Swallowing Function before and after Subtotal Glossectomy and Reconstruction with a Rectus Abdominis Musculocutaneous Flap: A Case Report

Purpose: Swallowing function was in a patient with tongue cancer that was evaluated with video fluorography before and after subtotal glossectomy and reconstruction with a rectus abdominis muscuocutaneous flap. Materials and Methods: A 41-year-old man underwent subtotal glossectomy and retained the unilateral posterior mylohyoid and unilateral stylohyoid muscles. The structure of the flap was evaluated postoperatively. To assess swallowing function, video fluorography was performed before surgery, 1 month after surgery and 1 year after surgery. Testing involved 1) ability to hold 10 mL of liquid in the oral cavity, 2) epiglottis turnover, 3) the presence of aspiration, 4) hyoid bone movement, and 5) maximum width of the esophageal entrance. Results: The flap was protuberant postoperatively. The patient was able to hold the test diet in the oral cavity before and after surgery. Epiglottis turnover was good before surgery but insufficient after surgery. Aspiration during swallowing was not observed before or after surgery. At rest, the hyoid bone sagged postoperatively, in comparison with preoperatively. Hyoid bone movement and width of the esophageal entrance decreased after surgery;however, they demonstrated gradual recovery. Conclusions: For good postoperative swallowing function after subtotal glossectomy, it is necessary to perform reconstruction with protuberant flap and to retain the suprahyoid muscles as much as possible.

原发性颈段气管癌外科治疗的研究

1980年1月～1992年12月为5例原发性颈段气管癌病人行手术切除,并常规把气管旁、颈内静脉、颈动脉旁淋巴结清扫,其中2例因怀疑甲状腺受累也一并切除。以颈阔肌皮瓣和舌骨瓣修复,3年生存率为80%(4/5)。

复合舌骨瓣悬吊修复额侧部分喉缺损的临床研究

目的报道用复合舌骨瓣悬吊修复额侧部分喉缺损，并且探讨术后喉功能和肿瘤预后情况。方法分析2008年9月至2012年8月中山大学肿瘤防治中心头颈科运用该技术治疗6例患者的临床资料。结果患者均在术后24h内进行鼻饲营养，进食糊状物、喝水和拔出鼻饲营养管的中位数时间分别是2．6，5．5和6．3d。未发生误吸和吸人性肺炎等严重不良事件。发声效果还是令人满意的。呼吸功能良好，无喉狭窄发生。第2例患者术后8个月声门旁间隙复发因而进行了喉全切除，其余病例均无瘤生存至今。中位生存时间是29．5个月（14—47个月）。结论复合舌骨瓣悬吊术可以一期修复额侧喉软骨和喉黏膜缺损，可以重建喉的吞咽、呼吸和发音功能。