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The aim of the present article is to demonstrate the relevance of revascularized free scapular flap in mandibular reconstruction in oncological cervicofacial salvage surgery. We will discuss the advantages and the disadvantages, indications and contraindications, together with possible complications and sequelae for this type of surgical flap.Retrospective study of 93 revascularized free scapular flaps used to reconstruct segmental substance defects in the mandible from April 1997 to October 2009 (in 91 patients). All patients benefited from 10 months to 12 years follow-up surgical and functional results. Functional assessment following anatomic site restoration focused on the quality of feeding and deglutition.The anatomical success rate was 94.63% (5 complete necroses out of 93 flaps). Results were considered to be good (normal or close to normal function for feeding and deglutition) in the majority of patients (83% at 6 months, 91% at 18 months). On the donor site: Functional sequelae were moderate when post-operative reeducation was correctly performed.Vascularized free scapular flap bone graft is very interesting for the reconstruction of mandibular discontinuity, composite (soft tissue and cutaneous resection) or exclusively osseous defects (not in excess of 13 cm), secondary to oncologic or osteoradionecrotic resections.

Consider whether surgery alone in the treatment of early cancers of the hypopharynx can give identical or better results in terms of survival and local control than radiotherapy.Forty-five patients were operated on during the years 1991-2004. Surgical treatment consisted in a resection by the transoral approach in four patients and 41 patients had a partial pharyngolaryngectomy. An elective neck dissection was performed on 43 patients.The 1-, 3-, and 5-year overall survival rates were 100, 95, and 75%. The 1-, 3-, and 5-year locoregional control rates were 93, 88, and 82% and were influenced by the presence of dysplasia on surgical margins (p=0.027). The oncological occurrences observed were five local recurrences, two nodal recurrences, ten second primary cancers, and two metastases. Five locoregional failures out of seven were controlled after a second treatment.Surgery alone gives completely satisfactory results in terms of survival and locoregional control. In case of recurrence, this makes it possible to operate on patients in nonirradiated areas with lower morbidity and mortality and better results. These results must be confirmed by a randomized trial.

From December 1987 to February 1998, 270 patients underwent a total laryngectomy with voice restoration by a voice prosthesis. The analysis is focused on the 62 live patients with a 5 year follow-up. Tracheoesophageal speech had a success rate of 81% after 1 year and 73% after 5 years. The daily use of the voice prosthesis is only 68% after 1 year and 61% after 5 years. During the 5 year follow up (for all patients) 16 (26%) presented an enlarged fistula with leakage around the fistula and 17 (27%) needed a removal of the prosthesis.Tracheoesophageal speech with a voice prosthesis appears interesting for laryngectomized patients with: a high success rate, the quality and precocity of the voice obtained. However, it requires extensive care and the results deteriorate with time.

The possibility to perform flow cytometry was examined in a series of 167 patients with primary untreated head and neck carcinoma referred to our Institution from February 1989 to January 1992. In all cases, flow cytometry was carried out on frozen tumour samples. The Cox model was used including age, tumour size, nodal status on clinical assessment, topography, treatment, malignancy grade, S phase fraction and ploidy as independent variables and overall survival as dependent variable. In this study, ploidy could be assessed in only 73% of cases and S phase fraction and G2M in 65% of the population studied. No correlation could be evidenced between ploidy or SPF with other clinical, pathologic characteristics or clinical outcome. We conclude that flow cytometry should remain a research tool until the method has proved to be relevant in clinical routine, and until the yield of the technique can be improved.