After hemiglossectomy due to tongue cancer, such factors as mobility, sensation, volume and the shape of the tongue are critical elements for successful rehabilitation. As long as there is a residual segment of mobile tongue with an intact motor nerve supply, the mobility of native tongue can be preserved by using tissue with thin, pliable and sensory potential. The residual tongue motion can be maximized by separating the reconstruction of mobile tongue from the reconstruction of the floor of mouth. Six patients who underwent significant glossectomy for squamous cell cancer were reconstructed with a bilobed design of sensate radial forearm flap. One lobe of the flap is used to restore the shape and volume of the tongue, while the other lobe is used to resurface the floor of the mouth. There were no flap failure and fistula formation. In all patients, the tongue mobility was preserved and the earliest recovery of sensation was noted 5 weeks following the surgery. The articulation was good enough for them to perform daily activities. With the bilobed design, we can maximize the mobility of the residual tongue by preventing tethering of the root of tongue to the inner table of the mandible. In this article e present our successful experiences with this method, especially in view of mobility and sensation.
Fistula ; Forearm* ; Free Tissue Flaps* ; Glossectomy ; Humans ; Mandible ; Mouth ; Mouth Floor ; Neoplasms, Squamous Cell ; Rehabilitation ; Sensation ; Tongue ; Tongue Neoplasms

Pulmonary embolism is a common medical complication following major orthopedic procedures of the lower extremities and a leading cause of morbidity and mortality. However, the clinical manifestations of pulmonary embolism are nonspecific and it may be difficult to diagnose. An 82 years old female with severe restrictive pulmonary disease received the elective operation for the fracture of left femur neck under combined spinal-epidural anesthesia. During the operation, we sometimes gave her oxygen via face mask and maintained oxygen saturation of more than 80% which was measured by a pulse oxymeter. The operation and anesthesia was performed uneventfully. On the seventh postoperative day, she showed tachycardia suddenly and cardiac arrest later on the electrocardiogram. After cardiopulmonary resuscitation, she was transferred to intensive care unit and checked by a computed tomography and echocardiography. She was diagnosed with pulmonary embolism and deep vein thrombosis and treated with heparin and urokinase. But she did not improve and died.
Aged, 80 and over ; Anesthesia ; Cardiopulmonary Resuscitation ; Echocardiography ; Electrocardiography ; Female ; Femur Neck ; Heart Arrest ; Heparin ; Humans ; Intensive Care Units ; Lower Extremity ; Lung Diseases ; Masks ; Mortality ; Orthopedic Procedures ; Oxygen ; Patients' Rooms* ; Pulmonary Embolism* ; Tachycardia ; Urokinase-Type Plasminogen Activator ; Venous Thrombosis

Ovarian pregnancy is rare form of ectopic pregnancy occurring in 0.5-1% of all ectopic pregnancies. But the presenting symptom is very similar and difficult to distinguish with other forms of ectopic pregnancy. We report a case of ovarian pregnancy mimicking cornual pregnancy managed with laparoscopy. Early detection is important role in preserving fertility to avoid the ablation of functional ovarian tissue. The diagnostic criteria, etiology, and management are discussed.
Adenomyosis* ; Female ; Fertility ; Laparoscopy* ; Pregnancy ; Pregnancy* ; Pregnancy, Ectopic*

OBJECTIVE: To ascertain whether fetal growth restriction with or without preeclampsia is associated with alteration of leptin concentration in maternal and umbilical cord serum. METHODS: Maternal serum and umbilical cord blood leptin concentrations were determined by ELISA assay in 25 women with singletone pregnancies complicated by fetal growth restriction without preeclampsia (IUGR), in 11 women with singletone pregnancies complicated by fetal growth restriction with preeclampsia (IUGR+PE), in 9 women with singletone pregnancies complicated by preeclampsia without fetal growth restriction (PE), and in 13 women with uncomplicated singletone pregnancies (Control). RESULTS: Maternal weight and BMI before pregnancy and in delivery were significantly different among groups. The lowest weight and BMI before pregnancy and in delivery was group IUGR. Neonatal birth weight was significantly different among groups. The lowest birth weight was group IUGR+PE. Maternal serum leptin concentration and umbilical cord leptin concentration were not significantly different among groups. Maternal serum leptin levels were not significantly correlated with maternal BMI or with neonatal birth weight. Umbilical cord blood leptin levels were significantly correlated with neonatal birth weight. CONCLUSION: Maternal serum leptin concentration and umbilical cord blood leptin levels were independent of presence of preeclampsia and/or IUGR. Umbilical cord blood leptin reflects neonatal birth weight.
Birth Weight ; Enzyme-Linked Immunosorbent Assay ; Female ; Fetal Blood* ; Fetal Development* ; Fetal Growth Retardation ; Humans ; Leptin ; Pre-Eclampsia* ; Pregnancy ; Umbilical Cord*

BACKGROUND: The alkaline single cell gel electrophoresis comet assay was applied to study the genotoxic properties of enflurane on the human peripheral blood lymphocytes (PBL) of cancer patients before and during anesthesia as compared to an non-cancer control group. Method: The cancer group consisted of 24 patients (aged 15-77 years), while the control group consisted of 14 trauma individuals (aged 20-81 years). After anesthesia induction (thiopental 4 mg/kg and vecuronium 0.1 mg/kg), it was maintained by enflurane inhalation; 1-2 minimal alveolar concentration in oxygen - nitrous oxide mixture. Venous blood samples were obtained before the induction of anesthesia, and after 60 and 120 min of anesthesia. The comet assay detects DNA damage, such as strand breaks and alkaline labile sites induced directly by genotoxic agents, and DNA degradation due to cell death. Fifty cells from each sample were examined and Olive tail moments (OTM) were calculated using Komet 4TM software. RESULTS: OTM values were no different between controls and patients before anesthesia. However, the OTMs of blood sampled from cancer patients at 60 (7.97 +/- 1.83) and 120 min (7.86 +/- 2.05), and from trauma patients at 120 min (8.04 +/- 1.32) of anesthesia were significantly increased. CONCLUSIONS: In immunocompromised cancer patients, we suggest the existence of a higher risk of an association DNA damage and enflurane exposure.
Anesthesia ; Cell Death ; Comet Assay ; DNA ; DNA Damage ; Electrophoresis* ; Enflurane* ; Humans* ; Inhalation ; Lymphocytes* ; Nitrous Oxide ; Olea ; Oxygen ; Vecuronium Bromide

Robotic surgery facilitates surgical procedures by employing flexible arms with multiple degrees of freedom and providing high-quality 3-dimensional imaging. Robot-assisted nipplesparing mastectomy with immediate reconstruction is currently performed to avoid breast scars. Four patients with invasive ductal carcinoma underwent robot-assisted nipple-sparing mastectomy and immediate robot-assisted expander insertion. Through a 6-cm incision along the anterior axillary line, sentinel lymph node biopsy and nipple-sparing mastectomy were performed by oncologic surgeons. The pectoralis major muscle was elevated, an acellular dermal matrix (ADM) sling was created with robotic assistance, and an expander was inserted into the subpectoral, sub-ADM pocket. No patients had major complications such as hematoma, seroma, infection, capsular contracture, or nipple-areolar necrosis. The mean operation time for expander insertion was 1 hour and 20 minutes, and it became shorter with more experience. The first patient completed 2-stage prosthetic reconstruction and was highly satisfied with the unnoticeable scar and symmetric reconstruction. We describe several cases of immediate robot-assisted prosthetic breast reconstruction. This procedure is a feasible surgical option for patients who want to conceal surgical scars.
Acellular Dermis ; Arm ; Breast Implants ; Breast ; Carcinoma, Ductal ; Cicatrix ; Contracture ; Female ; Freedom ; Hematoma ; Humans ; Mammaplasty ; Mastectomy ; Necrosis ; Robotic Surgical Procedures ; Sentinel Lymph Node Biopsy ; Seroma ; Surgeons ; Tissue Expansion Devices

Purpose: Robotic head and neck surgery is widespread nowadays. However, in the reconstruction field, the use of robotic operations is not. This article aimed to examine methodologies for conventional head and neck reconstruction after robotic tumor surgery in an effort to obtain further options for future reconstruction manipulations. Materials and Methods: A retrospective review of all patients who received head and neck robot surgery and conventional reconstructive surgery between October 2016 and September 2021. Results: In total, 53 cases were performed. 67.9% of the tumors were greater than 4 cm. Regarding defect size, 47.2% of the lesions were greater than 8 cm. In terms of TNM stage, stage 3 disease was recorded in 26.4% and stage 4 in 52.8%. To make a deep and narrow field wider, we changed the patient’s posture in pre-op field, additional dissection was done. We used radial forearm flap mostly (62.2%). Conclusion Conventional head and neck reconstruction after robotic ENT cancer surgery is possible. One key step is to secure additional space in the deep and narrow space left after robotic surgery. For this, we opted for a radial forearm flap mostly. This can be performed as a bridgehead to perform robotic head and neck reconstruction.

BACKGROUND: Reconstruction of oropharyngeal defects after resection of oropharyngeal cancer is a significant challenge. The purpose of this study is to introduce reconstruction using a combination of a buccinator myomucosal flap and a buccal fat pad flap after cancer excision and to discuss the associated anatomy, surgical procedure, and clinical applications. METHODS: In our study, a combination of a buccinator myomucosal flap with a buccal fat pad flap was utilized for reconstruction after resection of oropharyngeal cancer, performed between 2013 and 2015. After oropharyngectomy, the defect with exposed vital structures was noted. A buccinator myomucosal flap was designed and elevated after an assessment of the flap pedicle. Without requiring an additional procedure, a buccal fat pad flap was easily harvested in the same field and gently pulled to obtain sufficient volume. The flaps were rotated and covered the defect. In addition, using cadaver dissections, we investigated the feasibility of transposing the flaps into the lateral oropharyngeal defect. RESULTS: The reconstruction was performed in patients with squamous cell carcinoma. The largest tumor size was 5 cm x 2 cm (length x width). All donor sites were closed primarily. The flaps were completely epithelialized after four weeks, and the patients were followed up for at least six months. There were no flap failures or postoperative wound complications. All patients were without dietary restrictions, and no patient had problems related to mouth opening, swallowing, or speech. CONCLUSIONS: A buccinator myomucosal flap with a buccal fat pad flap is a reliable and valuable option in the reconstruction of oropharyngeal defects after cancer resection for maintaining functionality.
Adipose Tissue* ; Cadaver ; Carcinoma, Squamous Cell ; Deglutition ; Humans ; Mouth ; Oropharyngeal Neoplasms ; Reconstructive Surgical Procedures ; Surgical Flaps ; Tissue Donors ; Wounds and Injuries

BACKGROUND: Although previous studies have focused on determining prognostic and causative variables associated with fistula-related complications after head and neck reconstructive surgery, only a few studies have addressed preventive measures. Noting that pooled saliva complicates wound healing and precipitates fistula-related complications, we devised a continuous suction system to remove saliva during early postoperative recovery. METHODS: A continuous suction system was implemented in 20 patients after head and neck reconstructive surgery between January 2012 and October 2017. This group was compared to a control group of 16 patients at the same institution. The system was placed orally when the lesion was on the anterior side of the retromolar trigone area, and when glossectomy or resection of the mouth floor was performed. When the orohypopharynx and/or larynx were eradicated, the irrigation system was placed in the pharyngeal area. RESULTS: The mean follow-up period was 9.2±2.4 months. The Hemovac system was applied for an average of 7.5 days. On average, 6.5 days were needed for the net drain output to fall below 10 mL. Complications were analyzed according to their causes and rates. A fistula occurred in two cases in the suction group. Compared to the control group, a significant difference was noted in the surgical site infection rate (P < 0.031). CONCLUSIONS: Clinical observations showed reduced saliva pooling and a reduction in the infection rate. This resulted in improved wound healing through the application of a continuous suction system.
Fistula ; Follow-Up Studies ; Glossectomy ; Head* ; Humans ; Larynx ; Mouth Floor ; Neck* ; Saliva ; Suction* ; Surgical Wound Infection ; Wound Healing