; T2 17 cases; T3 11 cases; T4 6 cases. All patients were applied with ALT to restore swallowing and respiratory functions. The mean length of blood vessel pedicles of the ALT free flaps was 12.5 (8 - 18) cm. The flaps were 4 - 15 cm in width, 5 - 25 cm in length.</p><p><b>RESULTS</b>In the 43 cases applied with ALT free flaps, 40 cases were successful and 3 cases unsuccessful. Two of the failed cases were reconstructed with pectoralis major flap. In 11 cases of hypopharyngeal carcinoma, except 3 cases with total laryngectomy, 8 cases (72.7%) had their laryngeal function been preserved.</p><p><b>CONCLUSIONS</b>The successful rate of ALT free flaps is perfect. There were no serious complication in offered areas. The flap could be shaped into various forms. ALT free flap is an ideal flap to reconstruct the defect after surgery in some head and neck tumors.</p>

Preservation of parathyroid glands and their functions during total thyroidectomy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the protection methods of parathyroid glands (PTGs) and their functions during total thyroidectomy.</p><p><b>METHODS</b>The locations and the blood supplies of parathyroid glands in 292 cases underwent total thyroidectomy between February 1990 and December 2009 were studied. The protective measures for PTGs and their blood supplies during total thyroidectomy were analyzed.</p><p><b>RESULTS</b>Total of 542 superior PTGs and 467 inferior PTGs were found in 296 cases of total thyroidectomy. Of the superior PTGs, 444 (81.9%) consistently located in the back sides of the thyroid glands and at the level of inferior edge of thyroid cartilage. The locations of the inferior PTGs were variable, 231 (49.5%) of them located in the inferior 1/3 part of the back sides of the thyroids and 116 (24.8%) at the inferior thyroid, in where inferior thyroid artery (ITA) branches enter thyroid. The fine dissections showed that the blood supplies to superior PTGs were mainly from the upper branch of ITA, accounting for 71 (68.3%) of 104 superior PTGs and the blood supplies to inferior PTGs were from the inferior branches of ITA system, accounting for 114 (80.3%) of 142 inferior PTGs. There was 13 cases with short-term hypocalcemia postoperatively, but no case with permanent hypoparathyroidism.</p><p><b>CONCLUSIONS</b>The blood supplies of PTGs are associated with their locations. During total or subtotal thyroidectomy, parathyroid glands and their artery blood-supply should be exposed and preserved to prevent hypoparathyroidism after surgery.</p>

Level VI and II-V cervical lymph node metastasis in differentiated thyroid carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the characters of the cervical lymph node metastasis in differentiated thyroid carcinoma, and to provide evidence for proper surgery of differentiated thyroid carcinoma.</p><p><b>METHODS</b>From 1984 to 2000, 99 cases with differentiated thyroid carcinoma were performed thyroidectomy and neck dissection. The patients were followed up. A retrospective analysis was performed. Results In 99 cases with differentiated thyroid carcinoma, there were 61 papillary carcinoma, 13 papillary and follicular mixed carcinoma, 25 follicular carcinoma. According to 2002 UICC TNM classification, 60 cases were staged I, 1 case staged II, 5 cases staged III, 33 cases staged IV. Lobectomy and isthmectomy was performed in 80 cases, lobectomy was resected and opposite subtotal lobectomy in 15 cases, total thyroidectomy in 4 cases. One hundred and four neck dissection were performed in 99 cases (5 cases were bilateral neck dissection ). Among them, 66 (68 sides) were radical neck dissection, 33 (36 sides) were modified neck dissection. Pathological results showed that lymph nodes were positive in 86 sides of 83 cases. The rate of cervical lymph node metastasis was 83.8% (83/99). The positive rates of lymph node were 37.5% (39/104) in level VI and 76.9% (80/104) in II-V, which was statistically different (chi2 = 33.01, P < 0.01). The cervical lymph node metastasis in lateral area (level II-V) and that in VI had not relationship (chi2 = 2.08, P > 0.05). Ten and 15 year survival rates of all 99 cases were 88.3% and 84.5% respectively.</p><p><b>CONCLUSIONS</b>The occurrence of lymph node metastasis in level VI and level II was different and no relationship .One can not judge whether lateral neck metastasis by the lymph node statue in level VI only . Although they all had good prognosis, patients with positive nodes in level VI were not worse than that in lateral neck (II-V).</p>

Operation for well-differentiated invading thyroid carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the surgical data of well-differentiated invading thyroid carcinoma (WITC) , for acquiring the clinical experience.</p><p><b>METHODS</b>A retrospective analysis was made in 201 cases with well-differentiated invading thyroid carcinoma in Liaoning Tumour Hospital from 1984 to 2000. The data were statistically treated for survival curves according to the Kaplan-Meier method. The Log-Rank tests were employed to assess the statistical significance of various groups.</p><p><b>RESULTS</b>There were 3 cases with total laryngectomy and partial cervical trachea resection, 6 cases with partial cervical trachea resection, 67 cases with shaving off tumor from its surface, 9 cases with recurrent laryngeal nerve resection, 26 cases with shaving off tumor from the surface of recurrent laryngeal nerve. Other local structures invaded in 90 cases was resected with the thyroid tumour en bloc. One hundred and eighty nine cases with one thyroid lobe and isthmus ectomy, 5 cases one lobe and opsite subtotal ectomy. One hundred and twenty nine cases simultaneous neck dissection (5 cases bilateral neck dissection), in them, 75 neck radical neck dissection, 59 neck modified dissection. The 5-, 10- and 15-year living rates of well-differentiated thyroid carcinoma patients were 85.6% , 77.3% and 69.4% respectively. Multivariate analysis showed that patients' age, tumour invading structure were independent prognostic factors.</p><p><b>CONCLUSIONS</b>With proper operation, a better cure will be made in WITC.</p>

Re-operation for thyroid carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the results of re-operation of thyroidectomy for patients of thyroid carcinoma.</p><p><b>METHODS</b>268 patients of thyroid carcinoma received completion thyroidectomy were retrospectively reviewed from 1984 to 2000. There were 59 males and 209 female cases. 256 cases had received nodule enucleating or partial thyroidectomy in other hospitals and 12 cases had unilateral subtotal thyroidectomy in this hospital. The types of reoperation were: Total thyroidectomy for bilateral thyroid carcinoma (6 cases); expand isthmectomy for isthmus carcinoma (1 case). Lobectomy plus isthmectomy for unilateral disease (261) Simultaneous neck dissections were performed in 196 cases. Among them, 94 cases had classical neck dissection, 102 cases had modified neck dissection.</p><p><b>RESULTS</b>Pathological results confirmed that there were 78 cases with residual thyroid carcinoma. The rate of residual carcinoma was 29. 1% (78/268). There were 95 cases with lymphnode metastasis. The rate of lymphnode metastasis was 48.5% (95/196). The rate of recurrent laryngeal nerve injury was 1.1% (3/268). The 5-year and 10-year survival rates of patients were 94. 0% (251/267) and 85. 2% (127/149) respectively.</p><p><b>CONCLUSIONS</b>The residual carcinoma of completing thyroidectomy was high. Therefore re-operations of thyroid in selected cases were necessary.</p>