ObjectiveThis study compared the complications and functional outcomes of patients with oral tongue cancer who had undergone reconstruction using a submental island flap or a radial forearm free flap.MethodOf the 54 patients, 29 underwent reconstruction with a submental island flap and 25 patients with a radial forearm free flap. The complications and outcomes of speech and swallowing were evaluated.ResultsIn the submental island flap group, all the flaps were successfully transferred with no donor site complications. In the radial forearm free flap group, partial skin graft loss and arm function restriction were recorded. Mean operative time and duration of hospital stay were significantly shorter in the submental island flap group. Speech and swallowing function were comparable between the two groups. There was no significant difference in locoregional recurrence between the groups.ConclusionThe submental island flap is reliable and is suitable for oral tongue reconstruction. It has a lower complication incidence when compared to the radial forearm free flap, while maintaining speech and swallowing function.

Lingual abscess is a rare disorder, and current knowledge regarding clinical manifestations and treatment modalities has not been well established. This study presented 6 cases of lingual abscess patients between January 2012 and December 2017. There were three men and three women. Median age was 54 years. Odynophagia and local pain were the common presenting symptoms. Local trauma was the main predisposing factor of anterior abscess, while lingual tonsillitis or infected thyroglossal cyst was the predisposing factor of posterior abscess. An impending airway obstruction was identified in two patients, requiring tracheostomy. All patients achieved an excellent outcome with a combination of surgical drainage and proper antibiotics as well as using proper investigation for detecting unusual areas of lingual abscess. According to the data from the study's results and review of the relevant literature, an abscess located at the anterior two-thirds of the tongue is easy to diagnose while the posterior one-third of the tongue abscess is relative difficulty. Using contrast-enhanced computed tomography increases diagnostic accuracy, especially on the tongue base and deep space infection. The management strategies include (1) protecting the airway, (2) draining the abscess by needle aspiration or surgery, and (3) administering antibiotics early. Our series showed a superiority of surgical drainage when the patients present with marked tissue edema, deep loculated infection, and airway obstruction.

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The aim of this retrospective study, conducted by the Department of Otolaryngology, Chiang Mai University, Thailand, is to understand the clinical characteristics of patients with deep neck infection (DNI), especially in immunocompromised hosts, as well as to analyze the factors that influence multiple spaces' involvement and complications. The data collected (January 2004-July 2009) from 177 patients with DNI, excluding peritonsillar abscess, were reviewed, including demography, clinical presentation, etiology, involved fascial spaces, bacteriology, treatment, and complications. SPSS (15.0) was used to analyze the data. A p value of <0.05 was considered statistically significant. Among 177 DNI patients, there were 30 diabetic and 4 HIV infected patients, who were considered immunocompromised. Furthermore, two characteristics (complications and the Hb level) were statistically significant (p value <0.05) in the immunocompromised and immunocompetent groups. The 87 patients who presented with multiple space involvement were predicted by the level of white blood cell count (<5,000 or >12,000/μl) (OR 2.62; 95% CI 1.38-4.96) in univariate analysis. Complications were affected by both host immunity and abnormal Hb level (<10 or >15 g/dl), in univariate analysis, but Hb level was the only risk factor (OR 4.46; 95% CI 1.81-10.99) in multivariate analysis. Comorbidities such as diabetes mellitus and HIV infection required certain clinical assessment because of potential complications. In addition, blood tests (WBC and Hb levels) are the most important investigations necessary in patients suspected of having multiple space involvement and complications.

Nasopharyngeal tuberculosis (NPTB) is a noteworthy disease especially in its worldwide spread of the Mycobacterium infection. Although NPTB has been identified in less than one percent of TB cases, recent multiple case reports indicate an either increased awareness or incidence of this disease. The most helpful diagnostic tool is an uncomplicated nasopharyngeal biopsy. However, NPTB is usually ignored because it has varied clinical manifestations and similar presentations with other more common head and neck diseases. Furthermore, the most common presenting symptom is cervical lymphadenopathy mimicking nasopharyngeal carcinoma, a more common and serious disease. Treatment outcomes of NPTB are good in both HIV-positive or HIV-negative patients. In addition, pulmonary tuberculosis association was reported in wide range between 8.3% and 82% which should be considered in a treatment program. In conclusion, early diagnosis and management in NPTB can be achieved by (1) increased awareness of this disease, (2) improvement in knowledge regarding clinical manifestations, and (3) improvement of diagnostic techniques.

The pectoralis major flap in salvage total laryngectomy did not decrease the pharyngocutaneous fistula rate, and the incidence of flap-related complications was high. Appropriate surgical technique and post-operative care may reduce the incidence of pharyngocutaneous fistula.

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