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TRANSPOSITION FLAPS

Videos available online INTRODUCTION In contrast to rotation flaps, which have a curvilinear configuration, transposition flaps have a linear configuration. Both are pivotal flaps moving about a pivotal point. Both flaps develop standing cutaneous deformities (SCDs) at their bases and as a consequence, their effective length decreases as they pivot. This reduction in effective length must be considered when designing such flaps. Rotation flaps must be…

ROTATION FLAPS

INTRODUCTION Rotation flaps are pivotal flaps with a curvilinear configuration. By necessity they must be designed immediately adjacent to the defect. Thus a border of the defect becomes the advancing border of the skin flap. Although useful in many clinical situations, the configuration of rotation flaps creates curved incisions that frequently do not lie completely in relaxed skin tension lines (RSTLs). As with all pivotal flaps,…

FLAP CLASSIFICATION AND DESIGN

Videos available online INTRODUCTION The author defines a local cutaneous flap as an area of skin and subcutaneous tissue with a direct vascular supply that is transferred from its in situ position to a site located immediately adjacent to or near the flap. This is in contrast to a graft, which is tissue that is moved from one site to another without a direct vascular supply…

PREPARATION OF THE PATIENT

PREPARATION OF THE PATIENT Surgical restoration of the face may require a multistage procedure with a potentially protracted healing period before the final aesthetic outcome is evident. The initial reconstructive procedure is usually the most influential in predicting the aesthetic and functional result. Mucosa, cartilage, and facial skin are limited commodities. If the initial reconstructive effort squanders these resources through poor planning or surgical execution, subsequent…

WOUND CLOSURE TECHNIQUES

INTRODUCTION Local flap procedures can offer patients excellent options for the repair of soft tissue defects. After proper design and execution, the long-term results can be very satisfactory. Regardless of the local flap selected, proper soft tissue techniques are vital to the success of the procedure. A well-designed local flap may be compromised if wound closure is poorly performed. In contrast, even lengthy suture lines can…

BIOMECHANICS OF SKIN FLAPS

INTRODUCTION Scientific and clinical research in the areas of wound healing and the biomechanics of skin flaps has changed skin flap design from erratic, unsure, and artistic to consistent, scientific, and artistic. Today, skin flap design emphasizes vascular patterns, skin physiology, and the biomechanical characteristics of cutaneous tissue. The unique mechanical properties of skin influence blood flow and flap survival and thus are integral in the…

SKIN FLAP PHYSIOLOGY

INTRODUCTION The creation of a cutaneous flap applies specific stresses to otherwise normal skin. These stresses include local tissue trauma and reduced neurovascular supply to the affected tissue. The extent to which skin can survive these injuries is a reflection of the anatomy and physiology of skin as well as the cutaneous response to injury. Knowledge of these principles has led to improved skin flap survival…

ANATOMY OF the Skin

INTRODUCTION The skin is a complex organ that is essential for all forms of mammalian life. It may be viewed as a double-layered sheath, cushioned by the underlying subcutaneous adipose tissue, that covers the entire surface of the body. The outer layer of skin, known as the epidermis , is separated from the inner layer, or dermis, by the basement membrane zone. The dermis is attached…

Systemic Therapy

Open full size image Open full size image The role of systemic therapy in the treatment of head and neck cancer has increased in recent decades. Randomized clinical studies of integrated chemotherapy/radiotherapy programs have demonstrated improvements in locoregional control, organ preservation, and overall survival. However, high-grade acute toxicity and long-term sequelae of treatment remain a significant problem. In contemporary multimodality therapy, chemotherapy may be given before…

Radiation Therapy

Open full size image Open full size image The use of ionizing radiation in the treatment of cancer has evolved during the past century since the discovery of x-rays in 1895 by Wilhelm Conrad Roentgen, a German physicist. Professor Wilhelm Alexander Freund demonstrated the disappearance of a hairy mole with the use of x-rays in 1897, suggesting a potential role for x-rays in treating human disease.…

Oncologic Dentistry, Maxillofacial Prosthetics, and Implants

Open full size image Open full size image Open full size image Patients in need of treatment for head and neck or oral tumors, whether benign or malignant, require a multidisciplinary team approach, including the head and neck surgeon, prosthodontist, dental oncologist, speech and language pathologist, radiation oncologist, medical oncologist, highly skilled nursing, dieticians, psychiatrists/psychologists, and nurse navigators to coordinate their care. The expertise and collaboration…

Reconstructive Surgery

Open full size image Open full size image Open full size image The impact of major ablative surgery for cancer in the head and neck region can be devastating for the patient, aesthetically and often functionally. Reconstruction of oncologic defects is necessary to restore function and appearance in an effort to achieve total rehabilitation ( Fig. 17.1 ). Psychosocial, vocational, and emotional counseling may also be…

Bone Tumors and Odontogenic Lesions

Open full size image Open full size image Open full size image Bone consists of a solid mineral phase and a matrix of osteoid phase that contains osteoclasts (bone-resorbing cells), osteoblasts (bone-forming cells), and osteocytes (osteoblasts that become incorporated into the matrix). Although bone tumors are rare in the head and neck region, they span a wide spectrum of neoplasms. Primary bone tumors arise from either…

Soft Tissue Tumors

Open full size image Open full size image Open full size image Tumors of the soft somatic tissues form a very small component in the spectrum of tumors requiring surgical treatment in the head and neck region. These tumors may arise from the musculofascial compartment or the visceral compartment in the head and neck region. The histologic variants of benign and malignant soft tissue tumors are…

Neurogenic Tumors and Paragangliomas

Open full size image Open full size image Neurogenic tumors and paragangliomas form a very small percentage of all neoplastic lesions of the head and neck region. Although these tumors are considered under the major heading of “soft tissue tumors,” the unique presentation and systematic workup and imaging studies necessary for accurate diagnosis to facilitate selection of management strategy warrant their consideration as a separate entity.…

Salivary Glands

Open full size image Open full size image Open full size image Salivary glands are divided into major (parotid, submandibular, and sublingual) and minor salivary glands. Major salivary glands are paired structures, and minor glands exist in a submucosal location throughout the upper aerodigestive tract starting from the nasal cavity and lips down to the esophagus and trachea. Embryologically, the salivary glands are tubuloacinar structures arising…

Thyroid and Parathyroid Glands

Open full size image Open full size image Palpable nodularity in the thyroid gland is common, especially in women and older persons. The incidence of palpable nodularity in the thyroid gland in the United States is reported to be 4% to 7% of the adult population. However, sonographic or other imaging studies indicate that thyroid nodules may be present in as many as 50% of the…

Cervical Lymph Nodes

Open full size image Open full size image Open full size image One of the most important factors affecting prognosis for patients with squamous cell carcinoma of the upper aerodigestive tract is the status of cervical lymph nodes at the time of presentation. The presence of nodal metastasis reduces survival by nearly 50% in nearly all squamous cell carcinomas of the upper aerodigestive tract ( Fig.…

Larynx and Trachea

Open full size image Open full size image Open full size image The larynx plays a central role in coordinating the functions of the upper aerodigestive tract, including respiration, speech, and swallowing. The larynx is the second most common site for squamous cell carcinoma in the head and neck, which is causally related to tobacco and alcohol exposure. The larynx is divided into supraglottic, glottic, and…

Pharynx and Esophagus

Open full size image Open full size image Open full size image The pharynx is the intermediate part of the upper aerodigestive tract in the head and neck region, connecting the nasal cavity to the lower airway thru the larynx and the oral cavity to the esophagus. It is divided into three contiguous anatomic regions: the nasopharynx, oropharynx, and hypopharynx ( Fig. 9.1 ). Each of…