Head & Neck最新文献

{"title":"Evolution of a paradigm for free tissue transfer reconstruction of lateral temporal bone defects.","authors":"Eben L Rosenthal,&nbsp;Teresa King,&nbsp;Benjamin M McGrew,&nbsp;William Carroll,&nbsp;J Scott Magnuson,&nbsp;Mark K Wax","doi":"10.1002/hed.20744","DOIUrl":"https://doi.org/10.1002/hed.20744","url":null,"abstract":"<p><strong>Background: </strong>Tumors of the lateral skull base are best treated with surgery plus or minus radiation therapy. Surgical ablation may involve cutaneous structures, the auricle, the parotid, and the lateral temporal bone. These composite soft tissue defects are best reconstructed with composite tissue. Multiple pedicled flaps have been used to reconstruct these defects. Free flaps have been shown to provide the best tissue for these reconstructions. We review our experience and present an algorithm for their reconstruction.</p><p><strong>Methods: </strong>A case series of consecutive patients treated between 1999 and 2006 at 2 tertiary care institutions, Oregon Health and Science University and University of Alabama at Birmingham were reviewed. There were 73 patients who had periauricular defects requiring 74 free tissue transfers in this retrospective chart review. All defects had extensive cutaneous loss and underwent some form of parotidectomy. There were 57 lateral temporal bone defects and 16 periauricular defects where the external auditory canal was preserved. The majority of patients had nonmelanoma skin malignancies (65%). Eighty percent of patients had undergone previous treatment (radiation therapy, surgery, or a combination therof).</p><p><strong>Results: </strong>Early on, reconstruction was performed using a radial forearm (RFFF, n=29), evolving to lateral arm (n=6), rectus (n=11), and finally an anterolateral thigh (ALT, n=28) free flap. The average hospital stay was 6 days, and the overall complication rate was 22%. The rectus flap needed debulking in 34% of patients, and the anterolateral thigh in 9%. Periauricular defects were classified based on preservation of the external auditory canal (class I), lateral temporal bone resection with preservation of the auricle (class II), or lateral temporal bone with total auriculectomy (class III).</p><p><strong>Conclusion: </strong>Class I defects were best managed by RFFF reconstruction, class II defects were managed well with the ALT flap, and class III defects required the ALT or rectus flap.</p>","PeriodicalId":501638,"journal":{"name":"Head & Neck","volume":" ","pages":"589-94"},"PeriodicalIF":2.9,"publicationDate":"2008-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/hed.20744","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40412692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of sinonasal undifferentiated carcinoma.","authors":"Emily D Tanzler,&nbsp;Christopher G Morris,&nbsp;Christine A Orlando,&nbsp;John W Werning,&nbsp;William M Mendenhall","doi":"10.1002/hed.20748","DOIUrl":"https://doi.org/10.1002/hed.20748","url":null,"abstract":"<p><strong>Background: </strong>Our aim was to report the outcomes of treatment for sinonasal undifferentiated carcinoma (SNUC).</p><p><strong>Methods: </strong>Between September 1992 and October 2005, 15 patients were treated with curative intent with surgery (n=1), surgery and adjuvant radiotherapy (n=9), and definitive radiotherapy (RT) (n=5). Follow-up ranged from 11 to 151 months (median, 30); follow-up on living patients ranged from 12 to 151 months (median, 22). No patient was lost to follow-up.</p><p><strong>Results: </strong>Seven patients (47%) developed a recurrence from 3 to 50 months (median, 9) after treatment. The 3-year outcomes were: local control, 78%; locoregional control, 65%; distant metastasis-free survival, 82%; cause-specific survival, 77%, and survival, 67%. The local control rates versus treatment modality were: surgery, 0/1 (0%); surgery and postoperative RT, 7/7 (100%); preoperative RT and surgery, 2/2 (100%); and definitive RT, 2/5 (40%). One patient (7%) treated with surgery and postoperative RT sustained a fatal complication.</p><p><strong>Conclusions: </strong>Combined surgery and adjuvant RT likely offer the best chance of cure compared with either modality alone. The impact of adjuvant chemotherapy is unclear.</p>","PeriodicalId":501638,"journal":{"name":"Head & Neck","volume":" ","pages":"595-9"},"PeriodicalIF":2.9,"publicationDate":"2008-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/hed.20748","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27358374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}