Parathyroid gland autotransplantation after total thyroidectomy in surgical management of hypopharyngeal and laryngeal carcinomas: A case series.

BACKGROUND AND OBJECTIVES: Total thyroidectomy is indicated in most cases with postcricoid carcinoma, circumferential hypopharyngeal carcinoma and in advanced laryngeal carcinoma. Persistent hypoparathyroidism is a frequent complication after total thyroidectomy which is difficult to manage unlike hypothyroidism. This study was to assess the feasibility of parathyroid gland autotranplantation after total thyroidectomy in advanced carcinomas and their effectiveness in preventing persistent hypoparathyroidism. METHODS: This study included 26 patients with hypopharyngeal and laryngeal carcinoma presented to National Cancer Institute, Cairo University. Total thyroidectomy and total parathyroid gland excision were performed as a part of adequate oncologic surgical procedure. The parathyroid glands were identified, resected and stored in iced saline. Histological confirmation was necessary before implantation into separated muscle pockets in the anterior forearm muscles. Regular samples were drawn to assess serum parathormone and calcium levels. RESULTS: All patients experienced hypocalcaemia within 1-5 days after operation. Only one patient experienced parathyroid graft failure while the remaining patients were normocalcemic during follow up after surgery, indicating functioning parathyroid grafts. CONCLUSIONS: Parathyroid gland autotranplantation is a simple safe technique with high success rate in preventing persistent hypoparathyroidism after total thyroidectomy in surgical management of advanced hypopharyngeal and laryngeal carcinomas.

Continuous validity of pedicled myocutaneous and myofascial flaps in reconstruction after surgery for head and neck cancer.

PURPOSE: The aim of this study was to reevaluate the role and effectiveness of pedicled myocutanous and myofascial flaps in reconstruction after resection of head and neck cancer. PATIENTS AND METHODS: This study represents the authors own experience using pedicled myocutanous and myofascial flaps in reconstruction after resection of malignant tumors of different sites in the head and neck. The study included 121 patients with head and neck cancer operated upon at the National Cancer Institute, Cairo University and Alminia Cancer Center over 3 years duration, between July 2005 and the end of July 2008. Four types of flaps were used namely the Pectoralis major (Group I), lower trapezius (Group II), Latissimus dorsi (Group III), and the temporalis ((Group IV) flaps. Utility of the different types of these flaps was reevaluated in terms of indications, advantages, and postoperative complications. RESULTS: This study included 121 patients, 83 males and 38 females. The mean age was 56 years (range, 14- 65 years). Oral malignancies represented most of the cases (71 cases). Pectoralis major myocutaneous (PMMC) flap was the most commonly used flap (84 cases) and its main indication was oral and pharyngeal defects. Lower trapezius and Latissimus dorsi myocutaneous flaps were used in 14 and 12 cases respectively. Their main indications were tumors in the occiput, ear pinna, parotid and neck regions. The Latissimus dorsi myocutaneous flap was also used for reconstruction of oral and pharyngeal defects in 7 female patients with large breasts and for salvage reconstruction after failure of reconstruction by (PMMC) flap in one patient and for reconstruction after excision of local recurrence on top of previous (PMMC) flap in another patient. Temporalis myofascial flap was used in 12 cases and the main indication was orbital defects. The overall postoperative complications was 19.8% (24/121). It was 20% (17/84) in group I, 28.6% (4/14) in group II, and 25% (3/12) in group III. No flap related complications were reported in group IV. All complications were successfully managed except for one case in (Group I), in which a major flap loss developed and was successfully salvaged by pedicled latissimus dorsi myocutaneous flap. CONCLUSION: Pedicled myocutanous and myofascial flaps are still indicated in composite head and neck reconstruction. Their reliability, safety, and high degree of resistance to infection make them essential specially the (PMMC) flap previously described as the spare wheel of head and neck reconstructive surgery. It is suitable for lateral mandibular defects in edentulous patients and in partial pharyngeal defects in irradiated patients. Other pedicled myocutaneous flaps are still valid in certain occasions and sites. KEY WORDS: Head and neck cancer - Pectoralis major - Trapezius - Latissimus dorsi - Temporalis myocutaneous - Myofascial flaps - Reconstruction.