Search

Introduction : Squamous cell carcinoma of the head and neck presents a treatment challenge since it is often aggressive and has a high rate of recurrence. Initial treatment cures approximately 50% of newly diagnosed patients1, 2. Unfortunately, the average salvage rate of locoregional recurrence is only 16%3, 4. Recurrent tumor at the primary site is the most common pattern of failure, occurring in approximately 20-30% of patients1, 2. Regional recurrence in the neck occurs in 10-15% of patients and is the next most common cause of disease related death. Treatment options include salvage surgery, radiation, chemotherapy, various combinations of these therapies and palliative care. Most head and neck oncologists agree that salvage surgical procedures provide the best chance of long term disease control and possible cure for patients with resectable, recurrent cancers3. Complication rates in patients undergoing open salvage surgery are higher than in previously untreated patients, secondary to the effects of prior radiation therapy and/or surgery. Advances in reconstructive surgery have allowed more patients to be candidates for salvage surgery and have decreased the incidence of some complications. Free flap reconstruction in previously irradiated patients decreases local wound complications by bringing nonirradiated well-vascularised tissue into the wound. In this study, we present our experience with free single as well as multipaddled anterolateral thigh flaps for functional and aesthetical reconstruction of complex head and neck soft tissue defects after excision of recurrent oral cancer. Aim: The study aimed to evaluate the usefulness of the free anterolateral thigh flap for reconstruction of complex head and neck soft tissue defects after excision of recurrent oral cancer and the results of salvage surgery Patients & methods: Twelve patientswith recurrent squamous cell carcinoma of the oral cavity underwent salvage surgical treatment. All the twelve patients had received radiotherapy at the time of the initial treatment. Free anterolateral thigh flaps were used for the reconstruction of the extensive defects caused by excision of the tumors. The complications of the flap were analyzed with a follow-up from 1 to 14 months. Results: Four flaps were used for mucosal lining of the mouth, two flaps were used for reconstruction of the cutaneous defects and six flaps were used in a bipaddle fashion. The overall success rate of the flap was 91.6%. Flap related complications occurred in 4 patients (33.3%). Major complications occurred in 1 patient (8.3%) and minor complications occurred in 2 patients (16.6%). 2 patients (16.6%) had complications unrelated to the flap. Conclusions: The free anterolateral thigh flap is a reliable choice for reconstruction of complex soft tissue defects caused by excision of recurrent oral cancer because it can provide several independent skin paddles for multiple separate defects with minimal donor site morbidity. [ABSTRACT FROM AUTHOR]

Extraskeletal Ewing's sarcoma (EES) is rare. EES commonly arises in the soft tissues of trunk or extremities. EES is rare in the head and neck region;most of those have been documented in nasal cavity, paranasal sinuses and neck. Head and neck PNETs have an intermediate prognosis. We report the case of a 12 year old boy who presented with primitive neuroectodermal tumor of the thyroid and was treated with multimodal treatment including surgery, chemotherapy and radiotherapy. The patient is alive and fit with a functional larynx. Major drug regimens use vincristine, doxorubicin, ifosfamide or cyclophosphamide, dactinomycin and/or etoposide. Complete surgical excision is undertaken whenever possible to improve long-term survival.However, the relative radiosensitivity of tumors of the Ewing family, suggest multimodal treatment including adjuvant conformal radiotherapy in case of positive margins or poor response to chemotherapy rather than resection with 2-3 cm margins, which would imply laryngeal sacrifice for thyroid tumors. [ABSTRACT FROM AUTHOR]