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Adenoidectomy

Introduction The adenoid is a part of the Waldeyer’s ring of lymphoid tissue, which consists of palatine tonsil, adenoid or pharyngeal tonsil, tubal (eustachian) tonsil, and lateral pharyngeal band. The adenoid is a single, lobulated lymphoid tissue located on the roof of the nasopharynx. The entire nasopharynx is lined by respiratory epithelium, which covers the adenoid and the eustachian tube to the tympanic cavity. There are…

Midline Nasal Masses

Introduction Midline nasal masses and nasolacrimal duct cysts (NLDC) are pathologies that afflict infants and children. The pathophysiology of the midline nasal masses and NLDC is distinct, and the treatment of each of them is just as distinct. When a child presents with a mass near or within the nose, congenital nasal masses and NLDC are in the differential diagnosis. NLDC are intranasal cysts occurring in…

Choanal Atresia/Pyriform Aperture Stenosis

Introduction Nasal obstruction in the neonate can lead to severe respiratory distress and failure to thrive if not properly identified and treated. Newborn infants are obligate nasal breathers; therefore, nasal airway obstruction has significant downstream effects. Cyclic apnea, cyanosis, and respiratory distress temporarily relieved by crying should elicit a high index of suspicion for nasal airway obstruction. In the neonate, this can be caused by bilateral…

Osseointegrated Implants

Introduction The technique of osseointegration was introduced by Per-Ingvar Branemark in the 1980s. The definition of osseointegration as defined by Zarb and Alberktsson is “a time dependent healing process whereby clinically asymptomatic rigid fixation of specifically designed alloplastic materials is achieved and maintained during functional loading.” Dental implant therapy has provided an improvement in function and quality of life to replace missing teeth and other structures…

Fractures of the Orbit

Introduction Because the orbit is made up in part by two of the horizontal beams of facial structure and two of the vertical buttresses, orbital fractures are common, and proper repair of such fractures is critical to restoring normal facial appearance and function. Complicating evaluation and treatment are the vital and complex structures contained within the eye and optic nerve, extraocular muscles, and the lacrimal secretory…

Fractures of the Cranio-Orbital and Midfacial Skeleton

Introduction Injuries to the upper and middle facial skeleton occur regularly due to a variety of blunt and penetrating etiologies and often require operative intervention. Understanding the patterns of injury, diagnosis, treatment, and management of complications are important for any surgeon working in the craniomaxillofacial region to understand. Into this chapter I review the primary restoration of function and form of bony injuries to the cranio-orbital…

Fractures of the Mandible

Introduction There are numerous causes of mandibular fractures including assault, motor vehicle accidents, projectile missiles, and pathologic fractures. Multiple studies have shown motor vehicle accidents and interpersonal assaults as the leading causes for mandibular fractures. When a mandible fracture is suspected, careful evaluation of other injuries must be ruled out. A recent study reported a 64.8% association with life-threatening injury such as closed head injury, skull…

Nasal Fracture

Introduction The prominent, central position of the nose on the face makes it highly vulnerable to facial trauma. The nasal bones are the most commonly fractured facial bone and the third most common fracture in the human body. The most common cause of a nasal fracture is blunt trauma. When not promptly identified and treated, resultant nasal deformity and/or nasal airway obstruction may persist. Most fractures…

Mandibular Osteotomy Approaches

Introduction The mandibulotomy approach was first described by Roux in 1836. Dubner and Spiro, in 1959, developed the technique with paralingual extension, which is the origin of the modern mandibulotomy. Since then, several modifications to the technique have been described. However, the basic principle of the mandibulotomy still remains, which is to provide exposure and a surgical corridor to the oral cavity and oropharynx. The approach…

Segmental Mandibulectomy

Introduction Segmental mandibulectomy involves the removal of a full-thickness segment of the mandible, often secondary to a malignant or benign tumor, trauma, or osteoradionecrosis. Segmental mandibulectomy may be performed in the setting of a composite resection, a term coined by Ward and Robben in 1951. It was thought that cancer of the oral cavity had a propensity to spread via periosteal lymphatics to the mandible; thus…

Marginal Mandibulectomy

Introduction 1. The goal of surgical management of any cancer of the head and neck is to remove the cancer in its entirety and preserve form and function. Marginal mandibulectomy (MM) evolved as a surgical technique to obtain the margin around the tumor yet avoiding the cosmetic and functional complications of segmental mandibulectomy (SM). Crile first described the MM in 1923 as an incision that is…

Facial Reanimation

Introduction Rehabilitation of the patient with chronic facial paralysis must take into account the loss of form and function. When contemplating facial reanimation, the surgeon should consider all variables that might influence the choice of procedure, including the patient’s age, prognosis, pathology, the extent of paralysis and functional deficit, the current status of the nerve and the likelihood of spontaneous recovery, other neural deficits, comorbidities, and…

Eyelid Reanimation in Patients With Facial Paralysis

Introduction Prompt attention to the ophthalmic manifestations of facial nerve paralysis is crucial to the care of affected patients. Loss of facial nerve function causes numerous functional and cosmetic deficits in the periocular region. These include poor eyelid closure with an increased palpebral fissure height, lower eyelid ectropion causing limited lacrimal pump function, decreased meibomian gland function and rapid evaporation of tears, decreased lacrimation from loss…

Nerve Graft Techniques

Introduction Neural injury, repair, and subsequent recovery are widely studied, since these topics relate to the entire human body. There are few other regions of the body where impaired nerve function can be more devastating than in the head and neck. Peripheral cranial nerves contribute to our most personal attributes, such as speech, facial expression, and the complex neural coordination of deglutition. The technical aspects of…

Cranioplasty

Introduction Cranioplasty is the main reconstructive procedure in neurosurgery. Cranial defects can vary widely in size and etiology; they include traumatic, infectious, tumor, vascular, and iatrogenic defects. The majority of large defects created in modern neurosurgery are a result of decompression to relieve uncontrolled intracranial pressure (ICP) following trauma, stroke, or hemorrhage. Although decompressive craniectomy has been shown to decrease ICP and improve survival, the indications,…

Rib Graft

Introduction Rib graft is a useful adjunct for the reconstruction of the craniofacial skeleton and can be harvested in multiple forms to fit different situations. Rib graft may be harvested as a long, pliable bone graft. This is commonly used for mandibular reconstruction. It may also be used to reconstruct the bony buttresses of the face after trauma or tumor resection. Rib bone can be split…

Split Calvarial Graft

Introduction Calvarial graft may be the preferred bone graft for reconstruction of much of the craniofacial skeleton. Both cortical and cancellous bone can be harvested in relative abundance. Cortical calvarial bone graft is pliable, allowing for reconstruction of the complex three-dimensional contours of the facial skeleton. It is thin for orbital grafting and strong for recreation of the facial buttresses. These attributes make it ideal for…

Autologous Fascial Grafts and Acellular Allografts

Acknowledgment Case material kindly shared by Dr. Ernest K. Manders. Introduction Free fascial grafts and allogeneic options, such as acellular dermis like Alloderm, are available for use in various settings of head and neck reconstruction. There are many sources of these tissues including the fascia lata (FL), temporal fascia as well as those made from dermal sheets either autologous or “off the shelf” acellular versions. Not…

Skin Grafting

Introduction There are two basic types of skin grafts: full-thickness and split-thickness skin grafts (FTSGs and STSGs, respectively). Full-thickness grafts are composed of epidermis and full-thickness dermis, including adnexal structures, whereas split-thickness grafts are composed of epidermis and varying amounts of dermis without adnexal structures. Each type of graft has unique characteristics and indications for use in head and neck reconstruction. Although improved techniques with local…

Trapezius and Latissimus Dorsi Regional Flaps

Introduction Regional pedicle flaps for reconstruction of the head and neck are most commonly harvested from ventral body surfaces due to the favorable patient positioning, location close to the primary defect, and familiar anatomy. Flaps from the dorsal body surface are advantageous because they can provide significant tissue bulk for reconstruction and a multitude of tissue types including cutaneous, muscular, and osseous options. Additionally, in patients…