1/11. Lateral upper arm free flap for primary reconstruction of pharyngeal defects in ablative oncological surgery. Report of six consecutive cases.Free microvascular flaps are an established method for soft tissue reconstruction following ablative oncological surgery in the head and neck. Functional reconstructions of the hypopharynx and the pharyngoesophageal segment (PES) are of particular relevance, as they are highly demanding surgical procedures. So far, the radial forearm free flap (RFFF) and the free jejunal transfer have been the transplants predominantly used for this purpose. The lateral upper arm free flap (LUFF) presents an alternative method for the fasciocutaneous tissue transfer. We report on our experience with the LUFF in a 56-year-old male patient with a pT3pN0M0 squamous cell carcinoma of the hypopharynx. A pharyngocutaneous fistula developed 5 days after pharyngolaryngectomy with bilateral neck dissection. The fistula was localized between the pharyngeal constrictor muscle and the esophagus and was closed with an LUFF from the left arm. Excellent flap adaptation to the remaining pharyngeal mucosa was observed. Although the length of the vascular pedicle and the diameter of the vessels in the LUFF are smaller than those in the RFFF, neither pedicle length nor vessel diameter proved to be a problem. The LUFF can be recommended as a well-vascularized, relatively safe and reliable flap for reconstruction of tubular structures such as the hypopharynx and the PES after tumor ablation and as an alternative to the RFFF. The flexibility of the LUFF allows surgeons to reconstruct the anatomy of the lost soft tissues as adequately as possible.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/11. Image-guided surgical drainage of medial parapharyngeal abscesses in children: a novel adjuvant to a difficult approach.Surgical drainage of localized infections in deep neck spaces in children is often completed without a high degree of technical difficulty. However, abscess drainage within the superior parapharyngeal space medial to the great vessels is particularly challenging for otolaryngologists. Drawbacks to both the intraoral and external approaches to this area have led us to develop a new adjunctive technique that utilizes intraoperative image-guided technology to augment the intraoral approach. Here we present a case series of 12 children in whom this technique was successfully used.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
3/11. Embolization of an extracranial internal carotid artery pseudoaneurysm.Deep neck space infections are rarely complicated by pseudoaneurysms of the extracranial internal carotid artery. This condition has a high mortality rate with conservative management and significant morbidity with open surgical techniques. Recent advances in endovascular therapy have allowed embolization of the diseased vessel to be performed with a more acceptable safety profile. We report a case of an extracranial internal carotid artery pseudoaneurysm complicating a deep neck space infection in an adolescent that was treated with selective endovascular embolization. We present the findings of computed tomography, magnetic resonance angiography, and conventional angiography.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
4/11. Traumatic retropharyngeal hematoma.The development of a retropharyngeal hematoma following a whiplash injury is a rare occurrence. The potential for airway compression necessitates rapid assessment and treatment. An 80-year-old man who had been receiving long-term aspirin therapy sustained a retropharyngeal hematoma following a motor vehicle accident. Management consisted of tracheostomy, neck exploration, and evacuation and drainage of the hematoma. To the best of our knowledge, there are less than 20 citations of traumatic retropharyngeal hematoma in the English literature. Retropharyngeal hematoma has been associated with cervical extension/flexion injuries, anticoagulation therapy, great-vessel trauma, and foreign body ingestion.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
5/11. Thorium-dioxide--induced pharyngeal hemorrhage.thorium dioxide, a producer of alpha particle radiation, was used in the united states from 1930 to 1950 for carotid and cerebral angiography. Cervical thorium dioxide granuloma is a well-recognized sequela of extravasation of this material near the carotid bifurcation. Radical neck dissection to remove the granuloma for aesthetic and functional reasons may lead to massive postoperative hemorrhage if a patent, but radiation-weakened, carotid artery is present. Additionally, hemorrhage may occur spontaneously because of pharyngeal necrosis or following infection of a pharyngeal biopsy site. The case described illustrates that life-threatening, thorium-dioxide--induced pharyngeal hemorrhage may occur even with an occluded carotid system. The bleeding site may go unrecognized, and laryngopharyngectomy with radical neck debridement may be required for hemostasis. Extension of an infection into the retroesophageal space and thoracic inlet requires exteriorization of the entire neck wound to prevent placing the great vessels of the superior mediastinum at risk for rupture. Spontaneous rupture of the aorta may occur due to thorium-dioxide--induced necrosis of its wall.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
6/11. Thorotrast induced pharyngeal necrosis.Thorotrast, a radioactive contrast material used between 1930 and 1950, is often permanently retained within the patient. Individuals who have had diagnostic studies with Thorotrast may develop serious complications many years later. These complications fall into two major categories, desmoplastic and neoplastic. The inadvertent infiltration of Thorotrast into soft tissue, usually the neck during carotid arteriography, may later result in severe fibrosis with constriction of the surrounding vessels and nerves. Malignancies, the second major problem, have occurred at the site of previous Thorotrast instillations throughout the body. The following report describes the clinical course of an 82-year-old woman who presented with a Thorotrast induced desmoplastic reaction of her neck, complicated by pharyngeal necrosis and the development of a pharyngeal cutaneous fistula. The latter problem is quite rare, having been previously reported only once. Despite extensive tissue destruction conservative management prevailed. Repetitive debridement, controlling the intermittent infections, maintaining her nutritional status, and relieving her pain allowed spontaneous healing to occur.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
7/11. Traumatic retropharyngeal hematoma: a case report.We describe a case of retropharyngeal hematoma after a cervical hyperextension injury in an elderly man. Progressive hoarseness, dysphagia, and dyspnea were the early signs that necessitated oral endotracheal intubation and, ultimately, tracheostomy. The hematoma was explored and drained through a lateral cervical approach, and a bleeding vessel in a small tear in the anterior spinous ligament was noted and cauterized. The patient recovered uneventfully.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
8/11. Thymopharyngeal duct cyst: MR imaging of a third branchial arch anomaly in a neonate.Third branchial arch anomalies are rare. The authors present a case report of a neonate with a rapidly growing neck mass due to cystic dilation of a persistent thymopharyngeal duct, which is a derivative of the third branchial arch. The presence of thyroid and thymic tissue in the cyst wall, the communication of the cyst with the piriform sinus, and the relationship of the cyst to carotid vessels and the sternomastoid muscle were consistent with the features of a thymopharyngeal duct cyst embedded in the thyroid gland.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
9/11. Clinically probable brainstem stroke presenting primarily as dysphagia and nonvisualized by MRI.Ten patients with clinically probable brainstem stroke presenting primarily as acute dysphagia but without visible brainstem abnormality by MRI are described. The patients were evaluated with neurologic examinations, cinepharyngoesophagography, and brain MRI studies. Each patient solely or predominately experienced sudden pharyngeal dysphagia, and additional symptoms or signs other than dysphonia or dysarthria were scarce. Small vessel disease or cardiac embolism were the apparent causes of what appear to have been very discrete brainstem strokes in these patients. Acute pharyngeal dysphagia can be the sole or primary manifestation of brainstem stroke. A negative MRI study should not preclude consideration of this diagnosis, if brainstem stroke is otherwise clinically probable.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
10/11. Free gastro-omental flap reconstruction of the complex, irradiated pharyngeal wound.BACKGROUND: Reconstruction of the complex pharyngeal wound after radiotherapy presents a surgical challenge. methods: Evaluation of the gastro-omental flap in the reconstruction of the pharynx and overlying soft tissue after local flap failure. RESULTS: A 70-year-old patient underwent a total laryngectomy and radical neck dissection after 70 Gy of external beam radiotherapy for an advanced squamous cell carcinoma of the pyriform sinus. Postoperatively, a large pharyngocutaneous fistula developed. Attempted closure with a pectoralis major flap was unsuccessful. A tubed gastro-omental free flap based on the right gastroepiploic vessels was used to reconstruct the pharynx. The accompanying greater omentum was skin grafted after filling the large soft tissue defect in the neck. The wounds healed primarily, and oral alimentation was resumed on the seventh postoperative day. CONCLUSIONS: The gastro-omental flap is a versatile composite flap which can provide mucosal lining as well as abundant soft tissue. It should be considered a secondary option in irradiated, complex pharyngeal wounds when local flaps are not available to be used in conjunction with free jujunal transfer.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
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