Background Prophylactic surgical treatment of the neck in “early tongue tumors” is a controversial issue. Methods From a database of 226 patients with squamous cell carcinoma of the tongue treated at Canniesburn Hospital, Glasgow, U.K., between 1980 and 1996, a total of 137 patients with a minimum follow up of 24 months or until death were clinically identified as being T1/T2, N0 (UICC) when first seen. These patients were divided into three groups according to the management of the neck; 53 patients did not have a neck dissection at any time (NKD0), 47 patients underwent a synchronous neck dissection at the time of treatment of the primary (NKDS), and 37 patients subsequently required a metachronous neck dissection when lymph node metastasis became clinically apparent (NKDM). These three groups were compared with respect to age, sex, site, duration of symptoms, previous treatment (if any), initial treatment protocol, resection margin, type of neck dissection (if any), loco‐regional recurrence, systemic escape, number of positive lymph nodes, and presence of extracapsular spread. Disease‐related survival was calculated using Kaplan‐Meier survival curves with logrank test and chi‐square statistical analysis. Results The pT stage was upgraded to T3/4 in 3/53 patients (6%) of the NKD0 group, 11/47 patients (23%) of the NKDS group, and 2/37 patients (5%) of the NKDM group (p < 0.001). The 5‐year determinate survival rates for the three groups were: NKD0 59.7%, NKDS 80.5%, NKDM 44.8%, and (NKD0 + NKDM) 53.6% with a statistically significant improvement in survival for NKDS vs NKDM (logrank 10.58, p = 0.001) and for NKDS vs (NKD0 + NKDM) (logrank 6.06, p = 0.014). The incidences of positive nodes in the NKDS and NKDM groups were 18/47 patients (38%) and 32/37 patients (86%) respectively. Neck positive patients in the NKDM group had a significantly greater number of positive nodes in comparison with N positive patients in the NKDS group (chi trend, p = 0.001), a higher incidence of extracapsular spread, 30/32 vs 9/18 (chi test, p < 0.0001), and decreased survival. The incidence of occult cervical metastasis for the whole group was 41%. Conclusion Patients with clinical T1/2, N0 tongue tumors who underwent a synchronous neck dissection had an improved survival outcome even though as a group they had a higher incidence of occult metastasis, relatively more T2 lesions, a worse pT stage, and had more posterior third lesions requiring more difficult initial surgery. Tongue tumors have a high incidence of subclinical nodal disease, which is less curable when it presents clinically. The information gleaned from the nodal status allows a more informed plan of adjuvant therapy. © 1999 John Wiley & Sons, Inc. Head Neck 21: 517–525, 1999.

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Objective: Living donor liver transplantation is being increasingly carried out successfully in adults and children in many centers around the world. This multi tasked surgery is carried out by several teams of surgeons. The aim of this study is to present the results of hepatic artery reconstruction carried out by the Plastic and Reconstructive surgeons in the liver transplant surgery team at King Hussein Medical Center (KHMC). Methods:From June 2004 to October 2012 seventy five living donor liver transplant surgeries were carried out at KHMC for seventy four patients (one redo). There were 56 males and 18 females, with a mean age of 42 years (age range, 2-62 years). The mean body weight of these patients was 67.03 kg (range, 13-100kg). The hepatic artery in all patients was reconstructed using a classical end to end anastomosis using an 8/0 or 9/0 nylon suture under microscopic magnification by the same team of microsurgeons. We present our experience and show complications related to hepatic artery reconstruction. Results:The mean diameter of the graft's hepatic artery was 1.8 mm (Range 1.1-2.4mm), and the mean diameter of the recipient artery was 2.3mm (Range 1.3-3.2mm). Three of the recipients (4%) experienced early hepatic arterial thrombosis (HAT). In 16 occasions (21%) we had to redo the anastomosis of the hepatic artery due to inadequate flow. Conclusion:There is a learning curve during the progress of our program in living donor liver ransplants (LDLT). The results have significantly improved with better selection of the recipients, echnical refinements, and improvement in perioperative care. t t