Reconstruction of Glottis and Hyoppharynx using Radial Forearm - Palmaris Longus Composite Free Flap

Partial laryngectomy and pharyngectomy have been suggested for localized hypopharyngeal cancer to preserve the function of larynx. In case of limited partial laryngectomy, local soft tissue flaps are sufficient to provide adequate bulk for glottic closure. However, in case of extensive partial laryngectomy procedure in which more cartilaginous framework is resected, we feel an increased necessity of considering 'hard tissue' as well as soft tissue restoration to prevent airway collapse and glottic incompetency. We have tried radial forearm free flap including palmaris longus tendon for reconstruction of glottis and hypopharynx following a wide vertical hemilaryngopharyngectomy. We had 2 patients with hypopharyngeal cancers localized in pyriform sinus. The tendon was secured so as to drill holes in the cricoid and thyroid cartilage at the glottic level to help maintain the position of soft tissue lining and sewe as buttress for mobile vocal cord. A good restored phonation and respiration were obtained in two cases of hypopharyngeal cancer patients. But one patient suffered from frequent aspiration due to esophageal inlet stricture after radiation therapy.

Clinical Application of Artificial Edrmis (terudemis) for Exposed Tendon and Bone Area

Local or distant flap surgery has been applied in the soft tissue defect area where bone and tendon are exposed, but there are many pitfalls in these surgeries including limitation of donor site selection, as well as functional and aesthetic dissatisfaction of the donor and recipient site. So these problems have facilitated the development and study of skin substitute (artificial dermis). The history of artificial skin began in the 1980s with the invention of Stage I membrane by Yannas and Burke. Since then it has been developed and applied to chinical cases of extensive burn injury and soft tissue defect. In 1989, and artificial dermis (Terudermis) composed of fibrillar collagen and heat denaturated atelocollagen was developed by Konish. It has the advantage of allowing early-incorporation of cellular and vascular components into its collagen sponge, as well as dehydrothermal cross-linking, which is very weak. This study included 18 consecutive cases which underwent application of artificial dermis on bone and tendon from January 1997 to November 1998. The exposed areas were the result of trauma in 10 cases, postoperative complications in 2 cases, and other causes in 6 cases. The follow-up period ranged from 3 months to 18 months, averaging 11 months. A week after wound debridement and Terudermis application, neovascularization had begun and granulation tissue appeared aften 2-3 weeks. Then the split or full -thickness skin graft was secondarily applied resulting in the production of sufficient skin. In conclusion, Terudermis application to an area of exposed bone and tendon is a very useful method, especially when primary local or distant flap surgery cannot be used. This method is very simple, convenient and reliable.

The Histomorphologic Evaluation of Hair Follicles Before and After Tissue Expansion in the Human Scalp

Soft tissue expansion technique has been a very useful method for the reconstruction of scalp defects and alopecia since the scalp is an unyielding tissue allowing minimal distension in traditional local flap surgery. As a result, there has been wide use of the tissue expansion method in the reconstruction of scalp defect and treatment of alopecia in the plastic surgery. There have been many concerns about histomorphologic changes of the overlying skin and the underlying structure resulting from tissue expansion. We also know that progressive tissue expansion induces increased mitotic activity of the epidermis and thining of the dermis in the overlying skin, as well as significant gross, histologic bony erosion in the underlying structure. However, little informations have been reported about the changes of the hair and pilocebaceus units in scalp expansion. We compared the horizontal sections of the expanded scalp and its longterm histologic changes with a normal unexpanded scalp specimen as a control. The terminal hair proportions to the vellus hair both increased. There was a 32% decrease in follicular units, a 24% decrease in terminal hair, and a 23% decrease in total hairs 8 week after scalp expansion compared to the normal unexpanded scalp. The perifollicular inflammatory changes and fibrosis observed in the full expanded scalp specimen disappeared within 12 weeks after removal of the expander and the flap transposition. In our observation, tissue expansion at the hair-bearing scalp did not precipitate any adverse changes on the hair follicles. On the contrary, we observed that secondary scalp expasion could be safetly performed 3 months after the first scalp expansion.

Malignant Epithelial Edontogenic Ghost Cell Tumor in the Mandible and Tongue : A Case Report

Benign odontogenic neoplasms are rare, but malignant odontogenic neoplasms are extremely rare. The majority of malignant epithelial neoplasms occurring in the jaws are the result of metastasis from distant primary neoplasms of direct invasion from contiguous carcinoma of the oral mucosa, sinus mucosa, salivary gland or skin. A few remaining primary intraosseous carcinoma of the jaw are presumed to be of mostly odontogenic origin since epithelial remnants of odontogenesis are numerous in the maxilla arts mandible. Although calcifying odontogenic cyst(COC) is a well-established pathologic entity, it has been recognized that there is an odontogenic neoplasm with histologic features similar to the COC(malignant epithelial odontogenic host cell tumor; EOGCT) that has been diagnosed as COC. Some authors have reported previously in the literature describing malignant EOGCT. We experienced one case of malignant EOGCT with aggressive growth pattern and histologic features strongly implying its malignant potential. The lesion was excised by anterior mandibular resection, total 1 resection of the tongue and bilateral functional neck dissection. The tongue was reconstructed by using the infrahyoid muscle neurovascular island flap and neurovascular radial forearm free flap. The mandible was reconstructed by using the osteocutaneous fibular free flap.