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Introduction. The reconstruction of complex cervicofacial defects arising from surgical treatment for cancer is a real challenge for head and neck surgeons, especially in salvage reconstruction surgery and/or failed previous reconstruction. The pectoralis major myocutaneous flap (PMMF) has been widely used in these specific situations due to its reliability and low rate of failure or complications. Objectives. Identify factors that determine complications and influence the final outcome of the reconstructions with PMMF in salvage cancer surgery or in salvage reconstruction. Methods. A cross-sectional study design was used to evaluate a sample including 17 surgical patients treated over a period of ten years that met the inclusion criteria. Results. Reconstruction was successful in 13 cases (76.5%), with two cases of partial flap loss and no case of total loss. Complications occurred in 13 cases (76.5%) and were specifically related to the flap in nine instances (52.9%). An association was identified between the development of major complications and reconstruction of the hypopharynx (P=0.013) as well as in patients submitted to surgery in association with radiation therapy as a previous cancer treatment (P=0.002). The former condition is also associated with major reconstruction failure (P=0.018). An even lower incidence of major complications was noted in patients under the age of 53 (P=0.044). Conclusion. Older patients, with hypopharyngeal defects and submitted to previous surgery plus radiation therapy, presented a higher risk of complications and reconstruction failure with PMMF.

The search for a specific marker that could help to distinguish between differentiated thyroid carcinoma and benign lesions remains elusive in clinical practice. Heparanase (HPSE) is an endo-beta-glucoronidase implicated in the process of tumor invasion, and the heparanase-2 (HPSE2) modulates HPSE activity. The aim of this study was to evaluate the role of heparanases in the development and differential diagnosis of follicular pattern thyroid lesions. HPSE and HPSE2 expression by qRT-PCR, immunohistochemistry evaluation, western blot analysis and HPSE enzymatic activity were evaluated. The expression of heparanases by qRT-PCR showed an increase of HPSE2 in thyroid carcinoma (P = 0.001). HPSE activity was found to be higher in the malignant neoplasms than in the benign tumors (P<0.0001). On Western blot analysis, HPSE2 isoforms were detected only in malignant tumors. The immunohistochemical assay allowed us to establish a distinct pattern for malignant and benign tumors. Carcinomas showed a typical combination of positive labeling for neoplastic cells and negative immunostaining in colloid, when compared to benign tumors (P<0.0001). The proposed diagnostic test presents sensitivity and negative predictive value of around 100%, showing itself to be an accurate test for distinguishing between malignant and benign lesions. This study shows, for the first time, a distinct profile of HPSE expression in thyroid carcinoma suggesting its role in carcinogenesis.

Objectives: In this report we aim to describe the surgical technique required to utilize the pedicled temporoparietal galeal flap for repair of selected intraoral defects and to report our experience with this type of reconstructive procedure. Methods: The charts of 6 consecutive patients submitted to reconstruction of intraoral defects using the pedicled temporoparietal galeal flap were reviewed. All of the defects were located in the posterior oral cavity and oropharynx. After resection of the oral cancer, the temporoparietal galeal flap, based on the superficial temporal vessels, was raised and transposed to the mouth through a tunnel under the zygomatic arch. The oral defect was repaired, and no skin graft was applied over the flap. Results: There were no flap losses, and the reconstructive goal was achieved in all cases. The patients' deglutition and phonation abilities were restored, and the donor site scars were well hidden by hair growth. Conclusions: The pedicled temporoparietal galeal flap is another option for selected cases of reconstruction of intraoral defects — Mainly those located in the posterior oral cavity and oropharynx, in which thin and pliable tissues are usually required.

The aim of this paper was to determine if the subclavicular route of rotation improved the pectoralis major myocutaneous flap’s ability to reach head and neck sites in comparison to the traditional supraclavicular rotation. We dissected 50 flaps in 25 fresh adult male cadavers. The length of the pedicle and the flap’s ability to reach five anatomical head and neck sites (laryngeal prominence of thyroid cartilage, mentum, angle of the mandible, external auditory canal, and orbit) were tested by supraclavicular and subclavicular rotation. Although the average length of the flap’s pedicle was higher when the subclavicular rotation was employed, there was no statistical difference between the two techniques concerning the flap’s ability to reach the studied sites. Our results suggest that the subclavicular route apparently adds little to the reconstruction of head and neck defects using the pectoralis major myocutaneous flap. We believe that the indication of this technique should be evaluated on a case-by-case basis before it is recommended to keep from unnecessarily increasing the potential morbidity of the reparative procedure.

The overexpression of macrophage migration inhibitory factor (MIF) has been identified in a variety of tumors and the investigation of its molecular mechanisms in tumor progression is a key topic of research. The present study aimed to investigate MIF as a potential marker for disease control or recurrence, and to assess the association between serum and salivary MIF and the clinicopathological characteristics of patients with oral squamous cell carcinoma (OSCC). Serum and salivary samples were collected prior to and following the surgical treatment of 50 patients with OSCC. MIF concentrations were assessed by enzyme-linked immunosorbent assay and the adopted level of statistical significance was P<0.05. The results revealed that serum MIF concentrations were significantly reduced following tumor resection in OSCC patients. Furthermore, higher preoperative salivary MIF concentrations were observed in patients with larger tumors and in those who succumbed to the disease. In conclusion, high salivary and serological MIF concentrations were identified in patients with OSCC. Nevertheless, only serological MIF concentrations may be considered as a potential marker for the early detection of OSCC recurrence once the salivary levels, prior and following treatment, do not show any significant differences.

We describe an unusual technique for performing delayed pharyngoesophageal reconstruction following circumferential pharyngolaryngectomy. The patient was a 52-year-old man who underwent a circumferential pharyngolaryngectomy for the treatment of hypopharyngeal carcinoma. In view of the patient's poor clinical status, we opted to perform a pharyngostomy and an esophagostomy and to postpone pharyngoesophageal reconstruction for a more appropriate occasion. After the patient's clinical condition had sufficiently improved, the repair was planned. Microsurgical flaps were contraindicated because the blood flow through the cervical vessels was unreliable. Pharyngoesophageal continuity was restored with a cervical flap vascularized by the prevertebral fascia, a pectoralis major myocutaneous flap, and a deltopectoralis flap. A reasonable degree of deglutition was achieved, and no signs of stricture were detected. Although our technique was unusual, we believed that it might provide a valid alternative when a delayed pharyngoesophageal reconstruction is required and free flaps are contraindicated for any reason.