Introduction Free flaps have been the preferred method for reconstruction after resection of oral cavity cancer. However, pedicled flaps remain valuable alternatives in appropriate settings. Objective The main objective of the present study was to compare surgical complications, hospital costs, and functional outcomes of oral cavity cancer patients who underwent soft tissue reconstruction with pedicled flaps or free flaps. Methods A total of 171 patients were included in the study. Ninety-eight underwent reconstruction with a pectoralis major, submental, temporalis, or supraclavicular pedicled flap, and in 73 patients, a radial forearm or anterolateral thigh free flap had been used. The cases were retrospectively reviewed, and a comparative analysis was carried out between the two groups. Results Recipient site and flap complications, speech, and swallowing functions did not differ between groups, but donor site complications, operative time, hospital stay, and costs were significantly reduced in the pedicled flap group compared with the free flap group. However, the pectoralis major flap reconstruction resulted in a more inferior swallowing function than the free flap reconstruction. Conclusions With comparable complications and functional outcomes, while decreasing in costs, pedicled flaps are a useful alternative to free flaps in oral cavity cancer reconstruction. However, in an extensive defect (> 70 cm²), free flaps are the reconstruction of choice for the preservation of swallowing function. Received: 06 October 2020 Accepted: 04 August 2021 Article published online: 11 July 2022 © 2022. Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) Thieme Revinter Publicações Ltda. Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

Background: Hypocalcemia is the most common complication following total thyroidectomy. This study aimed to evaluate the efficacy of perioperative combined calcium and vitamin D supplementation compared to postoperative combined calcium and vitamin D supplementation in reducing symptomatic hypocalcemia. Materials and methods: A prospective randomized placebo-controlled trial was carried out in patients undergoing total or completion thyroidectomy from June 2017 to May 2022. Eligible patients were assigned to receive either calcium carbonate and alfacalcidol or placebo 3 days before surgery, and both groups were given calcium carbonate and alfacalcidol for 14 days after surgery. Clinical outcomes (signs and symptoms of hypocalcemia, requirement of intravenous calcium, and medication-induced hypercalcemia) and laboratory results (calcium and parathyroid hormone levels) were compared between the two groups. Results: One hundred and thirty-four patients were included in the analysis, 68 were in perioperative oral calcium and vitamin D supplementation group, and 66 were in postoperative oral calcium and vitamin D supplementation group. Symptomatic hypocalcemia rates were significantly lower in the perioperative group than in the postoperative group (8.8 and 22.7%, respectively, P=0.033). All symptomatic hypocalcemia cases in the perioperative group occurred in the first 24 hours after surgery. Mean calcium levels were significantly higher in the perioperative group at 24 and 48 hours after surgery. Intravenous calcium requirement rate was lower in the perioperative group but the difference was insignificant (2.9 and 12.1%, P=0.053). Mean parathyroid hormone levels were within the normal range and did not differ between groups. No medication-induced hypercalcemia was detected in either group. Conclusion: Perioperative oral calcium and vitamin D supplementation significantly decreased the risks of symptomatic and biochemical hypocalcemia compared to postoperative oral calcium and vitamin D supplementation. The perioperative supplementation also shortened the recovery period of symptomatic hypocalcemia to within 24 hours.

Introduction: Epidermoid and dermoid cysts in the floor of the mouth are uncommon. A large cyst can lead to functional morbidities including airway, swallowing and speech problems. The treatment of choice is surgical excision. To obtain a good result, the decision for optimal surgical technique is valuable. Case presentation: A young female patient presented with a slowly growing mass at the submandibular area and swelling in the floor of mouth. The MRI showed large sublingual cyst extended posteriorly to the parapharyngeal space. She underwent surgical excision of the cyst size 6.5 × 3.2 × 2.5 cm via an intraoral approach. The pathological examination revealed a benign stratified squamous epithelium-lined cyst with no evidence of adnexal structure consistent with an epidermoid cyst. The patient remained disease-free after two years of follow-up. Discussion: Generally, large sublingual cysts over 6 cm located or transgress below the mylohyoid muscle are removed by an extraoral approach. Our team reported the first case of a large lateral sublingual epidermoid cyst with parapharyngeal extension removed by an intraoral approach. Preoperative imaging is important for surgical approach selection. Conclusion: Successful management of sublingual epidermoid cyst extended to the parapharynx is feasible by an intraoral approach with excellent functional and cosmetic outcomes. Highlights:

This study aimed to evaluate the survival outcomes of surgically treated oral squamous cell carcinoma (OSCC) patients with or without adjuvant therapies and factors predicting treatment outcomes from the largest head and neck cancer center in Northern Thailand. Two hundred and sixty OSCC patients curatively treated between 2017 and 2021 were retrospectively recruited into the study to analyze the clinicopathological characteristics and oncological outcomes and compare them with historical data. A multivariate Cox proportional hazards model analysis was performed to evaluate factors affecting survival outcomes. Males were slightly predominant (58.1 %). The most common subsite was an oral tongue (48.5 %), followed by an alveolar ridge (18.5 %). Advanced stages (III-IV) presented most at 88.5 %. The majority of the patients (52.3 %) received surgery and chemoradiotherapy, followed by surgery and radiotherapy (36.9 %), and surgery alone (10.8 %). The five-year overall survival (OS), disease-specific survival, and disease-free survival were 28.8 %, 44.0 %, and 46.3 %, respectively. Age > 45, ECOG performance status 2, and positive surgical margin status were found to be independent predictors for decreased OS (aHR 1.74, 95 % CI 1.01-3.00, aHR 2.64, 95 % CI 1.22-5.68, and aHR 1.76, 95 % CI 1.18-2.63, respectively). Survival outcomes of OSCC in the study remain poor compared to other studies. The high prevalence of locally advanced stage presentation and inadequate surgical margin are the main problems. Public awareness, cancer screening programs, and intraoperative specimen-driven evaluation might help obtain adequate surgical margins and improve survival outcomes.

Background: Kimura’s disease is a rare inflammatory disease that usually appears in head and neck region. We reported natural history of the disease and treatment outcome of radiotherapy (RT) in Chiang Mai University Hospital. Methods: A retrospective review was performed for all Kimura’s disease patients treated with radiotherapy at our center between 2002 and 2017. Results: A total of 20 patients with Kimura’s disease were reviewed. There were 14 men and 6 women. All patients presented with the mass in head and neck region. Eleven patients were treated with a definitive intent with RT, 9 patients were treated with RT after recurrence from other modalities. All patients were treated with local external beam RT with 2 Gy per fraction to a median total dose of 30 Gy (range 30–40). The median follow-up time was 4 years (range 1–16.5 years). One patient died from HIV opportunistic infection after 1.5 year of radiation with complete response of Kimura’s disease. Most of the patients responded to radiotherapy and controlled the disease at the time of analysis. Two patients had multiple recurrences at new areas outside radiotherapy field. Skin toxicity grade 1 was the most common late side effect which was found in 8 (44%) patients. We did not find severe late toxicity or second malignancy in this patient cohort. Conclusion: Good local control of Kimura’s disease can be achieved, with a radiation dose of 30–40 Gy, with insignificant late toxicities. We suggest that radiotherapy should be one of the treatments of choice for Kimura’s disease both in primary or recurrence setting.

Background: Overexpression of excision repair cross-complementing Group 1 (ERCC-1) is related to cisplatin resistance and defective repair of radiation damage. The purpose of this study was to evaluate the clinical significance of excision (ERCC-1) expression in nasopharyngeal cancer (NPC). Materials and Methods: We conducted a retrospective review of patients diagnosed with NPC between 2000 and 2013. The archived tissues were analyzed using immunohistochemistry to determine ERCC-1 expression. The ERCC-1 expression level along with other clinical factors and overall survival (OS) were analyzed. Hazard ratio (HR) with a 95% confidence interval was calculated to assess the risk. Results: The analysis of ERCC-1 expression was available in 262 NPC patients who had medical records at our hospital. Among those patients, 221 (84%) were treated with curative radiotherapy (RT)/concurrent chemoradiotherapy, 22 (7%) were treated with palliative RT alone, and 19 (9%) were given best supportive care. There was no correlation between ERCC-1 expression and stage of cancer or OS. No difference in 5-year OS was found between patients with low ERCC-1 expression and high ERCC-1 expression (38% vs. 36%; P = 0.981). The adjusted HR (aHR) of cancer death increased with cancer stage (aHR = 2.93 for advanced Stages III–IV; P = 0.001) and age (aHR = 2.11 for age >55; P ≤ 0.001). ERCC-1 expression exhibited no prognostic significance in our study (aHR = 1). Conclusion: In this study, ERCC-1 expression has no statistical significance to be considered a prognostic factor for OS among NPC patients. On the other hand, cancer stage, age, and types of treatment can be prognostic factors in NPC patients.