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There has been little reported on the transoral reconstructive options following salvage transoral robotic surgery. This paper describes the facial artery musculomucosal flap as a method to introduce vascularised tissue to a previously irradiated resection bed.
A facial artery musculomucosal flap was used to reconstruct the lateral pharyngeal wall in 13 patients undergoing salvage transoral robotic surgery for oropharyngeal squamous cell carcinoma. Outcomes recorded include flap and donor site complications, length of stay, and swallowing and speech outcomes.
There were no immediate or late flap complications, or cases of delayed wound healing in this series. There were two facial artery musculomucosal related complications requiring surgical management: one bleed from the facial artery musculomucosal donor site and one minor surgical revision. Healing of the flap onto the resection bed was successful in all cases.
The facial artery musculomucosal flap provides a suitable transoral local flap option for selected patients undergoing salvage transoral robotic surgery for oropharyngeal malignancies.
The presentation of vocal fold palsy with associated goitre has historically been considered to be due to malignancy with recurrent laryngeal nerve involvement.
In total, 830 consecutive patients who underwent thyroid surgery were reviewed. Patients with vocal fold paralysis and thyroid disease were examined to determine the aetiology of the paralysis.
Nine patients were identified with new onset vocal fold paralysis prior to thyroid surgery. Six of the patients with recurrent laryngeal nerve paralysis had benign thyroid disease, and for three of the patients the paralysis was secondary to malignancy.
Recurrent laryngeal nerve paralysis in the presence of thyroid disease is not pathognomonic for malignancy. The current literature may underestimate the association between vocal fold paralysis and benign thyroid disease. The paper also highlights the importance of recurrent laryngeal nerve preservation in patients who present with palsy and thyroid disease; the relief of benign compression often leads to complete recovery of recurrent laryngeal nerve paralysis.
We report the case of a rare angiosarcoma, retiform haemangioendothelioma, in an 18-year-old young man, which presented as a recurrent ulcerating lesion of the left pinna.
Case report and literature review of retiform haemangioendothelioma. This is a low grade angiosarcoma with a high local recurrence rate and low metastasis rate, and was first described in 1994 by Calonje et al.
This patient represents only the third report of lymph node metastasis in a case of retiform haemangioendothelioma. To date, 31 cases of the tumour have been reported. Histological diagnosis of this group of vascular neoplasms can be challenging, as their histopathological appearance is intermediate between haemangioma and angiosarcoma.
Surgical excision remains the primary treatment modality, with adjuvant radiotherapy recommended in patients with large tumour size, local recurrence and lymph node metastasis, as seen in this case.
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