Between 1978 and 1991, 56 microvascular composite flaps were used for oromandibular reconstructions: 15 for primary total and subtotal tongue reconstruction and five for secondary major tongue reconstruction. The delayed reconstructions were performed to improve the oral and pharyngeal phases of swallowing. Using a floor of the mouth composite bone grafting technique to reposition the tongue and obliterate the oral dead space intraoral food transport was improved (three of five patients), but aspiration persisted (three of four patients). When compared with 10 patients evaluated for primary total and subtotal tongue reconstruction the primary reconstruction group showed superior swallowing (eight dynamic oral transport, no aspiration) and speech results. The poor results of secondary reconstruction are attributed to scarring and irreversible damage to remaining functional muscles involved in protecting the laryngeal aditus.

Aged↗

PubMedDate not supplied

Horizontal versus vertical block resection for early floor of mouth carcinoma.

Although the literature affirms the superiority of block resection over local excision for the surgical treatment of early squamous cell carcinoma of the anterior floor of the mouth, the best method of block resection is not certain. Two methods are in widespread use; a horizontal procedure (HB) and a vertical procedure (VB). This retrospective study compares these two procedures according to outcome in separate series of patients treated between 1970 and 1984. Patients were followed for a minimum of 3 years with an average follow-up of 6 years. Twenty-five patients underwent HB while 27 underwent VB. Control at the primary site was 100% for HB and 74% for VB. Neck metastasis and distant metastasis occurred with equal frequency. Determinate survivals at 3 and 5 years were 96% and 91% for the HB group and 93% and 65% for the VB group. Local recurrence correlated with tumor growth posteriorally toward the ventrum of the tongue, suggesting an explanation for the difference in outcome between the two procedures. We conclude that the HB procedure is the preferable surgical procedure for stage I and II disease.

Adult↗

PubMedDate not supplied

Variation's in the use of SMAS (superficial musculoaponeurotic system) to prevent Frey's syndrome after parotidectomy.

Since 1979, the SMAS (Superficial Muscular Aponeurotic System) has been used in over 100 parotidectomies to ameliorate the sunken facial appearance, and to prevent Frey's Syndrome. The procedure involves a rhytidectomy incision followed by variations including superior rotation, posterior advancement and plication of the SMAS. Appropriateness of such variations considers the defect from the surgery, and the histology of the tumor.

Face↗