[Application of transverse cervical artery flap in laryngeal function preservation surgery of hypopharyngeal carcinoma]

Objective

To explore the value and limitation of transverse cervical artery flap in laryngeal function preservation surgery of hypopharyngeal carcinoma.

Methods

Between January 2013 and December 2019, 18 male patients with hypopharyngeal carcinoma were admitted. The patients' age ranged from 48 to 77 years, with a median age of 65 years. The disease duration ranged from 3 to 8 months (mean, 5 months). All patients were diagnosed as squamous cell carcinoma by biopsy before operation. According to the American Joint Committee on Cancer (AJCC) guidelines (2017, 8th ed), TNM staging was T2N0M0 in 9 cases, T2N1M0 in 2 cases, and T3N0M0 in 7 cases, and cTNM staging was stage Ⅱ in 9 cases and stage Ⅲ in 9 cases. The lesions of 15 cases were located in the piriform fossa of hypopharynx on one side, among which the esophageal entrance was involved in 4 cases. The lesions of 3 cases were located in the posterior wall of the hypopharynx with esophageal entrance involvement. After partial pharyngo- laryngectomy and bilateral neck lymph node dissection, the hypopharyngeal and laryngeal defects were repaired with transverse cervical artery flaps, the size of the flap ranged from 4 cm×3 cm to 6 cm×4 cm. The accompanying vein of transverse cervical artery (7 cases), external jugular vein (6 cases), and combination of both (5 cases) served as venous reflux. Retrograde external jugular venous reflux exercise was performed in 2 flaps with venous reflux obstruction during operation. The incisions at donor sites were directly sutured or via relaxed incision sutured. Radiotherapy and chemotherapy were supplemented within 3 months after operation. Tracheal cannula with air bag was used to prevent patients from aspiration in the early postoperative stage.

Results

The operation time was 4-6 hours, with an average of 4.5 hours. All patients were followed up 1-5 years (mean, 2 years and 6 months). Postoperative pathological examination showed that 7 cases had cervical lymph node metastases on the affected side, and there was no lymph node metastasis in cervical region Ⅴ; the remaining 11 cases had no lymph node metastasis. After operation, 16 flaps survived successfully, and 2 flaps with external jugular vein reflux were covered with white pseudomembrane, no flap necrosis was found after the pseudomembrane fell off. Four cases had no obvious accidental aspiration after operation; 14 cases had obvious accidental aspiration, of which 13 cases were significantly reduced at 3 months after operation, and 1 case still had obvious accidental aspiration at 6 months after operation, and the accidental aspiration decreased significantly after pulling out the gastric tube. All patients had no aspiration pneumonia. One case developed upper mediastinal lymph node metastasis at 1 year and 2 months after operation, and died of recurrence and pulmonary infection at 1 year and 3 months after operation. No recurrence or metastasis was found in the remaining 17 cases during follow-up. Tracheal cannula was successfully removed in 7 cases at 2-5 months after operation. Different degrees of accidental aspiration in 11 patients were confirmed by esophagography, so the tracheal cannula was retained. All patients had pronunciation function after operation. All incisions at the donor sites healed by first intention, and the shoulder joint function was normal.

Conclusion

Using transverse cervical artery flap to repair the hypopharyngeal and laryngeal defects during hypopharyngeal carcinoma surgery in patients without lymph node metastasis in cervical region Ⅴ, can achieve good results of laryngeal function preservation. In cases with suspected lymph node metastasis in cervical region Ⅴ or venous dysplasia of accompanying vein of transverse cervical artery, there is a risk of tumor recurrence or flap necrosis, and the repair method needs to be cautiously employed.

[Cancerization of first branchial cleft cyst in the parotid gland: one case report]

A rare case of branchiogenic carcinoma from first cleft branchial cyst in the parotid gland is reported. An elderly male patient was admitted to the hospital presented with a mass accompanying with swelling and pain in the right parotid area for 5 days. Total right parotidectomy including the tumor resection and selective neck dissection were performed under general anesthesia. A thick-walled cyst containing necrotic tissue in the parotid gland was found. Postoperative histopathology showed that the tumor contained squamous epithelium and pseudostratified columnar epithelium. The cyst epithelium had atypical hyperplasia with necrosis. Some areas were cancerous with the formation of well-differentiated squamous cell carcinoma and cancer infiltration. No metastasis was found in the cervical lymph nodes. This case was in accordance with the diagnostic criteria of cancerization of the first branchial cleft cyst.

[Expression of RUNX2/LAPTM5 in MC3T3-E1 osteoblastic cells with induced mineralization]

OBJECTIVE

To investigate the association of the expressions of RUNX2/LAPTM5 with osteogenesis and lysosomes in osteoblastic cells during mineralization induction.

METHODS

MC3T3- E1 cells cultured in osteogenic induction medium was examined for mineralization and osteogenic differentiation using Alizarin red staining and alkaline phosphatase (ALP) staining, respectively. RT-qPCR and Western blotting were used to detect the mRNA and protein expressions of Runx2 and LAPTM5 in the cells during osteogenic induction for 5 days. The effects of overexpression and interference of RUNX2/ LAPTM5 on the expressions of ALP and osteocalcin (OCN) in the cells were examined with Western blotting.

RESULTS

MC3T3- E1 cells cultured in osteogenic induction medium showed an increased number of mineralized nodules over time, and the size of the mineralized nodules increased as the culture time extended; the number of purple-blue granules stained by ALP also increased gradually with time. RT-qPCR and Western blotting showed that the expressions of RUNX2 and LAPTM5 in the cells increased progressively during osteogenic mineralization (P < 0.001). Overexpression and interference of RUNX2 obviously affected LAPTM5 expression in the cells (P < 0.05); modulation of LAPTM5 expression did not significantly affect RUNX2 expression but caused significant changes in ALP and OCN expressions (P < 0.01).

CONCLUSION

RUNX2 /LAPTM5 may participate in the regulation of osteoblast differentiation, and RUNX2 may be involved in the regulation of LAPTM5 expression. RUNX2 /LAPTM5 may play a mediating role in the process of osteogenic mineralization involving lysosomes.

[Semi-free transverse cervical artery flap for repairing defects after head and neck tumor resection]

Objective:To investigate the feasibility of semi-free transverse cervical artery flaps for repairing the defect of head and neck tumors after operation. Method:Clinical records of 15 patients were retrospectively reviewed. Ten cases were diagnosed as oral cancer, 4 cases as hypopharyngeal carcinoma and 1 case as orbito-facial mucinous adenocarcinoma. The defects of tongue, floor of mouth, gingiva or orbitomaxillofacial region after tumor resection were repaired by semi-free transverse cervical artery flap with transverse cervical artery anastomosed to facial artery or superior thyroid artery and with external jugular vein reflux. All patients received postoperative adjunvant chemoradiotherapy except for the patient with mucinous adenocarcinoma. The patients were followed up for 1-3 years. Result:All the flaps survived after surgery. Except for one case of tongue base carcinoma recurrence, there was no definite recurrence or metastasis in the other 14 cases during the follow-up time. Conclusion:Semi-free transverse cervical artery flaps show favorable healing outcome. The surgical technique is relatively simple, time-saving and cost-effective, therefore are promising in repairing the defect after operation of head and neck tumors.