Abstract Background: Radiation is a known risk factor for poor wound healing. Patients undergoing intraoperative radiation therapy (IORT) typically receive higher cumulative doses to their wound beds than patients treated with conventional radiation therapy. We review our experience with IORT in patients undergoing resection of head and neck cancer and flap reconstruction. Logistics of delivery and outcomes are discussed. Methods: A retrospective chart review was performed on all patients at Beth Israel Medical Center who underwent IORT for head and neck cancer between 2000 and 2007. Twenty‐one patients receiving 22 treatments involving flap reconstruction were identified. The results of these reconstructions were evaluated for complications and functional outcome. Results: All patients had complex surgical wounds of the face, upper aerodigestive tract, or neck who received IORT in conjunction with pedicled or free flap closure. Twenty‐five flaps in 21 patients were performed in the setting of IORT. All patients received between 10 and 15 Gy of IORT administered directly to the wound bed. There were no perioperative mortalities. Wound breakdown occurred in three cases, all of which were treated successfully by operative revision. Functionally, most patients did well and performed similarly to historic controls for their type of reconstruction. Conclusions: Reconstruction using flaps in the context of IORT can be achieved with expectation of good wound healing in the majority of cases despite heavy cumulative doses of radiation to recipient wound beds.
Case reports of foreign bodies in the upper aerodigestive regions and descriptions of the various methods used to retrieve them have been recorded in the medical literature since ancient times. Sharp, penetrating foreign bodies are most dangerous and may cause acute complications if they perforate the air and food passages. Recently, the authors encountered nine cases of hypodermic needles in the tracheobronchial tree. Seven of the nine needles were removed endoscopically without complications and two were expelled by the patients.
During 1978-1988, we treated 197 patients with thyroid carcinoma. Twenty-seven patients (14.0%) presented with a regional cervical mass and a clinically normal thyroid gland on initial evaluation. Excisional biopsy proved the diagnosis of metastatic thyroid carcinoma in every patient. Subsequent thyroid scans were 42% sensitive. Only 3 patients underwent fine-needle aspirations; none showed evidence of malignant cells. Review of surgical specimens showed total involvement of the gland in 13 of 17 cases, with extracapsular spread of tumor in 3 patients. Multicentric disease was present in all but 2 neck specimens. Patient follow-up from 1 month to 10 years revealed an 11.5% recurrence rate. The results in this group of patients is compared to the larger group of thyroid carcinoma patients, where three recurrences were found in 170 patients presenting with a clinically palpable mass in the thyroid gland. Analysis of our population comparing the subgroup with the larger series of thyroid carcinoma patients suggests that thyroid carcinoma presenting as a regional neck mass is a more aggressive disease.
A case of hypernephroma metastatic to the esophagus and presenting with massive upper gastrointestinal hemorrhage is described. The literature on metastatic esophageal neoplasm is reviewed and the methods of spread and prognosis summarized.
The first case of anaplastic carcinoma arising in median ectopic thyroid (thyroglossal duct remnants) in an 84-year-old woman is presented. This expands the spectrum of histologic types of thyroid malignancies reported in this location and supports the theory that these carcinomas arise from thyroid rests associated with thyroglossal ducts. The presence of a histologically benign follicular neoplasm adjacent to the carcinoma suggests the possibility that the anaplastic carcinoma resulted from the transformation of an underlying well-differentiated tumor. Some unusual features of this case are discussed as well as the criteria for establishing the diagnosis of carcinoma arising in a thyroglossal duct remnant.
