The aim of this retrospective study is to review the experience of our institution in performing microvascular head and neck reconstruction between 2000 and 2004. During this period, 213 free flaps, including 146 radial forearm free flaps, 60 fibular flaps and 7 scapular flaps, were performed. Free flap success rate and complications were reported. The pre-treatment factors influencing these results were subsequently analyzed. Functional and aesthetic outcomes were evaluated by the same clinician. There were 14 free flap failures, giving an overall free flap success rate of 93.4%. Salvage surgery for recurrent cancer was the only factor correlated with a higher risk of free flap failure (P = 0.0004). The local complication rate was 20.9%. High level of comorbidity (P = 0.009), salvage surgery for recurrent cancer (P = 0.03) and hypopharyngeal surgery (P = 0.002) were associated with a higher risk of local complications. An unrestricted oral diet and an intelligible speech were recovered by respectively 76 and 88% of the patients. Microvascular free flaps represent an essential and reliable technique for head neck reconstruction and allow satisfactory functional results.

Despite some functional impairments, global QOL was preserved after major head and neck ablative surgery and microvascular free-flap reconstruction.

We present the results of a study on the value of ultrasound in the detection of metastasis to the cervical lymph nodes in connection with cancer of the ear, nose, and throat. Comparison of clinical, ultrasound, and histological findings for 100 patients who underwent surgery revealed that clinical examination had a sensitivity of 78% versus 92.6% for ultrasound. All 18 cases of thrombosis of the internal jugular vein were detected by ultrasound. Clinical staging of the disease was modified in 28 of these patients based on ultrasound findings, including three false positive findings. Ultrasonographic follow-up at three months for a second group of 110 patients who did not undergo neck dissection provided prognostic information, since lesion stability or progression was correlated with death in less than one year in 41 of 43 patients. Ultrasound is of primary value in providing information of an anatomic nature, including the detection of subclinical lymph nodes, volumetric evaluation, and determination of vascular connections, particularly detection of internal jugular venous thrombosis. Furthermore, for patients whose necks have been thickened as a result of radiotherapy, ultrasound allows assessment of local status.

Free-flap reconstruction of the head and neck is safe and reliable in the elderly. Nevertheless, meticulous patient selection, mainly based on the level of comorbidity, is necessary.

BACKGROUND.Scarce data exist concerning the outcome of very elderly patients with head and neck squamous cell carcinoma (HNSCC).METHODS.The clinical files of 316 patients aged ≥80 years with HNSCC who were included in the authors' hospital database between 1987 and 2006 were reviewed retrospectively.RESULTS.Approximately 88% of patients received locoregional treatment, 31% of patients underwent surgery, and 57% of patients received definitive radiotherapy. The median disease‐specific survival (DSS) was 21.3 months, and a plateau was observed after 5 years. The median overall survival (OS) was 13.0 months. Both the median DSS and the median OS were longer for patients with stage I/II HNSCC than for patients with stage III/IV HNSCC (median DSS, not reached vs 11.4 months; P < .001; median OS, 41.9 months vs 7.9 months; P < .001). On multivariate analysis, stage I/II disease, treatment with curative intent, and evidence of locoregional control were independent predictors of improved survival.CONCLUSIONS.The outcome of patients with stage I/II HNSCC aged ≥80 years was similar to that of younger patients, and the current results indicated that age should not be used to deny them optimal treatment. Elderly patients with stage III/IV HNSCC had poor survival. Geriatric tools should be used to identify elderly patients who are eligible for optimal locoregional treatment. Cancer 2008. © 2008 American Cancer Society.