Aruna Devi, B (2013) Reconstruction in head and neck malignancies: Evaluation of various treatment options. Masters thesis, Madurai Medical College, Madurai.
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Abstract
INTRODUCTION: The intricate anatomy of head and neck region provides challenge to reconstructive surgeon to restore form and function after cancer management. The aesthetic aspect of face has to be considered in reconstructive options. Surgery is the oldest treatment for cancer. Although various other modalities of treatment are available, surgery is the best modality in the cure of cancer. Also surgery helps in immediate reconstruction and rehabilitation of cancer patients. Both function and form have to be improved after reconstruction with minimal donor site morbidity. Reconstruction can be immediate or delayed. Immediate reconstruction is necessary for coverage of vital structures. Also it is easy to perform in soft pliable tissue. Delayed reconstruction is performed in scarred, often irradiated bed and also the tissue requirement is increased. So delayed reconstruction is considered only in cases of doubtful clearance of tumor, infection in cases of tumor necrosis, inability of patient’s condition for lengthy procedure. After determining the tissue defect, the reconstructive options are considered. The reconstructive ladder has to be considered for reconstruction. But in complex defect of head and neck reconstruction, for optimal function, following the reconstructive escalator, free flap can be used. The other options like tissue expander and vacuum assisted closure can be considered where-ever possible. But for best form and function, multiple stages may be required in head and neck reconstruction. In head and neck reconstruction losses have to be replaced in kind. In oral cavity lining, cover, support has to be considered for mucosa, skin and bone loss. Likewise in nose lining, cover, support has to be considered for mucosa, skin and cartilage loss. AIM OF THE STUDY: In head and neck reconstruction, multiple stages are needed to restore form, function and aesthetics. The aim of the study is to consider • The causative factors in head and neck malignancy. • Age and sex incidence of various malignancies in the head and neck region. • Tumor types in various sub sites of head and neck region, stage of tumor and management of tumor. • Tissue defect and options for reconstruction. • Complications and comorbidity in treatment outcome. • Secondary procedures needed for outcome. MATERIALS AND METHODS: MATERIALS: The study includes the study of 58 patients who underwent reconstruction for Head and Neck Malignancies at the Department of Plastic Surgery, Government Rajaji Hospital, Madurai. The study was from August 2010 to February 2013. METHODS: The methods include obtaining history from patients, thorough clinical examination and necessary investigations and appropriate surgical reconstruction. An informed written consent was obtained from every patient to include in the study. Proper preoperative counseling regarding the nature of the disease, treatment plan, complications and follow-up was done. All information was entered in a proforma specially designed for this study. METHODOLOGY: The patient’s name, age, sex, history of presenting illness and its duration was obtained. Past history of chronic medical illness and previous surgical history noted. Associated co-morbid conditions noted. Personal history like smoking, alcohol consumption, betel nut chewing and diet pattern were obtained. Detailed physical examination of the tumor, nodal status, metastatic status and donor site evaluation was done. Basic investigations like blood haemoglobin estimation, urine examination, blood sugar, blood group and renal parameters like urea, creatine were done. X-ray chest was obtained for anesthetic purpose and metastasis workup. Cardiac evaluation regarding fitness for surgery obtained. DISCUSSION: Ω The head and neck malignancy occurs mainly in sixth or seventh decade. BCC occurs mainly in head and neck region with 86% incidence in age range of 40-79 years (35). Oral cavity malignancy occurs mainly in sixth or seventh decade. In our study head and neck malignancy occurs in age range of 30-80 years with mean age incidence of 58 years and standard deviance of 8.96. Cutaneous malignancy has 64% incidence in 51-60 age groups and oral cavity malignancy has 39%; 34% age incidence in 51-60; 61-70 age groups respectively. Ω Head and neck malignancy has higher incidence in male with male: female ratio of 4:1. Contrarily, in our study there is increase in female incidence of head and neck malignancy. Oral cavity malignancy has equal sex incidence and Cutaneous BCC has increase in female sex incidence. The sunlight exposure and non-usage of preventive measures like sunscreens contributes to the increased incidence. Ω In skin, BCC is the common type and in the oral cavity SCC is the common type of malignancy in head and neck. In cutaneous malignancy, SCC forms only one-fourth the incidence of BCC. In cutaneous BCC, nose (26%) is the most common site followed by cheek (18%). CONCLUSION: • Mean age incidence of head and neck malignancy is 58 years with standard deviation of 8.96. • Cutaneous BCC has higher female sex incidence and oral cavity malignancy has equal sex incidence. • In head and neck malignancy, BCC is the most common skin tumor and SCC is the most common oral cavity malignancy. • Cheek is the most common sub site of cutaneous BCC followed by nose and buccal mucosa is the most common oral cavity sub site followed by lip. • The margin of clearance is 0.5 cm for BCC and 2cm for SCC. • Except for merkel cell carcinoma patient, other cutaneous malignancy patients do not need any form of treatment to neck. • In oral cavity malignancy, N0 stage patient without neck dissection have to be followed up and radiotherapy to be given to the neck. • Mandible reconstruction with vascularised fibula gives good aesthetic result. • Local flaps provide aesthetic cover for cutaneous malignancy. • Although free flap is ideal for oral cavity malignancy, regional flaps are viable alternative. • Comorbidity factors like diabetes mellitus and hypertension control reduce complication rate. • Secondary procedures like flap thinning, comissuroplasty improves the functional and aesthetic outcome.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Reconstruction ; head and neck malignancies ; evaluation ; treatment. |
| Subjects: | MEDICAL > Plastic and Reconstructive Surgery |
| Depositing User: | Kambaraman B |
| Date Deposited: | 12 Oct 2017 01:54 |
| Last Modified: | 12 Oct 2017 01:54 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/3519 |
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