RESUMEN

Since its inception, microvascular free tissue transfer has broadened possibilities for oncologic ablation and restoration of form and function. Developments throughout recent decades have resulted in increasing flap success rates and complexity. Advances in technology and knowledge gained from past experiences will continue to improve surgical efficiency, flap success rates, and ultimately, patient outcomes.

Asunto(s)

Neoplasias de Cabeza y Cuello , Procedimientos de Cirugía Plástica , Humanos , Neoplasias de Cabeza y Cuello/cirugía , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/tendencias , Microcirugia/métodos , Microcirugia/tendencias , Colgajos Tisulares Libres/irrigación sanguínea , Colgajos Quirúrgicos/irrigación sanguínea

RESUMEN

Margin status in head and neck cancer has important prognostic implications. Currently, resection is based on manual palpation and gross visualization followed by intraoperative specimen or tumor bed-based margin analysis using frozen sections. While generally effective, this protocol has several limitations including margin sampling and close and positive margin re-localization. There is a lack of evidence on the association of use of frozen section analysis with improved survival in head and neck cancer. This article reviews novel technologies in head and neck margin analysis such as 3-dimensional scanning, augmented reality, molecular margins, optical imaging, spectroscopy, and artificial intelligence.

Asunto(s)

Neoplasias de Cabeza y Cuello , Márgenes de Escisión , Humanos , Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/cirugía

RESUMEN

Head and neck cancer is a potentially traumatizing disease with the potential to impact many of the functions which are core to human life: eating, drinking, breathing, and speaking. Patients with head and neck cancer are disproportionately impacted by socioeconomic challenges, social stigma, and difficult decisions about treatment approaches. Herein, the authors review foundational ethical principles and frameworks to guide care of these patients. The authors discuss specific challenges including shared decision-making and advance care planning. The authors further discuss palliative care with a discussion of the role of surgery as a component of palliation.

Asunto(s)

Neoplasias de Cabeza y Cuello , Cuidados Paliativos , Humanos , Cuidados Paliativos/métodos , Cuidados Paliativos/ética , Neoplasias de Cabeza y Cuello/cirugía , Planificación Anticipada de Atención/ética , Toma de Decisiones/ética

RESUMEN

BACKGROUND: Vessel grafting is an important technique in head and neck free tissue transfer (FTT) reconstruction when a tension-free anastomosis is not otherwise feasible. To our knowledge, there are limited data regarding interposition artery grafts for arterial anastomoses in head and neck reconstruction. Here, we present a multi-institutional cohort of arterial interposition grafts for FTT reconstruction for head and neck defects. METHODS: A retrospective review was conducted at four tertiary care institutions for patients who underwent FTT reconstruction for head and neck defects which utilized an interposition artery graft for the arterial anastomosis. Charts were reviewed for type and length of artery grafts harvested, surgical indication, indication for artery graft, types of flaps harvested, and various preoperative characteristics (including history of radiation or previous FTT reconstruction surgery). Postoperative complications within postoperative day 30 were measured and reported. RESULTS: Nine patients met inclusion criteria. The lateral circumflex femoral artery (either transverse or descending branches) (n = 3) and facial artery (n = 3) were the most commonly harvested arteries. The scalp (n = 5) was the most common primary defect site. Seven grafts were harvested initially and in a planned fashion, while two were harvested as salvage techniques (either for flap salvage or vein graft failure). In planned grafts, arteries were the preferred interposition grafting method due to either size match preferences (n = 4) or similarities in wall thickness (n = 3) between graft and recipient artery. There were no reported cases of unplanned readmission, postoperative hematoma, fistula formation, wound infection, or donor site morbidities. Two patients required unplanned return to the operating room for flap compromise, both of which ultimately resulted in flap failure secondary to clot formation at both arterial and venous anastomoses. CONCLUSIONS: When arterial pedicle length is insufficient, interposition artery grafting is both a feasible and viable technique to achieve tension-free arterial anastomoses for select cases of highly complex head and neck free tissue reconstruction.

Asunto(s)

Anastomosis Quirúrgica , Colgajos Tisulares Libres , Neoplasias de Cabeza y Cuello , Procedimientos de Cirugía Plástica , Humanos , Estudios Retrospectivos , Colgajos Tisulares Libres/irrigación sanguínea , Colgajos Tisulares Libres/trasplante , Procedimientos de Cirugía Plástica/métodos , Anastomosis Quirúrgica/métodos , Masculino , Persona de Mediana Edad , Femenino , Neoplasias de Cabeza y Cuello/cirugía , Anciano , Adulto , Arterias/trasplante , Resultado del Tratamiento , Injerto Vascular/métodos

RESUMEN

OBJECTIVE: To investigate effects of preoperative protective carotid artery (CA) stenting in complex head and neck cancer (HNC) resection. MATERIAL AND METHODS: HNC that encases the CA is complex. Fifty-five patients diagnosed with complex HNC from 2018 to 2021 were enrolled, and were divided into Control group (general complex cases) and carotid artery stent (CAS) group (severe complex cases). All patients underwent standard tumor resection, while patients in the CAS group also underwent preoperative covered CA stenting. Medical information was retrospectively analyzed. RESULTS: CA stenting and tumor resection were successfully performed. Baseline demographics were recorded. CAS and Control groups had similar results for complete tumor resection rate, operation time, and intraoperative blood loss, although the CA was obviously more involved in CAS group than in Control group. However, recurrence rate in the CAS group was significantly lower than Control group, indicating that preoperative CA stent implantation facilitates complete tumor removal. Furthermore, perioperative CA-associated complications including common/internal CA ligation were more frequent in Control group. Overall survival and disease-free survival rate in CAS group and Control group was 87.5% and 69.2%, respectively. Disease-free survival rate in CAS group and Control group was 87.5% and 42.3%, respectively. No postoperative cerebral infarction was observed in either group. Overall hospitalization cost was recorded. CONCLUSIONS: Preoperative protective CA stenting facilitates more thorough tumor removal while better preserving the CA during complex HNC resection, reducing the surgical difficulty. Preoperative CA stenting may be a safe and effective therapeutic option for resection of HNC encasing the CA.

Asunto(s)

Neoplasias de Cabeza y Cuello , Stents , Humanos , Masculino , Femenino , Neoplasias de Cabeza y Cuello/cirugía , Persona de Mediana Edad , Anciano , Estudios Retrospectivos , Arterias Carótidas/cirugía , Cuidados Preoperatorios/métodos , Adulto

RESUMEN

BACKGROUND: In free jejunum transfer, knowing the ischemic tolerance time of the jejunum is crucial. It helps determine the need for reharvesting if an unexpected situation prolongs the ischemic time. The current ischemic tolerance time in humans is unknown. We investigated the relationship between ischemic time and postoperative complications in head and neck cancer patients who underwent free jejunum transfer. METHODS: The study included 76 patients with available medical records out of 103 patients who underwent free jejunum transfer between 2009 and 2023. The association between the surgical procedure, including ischemic time, and patient's background, and flap engraftment, stenosis of the intestinal anastomosis, the swallowing function, and other complications was investigated. RESULTS: The ischemic time for jejunal flaps ranged from 1 h 24 min to 6 h, with a mean of 197 ± 55.5 min. In 72 patients, the jejunum was successfully engrafted, but vascular occlusion occurred in another four patients. In three of these patients, jejunal necrosis occurred, and there was no specific trend in ischemic time. Stenosis of the intestinal anastomosis occurred in 17 cases (22%), with ischemic time (≥3 h) and age (≥75 years) being significant factors for stenosis (ischemic time: 30% vs. 10%, p = 0.048, age: 50% vs. 15%, p < 0.01). No significant correlations were observed with other complications or the swallowing function. CONCLUSION: There was no specific trend between ischemic time and jejunal survival rate, indicating that an ischemic time within 6 h may not have affected engraftment. Although we have recently performed intestinal anastomosis prior to vascular anastomosis, the choice of surgical technique should be adapted to the patient's age and background.

Asunto(s)

Colgajos Tisulares Libres , Neoplasias de Cabeza y Cuello , Isquemia , Yeyuno , Complicaciones Posoperatorias , Humanos , Yeyuno/trasplante , Yeyuno/cirugía , Yeyuno/irrigación sanguínea , Masculino , Femenino , Persona de Mediana Edad , Anciano , Colgajos Tisulares Libres/irrigación sanguínea , Colgajos Tisulares Libres/trasplante , Colgajos Tisulares Libres/efectos adversos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Adulto , Isquemia/etiología , Estudios Retrospectivos , Neoplasias de Cabeza y Cuello/cirugía , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/efectos adversos , Anciano de 80 o más Años , Supervivencia de Injerto , Anastomosis Quirúrgica/métodos , Anastomosis Quirúrgica/efectos adversos , Factores de Tiempo

RESUMEN

BACKGROUND: In this report, we describe an uncommon instance of fungating synovial sarcoma affecting the posterior aspect of the neck. Although the existing literature has documented a limited number of cases, this particular case contributes to the knowledge about it, which is scarce. CASE PRESENTATION: A total of 5 months before the examination, a Pakistani-Asian male, age 20 years, complained of a malodorous fungating swelling on the posterior aspect of his neck. An examination revealed a foul-smelling, 10 × 13 cm fungating enlargement surrounded by maggots and hemorrhaging at the site of the incision. A hemoglobin level of 6 and a total leukocyte count (TLC) of 23,000 indicated the patient's disoriented and pallid appearance. He was expeditiously admitted, and preoperatively, the general well-being of the patient was optimized. After a comprehensive discussion with the medical team, a strategy for marginal excision and coverage with a latissimus dorsi (LD) flap and grafting was devised. The tumor was successfully excised, and an LD flap with graft was conducted on the patient during surgery; however, the infection caused the failure of half of the graft. Following that, the lesion was debrided, and re-grafting was performed. The patient was subsequently administered 5 cycles of chemotherapy and 32 cycles of radiotherapy. He was diagnosed with pulmonary metastasis 2 years later. Sadly, the patient died during a follow-up visit 3.5 years later. CONCLUSIONS: The patient's unfavorable prognosis after surgical intervention, radiotherapy, and chemotherapy, despite undergoing all-encompassing treatments, underscores the importance of early detection and intervention in fungating tumor cases.

Asunto(s)

Neoplasias de Cabeza y Cuello , Sarcoma Sinovial , Humanos , Masculino , Sarcoma Sinovial/terapia , Sarcoma Sinovial/cirugía , Sarcoma Sinovial/patología , Adulto Joven , Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/terapia , Neoplasias de Cabeza y Cuello/cirugía , Colgajos Quirúrgicos

RESUMEN

PURPOSE: Surgical pathology reports play an integral role in postoperative management of head and neck cancer patients. Pathology reports of complex head and neck resections must convey critical information to all involved clinicians. Previously, we demonstrated the utility of 3D specimen and defect scanning for communicating margin status and documenting the location of supplemental margins. We introduce a newly designed permanent pathology report which improves documentation of intraoperative margin mapping and extent of corresponding supplemental margins harvested. METHODS: We test the hypothesis that gaps in understanding exist for head and neck resection pathology reports across providers. A cross-sectional exploratory study using human-centered design was implemented to evaluate the existing permanent pathology report with respect to understanding margin status. Pathologists, surgeons, radiation oncologists, and medical oncologists from United States-based medical institutions were surveyed. The results supported a redesign of our surgical pathology template, incorporating 3D specimen / defect scans and annotated radiographic images indicating the location of inadequate margins requiring supplemental margins, or indicating frankly positive margins discovered on permanent section. RESULTS: Forty-seven physicians completed our survey. Analyzing surgical pathology reports, 28/47 (60%) respondents reported confusion whether re-excised supplemental margins reflected clear margins, 20/47 (43%) reported uncertainty regarding final margin status, and 20/47 (43%) reported the need for clarity regarding the extent of supplemental margins harvested intraoperatively. From this feedback, we designed a new pathology report template; 61 permanent pathology reports were compiled with this new template over a 12-month period. CONCLUSION: Feedback from survey respondents led to a redesigned permanent pathology report that offers detailed visual anatomic information regarding intraoperative margin findings and exact location/size of harvested supplemental margins. This newly designed report reconciles frozen and permanent section results and includes annotated radiographic images such that clinicians can discern precise actions taken by surgeons to address inadequate margins, as well as to understand the location of areas of concern that may influence adjuvant radiation planning.

Asunto(s)

Neoplasias de Cabeza y Cuello , Márgenes de Escisión , Patología Quirúrgica , Humanos , Neoplasias de Cabeza y Cuello/cirugía , Neoplasias de Cabeza y Cuello/patología , Estudios Transversales , Patología Quirúrgica/métodos , Comunicación Interdisciplinaria , Imagenología Tridimensional

RESUMEN

Chronic skin defects in the head, face and neck pose challenges for closure, especially after multiple surgeries or radiation therapy. We report the case of a woman in her 70s with a chronic occipital wound following squamous cell carcinoma resections, resulting in exposed skull bone. Despite various options, we successfully treated the 4 cm x 5 cm wound with a Kerecis fish skin graft (FSG), observing significant improvement within a week. The FSG promoted granulation tissue formation, enabling subsequent full-thickness skin grafting from the patient's groin. Complete wound closure was achieved within 2 weeks, indicating FSG's efficacy in complex wound management. Our experience highlights FSG's potential as a valuable tool in wound healing and reconstruction, particularly in challenging cases involving the head and neck.

Asunto(s)

Carcinoma de Células Escamosas , Trasplante de Piel , Cicatrización de Heridas , Humanos , Femenino , Trasplante de Piel/métodos , Carcinoma de Células Escamosas/cirugía , Anciano , Animales , Peces , Neoplasias de Cabeza y Cuello/cirugía , Neoplasias Cutáneas/cirugía , Resultado del Tratamiento , Enfermedad Crónica , Hueso Occipital/cirugía

RESUMEN

INTRODUCTION: This study analyzed oncologic patient management from initial tumor diagnosis to tumor follow-up in oral and maxillofacial surgery (OMFS) in Germany. MATERIAL AND METHODS: A dynamic online questionnaire with a total of 44 questions was used to generate general and specific data regarding oncologic patient management with head and neck malignancies, supportive care, and (pre-) rehabilitation from initial tumor diagnosis to tumor follow-up and head and neck cancer center (HNCC) structures in OMFS in Germany. The questionnaire was sent to 81 OMFS departments affiliated with the German-Austrian-Swiss Working Group for Tumors of the Jaw and Facial Region (DÖSAK) and the German Association of Oral and Maxillofacial Surgery (DGMKG). Data analysis was conducted descriptively. RESULTS: Forty-eight OMFS departments participated (response rate 59.26%), of which 36/48 (75%) were certified HNCC. 28/34 (82.4%) reported subjective improvements in oncologic care, most often interdisciplinary collaboration (21/33, 63.64%) and clinic structure changes (21/34, 61.76%). Nearly all OMFS departments present patients in multidisciplinary tumor boards (45/46, 97.83%) and aim for osseous reconstruction post-tumor resection (43/44, 97.73%). Significant discrepancies regarding the frequency of masticatory-functional dental rehabilitation following osseous reconstruction were observed. Before oncologic therapy, patients are offered various supportive services, mostly psychotherapy and psycho-oncological support (24/26, 92.31%). Post-therapy, speech therapy (43/43, 100%), physiotherapy (40/43, 93.02%), lymphatic drainage, and follow-up rehabilitation (39/43, 90.7%, respectively) are most often offered. 17/43 (39.53%) have oncological nursing staff. 36/40 (90%) manage patients and side effects during adjuvant therapy, while 5/41 (12.2%) provide proprietary palliative care. 36/41 (87.8%) offer counseling to patients and families. CONCLUSION: Oncologic patient care in OMFS is highly standardized and potentially attributable to many certified HNCCs in Germany. Certain treatment aspects are handled differently, possibly due to institution-specific reasons. CLINICAL RELEVANCE: The high homogeneity in treatment protocols reflects the widespread high and comparable treatment quality of head and neck malignancies in OMFS in Germany.

Asunto(s)

Neoplasias de Cabeza y Cuello , Humanos , Neoplasias de Cabeza y Cuello/terapia , Neoplasias de Cabeza y Cuello/cirugía , Alemania , Encuestas y Cuestionarios , Cirugía Bucal

RESUMEN

PURPOSE: The current supraomohyoid neck dissection (SOHND) is performed above the omohyoid muscle to dissect levels I, II, and III in the levels of cervical lymph nodes. However, the anatomical boundary between levels III and IV is the inferior border of the cricoid cartilage. We investigated the anatomical relationship between the omohyoid muscle and cricoid cartilage using contrast-enhanced CT (CE-CT) images to assess the validity of the current SOHND. METHODS: CE-CT images of the head and neck regions in patients were reviewed. The patients were divided into two groups: "malignant tumors" and "others". The vertebral levels corresponding to the positions of anatomical structures such as the intersection of the omohyoid muscle and internal jugular vein (OM-IJ), and the inferior border of the cricoid cartilage (CC), were recorded. RESULTS: The OM-IJ was located around the seventh cervical to the first thoracic vertebra. There was a significant difference between the malignant tumor and others groups in females (p = 0.036). The CC was located around the sixth to seventh cervical vertebrae. There was a significant sex difference in each group (malignant tumor: p < 0.0001; others: p = 0.008). Both sexes tended to have lower OM-IJ than CC, and females had significantly lower OM-IJ than males. CONCLUSION: This study provides clear anatomical evidence showing the difference between the SOHND dissection area and levels I, II, and III. It could be considered that in most cases SOHND invades level IV, not just levels I, II, and III, especially in female patients.

Asunto(s)

Medios de Contraste , Neoplasias de Cabeza y Cuello , Disección del Cuello , Tomografía Computarizada por Rayos X , Humanos , Masculino , Femenino , Persona de Mediana Edad , Disección del Cuello/métodos , Anciano , Adulto , Neoplasias de Cabeza y Cuello/cirugía , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Cartílago Cricoides/anatomía & histología , Cartílago Cricoides/diagnóstico por imagen , Cartílago Cricoides/cirugía , Anciano de 80 o más Años , Estudios Retrospectivos , Venas Yugulares/anatomía & histología , Venas Yugulares/diagnóstico por imagen , Músculos del Cuello/diagnóstico por imagen , Músculos del Cuello/anatomía & histología

Asunto(s)

Procedimientos de Cirugía Plástica , Escápula , Colgajos Quirúrgicos , Humanos , Escápula/cirugía , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos/cirugía , Neoplasias de Cabeza y Cuello/cirugía , Metaanálisis como Asunto

Asunto(s)

Procedimientos de Cirugía Plástica , Escápula , Colgajos Quirúrgicos , Humanos , Escápula/cirugía , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos/cirugía , Neoplasias de Cabeza y Cuello/cirugía , Metaanálisis como Asunto

RESUMEN

OBJECTIVE: The objective of this study was to assess the utility of narrow-band imaging (NBI) for improving intraneural dissection during gross total resection of head and neck schwannoma. Specifically, we aimed to quantitatively evaluate whether NBI can enhance the identification of pseudocapsule and true capsule within the tumor. METHODS: Nine schwannoma surgery cases conducted between February 2018 and October 2022 were retrospectively analyzed. The surgical procedures followed established principles with a specific focus on utilizing NBI to distinguish between the pseudocapsule and true capsule. Intraneural dissection was performed by searching for a tumor surface with a fascicle-free window, followed by longitudinal incision of the pseudocapsule. NBI was used to distinguish between the pseudocapsule and true capsule. Surgical views were captured under both white light (WL) illumination and NBI for further analysis. The brightness and contrast of the pseudocapsule and true capsule were quantitatively measured using ImageJ and were compared. RESULTS: Under NBI, the pseudocapsule consistently appeared greenish-gray, whereas the true capsule exhibited a white appearance. Quantitative analysis revealed a statistically significant difference (p < 0.0001) in brightness between the pseudocapsule (mean grayscale value 52.1, 95%CI; 46.4-75.3) and true tumor capsule (mean grayscale value 120.8, 95%CI; 155.7-109.0) under NBI. Conversely, there was no statistically significant difference in the brightness of these structures under WL (p = 0.2067). NBI also showed significantly higher contrast between the two structures than did WL (contrast 73.6, 95%CI; 53.1-89.5 vs. 30.9, 95%CI; 1.0-47.5, p = 0.0034). Further spectral analysis revealed that the most substantial difference in brightness between the pseudocapsule and the true tumor capsule was observed in the red spectrum, with a difference in brightness of -0.6 (95%CI; -16.8-14.8) under WL and 83.5 (95%CI; 50.3-100.0) under NBI (p < 0.0001). CONCLUSION: NBI proved to be a valuable tool for enhancing the identification of pseudocapsule and true capsule during intraneural dissection in head and neck schwannoma surgery. The improved contrast and membrane visibility offered by NBI might have the potential to reduce postoperative neurological deficits and improve surgical outcomes. Further research is warranted to validate our findings and explore the broader applications of NBI in schwannoma surgery.

Asunto(s)

Neoplasias de Cabeza y Cuello , Imagen de Banda Estrecha , Neurilemoma , Humanos , Neurilemoma/cirugía , Neurilemoma/diagnóstico por imagen , Persona de Mediana Edad , Imagen de Banda Estrecha/métodos , Estudios Retrospectivos , Femenino , Masculino , Adulto , Neoplasias de Cabeza y Cuello/cirugía , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/patología , Anciano , Disección/métodos

Asunto(s)

Colgajos Tisulares Libres , Neoplasias de Cabeza y Cuello , Procedimientos de Cirugía Plástica , Infección de la Herida Quirúrgica , Humanos , Colgajos Tisulares Libres/irrigación sanguínea , Infección de la Herida Quirúrgica/prevención & control , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/efectos adversos , Factores de Riesgo , Neoplasias de Cabeza y Cuello/cirugía , Profilaxis Antibiótica/métodos , Masculino , Femenino , Persona de Mediana Edad

RESUMEN

Background and Objectives: Patients with advanced head and neck tumors require salvage surgery as a last resort. These extensive surgeries pose the challenge of complex reconstructions. The head and neck surgeon undertaking such complex cases needs to master different flaps. The team managing these patients needs input from various specialists, along with otorhinolaryngologists, plastic surgeons, maxillofacial surgeons, vascular surgeons, experienced radiologists, dedicated pathologists, oncologists and radiation therapists. We focus on the optimum solution between oncologic resections and the future quality of life of patients and overall survival. Each complex case requires a personalized medicine approach. This scoping review aims to assess the efficacy and outcomes of complex reconstructions using various flaps for head and neck tumors, with a focus on free flaps and emerging techniques. Materials and Methods: A systematic search of the literature was conducted following PRISMA guidelines, resulting in the inclusion of 44 articles that met the predefined criteria in the last 10 years. Results: The included studies encompassed diverse patient populations and evaluated various surgical techniques, outcomes, complications, and advancements in head and neck reconstruction. The review identified a variety of flaps utilized in head and neck tumor reconstruction, including free flaps such as the radial forearm, anterolateral thigh, scapular tip, and myocutaneous flaps, among others. The success rates for free flap reconstructions ranged from 85% to 100%, with notable variations attributed to patient selection, tumor characteristics, and surgical expertise. Conclusions: Complications such as flap necrosis, infection, hematoma, and donor site morbidity were documented across studies, highlighting the importance of meticulous surgical planning and postoperative care. Furthermore, the review revealed emerging techniques such as computer-aided design, virtual surgery, stereolithographic models, customized implants, tissue engineering, and allotransplants, offering promising reconstructive armamentarium. Advances in surgical techniques and emerging technologies hold promise for further enhancing reconstructive outcomes, minimizing morbidity, and improving patient quality of life.

Asunto(s)

Neoplasias de Cabeza y Cuello , Procedimientos de Cirugía Plástica , Colgajos Quirúrgicos , Humanos , Neoplasias de Cabeza y Cuello/cirugía , Procedimientos de Cirugía Plástica/métodos , Calidad de Vida

RESUMEN

Objective: To explore the surgical intervention strategy for metastatic cervical lymph nodes surrounding the carotid artery in head and neck squamous cell carcinoma. Methods: A total of 62 patients with advanced head and neck tumors and carotid wrap by disease treated in Department of Otorhinolaryngology and Head and Neck Surgery, the Affiliated BenQ Hospital of Nanjing Medical University between June 2019 and December 2023 were reviewed, of whom 9 patients presented with metastatic squamous cell carcinoma in cervical lymph nodes of unknown primary or with no recurrence of primary lesion and all the 9 patients were males, aged from 48 to 79 years old, with≤level 2 of Eastern Cooperative Oncology Group-Performance Status (ECOG-PS). Radiographically common carotid artery (CCA) and/or internal carotid artery (ICA) were surrounded by≥270° with tumor. All the 9 patients received implantation of covered stent in carotid artery and radical resection of metastatic cervical lymph nodes. The success rate, complications, surgery-related complications, local recurrence rate, quality of life (QOL) and overall survival (OS) were analyzed. The QOL of patients was compared by paired rank sum test, and P<0.05 indicated statistically significant difference. The OS was analyzed by Kaplan-Meier. Results: The success rate of stent implantation was 100%, with no implantation-related complications. R0 resection was performed in 8 cases and R1 resection in 1 case. The QOL of patients after surgery was improved, and the improvements in "pain", "mood" and "anxiety" were statistically significant(Z values were -2.236, -2.460 and -2.200, respectively, and all P values were<0.05). Follow-up was 1-18 months, with a median of 7 months, and 1 case was lost to follow-up. Local recurrence occurred in 3 patients with an incidence of 37.5% (3/8). OS was 59.9% at 12 months after surgery. Conclusion: Implantation of covered stent in carotid artery combined with radical resection is an effective method for the treatment of cervical lymph node metastasis.

Asunto(s)

Neoplasias de Cabeza y Cuello , Ganglios Linfáticos , Metástasis Linfática , Carcinoma de Células Escamosas de Cabeza y Cuello , Humanos , Persona de Mediana Edad , Masculino , Anciano , Carcinoma de Células Escamosas de Cabeza y Cuello/cirugía , Neoplasias de Cabeza y Cuello/cirugía , Ganglios Linfáticos/patología , Arterias Carótidas/cirugía , Cuello , Calidad de Vida , Recurrencia Local de Neoplasia , Femenino , Stents

RESUMEN

Objective:This study aims to discuss the necessity，surgical method and effect of reconstruction of internal carotid artery （ICA） in the resection of paraganglioma of head and neck. Methods:We retrospectively analyzed the data of the patients who underwent head and neck paraganglioma resection and ICA reconstruction in Peking Union Medical College Hospital from May 2015 to August 2023. The demographic characteristics, preoperative examinations, diagnoses, surgical techniques, and follow-up information were collected. Results:Six patients were enrolled, including four females and two males, with an average age of（39.8±13.0） years. All the patients presented mainly complaining local masses with or without pain. Four cases underwent surgery through Fisch infratemporal fossa approach type A+B, and one through approach type A and one through transcervical approach. Five patients had vascular reconstruction using the great saphenous vein while one patient used an artificial vessel. The average follow-up period was（43.8±31.6） months. One patient had tumor recurrence after 3 years and underwent second surgery to remove the residual tumor, and the other 5 patients had no tumor recurrence. One patient had acute bridging vessel embolism, and the other was found to have occlusion of the bridging vessel at follow-up. Conclusion:Carotid revascularization during resection of paraganglioma of head and neck is an important technique to completely remove the tumor, cure the disease, ensure intracranial blood supply, and reduce cerebrovascular complications. The "pre-reconstruction technique " is an effective method to minimize the duration of brain blood flow interruption, compared to traditional carotid revascularization. Close observation is necessary, along with regular radiological examinations to assess the patency of transplanted vessels, and the residual or recurrent tumors.

Asunto(s)

Arteria Carótida Interna , Neoplasias de Cabeza y Cuello , Paraganglioma , Humanos , Masculino , Femenino , Adulto , Neoplasias de Cabeza y Cuello/cirugía , Estudios Retrospectivos , Paraganglioma/cirugía , Persona de Mediana Edad , Arteria Carótida Interna/cirugía , Procedimientos de Cirugía Plástica/métodos

RESUMEN

Protection of cranial nerves is one of the major challenges in the resection of paragangliomas of head and neck, especially in complex paragangliomas. We report a case of bilateral jugular tumor with unilateral carotid body tumor. Baroreflex failure syndrome（BFS） occurred after staged resection of bilateral lesions. There is still a lack of effective treatment for this complication. More prudent and reasonable treatment strategy is important to reduce the incidence of BFS.

Asunto(s)

Neoplasias de Cabeza y Cuello , Paraganglioma , Humanos , Neoplasias de Cabeza y Cuello/cirugía , Paraganglioma/cirugía , Barorreflejo , Complicaciones Posoperatorias/etiología , Tumor del Cuerpo Carotídeo/cirugía , Masculino , Femenino , Persona de Mediana Edad , Síndrome , Adulto

RESUMEN

BACKGROUND: Cervical lipomas accompanied by neurovascular compression are extremely rare and require surgical treatment in case of appropriate symptoms. The preferable method is gross total resection, as otherwise they tend to recur. Invasive growth is not typical for lipomas. However, large tumors can involve adjacent nerves and vessels and significantly complicate resection. MATERIAL AND METHODS: We present a 57-year-old patient who underwent resection of giant soft tissue cervical lipoma invading neurovascular bundle and compressing the oropharynx and esophagus with dysphagia and positional asphyxia. The patient was followed-up for previous 5 years. Resection was necessary due to tumor enlargement with appropriate symptoms. Searching for literature data was performed in the Pubmed, Medline, EMBASE, Cochrane Library and eLibrary databases. RESULTS AND DISCUSSION: Gross total resection of 7-cm tumor was accompanied by mobilization of hypoglossal and vagus nerves, common, external and internal carotid arteries and jugular vein with repositioning of the oropharynx and esophagus. There was mild Horner's syndrome in early postoperative period. The patient was discharged in 4 days after surgery with regression of complaints. We found only 5 reports describing giant cervical lipomas invading neurovascular bundle. CONCLUSION: Giant cervical lipomas are extremely rare, and total resection with preservation of critical structures is possible in a specialized hospital.

Asunto(s)

Lipoma , Humanos , Persona de Mediana Edad , Arterias Carótidas/cirugía , Arterias Carótidas/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/cirugía , Neoplasias de Cabeza y Cuello/patología , Lipoma/cirugía , Lipoma/complicaciones , Lipoma/patología