ABSTRACT
The presence of cervical metastasis has substantial negative impact on survival of patients with laryngeal cancer. Bilateral elective selective neck dissection of levels II, III and IV is usually the chosen approach in these patients. However, there is significant morbidity associated with level IV dissection, such as phrenic nerve injury and lymphatic fistula. The objective of the present study was to evaluate the frequency of metastatic nodes in level IV in clinically T3/T4N0 patients with laryngeal cancer. The pathological reports of 77 patients with clinically T3/T4N0 laryngeal squamous cell carcinoma were reviewed. Patients underwent bilateral lateral neck dissection from January 2007 to November 2012. The surgical specimens were subdivided in levels before evaluation. There were 12 patients with neck metastasis (15.58%). In 3 cases (3.89%), there were metastatic lymph nodes in level IV, all T4 and with ipsilateral metastasis. In conclusion, the incidence of level IV metastasis was 3.89%, an in all patients was staged as T4.
Subject(s)
Carcinoma, Squamous Cell/secondary , Laryngeal Neoplasms/pathology , Adult , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/surgery , Female , Humans , Laryngeal Neoplasms/surgery , Lymph Node Excision , Lymphatic Metastasis , Male , Middle Aged , Neck , Neoplasm StagingABSTRACT
The pectoralis major myocutaneous flap (PMMF) is a safe and versatile flap used widely for head and neck cancer reconstructions, but one of the major and most feared complications is oro- or pharyngocutaneous fistula. Herein, we attempt to establish risk factors for fistula formation in reconstructions of mucosal defects in the head and neck using PMMF through retrospective analysis of PMMF performed during 3 years at a single institution, with a total of 84 procedures. There were 69 men and 15 women, with a mean age of 59.5 years. There were 15 cases of partial flap loss, two total flap losses and 31 fistulas. The independent risk factors for fistula formation were preoperative serum hemoglobin < 13 g/dl, preoperative serum albumin < 3.4 g/dl and hypopharynx reconstruction. The PMMF is still a very useful flap and this is the first multivariate analysis analysing risk factors for fistula formation. These findings are helpful in selecting patients with elevated risk of fistula formation, and therefore preventive measures can be undertaken to avoid potentially serious complications.
Subject(s)
Cutaneous Fistula/epidemiology , Fistula/epidemiology , Head and Neck Neoplasms/surgery , Myocutaneous Flap , Oral Fistula/epidemiology , Pharyngeal Diseases/epidemiology , Plastic Surgery Procedures/methods , Postoperative Complications/epidemiology , Aged , Female , Humans , Male , Middle Aged , Pectoralis Muscles/transplantation , Retrospective Studies , Risk FactorsABSTRACT
PIP: Kits for pregnancy tests available on the market and their prices in Brazil are listed. Those based on the agglutination inhibition reactions can be used 8-10 days after determining the absence of menstruation, when the levels of chorionic gonadotropin range from 1500 to 3500 IU/1. A colorimetric test based on a chemical reaction is also available, and can be used 15 days after determining the absence of menstruation. The kits and their manufacturers are: Gravindex (Johnson), Teste de Gravidez (Roche), Pregnosticon Planoteste (Organon), Pregnosticon All-in (Organon), and Uni-test (Novaquimica) (colorimetric test).^ieng
