Search

Restoration of a harmonious and pleasant appearance is a crucial aspect of surgical treatment for many congenital and acquired deformities of the face. A 38-year-old female patient with residual scarring on the right hemiface following evacuation of a odontogenic phlegmon underwent microsurgical reconstruction with a free adipofascial anterolateral thigh free flap. A stable result was achieved 7 years later. Thanks to adipofascial anterolateral thigh free flap fixation onto the periosteum a very good long-lasting aesthetic and dynamic result was obtained; this approach can be used in patients both with severe and mild abnormalities. Whereas many methods of facial contour restoration are described in the literature, in Authors' opinion, microsurgical techniques are the gold standard unless contraindications; fasciocutaneous flaps, in particular, have shown the best aesthetic results since they can be sculptured to match the defect and stable anchoring is possible thanks to the thick fascia of the anterolateral thigh free flap.

Carcinoma of the lip is a common lesion which is not always acknowledged as as a potentially lethal disease. The risk of cancer occurs most commonly among aging white men. The risk factors normally associated with lip cancer are rural residence and outdoor occupation. In addition, both actinic radiation and tobacco smoking have been considered casually related to lip cancer. The present study is based on a retrospective review of 86 patients (82 males, 4 females, mean age 65) affected by carcinoma of the lip, treated in Florence from 1970 to 1988. The most frequent site for carcinoma of the lip proved to be the lower lip (71 cases); other sites included the upper lip (7) and the commissure (8). The lip tumor was a squamous cell carcinoma in 82 patients and a basal cell carcinoma in the remaining four. Good prognosis was found for all those with relatively small lesions (T1-T2). On the contrary, the prognosis proved quite poor for those who exhibited tumor fixation to the mandible or erosion of the mandible (23.5%, 5 year survival). Primary radiotherapy may be used for the smaller lesions as cure rates proved equivalent to those achieved surgically although the authors found surgery is always preferable as a primary method of treatment. Surgical excision of the tumor is a relatively minor procedure with a minimum of morbidity as compared with radiation therapy which may lead to local tissue reaction and may disturb function. Surgical management is also recommended as it bears the advantage of being to give a histologically accurate tumor margin assessment. Moreover, with surgery, functional results are good.(ABSTRACT TRUNCATED AT 250 WORDS)

A retrospective study has been performed on 155 cases of surgically treated hypopharyngeal carcinomas in order to bring to light what effect the type of surgery has on survival and the reasons for failure. The following operations were performed: 103 hemipharyngectomies with total laryngectomy (HPTL); 28 total circular pharyngectomies with total laryngectomy (CPTL); 16 hemipharyngectomies with partial laryngectomy (HPPL); 4 exereses in lateral pharyngectomy; 2 total laryngectomies and 2 hemipharyngectomies in lateral pharyngotomy. Analysis of the results is only performed on the three most numerous groups of patients. The overall neoplastic mortality rate at 5 years was 79% for the HPTL group while it was 50% and 61% in the CPTL and HPPL groups, respectively. The actuarial survival curves show a higher, statistically significant, cumulative 5-year survival rate for the CPTL group (55.9%) than for the HPTL group (30.5%). The authors conclude that, considering the particular submucosa spreading to which hypopharyngeal carcinoma is subject and the good functional recovery which can be obtained with modern reconstructive surgery of the alimentary tract, CPTL should be the treatment of choice, even in the less advanced cases, in order to significantly reduce the risk of local recurrences.

During the surgical treatment of head and neck cancers the surgeon may have to face the problem of deciding what measures to adopt when the tissue at the margin of the surgical sections proves histologically to be cancerous. Many factors may influence the decision for supplementary therapy; among these, of primary importance are stage and site of the tumor, the effectiveness of non surgical therapy, and the psychophysical status of the patient. In order to better consider this problem a retrospective study, limited to laryngeal surgery, and a review of the literature have been carried out. Review of the patients undergoing surgery from 1972 to 1988 has revealed that histological examination of section margins during or after laryngeal surgery was performed in 56 cases: 10 stripping vocal cords, 11 cordectomies, 2 frontolateral laryngectomies, 2 hemilaryngectomies, 20 horizontal supraglottic laryngectomies, 10 total laryngectomies and 1 subtotal laryngectomy with cricohyoidopexis. The margin was negative in 35 cases while tumor lesions of various types were present in 21 cases. An invasive tumor was present in 14 patients and in 7 an 'in situ' tumor or premalignant diskeratosis was found. A policy of abstention was adopted in all but one of the cases. All cases of 'in situ' cancer and of invasive premalignant change were grouped together as they have in common base membrane integrity and the fact that the second lesion is to be considered precancerous. The following results were obtained: in 14 cases of invasive cancer at the section margin there were 8 recurrences (57.1%) 4 after total laryngectomy; 6 patients showed no evidence of disease (NED) after from 3 to 7 years. In the 7 cases of 'in situ' cancer and premalignant lesions at the surgical margin, 4 showed recurrence (57%) and of these 2 underwent surgery. The 3 other cases have been NED for 3 to 5 years. On the other hand, even in the group of 35 margin free patients 8 developed recurrences (22.3%) and of these 3 underwent surgery and 1 radiotherapy. It appears evident that in conservative surgery of the larynx the presence of tumor cells at the surgical margin does not necessarily lead to a recurrence; such recurrences vary from 18% to 60% depending on the study. Nonetheless, it is certain that a real possibility of recovery exists in 50% of these patients. It is, however, impossible to specify which patient manifesting a positive margin actually runs the risk of developing a recurrence.(ABSTRACT TRUNCATED AT 400 WORDS)

The authors present the developments made in the use of cutaneous cervical flaps in the reconstruction of the hypopharyngo-cervical esophagus since Mikulicz first introduced the technique in 1886. Mention is made of the most recent, valid reconstructive possibilities which have resulted in a progressive reduction in the use of cervical flaps. The advantages and disadvantages of the Wookey-operation are enumerated and considerations are made regarding the validity of this technique. The authors conclude that the use of cutaneous cervical flaps remains an effective method, particularly when more limited extirpation and/or further reconstructive stages are required or when a patient's poor general state contraindicates more stressing procedures.