Nasolahial flap in reconstruction of oral defects after ablative surgery in patients with oral cancer

This study highlights technical aspects and outcome of different types of nasolabial flap in reconstruction of oral cavity defects, following extirpation of mouth cancer. This is a prospective study, included 14 patients who had been treated surgically for oral cancerous lesions and reconstruction was performed by 16 nasolabial flaps in the period from June 2002 and December 2005 in Sohag University Hospital. Inferiorly based flaps were 10 unilateral and 1 bilateral, and superiorly based flaps were 2 unilateral and 1 bilateral. All flaps were for immediate reconstruction of the defects except in 2 cases. Perioperative complications were recorded. Functional outcome in terms of speech; chewing; swallowing; and cosmetic appearance were evaluated preoperatively and at 6 months postoperative. Patients were 10 men and 4 women and their average age was 63.8 years [45-82 years]. The commonest histology was squamous cell carcinoma [12/14] and presentation was early in stage I [6/14] and II [5/14]. The majority of patients were ASA grade II [5/14] and III [6/14]. Neck lymph nodes dissection with facial artery ligation was done in 8 patients without affecting the outcome. As complications, we noted one case with postoperative wound dehiscence and another case with minimal infection. On the other hand, we, found it technically feasible, versatile, and with satisfactory functional and acceptable cosmetic outcome. The nasolabial flap for replacement of soft tissue in the oral cavity is easy to harvest, with minimal morbidity. It represents a functional and aesthetically satisfactory alternative to reconstruction by other flaps in cases with small and medium sized defects, especially in elderly, medically compromised patients who are therefore of poorer surgical risk

Outcome of parathyroidectomy for primary hyperparathyroidism in Sohag university hospital in 5 years: retrospective study

Primary hyperparathyroidism [PHPT] is a common endocrine disease treated very effectively by surgery. It is the commonest cause of hypercalcaemia. The majority of cases are caused by adenoma [80% to 85%], whereas approximately 15% have diffuse hyperplasia of all four parathyroidglands. Rarely [1%], parathyroid carcinoma is the cause of hyperparathyroidism. Parathyroid diseases has not been investigated in our community before. This study had been conducted to analyze the outcome of surgical treatment of [PHPT], as regard the success rate, complications and recurrence. Between May 1999 and July 2004, 14 consecutive patients with [PHPT], who had been submitted to surgery in Sohag University Hospital were enrolled in this study. Analysis of clinical presentations, laboratory and imaging studies, surgical approach, intraoperative findings, and outcome assessment m terms of success rate, complications had been done. A total number of 14 patients diagnosed as PHPT, 10 were women and 4 were men. Their age ranged from 25-51 years, with a mean age of 41.2 +/- 6.9 years. Bone affection was the dominant presenting feature [79%]. All cases showed high level of serum calcium [mean 3.13 +/- 0.42 mmol/L] and parathormone hormone [mean 787.4 +/- 256.6 pg/mL]. Accuracy of ultratsound scanning of the neck was 71% in localization of parathyroid lesions, while that of CT and Sestamibi scan were 85% and 87.5% respectively. A single parathyroid adenoma was the commonest lesion [86%]. All patients, but two, had been followed up from 6 months to 18 months with a mean of 11 +/- 4 months. The success rate was achieved in all but one [92.9%], who had been found to be an ectopic parathyroid adenoma in the superior mediastinum. There was one case who died due to the morbid general medical condition. Postoperative temporary hypocalcaemia was observed in two cases. No permanent injury to RLN was reported in our cases. Parathyroid disease is not uncommon problem in our locality. Surgery of PHPT is a very successful operation with minimal morbidity. Early discovery of PHPT gives the best chance of cure and avoid disastrous complications of this disease