Total lower lip and chin reconstruction with the infrahyoid musculocutaneous flap.

A composite resection of total lip, chin and part of the mandible creates a defect that challenges the capability for reconstruction to obtain an acceptable result, both functionally and aesthetically. We have successfully used the infrahyoid musculocutaneous flap to reconstruct such a defect in a patient who had basal cell carcinoma of the low lip. Since the flap is pliable, relatively thin and can be used to reconstruct the defect in one stage, it deserves consideration as one of the flaps of choice for this particular defect.

Benign parotid tumors: 31 year experience at MDACC.

From 1954-1984 at M.D.Anderson Cancer Center (MDACC), 81 cases of benign parotid tumor were identified among more than 400 parotidectomized patients who were retrospectively reviewed. The ate of the patients ranged from 3-84 years with a median of 52 years. Twenty two out of 81 cases were previously treated patients from elsewhere. Benign mixed tumor and Warthin’s tumor were the 2 most common tumors which were found in 50 and 20 cases respectively. Superficial, total, superficial and partial deep lobe parotidectomy, total deep and partial superficial parotidectomy and excision were done in 49, 16, 14, 1 and 1 cases respectively. Facial nerves were sacrificed in 14 (main trunk = 1, branches of facial nerve = 13) and immediate nerve repair was accomplished in 10. Upper neck dissection was performed in 22 cases. The follow up time ranged from 4 to 34 years with a median of 10 years. There were no postoperative deaths. Only 5 cases (6% of the series) developed local recurrences. All of them were those who had been previously treated elsewhere, had benign missed tumor, and the recurrence developed in scar and soft tissue and were salvageable by further surgery. There was no recurrence among all 59 previously untreated patients. Adequate parotidectomy with facial nerve preservation is the treatment of choice for most benign parotid tumor. Enucleating or excision of the tumor not only causes an unacceptable high recurrent rate, but also makes the subsequent surgery (if necessary) more difficulty ad the facial nerve more vulnerable to injury.