Free jejunum reconstruction of upper esophageal defects.

The free jejunum has become an important method for reconstructing extensive oncologic defects of the upper esophagus and pharynx. The advantages of a single-staged reconstruction with a low incidence of morbidity have generally outweighed criticisms such as the requirement for a laparotomy and poor voice quality. The aim of the study was to present the technique and outcomes of free jejunal reconstruction of the upper esophagus in 31 consecutive cases. We reviewed our experience of free jejunal flaps undertaken over a 6-year period. Our surgical approach, complications, and results of swallow and speech restoration are described. A functional swallow was achieved by 27/31 patients. However, satisfactory voice restoration was seen in only a small proportion of patients. Complications at the donor site occurred in just one patient. The current review confirms the jejunal flap as a reliable reconstructive option with minimal donor site morbidity.

Internal carotid artery ectasia: the value of imaging studies prior to biopsy of a retropharyngeal mass.

The presence of retropharyngeal tissue mass often raises the suspicion of malignancy, especially in elderly patients. This prompts urgent biopsy to investigate tissue histology. We discuss a case where this is contraindicated as the retropharyngeal mass was illustrated by CT scanning and confirmed with MRI to be a tortuous coursing internal carotid artery. An awareness of this unusual anatomical variation and a careful interpretation of imaging studies both at the stage of differential diagnosis and pre-operative screening are essential to avoid damage to important structures, causing unnecessary complications.

Case report--an iatrogenic foreign body in the airway.

We report a case of an iatrogenic foreign body in the airway. An 80-year-old patient who had undergone major head and neck surgery several weeks early presented as an inpatient with a persistent cough and recurrent chest infections. Fibreoptic nasendoscopy revealed the presence of a nasopharyngeal airway sitting vertically in the airway. This foreign body presented indolently as it was cannulated. We suggest that in such patients, readers should be aware of this possible underlying iatrogenic cause of respiratory complications.

Squamous cell carcinoma in the head and neck.

Head and neck cancers are responsible for 10% of male cancers in the UK, and used to be six or seven times more common in men than women. Now these cancers are only about twice as common among men. This article reviews the presentation and management of these cancers.