Functional reconstruction after subtotal glossectomy in the surgical treatment of an uncommon and aggressive neoplasm in this location: primary malignant melanoma in the base of the tongue

Primary malignant melanoma of the oral cavity is a rare neoplasm, especially on the tongue. We report a case of mucosal melanoma at the base of the tongue, an extremely rare location (only about 30 cases have been reported in literature). The extension study doesn't revealed distant metastatic lesions. The patient was treated by subtotal glossectomy and bilateral functional neck dissection. Tongue is one of the most difficult structures to reconstruct, because of their central role in phonation, swallowing and airway protection. The defect was reconstructed with anterolateral thigh free flap. Surgical treatment was supplemented with adjuvant immunotherapy. The post-operative period was uneventful. At present, 24 months after surgery, patient is asymptomatic, there isn't evidence of recurrence of melanoma and he hasn't any difficulty in swallowing or phonation

The Clinical Application of Anterolateral Thigh Flap

The anterolateral thigh flap can provide a large skin paddle nourished by a long and large-caliber pedicle and can be harvested by two-team work. Most importantly, the donor-site morbidity is minimal. However, the anatomic variations decreased its popularity. By adapting free-style flap concepts, such as preoperative mapping of the perforators and being familiar with retrograde perforator dissection, this disadvantage had been overcome gradually. Furthermore, several modifications widen its clinical applications: the fascia lata can be included for sling or tendon reconstruction, the bulkiness could be created by including vastus lateralis muscle or deepithelization of skin flap, the pliability could be increased by suprafascial dissection or primary thinning, the pedicle length could be lengthening by proximally eccentric placement of the perforator, and so forth. Combined with these technical and conceptual advancements, the anterolateral thigh flap has become the workhorse flap for soft-tissue reconstructions from head to toe

Muscle Logic: New Knowledge Resource for Anatomy Enables Comprehensive Searches of the Literature on the Feeding Muscles of Mammals

Background: In recent years large bibliographic databases have made much of the published literature of biology available for searches. However, the capabilities of the search engines integrated into these databases for text-based bibliographic searches are limited. To enable searches that deliver the results expected by comparative anatomists, an underlying logical structure known as an ontology is required. Development and Testing of the Ontology Here we present the Mammalian Feeding Muscle Ontology (MFMO), a multi-species ontology focused on anatomical structures that participate in feeding and other oral/pharyngeal behaviors. A unique feature of the MFMO is that a simple, computable, definition of each muscle, which includes its attachments and innervation, is true across mammals. This construction mirrors the logical foundation of comparative anatomy and permits searches using language familiar to biologists. Further, it provides a template for muscles that will be useful in extending any anatomy ontology. The MFMO is developed to support the Feeding Experiments End-User Database Project (FEED, https://feedexp.org/), a publicly-available, online repository for physiological data collected from in vivo studies of feeding (e.g., mastication, biting, swallowing) in mammals. Currently the MFMO is integrated into FEED and also into two literature-specific implementations of Textpresso, a text-mining system that facilitates powerful searches of a corpus of scientific publications. We evaluate the MFMO by asking questions that test the ability of the ontology to return appropriate answers (competency questions). We compare the results of queries of the MFMO to results from similar searches in PubMed and Google Scholar. Results and Significance Our tests demonstrate that the MFMO is competent to answer queries formed in the common language of comparative anatomy, but PubMed and Google Scholar are not. Overall, our results show that by incorporating anatomical ontologies into searches, an expanded and anatomically comprehensive set of results can be obtained. The broader scientific and publishing communities should consider taking up the challenge of semantically enabled search capabilities

Modalities of Reconstruction in Oral Malignancy: A prospective study

INTRODUCTION: Carcinoma oral cavity affects 10 million people annually. It is the sixth commonest carcinoma in the world. According to National cancer registry program, Thanjavur district stands at the 11th place for oral cavity carcinoma in males in India. In spite of the easy accessibility for physical examination and biopsy, majority of the patient still remain a challenge for the treating physician. Surgery forms the mainstay of treatment and in most cases with addition of radiotherapy as an adjuvant therapy. The cosmetic, functional and psychosocial results of oral cancer may combine to produce devastating effect on the patient in view of wide range of functions of oral cavity including speech, deglutition, mastication and competence. These patients require a well-planned and well executed reconstructive strategies and extensive rehabilitative management. With the advent of the newer technique like microvascular free tissue transfer and availability of improved biomaterials like Osseointegrated implants, simultaneous reconstruction of defect and ensuring a near normal quality of life has become the standard care instead of previous concept of providing a skin coverage alone. A descriptive study of 40 patients with oral cavity malignancy and reconstructive strategies employed from October 2007 to April 2010 are discussed. AIMS AND OBJECTIVES: 1. To study the demographics of oral cavity reconstruction in our department during the period October 2007- April 2010. 2. To identify the various factors that influences the choice of reconstruction. 3. To analyse the various methods of reconstruction and their outcomes in terms of functionality and aesthetics. MATERIALS AND METHODS: This study is the prospective non randomized descriptive study conducted in the Department of Plastic Surgery, Thanjavur medical college and hospital. • A total of 40 Patients with oral malignancy who were treated in our department from October 2007 to April 2010 were included in the study. • Detailed History, Physical Examination & appropriate investigations were done to arrive at a clinical diagnosis. • Patients with prior histopathological diagnosis were included in the study. Co morbid conditions were thoroughly assessed. • Patients were clinically staged with the help of clinical examinations and staging investigations. • Based on the clinical stage of the disease, treatment and reconstruction was planned for each case in our departmental planning session. Inclusion Criteria: All patients diagnosed with oral malignancy during the study period. Exclusion Criteria: Patients with metastasis, Lesions involving retromolar trigone, Recurrent malignancy, Patients with N3 nodal status were excluded in the study. CONCLUSION: Oral cancer is a national problem. • It remains the challenge as a surgery forms the mainstay of treatment but the reconstruction of post excisional defect as the post excisional defect are complex wound which often requires replacement of lining, skin cover and bone. • With the multimodality management emerging as the treatment of choice, the reconstructive surgeon has to be the part of a team which includes oncosurgeon, radio therapist and oncopathologist. • Commonest age group affected were 50 – 60 years, because of easy accessibility of lesion, a rigorous screening program in these age groups especially those who are at high risk will enable early detection of lesion which would provide better curative and easier reconstructive options. • Tobacco in any form is the major predisposing factor, health education through mass media and posters in health centers in a large scale by Government and Non- Government organizations will create awareness and help in prevention

ImprovingtheSwallowingin TotalGlossectomy With Laryngeal Preservation

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Alteration of a radial forearm flap to adjust to the superficial radial artery: a case report

Aberrant branches of the radial artery at the level of the forearm have rarely been reported. Preoperative workups to identify aberrant branches of this type have also seldom been performed. However, surgeons elevating a radial artery-based flap should consider the possibility of aberrant arterial branching. Otherwise, the circulation of both the flap and hand may be endangered. We present a case of an anomalous radial artery branch that resulted in an intraoperative alteration of the flap design. A novel technique was used to preserve the circulation of the entire flap, and the patient recovered with adequate healing of the flap and donor areas. No hand function deficits or subjective complaints were noted. In conclusion, surgeons should be aware of the superficial radial artery or other aberrant branches of the radial artery that may be located in various locations during radial artery-related flap elevation.ope