Protection and functional repair of vagus nerve during the operation of cervical vagal paraganglioma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the clinical anatomy and the methods to protect or reconstruct the continuity and function of vagus nerve during the operation of cervical vagal paraganglioma.@*METHOD@#Six cases of vagal paraganglioma were reviewed. All tumors were identified to wrap the cervical vagus nerve stem and excised during surgery. The operative modality was to trace the vagus nerve stem inside the tumor as far as possible, to reconstruct the continuity by way of vagus nerve anastomosis (3/6) or alternatively, other motor nerve transplantation (3/6). Postoperative treatment included steroid, neurotrophic medication and voice and swallowing rehabilitation.@*RESULT@#Two cases of the recurrent paraganglioma experienced aspiration during swallowing preoperatively and no aspiration after surgery. Choking was gradually reduced in four recurrent cases half to one year postoperatively. Hoarseness was improved in five cases (5/6) half to one year postoperatively, while one case remained prolonged obvious hoarseness. Three months postoperatively, the vocal cord fibrillation at the tumor-related side was observed during pronunciation in the end-to-end anastomosis cases (3/6), sublingual nerve-transplanted case (1/6) and deep cervical nerve-transplanted cases (1/6) under fiberoptic laryngoscope, and the mobility was even more obvious at the time of half an year postoperatively. While in another deep cervical nerve-transplanted case (1/6), the vocal cord demonstrated no obvious fibrillation.@*CONCLUSION@#To carefully identify and preserve the vagus nerve fibers as much as possible during the operation of cervical vagal paraganglioma could significantly eliminate postoperative hoarseness and aspiration. End-to-end anastomosis, deep cervical nerve or sublingual nerve transplantation to resume the continuity of vagus nerve may improve the mobility of vocal cord thus the quality of voice and swallowing.

Free perforator flap transfer to reconstruct the defect resulted from resection of head and neck tumor / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the method of free perforator flap reconstructing the defect resulted from head and neck tumor resection.@*METHOD@#Twelve cases treated in our department because of head and neck tumor were reviewed, among which 3 cases employed rectus abdominis flap, 5 cases anterolateral thigh flap, 2 cases latissimus dorsi flap, 2 cases pectoris major flap.@*RESULT@#One case failure with the transfer of latissimus dorsi flap, one case of partial necrosis of anterolateral thigh flap resulting in pharyngeal fistula, one case of artery thrombosis and one case of venous thrombosis occurred and the flap revived after emergent exploration and re-anastomosis. The total survival rate of the transferred flap is 91.6%.@*CONCLUSION@#Free perforator flap is able to be a good choice to reconstruct big defect resulted from head and neck tumor resection because of its simple preparation, big size of donor site.