Colgajo supraclavicular como herramienta en el manejo multidisciplinar de un cordoma cervical c2-c4. A propósito de un caso / Supraclavicular flap as a tool in the multidisciplinary management of a cervical c2-c4 chordoma. Purpose of a case

Los cordomas son tumores óseos poco frecuentes, de crecimiento lento, derivados de remanentes de la notocorda. Se localizan predominantemente en la base del cráneo y la región sacrococcígea. La columna cervical se ve afectada únicamente en el 6 % de los casos. El tratamiento de elección incluye la resección en bloque, radioterapia y en ocasiones quimioterapia.Presentamos el caso de un paciente con diagnóstico de cordoma cervical sin respuesta a un tratamiento previo con radioterapia, que se somete a cirugía de rescate para resección, corpectomía C2-C3 y fijación con material protésico. Presentó una dehiscencia de herida quirúrgica en región orofaríngea en el postoperatorio, con exposición del material protésico. Se resolvió con un colgajo supraclavicular pediculado para cobertura del defecto en pared faríngea posterior. (AU)

Chordomas are rare, slow-growing bone tumors derived from remnants of the notochord. They are located predominantly at the skull base and the sacrococcygeal region. The cervical spine is affected in only 6 % of cases. The treatment of choice includes resection, radiotherapy and sometimes chemotherapy.A case of a patient diagnosed with cervical chordoma without response to previous radiotherapy treatment is presented. The patient underwent surgical rescue including tumor excision, C2-C3 corpectomy and fixation with prosthetic material. He presented a surgical wound dehiscence in the oropharyngeal region in the postoperative period, with exposure of the prosthetic material. It was resolved with a pedicled supraclavicular flap to cover the defect in the posterior pharyngeal wall. (AU)

Transmandibular Approach in Head and Neck Oncological Surgery.

Objective: To evaluate the advantages and disadvantages of the transmandibular approach to the posterior area of the maxilla, oropharyngeal region and the hypopharynx in head and neck surgery. Methods: A series of 42 patients who underwent a lip-split mandibulotomy procedure to access malignant tumours affecting deep areas of the head and neck region between 2008 and 2018 in the Department of Oral and Maxillofacial Surgery at the Ramón y Cajal University Hospital (Madrid, Spain) were retrospectively reviewed. The diagnosis and operations data of the patients were collected and analysed. Results: Using the transmandibular approach, 42 patients were operated on to access malignant tumours located in the oropharynx (n = 23, 54.76%) including the posterior third of the tongue, tonsil and soft palate, retromolar trygone (n = 9, 21.43%), floor of the mouth (n = 3, 7.14%), skull base (n = 2, 4.76%), superior maxilla (n = 3, 7.14%) and deep lobe of the parotid gland (n = 2, 4.76%). Primary reconstruction was carried out in all cases. The most used flap reconstruction method was the forearm fasciocutaneous flap in 48.71% of cases, followed by the anterolateral thigh flap in 20.51% of cases. The remaining cases were treated with other methods. The most frequent complication was surgical wound infection. Conclusion: The transmandibular approach is a good alternative to provide access for the removal of complex tumours affecting the oropharyngeal region. This approach facilitates direct visualisation of the lesion and bleeding control, allowing tumour resection with wide margins and making primary reconstruction easier. Although further progress in the transoral robotic approach could be a good option in selected cases, given the current state of knowledge, the transmandibular approach is a good option to access tumours affecting deep areas of the oral cavity and oropharynx.