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Purpose: The objective of this study was to implement a scoring system to analyze the authors' experience of donor-site morbidity after harvesting a submental flap for the reconstruction of surgical defects at the head and neck region after oncologic resection. Materials and Methods: A retrospective case series study was conducted of patients who underwent reconstruction with a submental flap at the Tri-Service General Hospital (Taipei, Taiwan) from 2008 through 2012. Five parameters representing donor-site morbidity (whistling, smiling, neck extension, beard change, and esthetic outcome) were evaluated with a scoring system developed by a blinded panel of 2 clinicians and the patients. Scores were analyzed and compared between patient subgroups. Results: Twenty-two patients (20 men and 2 women; mean age, 56 yr) underwent reconstruction with a submental flap after head and neck tumor ablation. Primary lesion sites included the oral cavity (13 patients), pharynx (6 patients), larynx (1 patient), neck (1 patient), and sinus (1 patient). The means of all 5 parameters evaluated were higher than 8 on a scale of 0 to 9 (whistling, 8.7; smiling, 8.7; beard change, 8.9; neck extension, 8.2; esthetic outcome, 8.2), showing that submental flap harvesting led to low donor-site morbidity. Conclusions: Donor-site morbidity after submental flap harvesting was evaluated with a scoring system measuring 5 parameters, namely whistling, smiling, beard change, neck extension, and esthetic outcome. In general, donor-site morbidity was very low. This implemented system and these findings will be helpful in future reconstructive surgical planning and management. [ABSTRACT FROM AUTHOR]

This study reported our experience of the clinical characteristics of periparotid recurrence of nasopharyngeal carcinoma (NPC) after parotid-gland-sparing radiotherapy. We retrospectively reviewed the charts of 296 patients with NPC who underwent parotid-gland-sparing radiotherapy at the Tri-Service General Hospital from 1998 to 2008. Eighty-three patients underwent three-dimensional conformal radiotherapy, and 205 patients underwent intensity-modulated radiotherapy; parotid glands were spared bilaterally in all patients. None of these patients had undergone previous radiotherapy or surgical treatment of the head and neck. Disease recurred in a spared parotid gland in three patients (1.04%). Two of these patients had undergone three-dimensional conformal radiotherapy and the third underwent intensity-modulated radiotherapy. All three patients had undergone parotidectomy. Adjuvant radiotherapy or concurrent chemoradiation was administered. One patient died of metastatic disease 26 months after diagnosis of recurrence; the others were well with no evidence of disease at 63 and 6 months after initial recurrence. Periparotid recurrence is an uncommon pattern of locoregional failure after parotid-gland-sparing radiotherapy for NPC. Early diagnosis and aggressive therapy for patients with periparotid recurrence may improve outcomes. [ABSTRACT FROM AUTHOR]

This study aims to establish a delineation guideline for the contouring of the hypoglossal nerve by dividing the nerve into different segments, and to test the possibility of a radiation dose reduction to the hypoglossal nerve in NPC patients receiving radiotherapy. Twenty NPC patients were selected arbitrarily. The hypoglossal nerves were delineated using anatomic landmarks and divided into the cisternal, intracanalicular, carotid, and transverse segments. The tumor coverage by radiation and dose-volume parameters of the nerve with and without various dose constraints to the hypoglossal nerve were compared. The hypoglossal nerve, which is invisible on CT images, can be delineated accurately with the assistance of several anatomic landmarks. Without a dose constraint to the hypoglossal nerve, the carotid space, intracanalicular, and transverse segments had high radiation dose-volumes. The dose-volume to the nerve, however, can be reduced when the nerve was defined and a dose constraint was given. The delineation of the hypoglossal nerve with its different segments is feasible. The carotid space, intracanalicular, and transverse segments received the highest dose, where the nerve damage was most likely located. The dose to the nerve can be reduced to less than 70 Gy using the intensity-modulated radiotherapy technique. [ABSTRACT FROM AUTHOR]

Summary: Injection laryngoplasty with autologous fat appears to be an effective and simple technique for the treatment of patients with glottic insufficiency in comparison with other surgical techniques. Despite of its advantages, associated complications have also been reported, including immediate donor-site morbidity (eg, hematoma and abscess), fat extrusion of the injection site, and delayed manifestation of vocal granuloma or overinjected vocal folds. In this article, a patient suffering from accidental injury to the deep abdominal fascia without peritoneal penetration in the fat harvest procedure is presented. Three months after the fat injection laryngoplasty, an umbilical hernia was proved to occur via the clinical imaging. Several etiologies are supposed to induce the herniation of intraabdominal structures, including surgeon''s incaution, abdominal obesity, intense wound inflammation and fibrosis, and the native weak point of the abdominal wall around the umbilicus. This case provides information that overdepth and negligence in fat harvest may injure the deep abdominal fascia, then possibly causing the umbilical hernia as a delayed donor-site complication. [ABSTRACT FROM AUTHOR]

Objectives: Recurrent idiopathic sudden sensorineural hearing loss (ISSNHL) is a rare disease. In this study, we evaluated the correlations between hearing recovery after the first and recurrent episodes of ISSNHL and characterized the clinical features of different episodes of ISSNHL.Methods: This retrospective study was conducted by reviewing medical records pertaining to the period 2008-2018. A total of 30 patients (16 male, 14 female) who had experienced at least two episodes of ISSNHL were included. All patients were had received steroid therapy (including systemic and IT) and/or hyperbaric oxygen therapy within 2 weeks after the onset of disease. The SDRG's criteria was used for the grading of hearing recovery.Results: The median age at the first and second episode of ISSNHL was 48 and 53.5 years, respectively; a total of 30% of patients presented with vertigo in the first episode and 40% presented with vertigo in the second episode. The hearing outcomes of both episodes showed significant improvement after treatment. The rate of complete recovery after the first and second episodes was 46.67% and 33.33%, respectively. A significant positive correlation was observed between the treatment outcomes of the first and second episodes (r = 0.721, p < 0.001).Conclusion: In ISSNHL, hearing recovery after a recurrent episode is significantly correlated with the hearing outcome after the initial episode (p = 0.042). The treatment outcome of the first episode is a prognostic factor for the outcomes of recurrent episodes. [ABSTRACT FROM AUTHOR]