Extramammary Paget's Disease: 20 years of Experience in Chinese Population

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Morbidities and quality of life after maxillary swing nasopharyngectomy for recurrent nasopharyngeal carcinoma

Congress Theme: Beyond the LimitsThis journal suppl. contain abstracts of the European Skull Base Society 11th Congress 2014BACKGROUND: The maxillary swing approach provides a good access that allows maximal resection of recurrent NPC. The aim of the current study was to report the morbidities and quality of life of patients after surgery. METHODS: A prospective study of the early and late morbidities after surgery was performed. A longitudinal investigation of the quality of life before and 1 year after surgery was performed using the self-reported, EORTC questionnaire. RESULTS: Salvage nasopharyngectomy was performed for 338 patients during 1990 to 2012. There was no hospital mortality. The morbidities were actively prevented by modifications of surgical techniques, leading to a significant reduction in the incidence of postoperative trismus (42.1 vs. 9.2%, p = 0.01) and palatal fistula formation (24.0 vs.3.7%, p = 0.01). Patients with locally advanced tumor, particularly those who required adjuvant chemoradiation, had higher chance of facial numbness, nasal blockage, and swallowing problem after surgery. There was no significant change in the mean global health system score after surgery, except those after palliative resection requiring adjuvant chemoradiation. Social functioning had the lowest scores among the five functioning scales in all groups of patients. Palatal fistula significantly affected social eating and weight loss, and osteoradionecrosis caused more pain and nasal discharge, severely affecting the social life of the patients. CONCLUSIONS: QOL of patients after salvage nasopharyngectomy

Clinical application of the free posterior tibial flap in the oral cavity

This journal suppl. contain abstracts of the 3rd IAOO 2011INTRODUCTION: Over the years, the radial forearm flap has been the flap of choice for the repair of shallow intra-oral mucosal defects. However, it is notorious for the potential donor site morbidities. It would be advantageous for any flap which can provide similar tissue properties, while at the same time carry less donor site morbidity. This study reports our experience with the free posterior tibia (PT) flap for the reconstruction of such defects. METHODS: Dissection of the leg was performed in 30 cadaveric legs and the characteristics of the posterior tibia vascular system was noted and recorded. Subsequently the free posterior tibia flaps were used for reconstruction after resection of tumours in the oral cavity. Results of the reconstruction were noted. Post-operative wound healing was observed and the range of ankle movement as well as the vascular status of the lower limb was assessed by measuring the temperature, ankle-brachial index (ABI) and the capillary perfusion pressure 1 year after the operation. RESULTS: Our anatomical study showed that the flap is supplied by constant septocutaneous perforators arising from the posterior tibial artery in the medial distal third of the leg. The skin paddle taken from the region is both thin and supple. In our clinical study, 48 patients had PT flap reconstruction of the intra-oral defects after resection of tumours of the tongue (n = 32), buccal mucosa (n = 8), soft palate (n = 6) and the floor of mouth (n = 2). The success rate is 100%. Mild donor wound infection occurred in 4.2% of our patients. The aesthetic outcome of the donor site has been satisfactory. None of our patients have problems on walking after surgery. There was no statistically significant change in pre- and post-operative range of ankle movement as well as the vascular perfusion of the lower limb. DISCUSSION: The posterior tibial flap is a safe and versatile flap to be used clinically. Because the donor site morbidity is low, it has the potential to replace the radial forearm flap to resurface shallow intra-oral mucosal defects.The 3rd World Congress of the International Academy of Oral Oncology (IAOO 2011), Singapore, 14-17 July 2011. In Oral Oncology, 2011, p. S59, abstract O8

Management of isolated nodal recurrence after head and neck cancer treatment

The status of the regional cervical lymphatics is one of the most significant prognostic indicators in head and neck cancers. The traditional treatment for cancers with cervical nodal metastasis has been surgical. With the global trend towards organ-preserving therapy, chemoradiation has gained increasing popularity over primary surgical therapies for cancers in the head and neck region. The subsequent management of the neck for those with residual or recurrent nodal metastasis, however, has become one of the most debated topics in the field of head and neck oncology. This review addresses several important controversies, including the optimal assessment of the nodal response to chemoradiation, the potential role and the oncological results of planned and salvage neck dissection after chemoradiation and the type and extent of neck dissection required in order to achieve the optimal balance between tumour control and surgical morbidities. Further clinical trials and ongoing researches will help us to define the best therapeutic option in such circumstances.link_to_OA_fulltex

Quality of life of patients after salvage nasopharyngectomy for recurrent nasopharyngeal carcinoma

BACKGROUND: The objective of this study was to examine the quality of life (QOL) of patients who underwent salvage nasopharyngectomy for residual or recurrent nasopharyngeal carcinoma and to justify the value of the procedure. METHODS: A self-reported, health-related QOL questionnaire was used to assess the QOL of patients after salvage nasopharyngectomy. The effects of potential complications after surgery also were evaluated. RESULTS: Between 2003 and 2011, 185 patients underwent salvage nasopharyngectomy using the maxillary swing approach. Curative resection was achieved in 80% of patients. There were no significant changes in mean global health system scores after surgery, except after palliative resection requiring postoperative adjuvant chemoradiation. Social functioning scores were the lowest of the 5 functioning scales in all patient groups. Palatal fistula significantly affected social eating and weight loss, and osteoradionecrosis caused more pain and nasal discharge, severely affecting the social life of patients. CONCLUSIONS: The QOL of patients after maxillary swing salvage nasopharyngectomy was good. The current results indicated that attention must be paid to the factors that adversely affect QOL after surgery, such as palliative resection, and complications like trismus, palatal fistula and osteoradionecrosis. Copyright © 2011 American Cancer Society.link_to_subscribed_fulltex

Management of head and neck tumours during pregnancy: case report and literature review

Ethical dilemmas arise in managing head and neck cancers during pregnancy. The timing of treatment is an important determinant on foetal wellbeing. Diagnostic and treatment modalities may harm the foetus, while delaying or choosing suboptimal treatment in order to preserve foetal health may worsen maternal outcome. A multidisciplinary approach should be adopted to enable parents and clinicians to make the best clinical decision. We report on two cases. Case 1 is a 34-year-old female who presented with squamous cell carcinoma of the tongue at 29 weeks' gestation. Partial glossectomy, selective neck dissection and posterior tibial flap reconstruction was performed at 31 weeks. She underwent induction and early delivery at 38 weeks prior to receiving radiotherapy. Case 2 is a 36-year-old female who presented with carcinoma of the cervical oesophagus complicated by tracheal invasion, thyroid and cervical lymph node metastasis at 13 weeks' gestation. Pregnancy was terminated at 16 weeks. She received a course of neoadjuvant chemoirradiation.link_to_subscribed_fulltex

Basal cell carcinoma of the head and neck region (HNBCC): a 10 year experience

Conference Theme: Shifting Paradigms in Head and Neck OncologyThe 4th World Congress of International Federation of Head and Neck Oncologic Societies (IFHNOS) 2010, Seoul, Korea, 15-19 June 2010