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Nasopharyngeal carcinoma is endemic in south-eastern parts of Asia. Primary treatment modality is definitive radiotherapy ± chemotherapy depending on the stage of disease. Surgery serves as a means of salvage for persistent or recurrent diseases. Maxillary swing operation offers an anterolateral approach for removal of tumors in the nasopharynx ± parapharyngeal space extension including retropharyngeal lymph nodes. Maxillary swing operation may be combined with craniotomy for resection of locally advanced tumors involving the internal carotid artery, temporal bone and temporal dura. Encasement of internal carotid artery warrants prior extracranial intracranial bypass, so that the vessel can be removed en bloc with the tumor to ensure microscopic clearance. Exposed dura, skull base bone and internal carotid artery warrant coverage with well-vascularized muscle flap to facilitate wound healing. Attention to details peri-operation and meticulous tissue handling can help to prevent life threatening complications postoperation. [ABSTRACT FROM AUTHOR]

Nasopharyngeal carcinoma is treated with definitive radiotherapy +/- chemotherapy depending on the stage of disease. Surgery serves as a means of salvage for persistent or recurrent diseases. Maxillary swing approach offers an anterolateral approach to tumours in the nasopharynx, ipsilateral parapharyngeal space including retropharyngeal lymph nodes and skull base invasion. Tumours abutting on the petrous part of internal carotid artery can be safely removed after identification and protection of the internal carotid artery. Exposed skull base bone and internal carotid artery post tumour extirpation warrant coverage with well vascularized muscle flap such as the vastus lateralis muscle. Attention to details peri-operation and meticulous tissue handling can help to prevent life-threatening complications post operation. [ABSTRACT FROM AUTHOR]

Orbital floor fracture is common among patients suffering from facial trauma. Open reduction and reconstruction of the orbital floor with Medpor is the treatment of choice in our centre to correct diplopia and enophthalmos.

The authors’ experience showed that palpebral spring is effective in restoring static and dynamic symmetry in paralytic lagophthalmos patients, and also provided ways to overcome unique challenges encountered in its application in Asian eyelids.

OBJECTIVE To study the safety and oncological outcome of salvage surgery for local tumor recurrence after previous maxillary swing nasopharyngectomy. SETTING University hospital. PATIENTS Between 1998 and 2011, a total of 252 patients who had local tumor recurrence after previous nasopharyngectomy were recruited for the study. MAIN OUTCOME MEASURES The locations of the recurrent tumor, operability, and surgical details of resection and reconstruction, as well as the complications and oncological results, were studied. RESULTS The local recurrence rate after nasopharyngectomy was 13.1%, the risk of which was significantly higher in patients with positive resection margins (39.6% vs 6.9%; P = .006). The chance of the development of local recurrence was significantly lower in patients who had received postoperative chemoradiation therapy than in patients who did not (29.4% vs 64.3%; P = .04). Overall, 63.6% of the patients with local recurrence were amenable to further surgery. Depending on the location of the tumor, remaxillary swing (n = 10), contralateral maxillary swing (n = 8), or central palatal resection (n = 3) was performed. Free-flap coverage of the exposed skull base and the petrosal internal carotid artery was required in 12 patients. There was no evidence of hospital mortality or major complications associated with the surgery. The mean duration of follow-up was 22.4 months, and the overall disease-specific survival in the group of patients who underwent surgery was 80.9%. CONCLUSIONS Surgical salvage for local tumor recurrence after previous nasopharyngectomy is safe, with a good oncological outcome. In the presence of previous maxillary swing surgery, reswing or contralateral swing operation is feasible, without major complications.

Background:The aim of the current study was to report results of salvage nasopharyngectomy using the maxillary swing approach for persistent or recurrent nasopharyngeal carcinoma after primary treatment.Methods:Between 1989 and 2011, Nasopharyngectomies were performed in 312 patients. Data were composed of retrospective review of records of the first 72 patients followed by a prospective collection of data for the remaining patients.Results:Among the patients, 41 (13.1%) had persistent tumours and 271 (86.9%) had recurrent disease. Curative resection was achieved in 248 (79.5%) patients. All patients survived the operations. The median follow up duration was 34 months. The overall 5-year actuarial local tumour control was 74% and the overall 5-year disease-free survival was 56%. Those with negative resection margins on frozen section and tumour size less than 1.5 cm in diameter had significantly better local tumour control in the nasopharynx as well as disease-free survival.Conclusions:Maxillary swing nasopharyngectomy is an effective salvage procedure for small, persistent or recurrent tumour in the nasopharynx after primary therapy.

•Indocyanine green real-time sentinel lymph node mapping in oral cavity cancer.•Indocyanine green and Firefly® for sentinel lymph node mapping in oral cavity cancer.•Robot assisted sentinel lymph node biopsy using indocyanine green and Firefly®.•Robot assisted real-time sentinel lymph node mapping in oral cavity cancer.