Bridging the Nerve Gap with Skeletal Muscle and Silicone Tube after Schwannoma Resection in Brachial Plexus: A case report

A large gap in peripheral nerve will not allow effective regenaration unless a grafting conduit is used to bridge the defect. Conventionally, nerve tissue has been used as a conduit in nerve reconstruction; however, results from techniques using these grafts are often unsatisfactory. A number of recent investigations have indicated that nerve fibers will regenerate through a nonneural tube. A 45-years-old female patient with a protruding mass on her lateral neck area visited our hospital. She complained of tingling sensation on the lateral aspect of palm, extending to 4, 5th finger. Mild degree of hypothenar muscular atrophy was also observed. Magnetic resonance image showed well-circumscribed mass with homogenous density located in brachial plexus area. We performed tumor excision with conglumerated C7 resection. The histologic finding was schwannoma with mixed type of Antoni A and B. A piece of sternocleidomastoid muscle was used as a conduit to bridge the gap and entubulization, the implantation of silicone guide tubes, was performed as an alternative method to the repair of transected nerves in the silicone tubes. The proximal and distal nerve stumps are introduced into each end of the tube and are held in place by epineural sutures. During three months of follow-up period, neuropathic pain and tingling sensation slowly subsided. Nerve conduction test and electromyography performed at the time of 86th day after the surgery showed much improved pattern compared to those performed on the 14th day after the operation. These results show that basement membrane of muscle fiber and silicone tube are able to orientate and promote peripheral nerve regeneration in a manner analogous to the endoneurial tubes of peripheral nerves.

Giant Carotid Body Tumor in Neck: A Case Report

A carotid body tumor, also known as a paraganglioma in neck, originates from cells of neural crest tissue and arises at the carotid bifurcation. Carotid body tumors may present at any age and do not occur more frequently in either sex. A 39-year-old woman visited our hospital with a mass on the left side of her neck. She had first noticed the mass 20 years ago, and it has rapidly grown recently, especially in last two years. Magnetic resonance imaging showed a large solid mass with marked posterior and superior extensions splaying at the carotid bifurcation. In addition, carotid arteriography revealed a solid vascular mass in the carotid bifurcation and many feeding vessels from large adjacent arteries. Under the fluoroscopy control, PVA particles and coils were used for embolization. On completion, angiogram demonstrated as approximately 80% reduction in tumor vascularity with obliteration of most of the afferent tumor vessels. Thereafter, the patient underwent surgery under general anesthesia. An incision was made along the anterior border of the sternocleidomastoid muscle and the carotid sheath was opened. The tumor was carefully dissected from the common carotid, external carotid, and then the internal carotid arteries which has close adherence of the sheath to the tumor. The internal jugular, facial veins, spinal accessory nerves and branches of vagus nerve were sacrificed. On gross finding, the tumor was a well encapsulated soft tumor mass measuring 12 x 9 x 6 cm in size and completely surrounded by a fibrous capsule. The patient was discharged 21days after the operation with satisfactory result and no specific neurologic deficit.

Benign Fibrous Histiocytoma of the Lip: Report of a Case

A fibrous histiocytoma(sclerosing hemangioma, dermatofibroma) is a benign skin lesion which has a predilection for the lower extremities. It varies in appearance from a depressed pigmented area to an elevated purplish brown or whitish lesion. It arises from the dermis or subcutaneous tissue, and the size varies from several millimeters to several centimeters. We report a rare case of lower lip fibrous histiocytoma in a 55-year-old woman who was noted to face slowly growing well-defined whitish nodular lesion on the lower lip after insect bite. We performed elliptical mass excision and primary closure. Histiologically, the tumor showed epidermal hyperplasia and extensive proliferation of fibroblastic cells which were uniform in shape and size. The tissue pattern was storiform and whorled, and scattered foamy histiocytes(xanthoma cells) were noted. This is a very rare case in which a benign fibrous histiocytoma occurred rapidly on the lower lip following an insect-bite episode and it supports the view that the lesion develops by a secondary immune-reactive mechanism rather than primary neoplastic process.

Functional Evaluation of Oral Cavity and Oropharyngeal Reconstrucion Using Radial Forearm Free Flap

The traditional focus of surgeon of all disciplines has been on curing patients. Unfortunately, this focus on cure has sometimes resulted in neglect of the functional outcomes and QOL that are experienced by patients. The treatment of oral cavity and oropharyngeal cancer can result in marked alteration in the functional status and general health. However, few studies have addressed themselves to measuring the speech, swallowing results, and the quality of life after definitive therapy. By use of sophisticated techniques, we can now document, quantify, and critically analyze the surgeon's reconstructive efforts. Using these methods, we have evaluated the radial forearm free flap in 26 patients receiving oral reconstruction between 1994 and 1999. The radial forearm fasciocutaneous free flap has proved extremely versatile in reconstructing defects of the orofacial region and has become a workhorse flap in head and neck reconstruction. It has advantages including small bulk, easy dissection, vascularity, and malleability. This study evaluated long term effects on performance statusin a cohort of patients successfully treated with a surgical approach. The results were compared by site and treatment modality. These patients age ranged from 33 to 75 years with a mean age of 52.6 years. The 10 patients in this series did not have preoperative radiotherapy, while sixteen other patients underwent full curative dosages of 6000-6300 Gy within six weeks of surgery. Sites of the lesions included the anterior two thirds of thw tongue, base of tongue, floor of mouth, and tonsil. The functional status were generally excellent. The speech, swallowing, aspiration, oral incompetence, VPI were examined in all pateints. The total score1 12.9 in mobile tongue cancer patients(hemiglossectomy), 7 in total glossectomy patients and 11.0 in tongue base, 12.5 in mouth floor, 9.5 in tonsilar cancer patients. Postopeative radiation therapy didn't affect the functional disability and the sensate flap can give more benefits for postoperative early rehabilitaition than non-sensate flap. Despite the devastating effects of ablative surgery, the application of avaliable reconstructive techniques can help to improve the quality of life of these patients. Our series serves to identify site-specific speech and swallowing problems to facilitate posttreatment rehabilitation of patients with oral cavity and oropharyngeal cancer.

Orbital floor and infraorbital rim reconstruction with vascularized calvarial bone flap

A number of methods have been introduced for support the orbital floor following a maxillectomy without orbital exenteration or severe facial trauma. These methods including skin graft and muscular sling provided the unsatisfactory results, like as diplopia, orbital ptosis, enophthalmos and severe facial deformity. Therefore the bone and soft tissue reconstructions using microvascular free flaps were performed recently by many surgeons, but long time operation, donor site morbidity, postoperative large scar, and ptosis of the flap were pointed out as disadvantages of free flap reconstruction. Vascularized calvarial bone flap, a modified method of free calvarial bone graft, was adequate for reconstruction of the orbital floor and the infraorbital rim as a horizontal buttress, especially in case of poor vascular bed and postradiated state. The authors introduced the vascularized calvarial bone flap for the orbital floor and the infraorbital rim reconstruction in 3 cases of maxillectomy, and could be obtained satisfactory results aesthetically and functionally.