Surgery Of Head And Neck TumorsPDF电子书下载

PART 1-BASIC PRINCIPLES OF CANCER SURGERY OF THE HEAD AND NECK 1

1 Historical Notes 3

Recent Advances Permitting Relatively Safe Radical Surgery of the Head and Neck 13

2 Preoperative Considerations 14

Planning the Operation—Selection of the Operative Procedure 14

Local as Compared to Total Excision of an Organ or an Anatomic Part 15

Resection of an Adjacent Anatomic Structure 15

Excision of Bone 16

Extraction of Teeth 16

Preoperative Working Models for Postoperative Prostheses 16

Extent of Neck Dissection 16

The＂Forgotten Zone＂ 17

Combination of Neck Dissection with Excision of Primary Lesion 18

Excision of Primary Lesion Leaving an Open Defect for Later Closure 18

Medical Work-up 18

The Problem of Operative Risk 18

The＂Noli me Tangere＂in Head and Neck Surgery 19

Age in Relation to Operative Mortality 20

Biopsy 21

Punch Biopsy 21

The Problem of the＂Lump in the Neck＂ 21

Aspiration Biopsy 29

Technic of Aspiration Biopsy 29

Frozen Section 33

3 The Operation—Technical Considerations 35

Shaving and Sterile Preparation of the Operative Field 35

Anesthesia 36

Nerve Block or Regional Anesthesia 37

Hypotensive Anesthesia 38

Free Airway for Duration of Anesthesia and Measures to Prevent Aspiration of Blood 33

Endotracheal Tube with Packing in Pharynx 38

Endotracheal Tube with Inflatable Cuff 38

Simple Tracheostomy with Packing in Pharynx 38

Tracheostomy Tube with Inflatable Cuff 41

Balloon Cuff Anesthesia Tube 41

Position of the Patient on Operating Table 41

Draping of the Patient 41

Selection of Instruments for an Operation 44

Nomenclature of Operative Procedures 44

Names of Specific Instruments 44

Blood Transfusions 45

Skin Incision and Operative Exposure 45

Hemostasis，Ligatures，and Knot-Tying：Endothermy 48

Specific Reasons for the Excision of Bone in Head and Neck Surgery 49

Invasion of Bone by Cancer 49

For Access to Operative Site 49

To Permit Shifting of Soft Tissues to Facilitate Closure 49

Form and Extent of Mandibular Bone Excision 50

Partial or Complete Excision of the Hyoid Bone 50

Partial Resection of the Clavicle 50

Peripheral and Deep＂Safe＂Margins for Excision of Cancer 50

Cosmetic Appearance and Restoration of Function versus Adequately Wide Excision of Cancer 51

Closure of Operative Wounds of the Head and Neck 51

The＂Pull-Through＂Technic 53

Ligation by Wire of the Residual Stump in Cystic Cervical Lymph-hygroma 53

Isolation of the Oral Cavity by Primary Closure of the Pharyngeal Opening 54

Marsupialization of Benign Bone Cysts 54

Exploratory Laryngofissure in Cancer of the Intrinsic Larynx 54

Resection of a Thyroid Lobe to Facilitate Surgery in the Root of the Neck 55

Various Reconstructive Procedures 55

Skin Grafts for Operative Defects of the Maxilla，Orbit，and Mouth 55

Skin Grafts on Stents for Closure of Annular Pharyngeal Defects 56

Rotated or Sliding Flap Grafts 57

Skin Grafts for the Repair of Superficial Facial Defects 58

Tubed Pedicle Grafts 58

Bone Grafts 59

Buried Metal Splints 60

Limitations in Usefulness of Bone Gratts and Metal Splints for Mandibular Defects 60

Fixation of the Mandible by Bite Block or by Wiring the Teeth 60

Surgical Prosthesis 61

Wound Drainage 62

Sump Suction Drainage 63

Essential and Prophylactic Tracheostomy 63

Tracheostomy Trocar for Acute Respiratory Obstruction 67

Prophylactic Arterial Ligations 68

Surgery After Radiation Therapy 68

4 Postoperative Care 71

Recovery from Anesthesia—Management of Endotracheal Breathing Tube 71

Immediate Pressure Dressings 71

Air Cushion Pressure Dressings 72

Pressure Dressings over Skin Grafts and Rotated Pedicle Flaps 72

Early Ambulation 74

Prevention and Control of Postoperative Sepsis 74

Antibiotics 74

Zinc Peroxide 74

Bacillus Pyocyaneus Infections 74

Care of the Tracheostomy 74

Nutritional Care 76

Liquid Diets for Naso-esophageal Tube Feeding 77

Minor Role of Gastrostomy in Head and Neck Cancer 78

5 Immediate Operative Risk and Functional Disability Following the Sacrifice of Specific Anatomic Structures of the Head and Neck 79

Jugular Veins 79

External Carotid Arteries 80

Common or Internal Carotid Artery 80

Arterial Grafts and Vascular Anastomoses 81

Subclavian Artery 81

Recurrent Laryngeal Nerve 82

Superior Laryngeal Nerve 82

Phrenic Nerve 83

Seventh Cranial Nerve 83

Vagus Nerve 84

Hypoglossal and Lingual Nerves 84

Cervical Sympathetics 84

Carotid Sinus Syndrome 84

Horner＇s Syndrome 85

Exposure of Dura and/or Cerebral Cortex 85

Sacrifice of Eye 86

Submaxillary and Parotid Ducts 86

Thyroid and Parathyroid Glands 87

Thoracic Duct 87

6 General and Local Complications of Head and Neck Surgery 88

Shock 88

Hemorrhage 88

Gastrointestinal Hemorrhage 89

Hematoma and Chyloma 90

Hematoma in Thyroid Surgery 90

Chyloma 90

Subcutaneous Emphysema 91

Infection—Wound Sepsis 91

Separation of the Suture Line within the Mouth 91

Influence of Diabetes or Liver Dysfunction on Wound Healing 92

Pulmonary Complications—Respiratory Obstructions 92

Pneumothorax and Pneumomediastinum—Air-Sucking Wounds in the Neck 92

Malnutrition—Dysphagia—Dysmaseis—Dysgeusia 94

Lymphedema 95

Postoperative Granuloma of the Larynx and Trachea 95

Granuloma Following Partial Laryngectomy 96

Granuloma Following Intubation 96

Granuloma of the Trachea following Tracheostomy 96

Stricture(Anterior Webbing)of the Glottis Following Partial Laryngectomy 96

Anterior Webbing 97

Salivary Fistula—Pharyngostome 97

Temporary Pharyngostome 97

Trismus 97

Corneal Injuries and Other Eye Complications 98

Tracheitis Sicca 99

Microstomia Following Total Laryngectomy 99

Inflammatory and Traumatic Hypertrophy of the Tail of the Parotid Following Neck Dissection 100

Keloid 101

Treatment 101

7 Long-Term Cosmetic and Functional Disabilities Following Radical Surgery of the Head and Neck 102

Cosmetic Appearance 102

Disability and Paresthesias Following Neck Dissection Due to Section of the Eleventh Cranial Nerve and Cervical Plexus 103

Tissue Defects of the Mouth Producing Salivary Incontinence 103

Dysphagia and Masticatory Difficulties 104

Speech Disabilities 104

Speech Re-education 104

The Reed Larynx 104

The Electro-larynx 104

Esophageal Voice 105

BIBLIOGRAPHY 107

PART 2-ATLAS OF OPERATIVE PROCEDURES 117

8 Operative Procedures of a General Character or Application 119

Neck Dissection 119

Segmental Excision of the Common Carotid Artery and End-to-End Anastomosis 127

Maneuver to Avoid Inadvertent Injury to the Marginalis Mandibulae Nerve During Neck Dissection 128

Combination Neck Dissection and Axillary Dissection 129

Excision of Submaxillary Salivary Gland(Submaxillary Dissection) 130

Excision of Congenital Cervical Cysts and Fistulae 131

Thyroglossal Duct Cyst 131

Branchiogenic Cyst 134

Branchiogenic Fistula 135

Tracheostomy 136

Ligation of External Carotid Artery 140

Ligation of Parotid Ducts 142

Anterior Pharyngotomy 143

Fusion of Eyelids 145

Formation of Tubed Pedicle Grafts 146

Migration of Tubed Pedicle Grafts 148

Migration to Defects in the Submental Area 150

Migration to Lateral Cheek Area 151

Migration to Lateral Face Area 153

Donor Sites for Skin Grafts for Facial Defects 156

Pinch Grafts as an Aid to Incompletely Closed Incisions 158

Reduction in Size of Circular Defects by Purse-String Sutures Before Skin Grafting 159

9 Operations for Cancer of the Skin of the Face(Eyelids，Nose，Lip，and Ear) 161

General 161

Elliptical Incisions for Excision of Small Cancers of the Face 161

Eyelids 163

Excision of Small Growth of Upper Eyelid by Simple Ellipse 163

Excision of Growth of the Upper Eyelid Approaching the Palpebral Margin—Closure by Rotated Flap from Adjacent Upper Eyelid 164

Closure of Upper Eyelid Defect by Rotated Flap from the Temporal Area 165

Circular-Shaped Excision with Z-Plastic Closure for Growth near Palpebral Margin 166

Wedge-Shaped Excision of Growth of Palpebral Margin 167

Excision of Growth Below the Inner Canthus；Closure by Rotated Flap from the Upper Eyelid 168

Excision of Growth of the Lower Eyelid；Closure by Rotated Flap from the Upper Eyelid 169

Excision of Growth of Lower Eyelid near Outer Canthus；Closure by Rotated Flap from the Upper Eyelid 170

Rotated Flap from Nasolabial Groove for Closure of Defects of Lower Eyelid 171

Temple and Cheek 172

Excision of Growth of the Temporal Region；Closure by Skin Graft 172

Excision of Growth of the Skin of the Cheek；Closure by Full-Thickness Skin Graft 173

Closure of Large Cheek Defect by Split Graft 174

Excision of Growth of the Skin of the Cheek；Closure by Rotated Flap from the Temporal or the Mastoid Area 175

Nose 176

Excision of Growth of Bridge of the Nose；Closure by Direct Suture 176

Excision of Growth Near Tip of Nose：Closure by Skin Graft and Sandwich-Type Pressure Dressing 177

Excision of Growth of Nasal Ala；Closure by Rotated Flap from Cheek 178

Excision of the Full Thickness of the Margin of the Nasal Ala；Repair by a Doubled Rotated Flap 179

Excision of Growth Near Tip of Nose；Closure by Rhinoplasty 180

Radical Excision of the Nose and Nasal Cavity for Deeply-Invasive Cancer of the Skin of the Nose 183

Lips 184

Excision of Growth of the Upper Lip；Closure by Rotated Flaps 184

Excision of Growth of the Skin of the Upper Lip；Closure by Sliding Flap 185

Excision of Skin Cancer of Lower Lip；Closure by Skin Graft and Mattress-Suture Pressure Dressing 186

Chin 187

Excision of Radiation Sclerosis and Cancer of Skin of Chin and Repair by Pedicle Tube Graft 187

Ear 189

Excision of Growths in and About Auricle 189

Excision of Growths in the External Auditory Canal 191

Radical Excision of External and Middle Ear with Skin Graft 193

10 Operations for Cancer of the Mucosa of the Lip 195

Local Excision of Cancer of the Lip by Simple Ellipse 196

V-Excision of Lower Lip 197

Subtotal Excision of Mucosa of the Lower Lip(Lip-Stripping Operation) 198

Combined V-Excision and Lip-Stripping Operation 200

Estlander Cheiloplasty 201

Bridged Cheiloplasty for Cancer of the Lower Lip 201

Homolateral Nonbridged Estlander Cheiloplasty 203

Bernard Cheiloplasty for Advanced Cancer of the Lower Lip 204

Bridged Estlander Cheiloplasty for Cancer of the Upper Lip 206

Cheiloplasty for Cancer of the Upper Lip；Closure by Bilateral Sliding Flaps 207

11 Operations for Cancer of the Mucosa of the Cheek 209

Local Excision of Cancer of Mucosa of Cheek and Closure by Simple Suture 210

Irregularly-Shaped Excision of Cancer of Mucosa of Cheek 211

Excision of Tumor of the Mucosa of the Cheek；Closure by Skin Graft 212

Excision of Widespread Multiple Cancer or Precancer of the Mucosa of the Cheek，Lips，Gum，and Palate：Closure by Skin Graft on Prothesis and on Buried Stents 214

Excision of Posterosuperior Buccal Tumors Through Weber-Fergusson Approach 217

Through-and-Through Excision of Cancer of the Cheek and Closure by Estlander Flap 219

Excision of Deeply-Infiltrating Tumor of the Buccal Mucosa Combined with Neck Dissection：Access to the Cheek by Splitting the Lower Lip 220

Through-and-Through Excision of Advanced，Deeply-Infiltrating Cancer of the Cheek Combined with Neck Dissection 223

12 Operations for Cancer of the Gum 225

Local Excision of a Small Cancer of the Edentulous Gum 226

Excision of Cancer of the Gum and Closure by Lateral Shifting of the Floor of Mouth 228

Marginal Resection of Mandible(Alveolar Process)for Cancer of the Gum 229

Marginal Excision of the Lower Alveolus and a Portion of the Ascending Ramus for Cancer of the Retromolar Area(Combined with Neck Dissection) 231

Excision of Cancer Involving Both Upper and Lower Gums and Retromolar Area by Partial Resection of the Mandible and Neck Dissection 234

Variation in Procedure when Cancer of the Gum Involves the Edge of the Tongue 238

13 Operations on the Mandible：For Primary Tumors of Bone；For Temporary Section of the Mandible；Hemimandibulectomy 241

Hemimandibulectomy 242

Resection of Ramus for Primary Bone Tumor 245

Temporary Section of the Mandible for Approach to the Pterygomaxillary Space 247

Resection of the Mandible Through the Open Mouth 249

14 Buxied Metal Splints and Bone Grafts for Mandibular Defects 251

Wire Mesh Splints 251

Partial Resection of Mandible and Repair by Wire Mesh Splint 252

Partial Resection of Mandible and Repair by Wire Mesh Splint：Variation in Method of Attaching Wire Mesh Splint 255

Resection of the Mandible and Repair by Wire Mesh Splint：Variation in Position—Anterior Portion of Mandible 256

Total Resection of Mandible with Replacement by Wire Mesh Spiint 257

Bone Grafts 259

Rib Grafts 259

Iliac Crest Grafts 261

15 Operations on the Tongue 265

Local Excision 266

Lesions on the Lateral Border 266

Lesions on the Dorsum 267

Lesions through Vertical Ellipse 268

Partial Glossectomy 269

Growths at the Tip，Lateral Border，or Dorsum of the Tongue 269

Lesions on the Undersurface Near the Tip of the Tongue 270

Superficial Lesions Involving the Tip and Most of the Dorsum of the Tongue 271

Base of the Tongue Via Anterior Pharyngotomy 274

With Resection of the Mandible and Neck Dissection 275

Subtotal Glossectomy Combined with Neck Dissection 277

16 Operations for Growths of the Floor of the Mouth 281

Simple Elliptical Excision for Superficial Cancer 282

Marginal Resection of the Mandible for Cancer of the Anterior Floor 283

Excision of Cancer of the Anterior Floor Combined with Marginal Resection of the Mandible and Neck Dissection 286

The＂Pull-Through＂Operation：Marginal Resection of the Mandible for Cancer of the Lateral Floor of the Mouth Combined with Neck Dissection 288

Excision of Extensive Primary Cancer of the Floor Combined with Partial Resection of the Mandible and Neck Dissection 290

Excision of Salivary Cyst(Rannula) 294

17 Operations for Tumors of the Palate 295

Excision of Small Tumor of the Hard or Soft Palate and Closure by Secondary Intention 296

Excision of Superficial Warty Benign Tumors of the Hard Palate and Closure by Skin Graft 297

Excision of Deeply-Infiltrating Tumors of the Hard Palate on or Invading the Bone 298

Excision of Moderate-Sized Tumor of the Upper Gum and Palate 299

Partial Excision of Maxilla and Palate for Osteogenic Tumors 300

18 Operations for Tumors of the Nasal Cavity 303

Lateral Rhinotomy 304

Approach to the Nasal Cavity Through the Alveolar Process via Antrostomy 305

Snare Removal of Polypoid Nasopharyngeal Tumors 308

19 Operations on the Antrum and Maxilla 311

Partial Resection of the Maxilla for Early Cancer of the Antrum 312

Radical Resection of the Maxilla for Advanced Cancer of the Antrum and Paranasal Sinuses 315

20 Operations for Parotid Tumors 321

Some Cardinal Principles of Tumor Surgery of the Parotid Gland 321

Excision of Small Peripherally-Placed Parotid Tumors 322

Surgical Anatomy of the 7th Nerve 323

Superficial Parotidectomy 324

Excision of Retromandibular Tumors 327

Excision of Bulky Benign Parotid Tumors 330

Subtotal Parotidectomy with Preservation of the 7th Nerve 332

Total Parotidectomy with Preservation of the 7th Nerve 333

Subtotal Parotidectomy with Partial Preservation of the 7th Nerve Combined with Neck Dissection 334

Total Parotidectomy with Complete Sacrifice of the 7th Nerve Plus Neck Dissection 335

21 Operations on the Larynx 337

Variations in Form and Extent of Laryngeal Surgery for Cancer 337

Partial Laryngectomy 338

Through Laryngofissure 340

Through Anterior Pharyngotomy 344

Total Laryngectomy 345

Total Laryngectomy Combined with Neck Dissection 353

Variations in Management of Wide Pharyngostome Following Pharyngolaryngectomy 358

Pharyngolaryngectomy Combined with Neck Dissection 361

Maneuver to Obtain Direct Exposure and Visualization of the Vallecula and of the Base of the Tongue 362

Total Laryngectomy with Bilateral Neck Dissection 365

Subtotal Laryngectomy Combined with Neck Dissection for Postcricoid Cancer 371

Subtotal Laryngectomy Combined with Neck Dissection for Unilateral Cancer of the Extrinsic Larynx and/or Lateral Pharyngeal Wall 376

Repair of Pharyngeal Defect by Split-Skin Graft on Latex Stent 381

Z-Plastic for Enlargement of Microstomia Following Total Laryngectomy 384

Delayed Closure of a Pharyngeal Stoma Following Total Laryngectomy 385

Closure of Pharyngostome by＂Trap-Door＂Plastic 386

Closure of Large Pharyngeal Stoma by Tubed Pedicle Flap 387

Excision of Esophageal Diverticulum 389

22 Operations for Growths of the Pharyngeal Walls 391

Excision of Small Tumor of the Pharyngeal Wall Through Anterior Pharyngotomy 392

Removal of Extensive Cancer of the Posterior Wall Through Anterior Pharyngotomy：Closure by Secondary Intention 393

Removal of Submucous Bulging Tumor of Posterior Pharyngeal Wall 394

23 Operations for Thyroid Tumors 397

Hemithyroidectomy(Lobectomy) 398

Thyroidectomy and Neck Dissection 401

Window Resection of the Trachea for Invasion by Thyroid Cancer 406

Substernal Thyroid Tumors 408

Appendix 415

Index 425