Prevention of anastomotic leak using an advanced pectoral flap in total pharyngolaryngectomy and free jejunal reconstruction for hypopharyngeal or laryngeal carcinoma.

BACKGROUND: We devised an advanced pectoral flap (APF) to prevent anastomotic leak after total pharyngolaryngectomy (TPL) and free jejunal reconstruction (FJR) in patients with hypopharyngeal or laryngeal carcinoma. The APF alleviates tension on the skin in the neck, reduces the subcutaneous dead space, and promotes adhesion between the neck skin and the anastomosis. OBJECTIVE: To investigate whether an APF is effective for prevention of anastomotic leak associated with TPL/FJR. PATIENTS AND METHODS: Anastomotic leak was compared between APF (n = 65) and non-APF groups (n = 25). Patients who had received preoperative radiotherapy or undergone tracheostomy or skin infiltration requiring neck reconstruction using a pedicle flap were excluded. RESULTS: There were significantly fewer cases of anastomotic leak in the APF group than in the non-APF group (1.5% [1/65] vs. 16.0% [4/25]; p = .02). An APF could be created bilaterally within approximately 15 minutes. Unlike a deltopectoral flap, an APF does not require a skin graft. CONCLUSIONS: The postoperative anastomotic leak rate was 1.5% in patients who underwent TPL and FJR for hypopharyngeal or laryngeal carcinoma with an APF. SIGNIFICANCE: An APF is easily created and can reduce the incidence of anastomotic leak after TPL and FJR.

Extent of thyroid resection and thyroid function after postoperative radiotherapy following total laryngectomy or total pharyngo-laryngo-esophagectomy.

OBJECTIVE: Concurrent chemoradiotherapy (CCRT) is often performed after total pharyngo-laryngo-esophagectomy (TPLE) or total laryngectomy (TL). Hypothyroidism is one of the side-effects of CCRT. The objective of this study was to ascertain the timing of onset and severity of latent hypothyroidism among patients who underwent radiotherapy (RT) or CCRT after TPLE or TL, using thyroid-stimulating hormone (TSH) as a biomarker, and to explore methods of preventing its development. METHODS: Participants comprised 21 patients who underwent these treatments at Tokyo Medical University Hachioji Medical Center between May 2009 and December 2013. TSH, free thyroxine 3, and free thyroxine 4 levels were used as indicators of thyroid function, and thyroid hormone was administered for TSH levels ≥15 µU/mL. RESULTS: Post-radiotherapeutic TSH levels in 17 of the 21 patients (81%) were not within the reference value, and 10 (48%) required thyroid hormone therapy. Pharmacotherapy was initiated within 1 year in 5 of these 10 patients (50%), and between 1 and 3 years in the remaining 5 patients. No patient who did not undergo thyroidectomy required hormone therapy. Early evaluation of thyroid function appears important when postoperative RT, including CCRT, is performed in combination with TPLE or TL. CONCLUSION: Our study suggested that postoperative CCRT or RT after TPLE or TL, especially hemithyroidectomy, carries a high risk for hypothyroidism.

Experimental model of benign paroxysmal positional vertigo with biphasic nystagmus using isolated semicircular canals.

CONCLUSIONS: The co-existence of cupulolithiasis and canalolithiasis might be a possible mechanism for the spontaneous inversion of positional nystagmus. OBJECTIVE: To investigate the mechanism of spontaneous inversion of nystagmus direction without a positional change in experimental models of co-existing cupulolithiasis and canalolithiasis. METHODS: Co-existing canalolithiasis and cupulolithiasis models were prepared using the bullfrog posterior semicircular canal (PSC). Ten bullfrogs were used. The ampullary nerve discharges were recorded as compound action potentials (CAPs). First, an otoconial mass was placed on the cupula to produce cupulolithiasis. Subsequently, another otoconial mass was introduced into the canal lumen to produce canalolithiasis. Decremental time constants for cupulolithiasis and incremental time constants for canalolithiasis were determined. RESULTS: At first the CAPs increased and continued for a long time when the cupulolithiasis was generated. Subsequently the CAPs were suppressed by creating canalolithiasis. Finally, the CAPs increased again after the motion of otoconia inside the canal lumen stopped. The decremental time constant for cupulolithiasis was significantly longer than the incremental time constant for canalolithiasis.

[The efficacy of genioglossus advancement and uvulopalatopharyngoplasty for obstructive sleep apnea syndrome].

OBJECTIVE: To evaluate the objective and subjective improvement after multilevel surgery, genioglossus advancement (GA) plus uvulopalatopharyngoplasty (UPPP) for the treatment of obstructive sleep apnea syndrome (OSAS). METHODS: GA and UPPP were undertaken in 24 patients with moderate and severe OSAS between January 2006 and December 2011. Epworth Sleepiness Scale (ESS) score, snoring, the feeling of having slept well and polysomnography were used for the evaluation of surgical outcomes. In addition, we determined whether baseline polysomnography, cephalometry, and authropometry data could predict GA and UPPP success or failure. RESULTS: The mean ESS score decreased significantly from 12.96 to 7.08. The mean apnea-hypopnea index (AHI) improved from 37.3 to 19.33. Objective success as evaluated by a 50% reduction in AHI or by AHI < 15 was obtained in 16 of 24 patients. The lowest oxygen saturation and stage 1 and stage 2 were also improved significantly. There were no major postoperative complications. There were significant differences in SNA, SNB, FX and PNS-P between the success and failure of GA and UPPP. The indication of GA and UPPP were SNA > 79.11 degrees, SNB > 75.69 degrees, FX > 78.67 degrees, and 36.79 mm < PNS-P < 42.29 mm. CONCLUSION: GA and UPPP surgeries are effective and safe for patients with moderate and severe OSAS. However, further studies are necessary to decide definitively if GA and UPPP are appropriate treatments for OSAS.