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Objective To evaluate the feasibility and validity of near infrared fluorescence imaging with indocyanine green in sentinel node biopsy for cN0 oral carcinoma.Methods Thirty cases of previously untreated oral carcinoma staged cT1-3 N0M0 were enrolled in this study.1 ml of indocyanine green (25 mg/ 5 ml) was injected both around the primary tumor in a 4 quadrant pattern and in the base of the tumor before skin incision.After elevation of the platysma flap and posterior retraction of the sternocleidomastoid muscle,fluorescence images were taken with a near infrared fluorescence detector until the hotspots were captured,then the hotspot lymph nodes were removed.Lymph nodes identified with fluorescent hotspots and verified in vivo were defined as sentinel nodes,and they were harvested and sent together with neck dissection specimen for pathologic study.Results Sentinel nodes were successfully harvested in all 30 cases.The number of sentinel nodes per case varied from 1 to 9,with an average number of 3.4.Routine pathology demonstrated that occult metastasis was exclusively found in the sentinel nodes in 5 cases (16.67％),and all the other lymph nodes were free from metastasis.No tracer associated adverse effects occurred in this series.Conclusion Near infrared fluorescence imaging with indocyanine green has a high detection rate in sentinel node biopsy for cN0 oral/oropharyngeal carcinoma and the sentinel nodes can evaluate the cervical metastatic status accurately.It is an easy,feasible and promising method,which is worthy of further investigation.
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[ABSTRACT]OBJECTIVEThis study was designed to compare the quality of life between patients who underwent a tongue reconstruction with radial forearm flap (RFF) and infrahyoid myocutaneous flap (IHMCF) after hemiglossectomy for their tongue cancers, and to figure out an optimal reconstructive method for the defects resulted from hemiglossectomy.METHODSA non-randomized case-control study was performed on 24 patients with tongue squamous cell carcinoma who underwent a standard hemiglossectomy combined with perfectly tongue reconstruction from June 2005 to June 2012. All of the cases were without tongue base invasion. Of the 24 cases, 19 had T2 disease, 5 had T3 disease, and they were divided into RFF group (n=10) and IHMCF group (n=14). The quality of life were evaluated one year after operation using EORTC-QLQ30 and FACT-H&N35 and compared between the two groups.RESULTSThe scores were comparable between the two group with regard to all domains of EORTC-QLQ30,with all P values>0.05.The scores of swallowing(P=0.005), speech (P=0.008), teeth (P=0.014), and cough (P=0.009) domains were significantly higher in IHMCF group than in RFF group, with P value of 0.005, 0.008, 0.014 and 0.009 respectively, while the other domains of FACT-H&N35 were comparable between the two groups, with allP values>0.05.CONCLUSIONOverall quality of life was similar in the two groups. Oral function domains were better in IHMCF group than in RFF group. When guarantee of flap survival is available, IHMCF could be used as a good alternative flap to RFF in tongue reconstruction after hemiglossectomy.
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ObjectiveTo compare the exposure, identification of parathyroid and postoperative complications between total thyroidectomy (TT) and subtotal/near total thyroidectomy (S/NT) for bilateral multiple thyroid nodules. MethodsA total of 278 cases were performed TT and S/NT randomly from Dec. 2006 to Dec.2009. The histology, identification of parathyroid and recurrent laryngeal nerves (RLN), and incidence of complications were compared between the 2 surgical procedures. The data were processed with t test or x2 test.Results227 cases were estimated to be benign preoperatively, among whom 28 cases ( 12.3％ ) were diagnosed as focal cancer by postoperative pathology. The identification rate of parathyroid was 96.5％ in TT group and 60.4％ in S/NT group (P＜0.05). The mean postoperative serum calcium level was 2.057 +0.016 mmol/L in TT group and 2. 15 + 0.019 mmol/L in S/NT group (P ＜ 0.05 ). The incidence rate of transient hypoparathyroidism (HPT) was 16.9％ in TT group and 5.7％ in S/NT group (P＜0.05). There was no statistical difference between the 2 groups in terms of the incidence rate of permanent HPT and transient recurrent laryngeal nerves (RLN) palsy ( P ＞ 0.05 ). The incidence rate of permanent HPT was higher in reoperation cases ( 11.1％ ) than in primary surgery cases (0.0％) in TT group ( P ＜0.05 ). ConclusionBased on the accurate technique under microscope field, TT is a safe surgical procedure for primary surgery with bilateral multiple thyroid nodules.
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Objective To report the clinical results and the advantages/disadvantages of anterolateral thigh flap (ALT) and forearm flap (FAF) in reconstruction of head and neck defect after cancer ablation. Methods 20 FAFs and 12 ALTs were performed to repair the head and neck tumor ablation defects. Of the 20 FAFs, 7 were used for repair of the through and through buccal defects, 4 for circumferential bypopharyngeal defects, 2 for plate defects, 1 for parotid area skin defect, 4 for floor of the mouth defects, and 2 for defect, of the base of the tongue, while of the 12 ALTs, 3 were used for repair of the defects of the base of the tongue, 4 for plate defects, and 5 for the floor of the mouth and/or lower gum defects. Survival of the flaps, function of the recipient site, and impact to the donor site were compared between these two groups to analyze the advantages/disadvantsges and key technique details of these two flaps. Results 19 FAFs totally survived. Vascular crisis occurred in 2 cases of FAF, of which 1 flap survived after conservative treatment, while the other 1 developed partial necrosis. All the 12 ALTs survived, without vascular crisis. 2 of the 14 planed ALTs were abandoned and replaced by FAFs, of which 1 because of absence of the perforating branch and the other 1 because of injury of the perforating branch. Secondary defects of the ALTs could be closed primarily, while secondary defects of the FAFs should be closed with skin grafts. Conlusion Both ALT and FAF can be performed with high survival rate. Each has its own advantages. Selection of the donor site deponds on situation of the defect and purpose of the reconstruction.
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Objective To study the values of neck dissection for thyroid carcinoma who received nonstandard operation and help to choose good re-operation methods. Methods Retrospective investigation was carried out in 38 cases of neck dissection for thyroid carcinoma patients who received nonstandard operation during 1997 to 2005, and 32 cases were treated with neck dissection. Results Pathological results confirmed there were 73.68 % with residual tumor, positive rate of thyroid was 47.38 %, and that cervical lymph node was 57.89 %. Conclusion The residual rate of cervical lymph nodes of reoperated patients with thyroid carcinoma was relatively higher, so neck dissection for thyroid carcinoma who received nonstandard operation was necessary.