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O112. Morbidity in selective neck dissection – A randomized control trial
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Abstracts / Oral Oncology 47 (2011) S28–S73
10 years were 8.9%. The rates of delayed neck metastasis at 5 and 10 years were 10.9%. The number of patients with recurrence will probably continue to increase in the future because of improved long-term survival rates due to advances in cancer therapy and a longer life expectancy. In addition, some patients with oral squamous cell carcinoma will develop recurrence and/or delayed neck metastasis much later than 5 years after initial treatment, which indicates a need for extended follow-up.
doi:10.1016/j.oraloncology.2011.06.221
Surgery O111. Free lateral arm flap: A versatile technique for reconstruction of different body districts F. Lembo *, L. Annacontini, D. Parisi, A. Portincasa Plastic and Reconstructive Surgery Department, Faculty of Medicine, ‘‘Ospedali Riuniti’’, University of Foggia, Italy Introduction: The lateral arm flap is a septo-fasciocutaneous flap from the radial collateral vessels. It can be a sensate flap including the posterior cutaneous nerve. We used this flap both for hand and head–neck reconstruction following traumatic and oncological demolition. Patients and methods: From January 2000 to December 2009, 28 patients observed. Nine post-traumatic cases, 19 oncological cases. Eighteen male, 10 female, mean age 64, range 21–72. In head and neck: 16 t-t suture to facial artery and vein, 2 t-t to temporal artery and vein, 2 t-t to thyroid superior artery and, with a t-l suture, jugular vein; in the hand: 8 t-t suture with radial artery and cephalic vein. Five innervated flaps performed. Mean defect dimension: 5 10 cm. All donor areas were directly closed but in one case we used skin graft. Intraoperative irrigation with heparin was used in all cases. Short term prophylaxis always used. Mean follow up 4 years. All cases were successful. Results: Advantages are: main vessels of the upper limb remain untouched, texture similar to that of reconstructed districts, thickness, pliability, hairless and the possibility to be sensate, chance to cover all defects both with good functional and aesthetical results. Disadvantages are: relatively short pedicle, limited flap dimension ipoanaesthesia of the postero-medial face of the arm. Conclusions: The lateral arm flap, in our hands, is a versatile flap reliable both in posttraumatic and oncological cases and in selected patients. An accurate preoperative plan is mandatory. Both functional and aesthetical results are satisfactory. doi:10.1016/j.oraloncology.2011.06.222
O112. Morbidity in selective neck dissection – A randomized control trial N.A. George *, P.G. Balagopal, P. Sebastian Regional Cancer Centre, Trivandrum, India Introduction: Selective neck dissection is done in stages I and II squamous cell carcinoma of tongue as it has less morbidity compared to comprehensive neck dissection. Even selective neck dissection has its associated morbidity due to accessory nerve neu-
ropraxia as a result of dissection around the accessory nerve to clear the level 2B group of lymph nodes. The aim of the study was to compare the accessory nerve dysfunction in patients who underwent extended supraomohyoid neck dissection with or without level 2B dissection. Methods: Sixty patients with stage I and stage II oral tongue cancers were selected, they were randomized into two groups: patients in the study group had removal of neck nodes from levels 1 to 4 avoiding level 2B group of neck nodes. Patients in the control group had an extended supraomohyoid neck dissection. At 3 weeks and at 9 months postoperatively the function of the accessory nerve is evaluated clinically and by EMG. Results: On final histopathological examination 9 patients had positive neck nodes. 5n9 (55%) patients had metastasis in level 1B alone. 2n9 (22%) patients had metastasis in level 2A alone. Two patients had metastasis in multiple levels, 1B and 2A levels in one patient and 2A and 3 levels in the other. None of the 30 patients in the control group had level 2B positivity. 6n30 (20%) patients in the control group and 4n30 (13%) in the study group had accessory nerve dysfunction on first post operative EMG. 3n30 (10%) patients of the control group had EMG changes even at 9 months; all the patients in the study group had a normal EMG at the end of 9 months. Conclusion: 1. In stages I and II oral tongue cancers level 2B nodal involvement is rare. 2. Permanent accessory nerve damage can be avoided by avoiding level 2B dissections.
doi:10.1016/j.oraloncology.2011.06.223
O113. Effect of absorbable sealing materials and fibrin glue to wound on partial glossectomy M. Iwata *, S. Hidaka, K. Shirakami Kishiwada Tkushukai Hospital, Japan Polyglycolic acid (PGA) felt is a bioabsorbable suture reinforcement consisting of polyglycolide, and nonwoven fabric with some elasticity by the special manufacturing process. There are many methods to cover wound on partial glossectomy, for example, suture only and covering by other materials. But we experienced they were difficult to cover the wound for a given period of time or we were difficult to check the patients after surgery. We report this method of partial glossectomy for the patients with tongue cancer. This method is using PGA felt and fibrin glue. The subjects were 15 patients, ranged in age from 38 to 87 years old with tongue cancer. In all cases we treated by partial glossectomy and covered wounds by new method. As a result of this method, this study indicated this method were very useful after partial glossectomy. We covered the wounds of operation region for a long time. And we avoided the indurations after operation and we were easy to check the progress of patients. doi:10.1016/j.oraloncology.2011.06.224
Abstracts / Oral Oncology 47 (2011) S28–S73
10 years were 8.9%. The rates of delayed neck metastasis at 5 and 10 years were 10.9%. The number of patients with recurrence will probably continue to increase in the future because of improved long-term survival rates due to advances in cancer therapy and a longer life expectancy. In addition, some patients with oral squamous cell carcinoma will develop recurrence and/or delayed neck metastasis much later than 5 years after initial treatment, which indicates a need for extended follow-up.
doi:10.1016/j.oraloncology.2011.06.221
Surgery O111. Free lateral arm flap: A versatile technique for reconstruction of different body districts F. Lembo *, L. Annacontini, D. Parisi, A. Portincasa Plastic and Reconstructive Surgery Department, Faculty of Medicine, ‘‘Ospedali Riuniti’’, University of Foggia, Italy Introduction: The lateral arm flap is a septo-fasciocutaneous flap from the radial collateral vessels. It can be a sensate flap including the posterior cutaneous nerve. We used this flap both for hand and head–neck reconstruction following traumatic and oncological demolition. Patients and methods: From January 2000 to December 2009, 28 patients observed. Nine post-traumatic cases, 19 oncological cases. Eighteen male, 10 female, mean age 64, range 21–72. In head and neck: 16 t-t suture to facial artery and vein, 2 t-t to temporal artery and vein, 2 t-t to thyroid superior artery and, with a t-l suture, jugular vein; in the hand: 8 t-t suture with radial artery and cephalic vein. Five innervated flaps performed. Mean defect dimension: 5 10 cm. All donor areas were directly closed but in one case we used skin graft. Intraoperative irrigation with heparin was used in all cases. Short term prophylaxis always used. Mean follow up 4 years. All cases were successful. Results: Advantages are: main vessels of the upper limb remain untouched, texture similar to that of reconstructed districts, thickness, pliability, hairless and the possibility to be sensate, chance to cover all defects both with good functional and aesthetical results. Disadvantages are: relatively short pedicle, limited flap dimension ipoanaesthesia of the postero-medial face of the arm. Conclusions: The lateral arm flap, in our hands, is a versatile flap reliable both in posttraumatic and oncological cases and in selected patients. An accurate preoperative plan is mandatory. Both functional and aesthetical results are satisfactory. doi:10.1016/j.oraloncology.2011.06.222
O112. Morbidity in selective neck dissection – A randomized control trial N.A. George *, P.G. Balagopal, P. Sebastian Regional Cancer Centre, Trivandrum, India Introduction: Selective neck dissection is done in stages I and II squamous cell carcinoma of tongue as it has less morbidity compared to comprehensive neck dissection. Even selective neck dissection has its associated morbidity due to accessory nerve neu-
ropraxia as a result of dissection around the accessory nerve to clear the level 2B group of lymph nodes. The aim of the study was to compare the accessory nerve dysfunction in patients who underwent extended supraomohyoid neck dissection with or without level 2B dissection. Methods: Sixty patients with stage I and stage II oral tongue cancers were selected, they were randomized into two groups: patients in the study group had removal of neck nodes from levels 1 to 4 avoiding level 2B group of neck nodes. Patients in the control group had an extended supraomohyoid neck dissection. At 3 weeks and at 9 months postoperatively the function of the accessory nerve is evaluated clinically and by EMG. Results: On final histopathological examination 9 patients had positive neck nodes. 5n9 (55%) patients had metastasis in level 1B alone. 2n9 (22%) patients had metastasis in level 2A alone. Two patients had metastasis in multiple levels, 1B and 2A levels in one patient and 2A and 3 levels in the other. None of the 30 patients in the control group had level 2B positivity. 6n30 (20%) patients in the control group and 4n30 (13%) in the study group had accessory nerve dysfunction on first post operative EMG. 3n30 (10%) patients of the control group had EMG changes even at 9 months; all the patients in the study group had a normal EMG at the end of 9 months. Conclusion: 1. In stages I and II oral tongue cancers level 2B nodal involvement is rare. 2. Permanent accessory nerve damage can be avoided by avoiding level 2B dissections.
doi:10.1016/j.oraloncology.2011.06.223
O113. Effect of absorbable sealing materials and fibrin glue to wound on partial glossectomy M. Iwata *, S. Hidaka, K. Shirakami Kishiwada Tkushukai Hospital, Japan Polyglycolic acid (PGA) felt is a bioabsorbable suture reinforcement consisting of polyglycolide, and nonwoven fabric with some elasticity by the special manufacturing process. There are many methods to cover wound on partial glossectomy, for example, suture only and covering by other materials. But we experienced they were difficult to cover the wound for a given period of time or we were difficult to check the patients after surgery. We report this method of partial glossectomy for the patients with tongue cancer. This method is using PGA felt and fibrin glue. The subjects were 15 patients, ranged in age from 38 to 87 years old with tongue cancer. In all cases we treated by partial glossectomy and covered wounds by new method. As a result of this method, this study indicated this method were very useful after partial glossectomy. We covered the wounds of operation region for a long time. And we avoided the indurations after operation and we were easy to check the progress of patients. doi:10.1016/j.oraloncology.2011.06.224