In series of 24 patients treated for squamous carcinoma of the oral cavity and oropharynx, 26 mandibular reconstructions using 27 grafts or flaps were performed. Reconstruction was immediate in 23 cases and delayed in three. There were five ‘simple’ bone grafts, 10 pedicled compound myocutaneous flaps, and 12 vascularized free compound flaps. Operative mortality was 12% and complication rate 65%, but 70% of the grafts survived till death or follow‐up of the patients. Three ‘simple’ bone grafts failed and were removed. Three of five compound pectoralis major flaps failed along with one of five pedicled compound latissimus dorsi flaps. Only one vascularized free compound flap was lost. The major cause of graft failure was intra‐oral suture line dehiscence exposing the bone to saliva. Under these circumstances, bone graft necrosis occurred when blood supply to the bone was poor – viz. ‘simple’ grafts and compound pectoralis major flaps. The vascularized free compound flaps were most reliable but the need for jaw preservation where possible and better patient selection are recognized.
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• An excellent method of rehabilitation for swallowing after total pharyngolaryngoesophagectomy is the reconstruction of the pharyngoesophagus with an autogenous visceral transplant. The most popular and reliable methods are the gastric "pull-up" and colonic "swing." A complication of this procedure—which can result in morbidity as well as mortality—is carotid artery rupture, especially when a neck dissection is performed. This is usually the result of wound breakdown secondary to adjunctive use of radiotherapy. When we have performed a radical neck dissection in conjunction with a visceral transplantation, we have used pedicled omentum as a live, durable cover for the carotid artery. (Arch Otolaryngol1982;108:685-687)
The case records of 235 patients who were treated for differentiated thyroid cancer between 1949 and 1981 were reviewed. Forty-two (18%) had distant metastatic spread outside the neck and received radioiodine (131I) therapy. In cases where the distant spread was confined to the lungs, 54% of patients were alive, free of disease, 10 years after 131I treatment was started. By contrast, no patient with skeletal involvement has survived for 10 years and only one for five years after treatment. A variety of cytotoxic drugs has been tried on an ad hoc basis with no notable success. One patient developed preleukaemia three months after completion of 131I treatment, but no other serious side effects were observed. Factors that influence the behaviour of metastatic thyroid carcinoma are discussed and a possible revised approach to 131I therapy is suggested in the light of these findings.
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