Enyi Tang

Trapezius muscle innervation from the spinal accessory nerve and branches of the cervical plexus.

The aim of this study was to demonstrate the extent of motor innervation of the trapezius muscle from the accessory nerve and branches of the cervical plexus using intraoperative electroneurography and histochemical staining. In 34 patients during radical neck dissection the accessory nerve and C2-C4 branches running to the trapezius were identified and stimulated. Potentials were registered under three conditions: intact accessory nerve, section of superior part of communication between the nerve and the cervical branches, and complete section of the nerve. Projections that did not elicit responses were analyzed for acetylcholinesterase activity. Before cutting the accessory nerve, its stimulation led to a recordable contraction in all parts of the trapezius muscle in all patients. C2 contributions were seen in 15, C3 in 21 and C4 in 20 patients. After sectioning of the upper half of the nerve, the results were similar. After the nerve was completely cut, C2 contributions were seen in only 2 patients, but C3 were seen in 20 patients and C4 in 19 patients. Histochemical staining revealed that the branches with no responses contained both motor and sensory axons. The accessory nerve provides the main motor input to the trapezius muscle, but preservation of the C2-C4 branches to the muscle during modified neck dissection should improve outcomes.

The treatment of sublingual gland tumours

This study assessed the clinical and histological features and therapeutic efficacy of 25 cases of sublingual gland tumours from 1998 to 2008. There were 17 female patients and 8 male, the ratio of females to males was 2.1:1. The mean age was 48.6 years. 4 cases were benign tumours (16%). 21 cases were malignant sublingual gland tumours (84%) and of these, 18 were adenoid cystic carcinoma (86%). Adenoid cystic carcinoma was mainly of the histological type, and the other histological classifications included mucoepidermoid carcinoma, pleomorphic adenoma, myoepithelioma, oncocytoma and polymorphous low-grade adenocarcinoma. Sublingual gland tumours are rare and most are malignant. For malignant sublingual gland tumours, early diagnosis and aggressive surgical treatment, especially for tumours with nerve involvement, is the key to improving prognosis. Free radial forearm flap or pectoralis major myocutaneous flap are appropriate methods for mouth floor reconstruction. For benign sublingual gland tumours, the resection of tumour and sublingual gland is the preferred treatment.

Clinical application of thin anterolateral thigh flap in the reconstruction of intraoral defects

OBJECTIVE The purpose of this study was to assess the clinical features and therapeutic efficacy of intraoral defect reconstruction with thin anterolateral thigh flaps. METHODS A total of 34 patients underwent simultaneous tumor resection and intraoral defect reconstruction with free thin anterolateral thigh flaps. RESULTS There were 16 male and 18 female patients; the ratio of males to females was 0.9:1; the mean age was 55.4 years. In these 34 patients, 26 flaps were musculocutaneous perforators (76.5%) and 8 flaps were septocutaneous perforators (23.5%). Partial loss of flap occurred in 2 patients (5.9%). CONCLUSIONS The free thin anterolateral thigh flap was the ideal soft tissue flap in intraoral defect reconstruction. This thin flap presents good functional results at the receiving site with the additional advantages of minimal donor-site morbidity and a high level of patient satisfaction.

Cervical metastases from squamous cell carcinoma of hard palate and maxillary alveolus: a retrospective study of 10 years.

The purpose of this study was to investigate the incidence of cervical metastasis in squamous cell carcinoma (SCC) of hard palate and maxillary alveolus and to define its impact factors.

Palatomaxillary reconstruction with titanium mesh and radial forearm flap

OBJECTIVE The purpose of this study was to assess the treatment and prognosis of the palatomaxillary reconstruction with titanium mesh and the free radial forearm flap. STUDY DESIGN This is a retrospective study of 19 patients with palatomaxillary defects who underwent immediate reconstruction using titanium mesh and a radial forearm flap during the 4-year period from 2004 to 2008. Intraoperatively, the titanium mesh was fixed to the residual bones for the reconstruction of hard-tissue defect after the tumor resection; then the free radial forearm flap was harvested to repair the soft-tissue defect, serving as the intraoral lining and titanium mesh covering. RESULTS Postoperative esthetic appearance and function were followed-up. All of the patients achieved a satisfactory facial appearance. The speech assessment was good, and the oronasal reflux did not occur in all patients. Only 3 patients had titanium mesh exposure during the follow-up period. CONCLUSION The free radial forearm flap with folded titanium mesh is a reliable option for reconstruction of palatomaxillary defects. It is highly effective for swallowing and speech rehabilitation as well as esthetic reconstruction.

Clinical application of free anterolateral thigh flap in the reconstruction of intraoral defects

OBJECTIVE The purpose of this study was to assess the clinical features and therapeutic efficacy of the intraoral defects reconstruction with 3 types of anterolateral thigh flaps. STUDY DESIGN The clinicopathologic data of 39 cases with oral tumors were obtained from the School of Stomatology, Nanjing University Medical Center, from December 2008 to June 2010. These patients underwent the simultaneous tumor resection and intraoral defects reconstruction with free anterolateral thigh flaps. RESULTS There were 22 male and 17 female patients; the ratio of male to female was 1.3:1; the mean age was 56.1 years. Twenty-two of the anterolateral thigh flaps were musculocutaneous flaps (56.4%), 8 were fasciocutaneous flaps (20.5%), and 9 were ultrathin flaps (23.1%). Five patients required operative exploration in the perioperative period. Three flaps were thrombotic events, 1 flap was hematoma, and 1 flap was twisting of perforator. After the salvages, 1 flap was partial failure, 1 flap was total failure, and the other 3 flaps were complete survival. CONCLUSIONS The free anterolateral thigh flap was the ideal soft tissue flap in the intraoral defects reconstruction. This flap presents good functional results at the receiving site with the additional advantages of minimal donor-site morbidity and a high level of patient satisfaction.

Salvage treatment for recurrent oral squamous cell carcinoma.

The treatment failures of oral squamous cell carcinoma (OSCC) are mostly local and regional recurrences. The aim was to estimate the prognosis of patients with recurrent OSCC through the prognostic staging system. We reviewed 81 patients with recurrent OSCC from April 1, 1999, to April 1, 2005. The independent prognostic factors for the patients with recurrent OSCC were identified by the univariate and multivariate Cox regression analyses. Then, to develop a prognostic staging system, and according to this staging system, the patients with recurrent OSCC were divided to 4 stages. By the Kaplan-Meier and log-rank statistical analyses, we found that the survival rate of patients with recurrent OSCC was significantly different at the different developmental stages. The primary TNM cancer stage before initial treatment, the extent of recurrence, and the recurrent tumor size are the independent prognostic factors for the patients with recurrent OSCC. Through this clinical study, the earlier-stage cases (stages I and II) for the patients with recurrent OSCC had a significantly better survival outcome compared with the advanced-stage cases (stages III and IV), and at the early recurrent stage, the salvage surgery represented a reliable and feasible treatment method.

Treatment of compartment syndrome in donor site of free fibula flap after mandibular reconstruction surgery

Compartment syndrome is a rare donor-site morbidity of the free fibula osteocutaneous flap in mandibular reconstruction. A case is reported where the major complication of compartment syndrome occurred in a 34-year-old man when the donor site defect was closed primarily after taking a skin paddle with a width of 3 cm. Then an anterolateral thigh flap was designed to cover the donor left leg defect.

Sebaceous lymphadenoma of parotid gland in a child

Sebaceous lymphadenoma is a rare tumor presenting predominantly in the parotid gland. Most sebaceous lymphadenomas are composed of variably sized sebaceous glands admixed with salivary ducts in a diffuse lymphoid background. The treatment is complete surgical excision, and this tumor is rarely recurrent. Reported here is a case of sebaceous lymphadenoma of the left parotid gland in a 16-year-old boy. A left superficial parotidectomy was performed.

Reconstruction of extensive through-and-through cheek defects with free anterolateral thigh flap.

ObjectiveThe purpose of this study was to assess the clinical features and therapeutic efficacy of extensive through-and-through cheek defects reconstruction with free anterolateral thigh flap. MethodsA total of 11 patients underwent simultaneous tumor radical resection and through-and-through cheek defects reconstruction with free anterolateral thigh flap. ResultsIn these 11 patients, 7 patients had undergone the reconstruction of through-and-through cheek defects with the folded anterolateral thigh flap (2 skin islands and an intervening de-epithelialized zone); 4 patients had undergone the reconstruction of through-and-through cheek defects with the 2 separate skin paddles anterolateral thigh flap in 1 single pedicle. All of these 11 flaps were free fasciocutaneous anterolateral thigh flaps. The subcutaneous fat thickness of the anterolateral thigh flap is less than 1.5 cm. ConclusionsThe free anterolateral thigh flap was one of the versatile soft tissue flaps in the extensive through-and-through cheek defects reconstruction.