Orofacial tumours; complexity and outcome

The anatomic, physiologic and aesthetic complexity of the head and neck poses significant challenges to the management of all neoplasm arising in this compact region. The oral cavity is the most common site for malignancies of the head and neck region [about 30%] with the tongue and floor of mouth, are the most frequent primary site. The primary objective of a reconstructive effort is an aesthetic result that approaches a normal appearance. Functional consideration, including oral competence, articulation, speech, and the role of the lip in mastication, must be kept in mind during reconstruction of the large lip defects. The aim of this work is to study the different available surgical techniques for reconstruction of orofacial area after tumour excision and to address the outcome of surgery, aesthetic result and recurrence after surgery. This prospective study included 75 patients with different orofacial tumours, who were admitted at both Plastic and General Surgery Departments, Sohag University Hospital, Egypt, in the period from Mars 2004 to October 2006. The age of the patients ranged from 7 months to 83 years, 40 patients [53.33%] were females and 35 patients [46.66%] were males. The aesthetic and functional results were evaluated by patients questionnaires, photographing and physical examination. The overall aesthetic and functional results were excellent in 65.41%, very good in 14.66%, good in 17.33% and fair in 2.6% of the cases respectively. The local and regional flaps are ideal methods for reconstruction of facial defects because they give excellent color and texture match. Distant flaps have a great role in reconstruction of large facial defect. Although split or full thickness grafts proved to be an easy, simple and fast technique of reconstruction, however the aesthetic results are usually unsatisfactory

Non microsurgical ear replantation after acute traumatic avulsion

Auricular reconstruction possess one of the most difficult challenges in reconstruction surgery of the head and neck. This is due to the unique architectural topography of the external ear. The multiple concavities and convexities of the cartilage framework are enveloped by a very thin, tightly adherent skin envelope. The aim of this work was to review different methods of non microsurgical techniques and to present our experience in many amputated ears. Our study included 25 cases of acute amputated auricle, 10 of the due to human bites [35%], 3 due to animal bites, [12%], 12 patients due to motor car accidents [48%]. Males were the commonest affected victims [80%]. None cases were attached with a small pedicle managed with simple replantation with excellent cosmetic and functional results. Thee cases with excellent complete avulsion [2 cases managed with mladick principle one succeeded, third one, third one managed with simple reimplantation and faileld]. Mladick princile used also in one case of incomplete avulsion. Baudet technique was used in 3 cases [succeeded], two cases showed loss of cartilage treated by postauricular flap and cartilage graft. One case with Brent technique. Five cases were treated by wedge excision and simple closure. The last 3 cases presented with loss of lobule of the ear that were corrected with local flap and showed satisfactory results