• Title/Summary/Keyword: Head and neck reconstruction

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Reconstruction of Through and Through Defect of the Cheek After Resection of Buccal Mucosa Cancer (협점막암 절제후 협부관통결손의 재건방법에 대한 고찰)

  • Choi Eun-Chang;Kim Eun-Seo;Hong Won-Pyo
    • Korean Journal of Head & Neck Oncology
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    • v.11 no.1
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    • pp.47-55
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    • 1995
  • A large lateral facial defects especially a through and through defect of the cheek remains as challenging field of reconstruction for the head and neck surgeons. Closure of these wounds is technically troublesome due to the magnitude and location of the soft tissue and skin defect, functional and aesthetic consideration. optimal cancer surveillance, and desire for good nourishment. Most traditional methods dealing with these defects, including split-thickness skin graft, local and regional flaps as well as musculocutaneous flaps have their limitations. We applied four different methods for these reconstruction in four cases. We utilized temporal muscle flap, forearm free flap and secondary healing for repair of mucosal defects, and medial base cervicopectoral flap, pectoralis major myocutaneous flap and cervicofacial flap for the reconstruction of external skin defects. In one case, both sides were reconstructed with single forearm free flap. In our experiences, secondary healing could be one of the useful method for mucosal repair in the defect between upper and lower gingivobuccal sulcus. However, forearm free flap was thought to be more ideal for the cases with mandibulectomy. For the external repair, the regional skin flap was considered to be superior to pectoralis major myocutaneous flap or forearm free flap especially on color matching.

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Reconstruction of Midfacial Defects with Free Flaps after Maxillectomy (상악골절제술 후 유리피판을 이용한 안면중앙부 재건)

  • Kim, Kyul-Hee;Chung, Chul-Hoon;Chang, Yong-Joon;Rho, Young-Soo
    • Archives of Plastic Surgery
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    • v.37 no.5
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    • pp.607-612
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    • 2010
  • Purpose: Maxillectomy for malignant tumor resection often leads to functional and aesthetic sequalae. Reconstruction following maxillectomy has been a challenging problem in the field of head and neck cancer surgery. In this article, we described three dimensional midface reconstructions using free flaps and their functional and aesthetic outcomes. Methods: We reconstructed 35 cases of maxillectomy defects using 9 radial forearm free flaps, 7 lattisimus dorsi musculocutaneous free flaps, 6 rectus abdominis musculocutaneous free flaps, 4 fibular osteocutaneous free flaps, and 9 anterolateral thigh free flaps, respectively. We classified post-maxillectomy defects by Brown's classification. 1 Articulation clarity was measured with picture consonant articulation test. Swallowing function was evaluated with the University of Washington quality-of-life Head and Neck questionnaire by 4 steps.2 Aesthetic outcomes were checked to compare preoperative with postoperative full face photographs by 5 medical doctors who did not involve in our operation. Results: The average articulation clarity was 92.4% (100-41.9%). 27 (81.9%) patients were able to eat an unrestricted diet. Aesthetic results were considered excellent in 18 patients (51.4%). Functional results were best in the group reconstructed with fibular osteocutaneous free flap. Considering the range of wide excision, aesthetic results is best in the group reconstructed with anterolateral thigh free flap. Conclusion: The free flap is a useful technique for the reconstruction of the midface leading to good results, both functionally and aesthetically. Especially, because osteocutaneous flap such as fibular osteocutaneous free flap offered bone source for osteointegrated implant, It produces the best functional results. And perforator flap like as anterolateral thigh free flap reliably provides the best aesthetic results, because it provides sufficient volume and has no postoperative volume diminution.

Surgery of Retromolar Trigone Cancer (후구치삼각암의 수술적 치료)

  • Lee Sei-Young;Choi Young-Choon;Jung Eui-Sok;Kwon Soon-Ho;Lew Dae-Hyun;Lee Won-Jae;Choi Eun-Chang
    • Korean Journal of Head & Neck Oncology
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    • v.20 no.2
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    • pp.167-171
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    • 2004
  • Background and Objectives: Squamous cell carcinoma of retromolar tringone (RMT) is an uncommon head and neck tumor. RMT cancer has unique clinical feature and specific considerations for surgical treatment are needed but, reports on the treatment of RMT cancer are still lacking. Patients and Methods: From May 1997 to July 2004, 8 patients with histologically proven squamous cell carcinoma of the RMT were treated in Severance Hospital. Surgical excision of the primary lesion and neck dissection were performed in all patients. Reconstruction was accomplishing using several methods. Charts and other medical records were reviewed. Results: In early cases, lower cheek flap was appropriate but, mandibular swing or madibulectomy approach was appropriate in advanced cases. Reconstruction was needed in all patients and excision of mandible was needed in majority of patients. 6 patients were disease free status and one died from recurrence and one was lost to follow up. Conclusion: In treatment of RMT cancer, several surgical approach methods and reconstruction should be considered before treatment. Surgical treatment of RMT cancer may be one of a useful primary treatment modality.

RECONSTRUCTION OF MIDFACIAL DEFECTS UTILIZING RECTUS ABDOMINIS FREE FLAP : REPORT OF 2 CASES (유리 복직근 피판을 이용한 중안모 결손부 재건의 2 치험례)

  • Lee, Seong-Geun;Sung, Iel-Yong;Kim, Jong-Ryoul
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.22 no.1
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    • pp.98-104
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    • 2000
  • Expansion in the scope and technique of head and neck tumor resection during the past two decades has paralleled precise tumor localization with advanced radiographic imaging and the availability of microvascular free tissue transfer. Especially, the defect reconstruction utilizing free flap results in improvement of patient survival due to decrease of local recurrence by wide resection of cancer. The rectus abdominis free flap has been used widely in reconstruction of the breast and extremities. However, the report of cases on its applications in the head and neck, based on the deep inferior epigastric artery and vein, is rare. This flap is one of the most versatile soft-tissue flaps. The deep inferior epigastric artery and vein are long and large-diameter vessels that are ideal for microvascular anastomosis. The skin area that can be transferred is probably the largest of all flaps presently in use. The versatility of the donor site is due to the ability to transfer large areas of skin with various thickness and amounts of underlying muscle. This article is to report reconstruction of midface defects utilizing the rectus abdominis free flap in 2 patients with maxillary squamous cell carcinoma and discuss briefly considerations in flap design and orbital exenteration, and healing of irradiated recipient site by hyperbaric oxygen therapy with literature review.

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