In this study, we investigated incidental parathyroidectomy during total thyroidectomy surgery that required central lymph node dissection and the potential risk factors. Patients requiring total thyroidectomy and tracheoesophageal groove node dissection were enrolled in the study from January 2013 to June 2015 and we obtained all medical information, including pathology reports. Furthermore, we recorded the parathyroid hormone level in all patients prior to operation and then 3 further times: 1 day, 1 week, and 3 months after surgery. A total of 341 patients (66 male and 275 female) were enrolled in the study. Microscopic examination of postoperative specimens revealed that incidental parathyroidectomy existed in 35 (10.3%) cases: 32 (91.4%) patients had 1 parathyroid gland excised, 3 (8.6%) patients had 2 parathyroid glands excised, and no patients had 3 or more parathyroid glands resected. The mean size of the resected glands was 4.6 mm. Parathyroid tissue from 16 (42.1%) cases was located in the intrathyroidal position, 6 glands were located in central lymphatic adipose tissue, and 16 glands were located within or along with thymus tissue. Lateral neck dissection significantly increased the risk of incidental parathyroidectomy (P < 0.001). No other factors including age, sex, and postoperative symptomatic hypocalcemia were significantly associated with incidental parathyroidectomy (all P > 0.05), though incidental parathyroidectomy tended to cause transient hypoparathyroidism (P = 0.051). Therefore, the risk of incidental parathyroidectomy in total thyroidectomy is relatively low; the majority of the resected parathyroid tissue is situated outside the thyroid, therefore we suggest future operations focus on preserving the parathyroid gland when the node dissection is close to the thymus. Incidental parathyroidectomy appears to have an effect on the expression of parathyroid hormone and it is significantly associated with lateral cervical lymph node dissection.

: Our goal was to compare clinical and functional results of the infrahyoid myocutaneous flap (IMF) with those of the radial forearm free flap (RFFF) for partial tongue reconstruction. Between January 2005 and June 2012, patients who had received an IMF or a RFFF reconstruction for cT1-2 tongue carcinoma were included, their medical records were reviewed, and they were asked to complete the University of Washington Quality of Life (UW-QoL) version 4 questionnaire at least 12 months postoperatively. Compared to patients with a RFFF reconstruction, patients treated with an IMF had significantly shorter operation time (p<0.001), less hospital cost (p<0.001) and shorter postoperative stay (p<0.001). There were no apparent differences in other scales between the two groups. The mean composite score for the two groups was 88.4 (SD: 14.9) and 86.4 (SD: 15.3), respectively, the finding was not significant (p=0.784). Patients with an IMF reconstruction had significantly better shoulder function, there were no significant differences regarding other domains between the two groups. Compared to RFFF, IMF was a reliable procedure for partial tongue reconstruction.

Our goal was to introduce the application of submental island flap in reconstructing through-and-through cheek defects. From January 2009 to January 2013, 7 patients (5 men and 2 women) with full-thickness buccal defects due to tumor resection received submental flap reconstruction at the Affiliated Tumor Hospital of Zhengzhou University; surgical procedure and success rate as well as functional results were described. Distal partial necrosis occurred in 1 flap, but all flaps survived. All patients were capable of maintaining a regular oral diet, and no patients complained of an inability to eat in a public setting, microstomia, or drooling; the appearance was reported to be good or acceptable in all cases, and the mean postoperative mouth-open width was 4.2 (range, 3.7-5.0) cm. One patient had a local recurrence in the follow-up. Therefore, submental island flap is a reliable procedure for through-and-through buccal defects in selected patients.

The purpose of our study was to investigate (by postal questionnaire) the long-term quality of life (QoL) in Chinese patients who have had resections of head and neck cancer and immediate reconstruction by radial forearm free flaps. We performed a retrospective questionnaire survey and case series in the Affiliated Tumor Hospital of Zhengzhou University. The subjects were consecutive patients treated for head and neck cancers during a 13-year period. The patients completed the University of Washington Quality of Life (version 4) questionnaires. Among the 178 patients treated during the course of 13 years, 87 were alive and disease free. Fifty-six (64.4%) of the 87 questionnaires were returned. The mean follow-up duration was 7.9 years (range, 3-13 y). Of the 12 disease-specific domains on the University of Washington Quality of Life, the best-scoring domain was pain, followed by mood, anxiety, and shoulder, whereas the lowest scores were for saliva, taste, and speech. The domains considered as the most important were saliva, speech, and taste. We conclude that the radial forearm free flap for the reconstruction of defects of the head and neck after resection for cancer significantly influenced the patients' long-term QoL.

Objective To study the clinical diagnosis and preoperative management of carotid body tumor.Methods A total of 24 cases with carotid body tumors underwent surgery from 2003 to 2013 were reviewed.The clinical and imaging features,treatment and prognosis were retrospectively evaluated.Five of the 24 patients were males and 19 were females.Twenty-three cases were benign and one case was malignant.Seven of the 24 patients had bilateral tumors.Results Nineteen of twenty-four patients underwent digital subtraction angiography (DSA) and temporary balloon occlusion (TBO) test,and one case of them was positive in the test.Twenty-three benign case were treated with operation.The malignant one treat with biopsy.Three cases underwent resection of tumors with both the internal and external carotid arteries without carotid reconstruction,and none of the three patients died or presented with hemiplegia after operation.Twenty-three benign cases were followed up for 6-122 months,the median was 75 months.The malignant patient died 6 months after operation.Conclusion TBO and DSA are reliable and practical methods to determine the safety of carotid ligation and can be used as routine preoperative examinations.

Adenoid cystic carcinoma (ACC) arising in the pterygopalatine fossa was rare, only 3 cases have been reported. In previous literature, few authors reported whether the visual deficit could be resolved following the resection of the tumor.One patient with visual dysfunction induced by ACC arising in the pterygopalatine fossa was reported.Complete visual recovery was achieved following the operation. And the patient was satisfied with the appearance and the functional results in the follow-up.Visual loss contributed by the tumor in the pterygopalatine fossa could recover in selected patients.

OBJECTIVE:To evaluate clinical outcomes and pronouncing and swallowing functions after supracricoid partial laryngectomy (SCPL).METHOD:Eight-five cases underwent supracricoid partial laryngectomy from 1990 to 2008 were reviewed.RESULTS:The 3- and 5-year accumulative survival rates were 90.4% and 81.6%, respectively. 97.6% (83/85) patients were decannulated. 89.4% (76/85) were able to eat normally within 6 weeks after surgery and the swallowing functions in the rest patients were recovered by training in different time after surgery. Fiber laryngoscope showed the reconstructed throats could close well with good swallowing functions six months after the operation.CONCLUSION:SCPL is a good choice in selected cases with laryngeal cancer, with satisfactory pronouncing and swallowing functions after surgery.

OBJECTIVE:To investigate the clinical manifestations and diagnostic method of hyperparathyroidism due to parathyroid tumors and to evaluate the intra-operative detection of parathyroid hormone in surgical treatment.METHOD:Thirty-seven cases with functional parathyroid tumors from January 2003 to October 2012 were retrospectively analyzed. The clinical manifestation, examination and operation method, changes of parathyroid hormone before and after operation were collected.RESULT:All cases were definitely diagnosed before operation. The sensitivity and the positively predictive values of neck ultrasonography were 86.5% and 97.6% respectively, and the same data of Tc-99m-MIBI was 97.2% and 100.0%. The PTH levels declined by 84.9% ten minutes after tumor resecting compared with the level before operation. The serum calcium and PTH returned to normal levels and symptomatic relief occurred after operation.CONCLUSION:Recurrent bone disease, long-term urinary calculus and obscure gastrointestinal symptoms were common symptoms of hyperparathyroidism due to parathyroid tumors. The neck ultrasonography and Tc-99m-MIBI were suitable for location of parathyroid tumors. Surgical operation was an effective treatment for parathyroid tumor. Intra-operative PTH assay would be able to ensure the radical excision and the operative safety for functional parathyroid tumors.

Objective:To explore the imaging diagnosis and reasonable surgical approach of parapharyngeal space tumors. Methods:A retrospective study of 15 patients with primary parapharyngeal space tumors treated from 1995 to 2009 in Panyu Central Hospital was performed. All the patients were examined by MRI, some of them were examined by MRA and/or CT. The transcervical approach was used in 13 cases,the transoral approach was used in 2 cases. Results:Using MRI and CT scan could obtain useful information about the positon,nature,size and the relationship with cervical blood vessels of the tumors,and was helpful to make surgical plan. There was no recurrence and severe complications in all cases at a mean flow-up of 3years.Conclusion:MRI and CT scan are extremely useful for the diagnosis and presurgical planning. The transcervical approach is a safe approach,and suitable for most parapharyngeal space tumors,especially for large benign tumors.

OBJECTIVE:To explore the clinical features, diagnosis and surgical treatment of parathyroid neoplasms.METHODS:From January 2003 to December 2011, a total of 51 patients were recruited. Their clinical data, presentations, examinations and surgical approaches were analyzed retrospectively.RESULTS:Among them, there were parathyroid adenoma (n = 32), parathyroid cysts (n = 18) and parathyroid carcinoma (n = 1). The sensitivity and positive rate of neck ultrasonography and (99)Tc(m)-methoxyisobutylisonitrile (MIBI) were 84.3% and 93.5%, 91.7% and 100.0% respectively. The high levels of serum calcium and parathyroid hormone (PTH) in 32 cases of parathyroid adenoma and 1 case of parathyroid carcinoma returned to normal after operation. The levels of serum calcium and PTH remained normal in 18 cases of parathyroid cysts.CONCLUSIONS:The clinical manifestations of parathyroid adenoma were complex. The serum levels of calcium and PTH and neck ultrasonography are preferred screening tools for parathyroid neoplasms.(99)Tc(m)-MIBI is suitable for tumor localization.Surgery is effective and safe for parathyroid neoplasm.Real time intraoperative monitoring of PTH is of great importance.

The intra- and postoperative complications resulting from surgery for giant thyroid gland tumors (diameter greater than 10 cm) present serious challenges to patient recovery. Although there are a number of methods, all have limitations. In this study, we present our experience with several complications of surgical treatment of giant thyroid gland tumors to increase the awareness and aid the prevention of these complications. A total of 137 consecutive patients who underwent surgical treatment in Henan Tumor Hospital were retrospectively analyzed. Statistics pertaining to the patients' clinical factors were gathered. We found that the most common surgical complications were recurrent laryngeal nerve (RLN) injury and symptomatic hypoparathyroidism. Other complications included incision site infections, bleeding, infection and chyle fistula, the incidence of which increased significantly with increasing extent of surgery from group I (near-total thyroidectomy) to group V (total thyroidectomy plus lateral neck dissection). Low complication rates may be achieved with more accurate knowledge of the surgical anatomy, skilled surgical treatment and experience. More extensive surgery results in a greater number of complications.

Objective: To evaluate the effect of using free thinning anterolateral thigh flap transplantation to repair the defects after tongue cancer resection.Methods: Twenty-eight patients with tongue squamous cell carcinoma underwent resection and flap transplantation.Results: The flaps of all 28 patients survived,tongues were reshaped well after operation,and the incisions both on thighs and on tongues were healed.All of the tongues' shape and function recovered well during the follow-up.Conclusion: The outcomes of free thinning anterolateral thigh flap transplantation were satisfactory to repair the defects after tongue cancer resection,and the tongue's function was recovered as well.