Diagnosis and treatments for recurrent malignant tumors involving the carotid artery / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the diagnosis and treatment of the malignant tumor involving carotid artery.</p><p><b>METHODS</b>A total of 23 cases of recurrent malignant tumors involving the carotid artery were included in this study. For the primary cancers, 8 of 23 cases were laryngeal carcinomas, 10 hypopharyngeal carcinomas, 2 thyroid carcinomas, 1 tonsil carcinoma, 1 parotid gland carcinoma, and 1 hypopharyngeal sarcoma with the invasion of cervical esophagus. Detailed evaluation on each case was performed before treatment. The relations of recurrent tumors with neck blood vessels were determined with enhanced CT/CTA. Of 23 cases with recurrent malignant tumors involving the carotid artery, 16 cases received surgery and 7 cases received the palliative treatment without operation.</p><p><b>RESULTS</b>Seven patients with palliative treatments died of hemorrhage from the invaded neck blood vessels, systemic failure or pulmonary metastasis in six months. Of 16 cases with surgery, recurrent tumors were completely excised in 14 cases and there were residual tumor tissues on artery walls in 2 cases. Within 16 surgical cases, 2 cases died of neck hemorrhoea after one week because of infection, 2 cases died of lung metastasis 8 months later, 3 cases died of neck local recurrence 1 year later, 2 cases died of lung metastasis after 2 years, 1 case died of neck local recurrence 2 years later and 1 case died of a heart attack 2 years later. The rest 5 cases were alive.</p><p><b>CONCLUSIONS</b>Enhancement CT/CTA can used in the evaluation for recurrent malignant tumors involving the carotid artery. Surgical treatments can be applied to some selected patients, which can improve the quality of life and survival time of the patients.</p>

Application of lateral cervical incision in the removal of the cervical esophageal foreign body / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the indication and clinical application of lateral neck incision for the removal of cervical esophageal foreign bodies.</p><p><b>METHODS</b>From January 1999 to January 2009, 2189 cases esophageal foreign bodies were treated. The clinical data of 137 cases (6.25%) with lateral neck incision were retrospectively analyzed. In these 137 cases, 114 cases were over 16-years-old (adult group), while 23 cases were under 16-years-old (children group). In adult group, 67 cases (58.8%) had esophageal perforation (esophageal perforation with neck abscess 29 cases, esophageal perforation without neck abscess 38 cases); 47 cases did not have esophageal perforation (impacted foreign body without neck abscess 40 cases, foreign body with esophageal abscess 7 cases). In children group, 19 cases (82.6%) had esophageal perforation including 15 cases with neck abscess; 4 cases without esophageal perforation, 3 cases had esophageal abscess and one case without abscess but of huge foreign body.</p><p><b>RESULTS</b>All 137 patients with foreign body were cured through lateral neck incision. Nineteen cases (13.9%) had hoarseness and recovered in 3 months. Five adult patients had post-operative cicatricial stricture of the esophagus, but it was mild and completely recovered by the treatment of dilatation in 3 to 11 months. Nine adult patients with esophageal perforation were cured by secondary suture, the remaining esophageal perforation cases were healed by first intention. One case with common carotid artery impairement by the foreign body was successfully treated by carotid artery ligation without hemiplegia, aphasia and other sequelae. Two cases had cardiopulmonary arrest, 2 cases had febrile convulsions and 1 case had acute respiratory failure, 5 cases had septic shock, all these patients were effectively controlled and cured. Seven of the 9 cases with tracheotomy had the tracheal tube removed during hospitalization; 1 of the two obese patients had the extubation 3 months after the discharge and the other one still had the tube. All esophageal perforation cases in children group had primary healing by perforation apposition suture. Four of the 5 children had successful tracheotomy decannulation, one child had extubation by 2 months through continuously reduced tracheal tube model.</p><p><b>CONCLUSION</b>Penetrating esophageal foreign body and neck abscess were indication of the lateral neck incision, and positive prevention and cure the complications of lateral neck incision could achieve good curative effect.</p>

Swallowing and laryngeal function preserving in surgical treatment of the head and neck tumors involving the tongue root / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the surgical technique which could preserve the swallowing and laryngeal function effectively in the malignant head and neck tumors involving the tongue root.</p><p><b>METHODS</b>From January 2003 to December 2008, 31 cases of malignant head and neck tumors involving the tongue base had been treated in this hospital were retrospectively analyzed. There were 27 males and 4 females in which 9 cases of primary malignant tumor were from the base of tongue; 3 cases were from the tonsil, 11 cases were from supraglottic laryngeal carcinoma and 8 cases were from hypopharyngeal carcinoma. Preserved the lingual artery of the reserved side and the normal tissue of the root of tongue according to the clinical anatomy of lingual artery during the operation. If preoperative CT had indicated that bilateral lingual arteries were involved, total glossectomy should have been done. The epiglottis, vocal cords and the ventricular band of larynx was preserved as much as possible for the mechanisms of laryngeal function.</p><p><b>RESULTS</b>In this group, residual tongue necrosis did not occurred. One case with total glossectomy didn't remove the trachea cannula. Five had total laryngectomy. The other 25 cases decannulated from 14th days to 90th days postoperatively. The time of oral feeding was started from 10th days to 31st days postoperatively. Two cases with hypopharyngeal carcinoma developed fistula, which were cured by dressing change. Two with root of tongue cancer and 1 with tonsil cancer had postoperative infection and healed in 2 weeks. The median follow-up time was 36 months, and the Kaplan-Meier 3-years and 5-years survival rates were 79.5% and 69.6% respectively.</p><p><b>CONCLUSIONS</b>In the surgical treatments of the malignant head and neck tumors involving the base of tongue, the excisions and reconstructions of the primary tumor and the involved tongue base according to the clinical anatomy of lingual artery and the protection mechanisms of laryngeal function during the operation was one of the most effective technique to preserve the swallowing and laryngeal function.</p>