The infrahyoid flap: A comprehensive review of an often overlooked reconstructive method.

The infrahyoid flap is a myocutaneous pedicled flap mainly nourished by the superior thyroid vessels through the perforators of theinfrahyoidmuscles. This thin and pliableflap provides a skin island of about 7 by 4cm from the central part of the anterior neck. Theflapcan be transferred on its pedicle of superior thyroid artery and vein to reconstruct medium sized head and neck defects created aftercancer ablation. We have successfully used this flap in a series of 40 cases with no total flap loss and with 1 case of superficial skin necrosis. The aim of this review is to highlight the clinical usefulness of this pedicled flap even in the microvascular free flap era. A comprehensive review of the available literature reporting on the infrahyoid flap has been carried out using a web search. The history of the infrahyoid flap, the surgical technique with technical innovations, the clinical utility and limitations of this flap, are reported and discussed. Among the 7 larger series (cohort larger than 50 cases) a total of 956 flaps were performed, and the global success rate was 91.7\%, with failures being mainly related to partial skin necrosis, as the rate of total (skin and muscle) flap necrosis was only 1\%. This flap is reliable, easy to harvest during neck dissection, oncologically safe, it does carry a negligible donor site morbidity. This paper highlights how the infrahyoid flap can represent an excellent reconstructive solution in selected patients and head and neck sites

Effect of doping and oxygen vacancies on the octahedral tilt transitions in the BaCeO3 perovskite

We present a systematic study of the effect of Y doping and hydration level on the structural transformations of BaCeO3 based on anelastic spectroscopy experiments. The temperature of the intermediate transformation between rhombohedral and orthorhombic Imma phases rises with increasing the molar fraction x of Y roughly as (500 K)x in the hydrated state, and is depressed of more than twice that amount after complete dehydration. This is explained in terms of the effect of doping on the average (Ce/Y)-O and Ba-O bond lengths, and of lattice relaxation from O vacancies. The different behavior of the transition to the lower temperature Pnma orthorhombic phase is tentatively explained in terms of progressive flattening of the effective shape of the OH ion and ordering of the O vacancies during cooling.Comment: 8 pages, 5 figure

First bite syndrome as presenting symptom of parapharyngeal adenoid cystic carcinoma.

First bite syndrome refers to the development of pain in the parotid region after the first bite of each meal.A man was referred to our institution with first bite syndrome as his only symptom. Magnetic resonance imaging of the head and neck revealed a deep lobe parotid mass in close contact with the external carotid artery. Computed tomography guided fine needle biopsy indicated adenoid cystic carcinoma. Total parotidectomy was performed, with en bloc resection of the infiltrated external carotid artery and a selective neck dissection of levels Ib to III. High-weight ion radiotherapy was administered post-operatively.First bite syndrome has hitherto only been described following parapharyngeal space surgery. We present the first case of parotid gland adenoid cystic carcinoma presenting with first bite syndrome as the only symptom. The presence of first bite syndrome should prompt the clinician to investigate the parapharyngeal space and deep lobe of the parotid gland, especially in the absence of other signs or symptoms

Spontaneous internal carotid artery rupture during neck dissection in osteogenesis imperfecta patient.

Several connective tissue disorders are associated with vascular wall abnormalities, including spontaneous dissection of the cervical arteries. Osteogenesis imperfecta (OI) is a hereditary disorder, with rare neurovascular complications, which potentially lead to life-threatening events.We presented a case of spontaneous internal carotid artery (ICA) rupture that occurred in a 52-year-old-woman, suffering from OI type I, and who underwent a bilateral modified radical neck dissection (mRND) plus total thyroidectomy for a T4aN1b thyroid cancer. During mRND, an ICA's spontaneous rupture occurred.Histopathologic report suggested a structural defect of the arterial wall without cancer infiltration. The patient did not experience any neurologic complications.Head and neck surgeons have to be aware about early clinical recognition of possible cervical vascular abnormalities, in patients with connective tissue disorders, potentially responsible for dramatic vascular rupture during cervical surgical procedures

Palliative combined treatment for unresectable cutaneous basosquamous cell carcinoma of the head and neck.

A case is presented of a patient with a skin basosquamous cell carcinoma of the frontal region infiltrating the cerebral tissue and with a widespread unresectable regional metastatic ulceration of the left parotid region. The patient underwent combined palliative treatment: surgical coverage of the ulceration by means of a pectoralis mayor flap transposition and radiotherapy. After 18 months of follow-up, no signs of tumour progression were noted, the patient is currently free from pain, no increase in trismus was seen, and a slight gain in weight was recorded. Unresectable cancer is mainly treated by concurrent chemoradiation; radiotherapy, however, is contraindicated in deep neoplastic ulcerations with exposure of large vessels. The data reported suggest that surgical coverage of an unresectable neoplastic ulcer is feasible, and combined with early administration of radiation permits a palliative approach in an otherwise untreatable condition.Abstract available from the publisher

Oral cavity reconstruction with the masseter flap.

The purpose of this report is to highlight how an unusual, outdated, unpopular and overlooked reconstructive method such as the masseter flap can be a reliable, straightforward and effective solution for oral reconstruction in selected cases. We report the transposition of the masseter crossover flap in two previously pre-treated patients presenting a second primary oral squamous cell carcinoma; excellent functional results with satisfactory cosmetic appearance were obtained in both cases. In the literature, only 60 cases of oral cavity and oropharyngeal reconstructions using the masseter flap have been reported. The possible clinical utility of this flap, even in modern head and neck reconstructive surgery, is presented and discussed. We believe that the masseter flap should enter in the armamentarium of every head and neck surgeon and be kept in mind as a possible solution since it provides an elegant and extremely simple procedure in suboptimal cases for microvascular reconstruction

Hydrogen tunneling in the perovskite ionic conductor BaCe(1-x)Y(x)O(3-d)

We present low-temperature anelastic and dielectric spectroscopy measurements on the perovskite ionic conductor BaCe(1-x)Y(x)O(3-x/2) in the protonated, deuterated and outgassed states. Three main relaxation processes are ascribed to proton migration, reorientation about an Y dopant and tunneling around a same O atom. An additional relaxation maximum appears only in the dielectric spectrum around 60 K, and does not involve H motion, but may be of electronic origin, e.g. small polaron hopping. The peak at the lowest temperature, assigned to H tunneling, has been fitted with a relaxation rate presenting crossovers from one-phonon transitions, nearly independent of temperature, to two-phonon processes, varying as T^7, to Arrhenius-like. Substituting H with D lowers the overall rate by 8 times. The corresponding peak in the dielectric loss has an intensity nearly 40 times smaller than expected from the classical reorientation of the electric dipole associated with the OH complex. This fact is discussed in terms of coherent tunneling states of H in a cubic and orthorhombically distorted lattice, possibly indicating that only H in the symmetric regions of twin boundaries exhibit tunneling, and in terms of reduction of the effective dipole due to lattice polarization.Comment: submitted to Phys. Rev.

New surgical technique for endoscopic management of anterior glottic web.

In this study we report a new endoscopic technique for the management of anterior glottic web (AGW). Previously, various procedures with endoscopic or open surgical approaches have been described for the treatment of symptomatic AGW. We present an original, highly effective endoscopic technique that seems to have several advantages over traditional approaches.We used this novel technique in a preliminary series of four patients. Using a CO2 laser, a curvilinear mucosal flap based on the web is elevated from the superior surface of one vocal chord. The web is divided, and the flap is sutured at the inferior surface of the opposite vocal chord, ensuring that no raw surfaces will be left exposed on this side of the larynx. We accurately describe the technique, displaying diagrams of the surgical steps.In three cases, a restoration of the laryngeal airway, with complete resolution of the AGW, was achieved. A limited residual web persisted close to the anterior commissure in the fourth patient.The new endoscopic technique utilized in our preliminary series of patients is a simple, repeatable, and effective surgical procedure for managing AGW

Risk Factors for Multiple Malignancies in the Head and Neck

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