ABSTRACT
Purpose: To report technical details and 15-month outcomes of a patient with node-positive external auditory canal (EAC) squamous cell carcinoma (SCC) treated with definitive intracavitary high-dose-rate (HDR) brachytherapy to primary tumor, and external beam radiotherapy (EBRT) to draining lymphatics. Material and methods: A 21-year-old male was diagnosed with SCC of the right EAC. The patient underwent definitive HDR intracavitary brachytherapy, 340 cGy/fraction for 14 twice-daily fractions, followed by EBRT using intensity-modulated radiation therapy (IMRT) to cover the grossly enlarged pre-auricular node, ipsilateral intra-parotid, and cervical lymph node levels II and III. Results: The approved brachytherapy plan had an average high-risk clinical tumor volume (CTV-HR) D90 of 341 cGy with a total dose of 47.7 Gy (BED, 80.3 Gy, EQD2, 66.6 Gy). For the approved IMRT plan, the prescription to the involved right pre-auricular node was 66 Gy in 33 fractions, and more than 95% of the target received at least 62.7 Gy. High-risk nodal regions were simultaneously prescribed: 59.4 Gy in 1.8 Gy fractions, and more than 95% received at least 56.4 Gy. Organs at risk (OARs) were kept below their dose constraints.The patient tolerated both the procedures with no grade ≥ 2 treatment-related adverse events. Grade 1 dermatitis in the right pre-auricular and cervical areas during the course of EBRT was experienced. Fifteen months post-RT, the patient has no evidence of disease, and was noted to have EAC stenosis, which translated to moderate conductive hearing loss of the right ear. Thyroid function was normal at 15 months after EBRT. Conclusions: This case report illustrates that the delivered definitive radiotherapy is technically feasible, effective, and well-tolerated in patients with SCC of EAC.
ABSTRACT
OBJECTIVE: To determine if the anatomic dimensions (length, cross-sectional width, cortical thickness) of the Filipino fibula are ideal for mandibular reconstruction.METHODS:Design: Cross-Sectional StudySetting: Anatomy dissection laboratoryParticipants: 40 fibulas from 20 adult cadaversRESULTS: Morphometric examination showed the mean length of the harvested fibulas was 33.5 cm. The mean horizontal (a-d) and vertical (b-c) widths of the proximal cross-section (point B) were 15.1 ± 0.28 mm and 9.9 ± 0.15 mm respectively. The mean horizontal (a-d) and vertical (b-c) widths of the distal cross-section (point D) were 15.4 ± 0.24 mm and 10.3 ± 0.49 mm, respectively. The mean cortical thickness of the anterior (a), lateral (b), posterior (c) and medial (d) aspects of the proximal cross-section (point B) were 5.2 ± 0.1 mm, 3.2 ± 0.04 mm, 3.6 ± 0.01 mm, and 2.9 ± 0.06 mm, respectively. The mean cortical thickness of the anterior (a), lateral (b), posterior (c) and medial (d) aspects of the distal cross-section (point D) were 5.1 ± 0.21 mm, 3.1 ± 0.11 mm, 3.5 ± 0.04 mm, and 2.9 ± 0.09 mm, respectively.CONCLUSION: Our findings show that the Filipino fibulas studied have dimensions that are ideal for mandibular reconstruction.
Subject(s)
Humans , Male , Female , Mandibular Reconstruction , Fibula , Cadaver , DissectionABSTRACT
Objective@#To present our application of a double anterolateral thigh (ALT) free flap in reconstruction of a large full thickness defect of the oral cavity, cheek and cervical area.@*Methods@#Design: Case Report Setting: Tertiary Government Hospital Patient: One@*Results@#A 77-year-old male with a 20 x 25 cm full thickness soft tissue defect on the facial and cervical area contiguous with a 6 x 6 cm buccal defect resulting from wide tumor ablation of a Stage IVA (T4aN2bM0) squamous cell carcinoma of the buccal mucosa underwent reconstruction using two ALT free flaps. An ALT flap was designed to cover the intraoral and cheek defect, while another ALT flap was used for external coverage of the cervical defect. The first ALT flap measured approximately 8 x 22 cm while the second ALT flap measured 6 x 22 cm harvested from the left and right thigh respectively. Temporary venous congestion was observed on the inferiorly placed ALT flap due to neck edema that spontaneously resolved on the 2nd post-operative day. Minimal donor site complications observed were linear scars, and a 1 x 4 cm dehiscence on the right thigh that healed spontaneously by secondary intention.@*Conclusion@#The utilization of a double anterolateral thigh free flap allowed single-stage reconstruction of the large soft tissue head and neck defect with little donor site morbidity, shorter operating time and shorter hospital stay.
