Laboratory and Radiologic Studies

The reconstructive surgeon should review the laboratory and radiologic exams ordered by the extirpative surgeon during the preoperative and metastatic workup of the head and neck patient. Abnormal liver function, platelet count, blood urea nitrogen, prothrombin, and or prothromboplastin time may lead to significant intraoperative blood loss and post-operative hematomas and possible compressive flap loss and or infection. These abnormalities need to be investigated and corrected as much as...

References

Upper aerodigestive tract cancers. Cancer 1995 75 147-153. 2. Boyle P, Macfarlane GJ, Zheng T, Maisonneuve P, Evstifeeva T, Scully C. Recent advances in epidemiology of head and neck cancer. Curr Opin Oncol 1992 4 471-477. 3. Vokes EE, Weichselbaum RR, Lippman SM, Hong WK. Head and neck cancer. N Engl J Med 1993 328 184-194. 4. American Cancer Society. Cancer Facts and Figures. Atlanta American Cancer Society, 1996. 5. Swango PA. Cancers of the oral cavity and pharynx in the...

Embryology

The embryologic origins of the various tissues composing the oral cavity can be traced back to the mesoderm of the paraxial and lateral plates, the ectodermal placodes, and neural crest tissue (1). However, the most straightforward organization of these derivatives is to consider their origins from the pharyngeal arches, which form in the fourth and fifth weeks of gestation. Each arch contains all three germ cell layers and gives rise to a major arterial derivative, a bone or cartilaginous...

Primary and Neck Resection

Throughout the extirpation, there must be good communication between the extirpative and reconstructive surgeons. Frequently, both are working concurrently to minimize anesthesia time. Continuous monitoring of the patient status intraopera-tively is also crucial, as any decline in the medical status of a patient, requires an immediate change in the operative plan. Unlike the aesthetic resection of a complete nasal unit, in the oral cavity, any native tissue in the oral cavity that can be spared...

Introduction

Surgical oncologic treatment of head and neck cancer has advanced considerably, but the overall cure rate has not improved proportionally (1). To increase the cure rate, new therapies and techniques have been developed and more emphasis is being placed on the improvement of the overall quality of the treatment of these onco-logically challenging patients. Thus, success should be measured not only by disease control, but also by the restoration and maintenance of the patient to as normal as...

Surgical Planning Incisions

Reconstructive planning occurs from initial presentation and undergoes an evolving process until a final plan with possible contingencies is developed. This plan can even change intraoperatively due to unexpected oncologic findings, anatomic abnormalities, and anesthetic instability. Surgical incision planning extends beyond just the purview of the oncologic surgeon. Adequate access and visualization of the surgical field, especially for posteriorly based neoplasms, is paramount for resection....

Evaluation And Planning

Aesthetics and function are both very important in lip reconstruction. The surgeon should plan to place lines of incision compatible with the creases that surround the lip, the relaxed skin tension lines respective to that part of the lip, or to the anterior vermilion line for optimal scar camouflage. Incision lines hi the central region of the upper lip may in some cases be made compatible with the vertical lines of the philtrum. Reconstruction of smaller defects of the lip can generally be...

B

Figure 6 (A) Large defect of left central region of upper lip. (B) Typical rotation advancement flap with some early local distortions apparent. (C) Result at about one year after tissues have settled. Very slight asymmetries still present, but acceptable for this case. This flap is easier to use when defect involves more lateral portion of upper lip. Figure 6 (A) Large defect of left central region of upper lip. (B) Typical rotation advancement flap with some early local distortions apparent....

Reconstructive Options

The surgeon's choice of approach must be communicated to anesthesia and operating room personnel prior to the patient entering the operating room. The anesthesiologist should be instructed on whether a nasotracheal or orotracheal intubation is preferred and, if the latter, on what side of the mouth should the tube be taped, or if the surgeon plans to stabilize the tube in the midline with a Crowe-Davis mouth gag or similar instrumentation. Endotracheal tube placement becomes less important if...

A

Island Flap Definition

Figure 3 (A) Options for W-lip closure, opposing advancement flap repair, and cross-lip flap are all being considered for this patient as the lip cancer is about to be resected. (B) Note divergent outline planned along mental crease for possible opposing advancement flap repair versus circumoral Karapandzic flaps. Figure 3 (A) Options for W-lip closure, opposing advancement flap repair, and cross-lip flap are all being considered for this patient as the lip cancer is about to be resected. (B)...