Cases reported "Carcinoma, Squamous Cell"

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21/23. Laryngeal reconstruction by composite nasal mucoseptal graft after partial laryngectomy. three years follow-up.

    We have used autogenous nasal mucoseptal (NMS) graft for the reconstruction of the larynx after partial laryngectomy in glottic carcinoma invading the anterior commissure, for the past three years. The composite graft, readily available and obtained without sequela, provides satisfactory and large enough replacement tissue. It provides both a dependable rigid cartilaginous wall and a respiratory mucous lining of the lumen. The method was found to be simple and effective in bridging the laryngeal defect. The free NMS graft was used for reconstruction after extended frontal and frontolateral laryngectomy in 10 patients. The patients were successfully decannulated within 4 to 6 days after the operation and in none of the cases was nasogastric feeding tube or laryngeal stenting necessary. In eight patients anatomical and functional results were achieved; the neolarynx prevented a permanent tracheostomy and a fair voice was obtained.
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keywords = voice
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22/23. Pharyngoesophageal reconstruction using the radial forearm fasciocutaneous free flap: preliminary results.

    Pharyngoesophageal reconstruction remains a challenge to the head and neck surgeon. The goals of pharyngoesophageal reconstruction include restoration, with minimal morbidity, of a person's ability to swallow and to speak. Myocutaneous flaps, gastric pull-up, and the jejunal free flap are popular methods of pharyngoesophageal reconstruction; however, none of these modalities is clearly ideal. We have begun utilizing the radial forearm fasciocutaneous free flap for pharyngoesophageal reconstruction. Twelve patients have had reconstruction with this flap with follow-up from 2 to 15 months. Seven defects were circumferential, and five were noncircumferential. Ten patients (83%) have had successful restoration of both swallowing ability and voice. Donor site morbidity was minimal. The leading complication was salivary leak, which was present in eight (67%) patients. Five of the leaks closed with nonsurgical intervention. No cases of flap necrosis occurred. The radial forearm free flap is a thin and pliable flap that closely approximates the tissue consistency of normal pharynx. Successful restoration of a patient's ability to swallow approximates that of enteral flaps and is superior to that of MC flaps. Successful speech restoration is superior to that of enteral and MC flaps. Donor site morbidity is less than that caused by enteral flaps because laparotomy is avoided. Salivary leak is higher than with enteral flaps. Part of this difference is accountable to the high number of secondary and technically challenging reconstructions in this series, and we have taken steps to lower this rate of leakage. These preliminary data show that the radial forearm fasciocutaneous free flap is well suited for pharyngoesophageal reconstruction.(ABSTRACT TRUNCATED AT 250 WORDS)
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ranking = 1
keywords = voice
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23/23. An improved method of flexible endoscopic creation of tracheoesophageal fistula for voice restoration.

    We present improvements of a previously reported method of tracheoesophageal puncture for voice restoration in postlaryngectomy patients. Our method utilizes a flexible endoscope to enable the tracheoesophageal puncture to be made under direct visualization using only local anesthesia and intravenous sedation. After 3 days, the created tracheoesophageal fistula tract is mature enough to allow placement of a voice prosthesis in the office. This allows the entire procedure to be performed in an outpatient setting with minimal risk.
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ranking = 6
keywords = voice
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