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Cheek Reconstruction

Acknowledgments The authors would like to thank Associate Professor Michael Leung in the preparation of this chapter. Introduction Defects of the cheek pose a challenge for the reconstructive surgeon. It is a mostly flat and relatively featureless terrain whose superficial appearance conceals a complex arrangement of fascia, arteries, and nerves. Its esthetic significance is associated with its contour, the preservation of which should be a priority…

Reconstruction of the Skull Base

Introduction The skull base is a complex anatomic region through which the major blood vessels of the head and neck, cranial nerves, and spinal cord pass. A variety of congenital malformations and neoplasms can involve the skull base. As surgical techniques, instrumentation, and imaging technology have improved over recent years, many skull base lesions can now safely be resected using an endonasal approach, thus minimizing morbidity…

Pharyngeal Reconstruction

Introduction The upper aerodigestive (UAD) tract is an intricate maze of alleyways, muscular tubes, and cords that allows humans to have a common functional pathway for oral intake and breathing, as well as harmonizing vibrations into speech. Articulation of speech is dependent on the symphony of functions of these passages, influenced by the larynx, epiglottis, pharyngeal walls, soft and hard palate, the tongue musculature, salivation, lip…

Midface Reconstruction

Introduction Reconstruction of the midface, particularly of the maxilla, following tumor removal is a significant challenge because of its complex three-dimensional architecture and important role in facial esthetics and function. The goals of reconstruction include: (1) maintaining midfacial height, width, and projection; (2) creating a stable platform for mastication and dental restoration; (3) separating the oral cavity from the nasal cavity; (4) preserving a patent nasal…

Oral Tongue and Mandibular Reconstruction

Introduction The oral tongue and mandible act as an inseparable functional unit of the lower face. Embryologically, tongue, mandible, and muscles of mastication share a common origin from the first branchial arch (BR). There is an interdependent developmental relationship between tongue and mandible, and the architectural malposition of one can lead to deformity of the other. The classic example is Pierre Robin Sequence, the syndromic condition…

Head and Neck Malignancies

Introduction Head and neck cancers are the sixth most common group of malignancies worldwide. In the United States, the estimated incidence is 65,000 new cases per year, which are most commonly diagnosed among adults older than 50 years of age. Geographic variations in the incidence and mortality rates of head and neck cancers are related to differences in patterns of exposure and behavior. Well-known risk factors…

Facial Reanimation

For videos accompanying this chapter see ExpertConsult.com . See inside cover for access details. Introduction Facial paralysis presents a complex challenge to the reconstructive surgeon. Since Sir Charles Bell first described the course of the facial nerve in 1821, our understanding has led to the development of the vast array of surgical options used to treat patients with facial paralysis. Sir Harold Gillies stated in 1919…

Orthognathic Surgery and Genioplasty

Orthognathic Surgery History The term “orthognathic” stems from the Greek words ortho , which is to straighten, and gnathic , which describes the jaw. Orthognathic surgery is a subspecialty practiced by numerous disciplines, including oral and maxillofacial, plastic and reconstructive, and ear, nose, and throat surgeons. It is defined as osteotomies performed to the midface and mandible to reposition the tooth-bearing bony segments. The concept of…

Craniosynostosis

History Hippocrates provided the first description of what is now called craniosynostosis in 100 BC and noted the variation of skull deformities and correlated it with the pattern of cranial suture involvement. There are many historical descriptions of people with unusual head shapes. The Greek statesman and General Pericles had an unusually long, narrow head shape and was nicknamed “Squill head,” and he might have had…

Rare Craniofacial Clefts

Craniofacial clefts include a complex and heterogenous group of deformities that affect the face, causing significant functional and appearance-related issues for affected patients. The term “rare” craniofacial cleft is used to differentiate them from the more “typical” clefts of the lip and palate. Fortunately, atypical facial clefts are exceptionally rare, with a reported incidence of 1.4–4.9 for every 100,000 births. Etiology Two theories predominate in establishing…

Congenital Ear Anomalies

For video accompanying this chapter see ExpertConsult.com . See inside cover for access details. Ear Development The intricate contours of the external ear are attributed to delicate elastic cartilage covered with a thin layer of subcutaneous tissue and skin. The ear develops around the first branchial cleft, which is the groove between the first (mandibular) and second (hyoid) pharyngeal arches. Auricular development begins during the fifth…

Cleft Palate and Velopharyngeal Dysfunction

For video accompanying this chapter see ExpertConsult.com . See inside cover for access details. Embryology The primary and secondary palates arise from the frontonasal process and palatal processes of the maxilla, respectively, separated by the incisive foramen. From the incisive foramen, fusion of these processes occurs, progressing anteriorly during weeks 5–6 for the primary palate and posteriorly in weeks 7–8 for the secondary palate. Aberration of…

Cleft Lip

For videos accompanying this chapter see ExpertConsult.com . See inside cover for access details. Embryology Between the 4th and 7th weeks of gestation, the two medial nasal prominences of the frontonasal process fuse to form the intermaxillary segment ( Fig. 16.1 ), consisting of premaxilla and prolabium. In addition, the two maxillary prominences merge, from which the lateral lip and maxillary arch elements arise. By week…

Vascular Anomalies

Introduction Vascular anomalies are disorders of the endothelium, which can be subclassified into vascular tumors and vascular malformations, distinguished by proliferating endothelium and quiescent endothelium, respectively ( Table 15.1 ). Vascular anomalies can present in individuals of any age and due to their varied subtypes and morphologies, patients present to clinicians in a wide variety of clinical specialties. These lesions often require significant diagnostic expertise and…

Congenital Melanocytic Nevi

Incidence of Phenotypic Classification Congenital melanocytic nevi (CMN) are present at birth, or very occasionally arise in the first few years of life; tardive CMN. These lesions grow commensurate with the child, but tardive lesions can appear to grow more rapidly as the full extent of the CMN is often not initially apparent. The incidence ranges from 1% for small single CMN to approximately 1 in…

Burns: Acute Care and Reconstruction

Introduction Burns can be a devastating injury that is nondiscriminatory, affecting individuals of all ages, races, and socioeconomic backgrounds. In the United States the incidence of burn injuries continues to rise, with approximately half a million individuals requiring medical therapy, 40,000 hospital admissions, and more than 3000 deaths annually. The sequelae of burn injuries place a heavy financial burden on the national economy. As critical care…

Radiation Therapy and Soft Tissue Response

Radiation Principles Radiotherapy is the medical use of ionizing radiation, generally as part of cancer treatment to control or kill malignant cells. Ionizing radiation is composed of particles that individually carry enough kinetic energy to liberate an electron from an atom or molecule. Directly ionizing radiation consists of alpha and beta particles. Indirectly ionizing radiation includes photon radiation which may be gamma radiation if produced by…

Vascularized Composite Allotransplantation

“Losses must be replaced in kind.” Sir Harold Gillies Historical Background Advances in regenerative medicine have opened a new era and enabled reconstruction of devastating soft and bony tissue defects due to trauma, congenital deformities, and neoplastic conditions. Among the most promising advances within the realm of regenerative and restorative surgery is vascularized composite allotransplantation (VCA), which now allows for the reconstruction of defects that previously…

Atypical Skin Lesions

Introduction The atypical skin lesions are a diverse group of tumors that are uncommon but clinically important. They include a spectrum from benign lesions through to those that demonstrate local invasion and/or distant metastatic potential. Since these lesions are only seen infrequently during clinical practice, it is important to know the patterns associated with the more malignant of these tumors, how they may be discerned from…

Nonmelanoma Skin Cancer

Introduction Nonmelanoma skin cancer (NMSC) is the most common malignancy amongst Caucasians and occurs sporadically in all other populations. NMSCs are comprised predominantly of basal cell (BCC) and squamous cell (SCC) carcinoma, among other rarer types of cutaneous malignancy. UV radiation exposure initiates approximately 90% of NMSCs, resulting in malignant transformation of keratinocytes. Despite improvements in public awareness and warnings of the harmful effects of excessive…