Foster Paul K, Weed Donald T
Department of Otolaryngology, University of Miami School of Medicine, 1475 NW 12th Ave. #4037, Miami, FL 33136, USA.
Ear Nose Throat J. 2003 Sep;82(9):720-2, 724.
A 73-year-old man came to us with a second primary tumor of the tongue base. He had undergone a total laryngectomy, neck dissections, and radiation for squamous cell carcinoma of the glottis 25 years earlier. Surgery was performed, including a subtotal tongue-base resection and pectoralis myocutaneous flap reconstruction. Intraoperative findings confirmed tumor involvement of the left lingual artery and hypoglossal nerve, both of which were sacrificed. Dissection revealed an intact but apparently thrombosed right lingual artery, and this was verified by intraoperative Doppler evaluation. Postoperatively, the preserved oral tongue remained well perfused and viable, and tongue mobility was good. In patients who have undergone previous head and neck cancer resections, collateral blood supply to the tongue might develop if the flow of one or both of the lingual arteries is interrupted. This possibility can be fully evaluated by preoperative angiography, which might offer these patients the potential for tongue preservation.
一名73岁男性因舌根第二原发性肿瘤前来就诊。25年前，他因声门鳞状细胞癌接受了全喉切除术、颈部淋巴结清扫术及放疗。此次进行了手术，包括次全舌根切除术和胸大肌肌皮瓣重建术。术中发现证实肿瘤累及左舌动脉和舌下神经，二者均被切除。解剖显示右侧舌动脉完整但明显血栓形成，术中多普勒评估证实了这一点。术后，保留的口腔舌部血运良好且存活，舌活动度良好。在既往接受过头颈部癌切除术的患者中，如果一条或两条舌动脉血流中断，舌部可能会形成侧支血供。术前血管造影可充分评估这种可能性，这可能为这些患者保留舌部提供可能。
