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Cervicofacial Transposition Flaps

Introduction Historically, regional flaps from the cervicofacial region have played a key role in the reconstruction of defects in the head and neck. A regional flap is a vascularized tissue flap that is pedicled on an axial blood supply and is not immediately adjacent to the defect area that requires reconstruction. Since the introduction of this technique in the 1960s, the possibility of reliably transposing large…

Pectoralis Major Musculocutaneous Flaps in Head and Neck Surgery

Introduction Regional flaps play an important role in reconstructive surgery of the head and neck. Introduced in 1979, the pectoralis major musculocutaneous flap was an important improvement over the deltopectoral flap and multistage tissue transfers that had dominated the reconstruction attempts previously. This flap allowed effective and more reliable single-stage tissue transfer for reconstruction of complex defects of the neck and face, upper aerodigestive tract, and…

Deltopectoral Flap

Introduction The deltopectoral flap (DP), introduced by Bakamjian in 1965, dramatically changed how defects in the head and neck were reconstructed. For instance, reconstruction following total laryngopharyngectomy was accomplished using a combination of local skin flaps (Wookey procedure); delayed pedicle flaps from the back, chest, or abdomen; or split-thickness skin grafts fashioned over a stent. These procedures frequently failed as a result of poor skin graft…

Temporalis Muscle Transposition

Introduction The pedicled temporalis muscle flap is a very versatile, local, axial flap with many uses in craniofacial reconstruction (e.g., orbital cavity augmentation following exenteration, coverage of a temporal/subtemporal calvarial defect, maxillectomy augmentation, hemipalatectomy reconstruction, and mastoid/temporal defect reconstruction). As a moderately bulky flap with a good range of rotation, it allows for the reliable reconstruction of a variety of sites. In particular, it is the…

Temporoparietal Fascial Flap

Introduction In general, the temporoparietal fascia is a poorly recognized, but highly useful, layer of tissue that invests the lateral scalp overlying and extending beyond the surface area of the underlying temporalis muscle. Skill in recognizing and elevating the temporoparietal fascia is important in both skull base exposures such as the infratemporal fossa approach and in reconstructive procedures that use the temporoparietal fascia as a pedicled…

Pericranial Scalp Flap

Introduction Surgical extirpation and reconstruction represent the shared common core goals in both open and endoscopic anterior skull base surgery. Successful operative intervention requires thoughtful planning in the context of the patient’s anatomy, pathology, and comorbidities. It is important to realize that the goals for the treatment of benign processes differ from those of malignant processes. Although gross total resection is always favored, surgical decompression with…

Paramedian Forehead Flaps

Introduction The origin of forehead flaps dates back thousands of years. Practitioners in ancient India were the first known to harvest skin from the forehead to repair facial defects, mainly of the nose. Due to nasal amputation as a common form of judicial and political punishment at the time, there was ample opportunity for the practice of reconstruction using forehead skin. Interestingly, the practitioners of the…

Scalp Reconstruction : Role of Tissue Expansion and Flap Reconstruction

Introduction Scalp defects can occur secondary to trauma, tumor resection, infection, radiation, and congenital abnormalities. Strategies for scalp reconstruction must take into account the size of the defect, its characteristics, quality of surrounding tissue, donor site morbidity, timing of the adjuvant treatments, and patient-related variables. The reconstructive process may target skeletal and tissue defects. Staged revisional operations are commonly indicated in order to optimize aesthetic outcomes.…

Nasal Reconstruction

Introduction The nose is of critical aesthetic and functional significance. Mastery of nasal reconstruction requires not only a knowledge of flaps and grafts but also an appreciation of facial aesthetics and functional rhinoplasty. A skin graft or local flap will close most nasal defects, but without a comprehensive evaluation of the nasal defect and of anticipated reconstructive outcome, the reestablishment of facial balance and nasal breathing…

Microvascular Reconstruction of the Head and Neck

Introduction Free tissue transfer offers a well-accepted, superior ability to restore form and function to certain major defects of the head and neck. Microvascular surgery provides distinct advantages for reconstruction of osseous defects of the mandible, large glossectomy defects, total or near-total pharyngeal defects, and complex defects of the midface and skull base. Theoretically, any tissue with a defined vascular circuit (i.e., perforator) can be transferred…

Management of Skin Cancer of the Head and Neck

Introduction Cancer of the skin is the most common form of cancer in humans. The incidence of skin cancer is greater than that of all other forms of cancer combined and is increasing more rapidly than any other, largely because of an aging population and an increased exposure to ultraviolet radiation. Skin cancer is most common in the 60- to 80-year-old age group, and as our…

Cosmetic Botox and Fillers

Introduction Aesthetic procedures have gradually become more mainstream and popular over the past 15 years, largely led by the significant increase in minimally invasive procedures since the US Food and Drug Administration (FDA) approval of Botox Cosmetic treatment for glabellar rhytids in 2002. In 2014, more than 15.6 million cosmetic procedures were performed, of which 13.9 million were minimally and noninvasive procedures (ASPS 2014 statistics). Of…

Facial Resurfacing: Peels and Lasers

Introduction Facial resurfacing with chemical peels and lasers is indicated for patients with photoaged skin. Photoaging is a term used to describe the changes that occur within the skin with aging and ultraviolet (UV) exposure, such as skin dullness due to loss of skin turnover and subsequent thickening of the stratum corneum, loss of elasticity due to breakdown of collagen and elastin, and pigmentary changes due…

Face lift

Introduction Much has been written about the aging face. The face lift procedure (rhytidectomy) is a critical component in addressing the issues of volume loss, sagging tissues, deep rhytids, jowling, and skin stretching. There are numerous trademarked names and even more nontrademarked names including “Vampire Lift,” “Weekend Face lift,” “Advanced Lift,” “Quick Face lift,” mid face lift, deep plane face lift, “Swift Lift,” “Liquid Face lift,”…

Brow Lift

Introduction The brow lift procedure is a rewarding one to master. It allows for both functional and cosmetic concerns to be addressed, resulting in above average patient satisfaction. One of the earliest signs of aging is brow ptosis coupled with an accumulation of redundant tissues in the glabella region and forehead rhytids. A combination of sun exposure and time induced facial skin laxity allow brow tissue…

Blepharoplasty

Introduction As our population continues to grow older, society’s emphasis on a more youthful appearance continues to increase and has led to rising interest in reversing the visible signs of aging. The periorbital region is one of the first areas of the face to show signs of aging. Correction of this imperfection can significantly “turn back the clock” of aging and has thus led to the…

Rhinoplasty and Surgery of the Nasal Valve

Introduction Rhinoplasty includes functional, cosmetic, and reconstructive surgery to address the function and appearance of the nose. Functionally, the airway begins at the nostril, and issues such as static or dynamic collapse (collapse on inspiration) may present at the level of the external or internal nasal valve. The nose is the central facial aesthetic unit that is divided into nine subunits, and its structure has a…

Orbital Exenteration

Introduction The radical surgery of orbital exenteration is occasionally necessary in the management of cancer of the head and neck. For the Otolaryngologist, it will most frequently be due to the spread of a malignant tumor from the adjacent paranasal sinuses or the skull base. Some cancers arising in the skin will also require total or subtotal removal of the orbital contents. Invasive fungal infections are…

Lateral Canthotomy

Introduction The lateral canthotomy coupled with an inferior cantholysis is often the first step in many eyelid and orbital procedures. The detachment of the inferior crus of the lateral canthal tendon allows for greater horizontal laxity of the lower eyelid. It is commonly used in lower eyelid reconstruction techniques (i.e., semicircular advancement flap), inferior or lateral orbitotomies for greater exposure, or in eyelid tightening procedures such…

Orbital Abscess

Introduction Subperiosteal orbital abscess (SPOA) is a well-defined complication of bacterial ethmoid sinusitis with potential vision and life-threatening sequelae. In fact, the most common cause of orbital cellulitis is sinusitis, especially of the ethmoid sinuses. The severity of these potential outcomes emphasizes the importance of rapid clinical identification, risk stratification, and treatment. During the second half of the 20th century, these sequelae prompted surgical drainage of…