Clinical teaching way in pediatrics has been investigated,and its current state understood to provide the direction of clinical teaching in pediatrics.

Ear ; surgery ; Humans ; Parotid Neoplasms ; surgery ; Surgical Procedures, Operative ; methods

Objective To analyze our clinical results of head and neck reconstruction using microsur- gical free flap transfer techniques.Methods The free flap donor sites with long vascular pedicle and large diameter of vessel were routinely chosed,and chose receipt vessels with large diameter and proper position, and perform vessel ananstomosis under surgical loups instead of microscope.The un-buried free flap with a mo- nitoring window were harvest,and do double venous anastomoses in some flaps to ensure adequate venous out- flow.Results From May 1999 to March 2005,1066 consecutive free flap transfers were used to reconstruct head and neck defects.The overall success rate of free flap was 98.3%.The vessel thrombosis rate was 3.1%,and the flap salvage rate was 45.5%.Conclusion Head and neck reconstruetion using microsurgi- cal free flap transfer technique is safe and reliable,and good clinical results can be obtained.

Objective To investigate the clinical feature,treatment,and prognosis of hospitalized patients with jaw osteoradionecrosis. Methods A total of 93 cases with jaw osteoradionecrosis treated between 2000 and 2010 was reviewed.Of the 93 cases,79 cases were with mandible lesions,13 cases with maxillary lesions,and 1 case with both mandible and maxillary lesions.Sixty-six cases received one course of radiotherapy,with the radiation doses of 34 -90 Gy (mean 64.6 Gy).Twenty-two cases experienced tooth extraction or other operative procedures before exhibition of the clinical symptoms for osteoradionecrosis.The interval time between radiotherapy and the onset of osteoradioneerosis varied from 2 weeks to 32 years (mean 54 months).Results Of 93 cases,56 patients underwent radical resection of the pathologic bone and reconstruction with free tissue flaps,in whom 7 cases received the second surgery due to microvascular thrombosis in flap vessels,and flaps were survival by new vascular anastomosis in 3 cases,the failed flaps were removed and replaced successfully by non vascularized bone grafts in 2 cases,and the failed flaps removed and the defects were repaired with adjacent skin in other 2 cases.In the 56 cases,only one case was with disease recurrence and 53 cases with significant improvement in chewing and swallowing functions.Only 2 of 93 cases underwent resection of the pathologic bone and reconstruction with titanium plates,and thereafter they encountered titanium exposure.Scaling of osteoradionecrosis lesions was applied to 20 of 93 patients and 9 cases of them were with disease recurrence.Fifteen cases had resection of the effected mandible without reconstruction.Disease relapse was encountered in 2 of them,others had poor chewing and swallowing.Conclusions The mandible is more susceptible to osteoradionecrosis than maxilla.Radical resection with reconstruction by free tissue flap is recommended for the treatment of jaw osteoradionecrosis,and scaling and reconstruction only with titanium plate should be avoided because of high risks of titanium exposure and disease relapse.

OBJECTIVETo compare the impact of various types of neck dissection on postoperative shoulder function.

METHODSThe shoulder functions of 66 patients with oral squamous cell carcinoma (OSCC) and cN0 necks who underwent various types of neck dissection were evaluated by Constant's shoulder function test and neck dissection impairment index at least 12 months after surgery.

RESULTSThe patients with accessory spinal nerve reserved had better shoulder function than those with accessory spinal nerve resected. In the group with accessory spinal nerve reserved, the patients receiving selective neck dissection (SND) showed better shoulder function than those with modified radical neck dissection (MRND). The shoulder dysfunction and pain arising from SND were minor in patients with selective neck dissection.

CONCLUSIONSThe shoulder function after SND was superior to those after RND and MRND.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; pathology ; physiopathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Mouth Neoplasms ; pathology ; physiopathology ; surgery ; Neck Dissection ; methods ; Shoulder ; physiopathology

OBJECTIVETo analyze the reliability and feasibility of free flap transfer for head and neck reconstruction in the paediatric patients.

METHODSThirty consecutive free flap transfer performed in 28 patients younger than 15 years-old were reviewed. Data concerning the operation included date of surgery, defect description and site, stage and histology of tumor, flap type, recipient vessel and complications.

RESULTSThe average age of patients was 12.3 years-old, with age ranged from 5 to 15. There were 19 males and 9 females. Four kinds of free flap were used. The free fibula flap was most commonly used, followed by free radial forearm flap, rectus abdominis myocutaneous flap, and free scapular flap. The overall success rate of the flaps was 93.3%. The overall complication rate was 36.7%. The vessel thrombosis rate was 6.7%.

CONCLUSIONFree flap transfer in the paediatric patients for head and neck reconstruction is safe and reliable. There is no difference between the normal patients and paediatric patients in the success rate and complication rate.

Adolescent ; Child ; Child, Preschool ; Female ; Free Tissue Flaps ; Head and Neck Neoplasms ; surgery ; Humans ; Male ; Reconstructive Surgical Procedures

OBJECTIVETo assess the effectiveness and reliability of free flap transfer for treating the advanced osteoradionecrosis (ORN) of mandible.

METHODSEleven cases of free flap transfer for treating the advanced ORN of mandible from October 1999 to February 2003 were reviewed. Data concerning the operation included site, stage and histology of primary tumor, dosage of radiotherapy, defect description, design of free flap, recipient vessel, free flap survival and complications.

RESULTSThere were 8 males and 3 females, with age ranged 29-65 years old. Fifteen free flaps were used for reconstructing the defects, 12 were fibula flap, 2 were rectus abdominis myocutaneous flap, and 1 was radial forearm flap. All the free flaps survived completely without partial or total necrosis. The complication rate was 36.4%. All patients had complete resolution of ORN symptoms. No evidence of ORN recurrence was observed in any patient.

CONCLUSIONFree flap transfer provides a reliable and effective means for treating the advanced ORN of mandible. Free fibula flap is the workhorse flap for reconstruction of mandible.

Adult ; Aged ; Female ; Free Tissue Flaps ; Humans ; Male ; Mandible ; pathology ; Middle Aged ; Osteoradionecrosis ; surgery ; Reconstructive Surgical Procedures

OBJECTIVESThe value of supraomohyoid neck dissection used in treating oral squamous cell carcinoma was discussed.

METHODSTwenty-seven cN0 patients with oral squamous cell carcinoma were entered into the study. Supraomohyoid neck dissection was performed to remove the lymphatic tissue of level I, II, and III. The operation duration and shoulder function were recorded.

RESULTSThe average operation duration was (1.6 +/- 0.2) h. Nineteen percent (5/27) of the cN0 neck were proved positive pathologically which included two cases in level I and four in level II (one case had both level I and II metastases). Shoulder function recovered in three months after operation. All patients were followed up from two years to four years and none of them had local or neck recurrence.

CONCLUSIONSSupraomohyoid neck dissection is a right choice for cN0 patients with oral squamous cell carcinoma with its advantages in both curing neck lymphatic metastases and preserving neck and shoulder contours and functions.

Adult ; Aged ; Carcinoma, Squamous Cell ; pathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Mouth Neoplasms ; pathology ; surgery ; Neck Dissection ; methods ; Neoplasm Staging

OBJECTIVETo evaluate the reliability and effectiveness of free flap transfer with double vein anastomosis for reconstruction of head and neck defects.

METHODSOne hundred and sixty-eight cases of free flap transfers with double vein anastomosis for head and neck reconstruction from September 1999 to April 2003 were reviewed. There were 92 males and 76 females. The age range was 11 to 79 years old, with the average of 44.6 years old. Data concerning the operation included site, stage and histology of tumor, defect description, design of free flap, recipient vessel free flap survival and complications.

RESULTSAmong 168 free flaps, there were 126 free fibula flaps, 32 radial forearm flaps, 7 rectus abdominis flaps, one scapular flap, one jejunal flap, and one anterolateral thigh flap. The overall success rate of free flap was 99.4%. One fibula flap was lost because of arterial thrombosis. No venous thrombosis occurred in this group.

CONCLUSIONFree flap transfer with double vein anantomosis for head and neck reconstruction improves the outflow of free flap, reduces the venous thrombosis rate, and ensures a high success rate of free flaps.

Adult ; Aged ; Female ; Free Tissue Flaps ; Head ; Head and Neck Neoplasms ; Humans ; Male ; Middle Aged ; Neck ; Reconstructive Surgical Procedures ; Reproducibility of Results ; Surgical Flaps

OBJECTIVETo evaluate speech outcomes in patients of maxillary reconstruction with free fibula composite flap.

METHODSSpeech measurements of 20 patients of maxillary reconstruction with free fibula composite flap were collected. Palatopharyngeal valve, the symmetry and movement of soft palate, hypernasality and nasal emission were examined by nasoendoscopy. At the same time the speech intelligibility was measured.

RESULTSNo palatopharyngeal valve insufficiency was found and all the soft palates had good symmetry and movement. The average speech intelligibility was 98.4%.

CONCLUSIONSFree fibula composite flap can reconstruct the phonatory structure and support the function of soft palate, which can restorate speech function well. It is a good choice for maxillary reconstruction.

Adult ; Female ; Fibula ; Humans ; Male ; Maxilla ; surgery ; Middle Aged ; Speech Intelligibility ; Surgical Flaps