摘要:

AbstractThe defect resulting from partial or complete maxillectomy can often be reconstructed with a skin graft and a prosthesis. In situations where this simple maneuver is unsatisfactory, a more complex reconstructive modality, providing the restoration of composite tissue, is required. The scapular microvascular‐free flap was used in this series of 11 patients, as a cutaneous flap in 3 and as an osteocutaneous flap in 8, to meet the specific reconstructive needs of each patient. Excellent to satisfactory restoration of facial contour and palatal function was achieved in 10 patients. There was 1 flap failure. There were no donor site complications. Selected case histories are presented to demonstrate a spectrum of reconstructive problems. There are clear limitations to its applicability, such as the odd scapular bone contour, the thickness of the cutaneous paddle, the position change required for flap harvesting, and the risk of flap failure. The scapular flap has proven to be useful in restoring bony and soft tissue contour of the face, rigid support for the velum, oronasal separation, support for the orbit, and obliteration of the maxillary sinus. We found the scapular‐free flap to be a useful tool for reconstructing complex and variable maxillectomy defe

ISSN:1043-3074    

DOI:10.1002/hed.2880120502

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

摘要:

AbstractA series of 34 patients repaired by folded, bipaddled composite flaps for head and neck cancer surgical defects is presented. Pectoralis major composite flap was used in 33 patients on musculovascular pedicle and 1 patient had a latissimus dorsi composite flap free‐tissue transfer. The pectoralis major rib, osteomyocutaneous flap was utilized in 6 patients who had lesions of the mouth floor and anterior mandibular arch. The incorporated rib was used as a vascularized bone graft for the stability of mandibular fragments. Thus, one regional composite flap used in bipaddled fashion enabled the reconstruction of mucosal, skin, and mandibular arch defect

ISSN:1043-3074    

DOI:10.1002/hed.2880120503

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

摘要:

AbstractChemodenervation of cervical muscles with botulinum A toxin, although useful in treating spasmodic torticollis, has been associated with dysphagia. Retrospective analysis of dose and injection site (sternomastoid vs. posterior cervical muscle groups) in 26 patients (49 injections) suggested that dysphagia was related to the quantity of toxin injected into the sternomastoid muscle: dysphagia, median 150 IU (7 injections); and no dysphagia, median 100 IU (42 injections; p = 0.026 Wilcoxon test). In a prospective study (31 injections to 24 patients), limiting the dose administered to the sternomastoid to 100 IU, substantially reduced the incidence of dysphagia (0 of 31, p = 0.27, Fisher's exact test).Denervation of human orbicularis muscle fibers, 5 weeks to 4 months after injection of botulinum A toxin for the treatment of blepharospasm, was successfully demonstrated by intense, diffuse acetycholinesterase staining. A weight‐adjusted dose similar to that given for torticollis was injected into longissimus dorsi muscle in 6 albino rabbits. Using the acetylcholinesterase stain as a marker, a diffusion gradient was noted over a distance of 30 to 45 mm from the point of injection and in contralateral muscle 15 to 25 mm from this point. Thus, denervation was demonstrated to occur within a definable area which crossed anatomic barriers, such as fascia and bone. These clinical and laboratory data suggest that dysphagia following botulinum toxin therapy results from toxin spread to pharyngeal musculature from the sternocleidomastoid injection site. Limiting of the injection dose to 100 IU or less to the sternomastoid substantially decreases the incidence of this complicatio

ISSN:1043-3074    

DOI:10.1002/hed.2880120504

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

摘要:

AbstractBiopsied specimens of 82 oral squamous cell carcinomas were immunohistochemically studied for detection of type IV collagen existence in the basement membrane (BM). Immunoreactivity on BM was semiquantitatively evaluated as limited (±), moderate (+), or extensive (++), and matched against clinical and histopathologic features. No clear difference in BM deposition could be found in the tumor sites. The amount of type IV collagen decreased in advanced T stage (T3 and T4) tumors. BM deposition was significantly correlated with lymph node metastasis. In 54 N‐, 32 had extensive deposition, 18 had moderate, and the remaining had limited. Conversely, only 5 of 28 N+ cases showed good type IV collagen immunoreactivity and 14 cases exhibited limited BM deposition. BM existence was also associated with the mode of invasion. BM deposition decreased in order with the grade (i.e., the more limited the BM deposition, the more diffuse the invasion mode). BM deposition was, however, not related with stromal responses, such as cellular infiltrates and fibrosis. We conclude that immunohistochemical examinations of BM deposition on biopsied specimens seem beneficial for cancer treatme

ISSN:1043-3074    

DOI:10.1002/hed.2880120505

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

摘要:

AbstractThe chemosensitivities of 42 human head and neck squamous cell carcinomas were examined using the in vitro succinate dehydrogenase inhibition (SDI) test. The tumor tissues obtained at surgery or biopsy were exposed to five different antitumor drugs: adriamycin (ADM), cisplatin (CDDP), carboquone (CQ), 5‐fluorouracil (5‐FU), and 1‐hexylcarbamoyl‐5‐fluorouracil (HCFU). The results were analyzed according to the histopathologic degree of differentiation of well, moderately, and poorly differentiated squamous cell carcinoma. The average decrease in succinate dehydrogenase activity was 43.2 /pm 24.9 for ADM, 29.0 /pm 14.2 for CDDP, 32.9 /pm 17.6 for CQ, 64.2 /pm 20.6 for 5‐FU, and 26.8 /pm 16.9 for HCFU. There was a statistically significant difference in the decrease of succinate dehydrogenase activity between well and poorly differentiated squamous cell carcinomas. These data suggest that, for patients with a poorly differentiated squamous cell carcinoma, the response to anticancer drugs may be more satisfactory than in those with a welldifferentiated squamous cel

ISSN:1043-3074    

DOI:10.1002/hed.2880120506

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

摘要:

AbstractThe objective of this study was to determine whether transforming growth factor alpha (TGF alpha) levels could be used as nonspecific tumor markers in patients with advanced squamous cell carcinoma (SCC) of the head and neck. Fourteen patients with epidermoid carcinoma of the head and neck were followed with serial urine TGF alpha levels, and the results were compared with the extent of cancer and the course of the disease. Based on the findings of this study further research is necessary before urine TGF levels can be recommended as a routine screening test for SCC of the head and neck.

ISSN:1043-3074    

DOI:10.1002/hed.2880120507

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

摘要:

AbstractAn unusual case of a mucinous carcinoma originating from the external auditory canal in a 70‐year‐old man is described. Multiple metastatic lesions also appeared in the parotid gland. After a local excision of the primary lesion, the tumor was seen to extend anterosuperiorly along the middle cranial cavity dura. The occurrence of this tumor is exceedingly rare, and, to our knowledge, this is the first report of a mucinous carcinoma of the external auditory canal. The clinical pictures of this tumor and the histological findings are discussed with reference to other repo

ISSN:1043-3074    

DOI:10.1002/hed.2880120508

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

摘要:

AbstractMetastases to the salivary glands from outside the head and neck are rare. The world literature reports 53 cases to the parotid, and 25 to the submandibular‐submaxillary gland. This is the first report of a metastasis to the accessory parotid glan

ISSN:1043-3074    

DOI:10.1002/hed.2880120509

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

摘要:

AbstractThe cavernous sinus is an unusual site for metastases from tumors of the larynx and pharynx. In postmortem studies of patients with cancers of the larynx, hypopharynx, and other sites, cavernous sinus metastases have been detected in very few cases. We present 3 cases of metastatic cavernous sinus disease. Despite the lack of pathologic diagnosis by biopsy, we feel that the clinical presentation combined with computed tomography provides an accurate diagnosis.

ISSN:1043-3074    

DOI:10.1002/hed.2880120510

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

摘要:

AbstractThe sternocleidomastoid (SCM) muscle has been used in various ways for reconstruction following cancer resections in the head and neck. Its use has been restricted because of the presumed precarious nature of its blood supply and its proximity to disease. Patients with large or recurrent benign parotid tumors were the first in our series to have a SCM muscle flap (either superiorly or inferiorly based) used to improve cosmesis. After demonstrating the utility of these flaps, we extended the indications for their use to include patients with primary or recurrent malignant disease. The flaps provide soft tissue contour, coverage of facial nerves and nerve grafts, act as a healthy bed for skin grafts, and help close salivary fistulas. There were no complications attributed to the flaps. This paper discusses 31 patients with benign and malignant parotid disease in whom the SCM flap was used.

ISSN:1043-3074    

DOI:10.1002/hed.2880120511

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY