Immediate reconstruction following maxillolectomy
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250 Abstracts from nternational literature Immediate reconstruction following maxillolectomy Ye Bin-Fei, Shen Yan-Bei, Ma Guang- Sheng, Hu Qing-Gang, Zhang Yi-Zhou, Ghu Jia.Qi, Shi Xiao-Feng, Lu Ming- Zhou West China J Stomatol. 1990: 8:187-90 Reconstruction of the maxilla after tu- mor resection is presented in this paper, simultaneously using a temporal ramus osteomuscular flap (Fig. 1), the buccal fat pad, and an island palatal flap. The technique involves the use of the bone graft of the osteomuscular flap to recon- struct the missing bone after which the fat pad is draped around it. The palatal island flap is used to cover the oral side (Fig. 2). Ten patients were treated this way, 9 had a malignant tumor and one a benign tumor. The patients were fol- Fig. 1. Diagram of temporal-ramus osteo- muscular flap (A). p..- A Fig. 2. Diagram of the 3 flaps for reconstruc- tion of the defect. A: temporal-ramus osteo- muscular flap. B: buccal fat pad. C: island palatal flap. lowed for at least 6 months. The results were generally good in that 7 of 10 pa- tients had maintained facial symmetry with normal speech and without oro- nasal communication. In 3 patients the results were less adequate but still ac- ceptable. The authors conclude that this technique might be a useful adjunct in selected tumor patients. LO PEI-KuN Hierarchical immunosuppression of regional lymph nodes in patients with head and neck squamous cell carcinoma M. B. Wang, A. Lichtenstein, R. A. Mickel Otolaryngol Head Neck Surg 1991: 105: 517-27 Patients with head and neck squamous cell carcinomas (HNSCC) manifest de- fects in cell-mediated immune function. Previous studies in this laboratory have demonstrated regional alterations in the immunocompetence of draining lymph nodes (LN) in HNSCC patients. In this investigation, we studied functional ac- tivity of lymphocytes from lymph nodes in different locations in the radical neck dissections (RND) from patients undergoing operations for HNSCC. Lymphocytes from nodes close to the primary tumor ("near" lymph nodes or NLN) exhibited a significant decrease in interleukin-2 (IL-2) activated cyto- toxicity when compared to lymphocytes from distant nodes ("far" lymph nodes or FLN). In addition, co-culture experi- ments suggested the existence of a sol- uble regulatory factor, produced by lymph nodes, that inhibited the devel- opment of lymphokine-activated killer (LAK) cells in vitro. Further experi- ments with conditioned supernatants from the lymph node cells confirmed the presence of this soluble inhibitory factor. The inhibitory effect is signifi- cantly greater in NLN than in FLN. This hierarchical phenomenon suggests a regional network of immunosuppres- sion in HNSCC patients. It is likely that tumor- and lymph node-induced sup- pression plays a role in limiting the effi- cacy of current immunotherapy proto- cols in human beings. A greater under- standing of mechanisms of local inhibition of immune function will aid in improving adoptive immunotherapy for treatment of cancers in human beings. H. TIDEMAN The extended pectoralis major myocutaneous flap: uses and indications R. C. Russell, A. M. Feller, L. F. Elliott, J. O. Kucan, E. G. Zook Plast Reconstr Surg 1991: 88:814-23 The vascular territory of the pectoralis major muscle and overlying skin was studied by selective intraarterial dye in- jections in fresh cadavers. The area of skin overlying the anterior chest and abdominal wall beyond the limits of the pectoralis major muscle that can be el- evated as an extended myocutaneous flap was determined. The cadaver injec- tions were evaluated to determine the size and shape of the skin island used to reconstruct defects of the head, neck, and upper trunk with an extended skin paddle off the pectoralis major muscle. Pectoralis muscle flaps with variously shaped skin paddles, some extending be- yond the limits of the muscle, were used in 27 patients to cover large soft-tissue defects of the upper thorax, face, and floor of the mouth and as a skin tube to reconstruct the cervical esophagus. The size of the skin paddle ranged from 5x7 cm to 26x 16 cm. All flaps sur- vived completely, and there were no ma- jor donor complications. H. TIDEMAN
Transcript of Immediate reconstruction following maxillolectomy
250
Abstracts from nternational literature
Immediate reconstruction following maxillolectomy
Ye Bin-Fei, Shen Yan-Bei, Ma Guang- Sheng, Hu Qing-Gang, Zhang Yi-Zhou, Ghu Jia.Qi, Shi Xiao-Feng, Lu Ming- Zhou West China J Stomatol. 1990: 8:187-90
Reconstruction of the maxilla after tu- mor resection is presented in this paper, simultaneously using a temporal ramus osteomuscular flap (Fig. 1), the buccal fat pad, and an island palatal flap. The technique involves the use of the bone graft of the osteomuscular flap to recon- struct the missing bone after which the fat pad is draped around it. The palatal island flap is used to cover the oral side (Fig. 2). Ten patients were treated this way, 9 had a malignant tumor and one a benign tumor. The patients were fol-
Fig. 1. Diagram of temporal-ramus osteo- muscular flap (A).
p . . - A
Fig. 2. Diagram of the 3 flaps for reconstruc- tion of the defect. A: temporal-ramus osteo- muscular flap. B: buccal fat pad. C: island palatal flap.
lowed for at least 6 months. The results were generally good in that 7 of 10 pa- tients had maintained facial symmetry with normal speech and without oro- nasal communication. In 3 patients the results were less adequate but still ac- ceptable. The authors conclude that this technique might be a useful adjunct in selected tumor patients.
LO PEI-KuN
Hierarchical immunosuppression of regional lymph nodes in patients with head and neck squamous cell carcinoma
M. B. Wang, A. Lichtenstein, R. A. Mickel Otolaryngol Head Neck Surg 1991: 105: 517-27
Patients with head and neck squamous cell carcinomas (HNSCC) manifest de- fects in cell-mediated immune function. Previous studies in this laboratory have demonstrated regional alterations in the immunocompetence of draining lymph nodes (LN) in HNSCC patients. In this investigation, we studied functional ac- tivity of lymphocytes from lymph nodes in different locations in the radical neck dissections (RND) from patients undergoing operations for HNSCC. Lymphocytes from nodes close to the primary tumor ("near" lymph nodes or
N L N ) exhibited a significant decrease in interleukin-2 (IL-2) activated cyto- toxicity when compared to lymphocytes from distant nodes ("far" lymph nodes or FLN). In addition, co-culture experi- ments suggested the existence of a sol- uble regulatory factor, produced by lymph nodes, that inhibited the devel- opment of lymphokine-activated killer (LAK) cells in vitro. Further experi- ments with conditioned supernatants from the lymph node cells confirmed the presence of this soluble inhibitory factor. The inhibitory effect is signifi- cantly greater in N L N than in FLN. This hierarchical phenomenon suggests
a regional network of immunosuppres- sion in HNSCC patients. It is likely that tumor- and lymph node-induced sup- pression plays a role in limiting the effi- cacy of current immunotherapy proto- cols in human beings. A greater under- standing of mechanisms of local inhibition of immune function will aid in improving adoptive immunotherapy for treatment of cancers in human beings.
H. TIDEMAN
The extended pectoralis major myocutaneous flap: uses and indications
R. C. Russell, A. M. Feller, L. F. Elliott, J. O. Kucan, E. G. Zook Plast Reconstr Surg 1991: 88:814-23
The vascular territory of the pectoralis major muscle and overlying skin was studied by selective intraarterial dye in- jections in fresh cadavers. The area of skin overlying the anterior chest and abdominal wall beyond the limits of the pectoralis major muscle that can be el- evated as an extended myocutaneous flap was determined. The cadaver injec- tions were evaluated to determine the size and shape of the skin island used to reconstruct defects of the head, neck, and upper trunk with an extended skin paddle off the pectoralis major muscle. Pectoralis muscle flaps with variously shaped skin paddles, some extending be- yond the limits of the muscle, were used in 27 patients to cover large soft-tissue defects of the upper thorax, face, and floor of the mouth and as a skin tube to reconstruct the cervical esophagus. The size of the skin paddle ranged from 5 x 7 cm to 26x 16 cm. All flaps sur- vived completely, and there were no ma- jor donor complications.
H. TIDEMAN
