Dysphagia in tongue cancer patients before and after surgery Huang, Zhuo-shan, MS, PhD, Attending; Chen, Wei-liang, DDS, MD, MBA, Professor and Director; Huang, Zhi-quan, DDS, MD, PhD, Assistant Professor ...
Journal of oral and maxillofacial surgery,
10/2016, Letnik:
74, Številka:
10
Journal Article
Recenzirano
Abstract Purpose To define factors influencing postoperative aspiration in tongue cancer patients and to analyze the characteristics of dysphagia before and after surgery. Methods A total of 112 ...tongue cancer patients participated in the present work. Videofluoroscopic swallowing studies (VFSSs) were performed on all patients before and after surgery. A Penetration–Aspiration Scale (PAS) score ≥3 was defined as an aspiration risk. Qualitative data were collected on a frame-by-frame basis from each VFSS and analyzed. Results Smoking (58.14%, p <0.01), tongue resection >50% (38.71%, p <0.05), and advanced tumor stage (49.18%, p <0.01) were strong risk factors for aspiration. High incidences of inadequate tongue movement, delayed oral transit time, reduced hyoid bone elevation, poor aspiration or penetration, vallecula epiglottica, and residual material in the pyriform sinuses were evident after surgery (all p values <0.001). The PAS score was significantly higher after than before surgery. The incidence of silent aspiration increased to 6.25% postoperatively. Conclusions Smoking, larger tongue resection, and advanced tumor stage were strong risk factors for postoperative aspiration and dysphagic complications in tongue cancer patients. The aspiration rate was higher after surgery. Further studies should focus on the prevention and early treatment of dysphagia, especially postoperative aspiration, in tongue cancer patients.
Purpose Head and neck tumors that involve the craniomaxillofacial region are classified as stage IVb disease and are clinically challenging. In this study, the outcomes of craniofacial resection and ...craniofacial reconstruction in patients with recurrent malignant tumors involving the craniomaxillofacial region were evaluated. Patients and Methods This retrospective observational study was conducted from January 2008 to August 2015. Data collected for each patient included age, gender, tumor site, initial treatment, craniofacial resection, reconstruction flaps and complications after craniofacial resection, adjuvant treatment, and reported outcomes of craniofacial resection and craniofacial reconstruction. The χ2 test in SPSS was used to analyze the data. Results Twenty-four patients with recurrent malignant tumors involving the craniomaxillofacial region were identified who had undergone craniofacial resection at the Center of Craniomaxillofacial Surgery of Sun Yat-sen University (Guangzhou, Guangdong, China). The study population was comprised of 24 patients (15 men and 9 women; age range, 21 to 73 yr) with recurrent tumors (58.3% with squamous cell carcinoma SCC, 41.7% with sarcoma SA) involving the craniomaxillofacial region who underwent craniofacial resection. Craniofacial resection consisted of orbital exenteration and maxillotomy; anterior skull base surgery, facial resection, and mandibulotomy; or ipsilateral radical neck dissection. The resultant craniomaxillofacial defects were reconstructed using extended vertical lower trapezius island myocutaneous flaps (TIMFs), temporalis myofascial flaps, or submental flaps. All patients with recurrent malignant tumor involving the craniomaxillofacial region underwent gross total resection of the tumor; 22 patients underwent craniofacial reconstruction. There were no major surgical complications. Minor flap failure and wound dehiscence in the donor site occurred in 4 patients. The follow-up period ranged from 8 to 36 months. Seven patients in the SCC group and 7 in the SA group were alive with no evidence of disease (AND), 3 in the SCC group and 2 in the SA group were alive with disease (AWD), and 4 in the SCC and 1 in the SA group died of the disease (DOD) after local recurrence or distant metastases at 8 to 18 months. There were no statistical differences among the AND, AWD, and DOD groups. Conclusions Craniofacial resection remains an effective salvage treatment for patients with recurrent SCC and SA involving the craniomaxillofacial region. The extended vertical lower TIMF is a large, simple, and reliable flap for reconstructing major defects after a craniofacial resection.
Purpose Outcomes of salvage surgery and carotid artery (CA) management were evaluated in patients with oral and oropharyngeal cancer. Patients and Methods Eighteen patients with recurrent oral and ...oropharyngeal squamous cell carcinoma involving the CA underwent salvage surgeries consisting of wide resection of the tumor, CA resection without and with reconstruction, and CA subadventitial dissection without and with encapsulation. Major tissue defects were reconstructed using a flap. Results One patient showed postoperative transient hemiplegia, and wound dehiscence occurred at the recipient site in 2 patients. Two patients had carotid blowout. One patient who underwent CA resection and reconstruction had a carotid embolism. After 5 to 42 months of follow-up, 12 patients were free of disease, 2 remained ill, and 4 died of local recurrence or distant metastases. Conclusions Salvage surgery remains an effective treatment modality. CA sacrifice offers a viable treatment strategy. Major defects can be reconstructed with a trapezius flap.
Abstract We have evaluated the outcomes of endoscopically-assisted resection of large benign tumours of the parapharyngeal space by an intraoral approach. Six patients with primary benign tumours ...were treated in this way. The lesions were pleomorphic adenomas, Warthin's tumour, and schwannoma. The sizes of the tumours varied from 4 × 4 cm to 7 × 7 cm. All tumours were removed completely without rupture and without damage to the facial nerve. No patient developed any permanent postoperative complications such as damage to the facial nerve, salivary fistula, or limited mouth opening. The cosmetic effects were excellent. The patients were followed up for 8 to 21 months without recurrence. Endoscopically-assisted transoral resection of large benign tumours of the parapharyngeal space is a simple and safe technique that achieves excellent aesthetic and functional results.
Purpose Surgical removal of lesions from the base of the tongue can be challenging for head and neck surgeons. This study evaluated the clinical outcomes of patients with benign lesions at the base ...of the tongue who underwent endoscopy-assisted resection through the transoral approach using an ultrasonic harmonic scalpel. Patients and Methods This retrospective observational study was conducted from May 2013 to January 2016. Data collected for each patient included age, gender, chief complaints, clinical symptoms, diagnostic imaging, complications after resection, and reported outcomes of resection. Diagnoses were made based on patient complaints, clinical symptoms, and computed tomography or magnetic resonance imaging. Diagnoses were confirmed by permanent pathologic sections. Results Twelve patients with benign lesions on the base of the tongue were identified who had undergone endoscopy-assisted resection through the transoral approach using an ultrasonic harmonic scalpel. The patients had a mean age of 38.9 years. The benign lingual lesions consisted of lingual thyroid masses, squamous papillomas, schwannomas, pleomorphic adenomas, myoepithelioma, and lymphoid hyperplasia. Tumor size varied from 2.0 × 1.8 to 3.0 × 2.8 cm. All tumors were completely removed, and no complications occurred during or after surgery. The patients were followed for 6 to 30 months; 1 recurrence was found and was treated using a second endoscopy-assisted transoral resection. Conclusions Under endoscopic assistance, use of the harmonic scalpel through the transoral approach is a safe and feasible surgical technique for the removal of benign lesions at the base of the tongue.
Purpose This clinical study assessed a pedicled supraclavicular fasciocutaneous island flap (SFIF) based on the transverse cervical artery that was extended to include shoulder skin for ...reconstructing the head and neck. Patients and Methods Pedicled SFIFs extended to include the shoulder skin based on the cutaneous feeder vessels and perforator vessels in the deep fascia of the transverse cervical artery were designed for 24 patients with defects of the head and neck after cancer ablation. Preoperative 3-dimensional computed tomographic angiography was performed in all patients. The patients consisted of 15 men and 9 women ranging in age from 24 to 73 years. Results The primary lesions included squamous cell carcinoma of the tongue, buccal mucosa, floor of the mouth, oropharynx, palate, and lower gingiva. Three-dimensional computed tomographic angiography showed that the transverse cervical artery arose from the thyrocervical trunk in 13 cases and from the subclavian artery in 11 cases. The diameter of the artery ranged from 0.15 to 0.24 cm. The size of flaps ranged from 4 × 8 cm to 6 × 12 cm, and the mean length of the vascular pedicle was approximately 18.5 cm. Of the flaps, 23 survived completely, for a success rate of 95.8%. Three patients underwent radiotherapy, and the follow-up period ranged from 3 to 12 months. One patient died of local tumor recurrence, and cervical recurrences developed in 3 patients. Conclusion An SFIF extended to include the shoulder skin based on the cutaneous feeder vessels and perforator vessels in the deep fascia of the transverse cervical artery is a useful, viable option for defects of the head and neck after cancer ablation.
Purpose The purpose of this study was to assess the reliability of 2 patterns of submental island flaps—the facial-submental artery island flap and the reverse facial-submental artery island ...flap—used for reconstruction of oral and maxillofacial defects following cancer ablation. Patients and Methods Thirty-eight soft tissue defects were repaired with facial-submental artery island flaps and reverse facial-submental artery island flaps following cancer surgery. The ages of the patients ranged from 28 to 90 years; 24 were male and 14 were female. The primary lesions included squamous cell carcinoma of the tongue (8 cases), buccal mucosa (16), floor of the mouth (4), lower gingiva (3), oropharynx (2); recurrent squamous cell carcinoma of the palate (3); and basal cell carcinoma of the facial skin (2). The clinical stage of the tumors was stage I in 5 cases, stage II in 25, and stage III in 8. Facial-submental artery island flaps were used in 20 cases, reverse facial-submental artery island flaps in 18. The size of the skin paddle varied from a minimum of 4 cm × 8 cm to a maximum of 5 cm × 15 cm. Direct closure was achieved at all donor sites. Results The postoperative outcome for 2 patterns of submental flaps was 36 cases surviving, 2 of complete necrosis, and one other of temporary palsy of the marginal mandibular branch of the facial nerve. The success rate was 95% and 94.4% for the facial-submental artery island flap and the reverse facial-submental artery island flap, respectively. The form and function of recipient sites were well recovered. The donor site leaves a well-hidden scar. The follow-up period was 3 to 24 months, 1 patient died of tumor local recurrences and 2 cases of cervical recurrence were observed. Conclusion Two patterns of submental island flaps are safe, rapid, and simple to elevate. The facial-submental artery island flap can reliably be used for reconstruction of the lower and middle thirds of the medium-sized oral and maxillofacial defects and the reverse pattern for reconstruction of the middle and upper thirds of the medium-sized oral and maxillofacial defects.
Purpose Plate exposure is the most common complication after reconstruction of oncologic resection using a titanium plate. The outcomes of covering exposed reconstructive plates with extended ...vertical lower trapezius island myocutaneous flaps (TIMFs) were evaluated. Patients and Methods Twelve instances of exposure of reconstructive plates occurred in patients after segmental mandibulectomy to treat cancer of the oral cavity and oropharynx. The plates were covered with extended vertical lower TIMFs. The site of the primary tumor was the gingiva or mandible in 5 cases, the buccal mucosa in 3, the floor of the mouth in 2, and the base of the tongue in 2. The types of bone defect were hemimandibular in 1 case, central in 2, and lateral in 9. Intraoral, extraoral, and intra- and extraoral exposures occurred in 1, 7, and 4 instances, respectively. Intraorally and extraorally exposed plates were re-covered with skin paddles measuring 6 × 7 to 6 × 23 cm (average, 6.0 × 13.5 cm). Four folded extended vertical lower TIMFs were constructed to cover plates exhibiting intra- and extraoral exposure. Results All flaps survived. Patients were followed for 12 to 36 months (median duration, 22.8 months). One patient (8.3%) exhibited external plate exposure at 20 months. Nine patients (75.0%) were alive with no evidence of disease at 12 to 36 months, and 2 (16.7%) were alive with disease at 20 to 28 months. One patient (8.3%) died of local recurrence at 23 months. Conclusions The use of extended vertical lower TIMFs to cover intraorally, extraorally, or intra- and extraorally exposed plates is reliable.
Purpose The present clinical study assessed the feasibility of extensive pedicled supraclavicular fasciocutaneous island flaps combined with extended vertical lower trapezius island myocutaneous ...flaps for large, full-thickness cheek defect reconstruction after ablative oral cancer surgery. Patients and Methods A retrospective review of data from consecutive patients requiring extensive pedicled supraclavicular fasciocutaneous island flaps and the extended vertical lower trapezius island myocutaneous flap to provide both an inner and an outer lining for major full-thickness cheek defects after oncologic resection. Results Eight patients had advanced oral squamous cell carcinoma. All patients had combined bone and extensive soft-tissue defects. The extensive pedicled supraclavicular fasciocutaneous island flap with a skin paddle measuring 10 × 8 cm to 14 × 10 cm and the extended vertical lower trapezius island myocutaneous flap with a skin paddle measuring 25 × 10 cm to 15 × 8 cm were used to reconstruct the major through-and-through defects. No major complications occurred in any patient. The patients were followed up for 6 to 20 months; 6 patients were living with no evidence of disease, 1 was living with disease, and 1 had died of local recurrence. Conclusions The combined use of the extensive pedicled supraclavicular fasciocutaneous island flap with an extended vertical lower trapezius island myocutaneous flap to reconstruct major through-and-through cheek soft defects is reliable and an excellent alternative to other pedicles, even microsurgical free flaps, for patients who have previously undergone radiotherapy and surgery of the head and neck.
Purpose This clinical study assessed the reverse facial artery–submental artery mandibular osteomuscular flap with titanium dental implants for the functional reconstruction of maxillary defects. ...Patients and Methods Class 2a defects in 5 patients were repaired with a reverse facial artery–submental artery mandibular osteomuscular flap with titanium dental implants (n = 21). All patients received a fixed partial denture after a 3- to 6-month healing period. Results All lesions were widely excised in an area extending to the maxilla. Of the implants, 20 (95.2%) were loaded and 1 was lost before loading. Reconstruction with a fixed partial denture was successful in all patients. The patients were followed up for 12 to 20 months (mean, 15.8 months), and no recurrence was observed. Conclusion The reverse facial artery–submental artery mandibular osteomuscular flap with titanium dental implants is safe, quick, and simple to elevate and is reliable for the functional reconstruction of maxillary defects.
