Epithelium and neoplasms of epithelial origin. A perspective for the surgeon.

Understanding the language which pertains to the description of neoplasms of epithelial origin carries the prerequisite of being conversant with the definition of epithelium. Clinicians and surgeons must be able to speak intelligently and correctly understand the ingredients which constitute the idiom and its requirements.

The viscerovertebral angle. The surgical avenue of the neck.

The viscerovertebral angle represents the evolution of thoughts assimilated from personal surgical experience and technique in the cervical area. It is a means whereby the surgeon may approach the operative challenge with ease, whether it involves singly or collectively the myovertebral pillar, the great neurovascular conduit, or the cervical visceral column from the level of the skull base well into the thorax to the innominate level. Thus, the surgeon is able to operate in a logical progression from the known to the unknown, comfortably and confidently in a predictable, reproducible manner.

Surgery of the parotid gland and the viscerovertebral angle.

The use of consistent anatomic landmarks and the mobilization of the viscerovertebral angle facilitate localization of the facial nerve. This straightforward approach to surgery of the parotid gland provides a reproducible methodology for the preservation of the seventh cranial nerve.

Biogeometry. The logic in the process of selection, siting, design, construction, and transfer of flaps.

As knowledge of the basic sciences of anatomy and physiology increases and as clinical skills are enhanced by biotechnical advances, once-held perceptions of concepts and interpretations of principles are modified. The observation of these truths inspired this writing and will no doubt culminate at another time in a revision of biogeometry.

Total extrathoracic neoesophageal construction by combined cutaneous and myoepithelial flaps.

A previously unreported low-morbidity staged procedure for the extrathoracic construction of neoesophagus employing a combination of skin-lined cutaneous an myoepithelial flaps is proposed as an adjunct to, or as a primary method for, the surgeon confronted with the problem of restoring the continuity of the food passage, which follows thoracic esophageal resection. The case report does not mean to imply or convey the impression that this procedure is a first-line method. Rather, it is offered as an alternative or adjunct in those instances in which customary and accepted techniques cannot be executed, as in this presentation.

Surgical palatomaxilloschisis: an avenue to the pterygomaxillary space.

The pterygomaxillary space (PMS) is a potential reservoir for expansion of the neoplasms originating in the epipharynx. Palatotomic and mandibulotomic approaches to this secluded site have been reported. The advantages of surgical palatomaxilloschisis are twofold. First, the exposure of the operative field is panoramic. Second, the carotid arterial system is identifiable prior to surgical intervention. The triangular pterygomaxillary recess is bounded superiorly by the greater wing of the sphenoid, posteriorly by the pterygoid process and anteriorly by the dorsal convexity of the posterior wall of the maxilla. Ascending laterally to the PMS in its route to penetrate the temporal bone is the internal carotid artery. In particular, juvenile angiofibromas which originate in the epipharynx may in their growth encroach upon the bounds of the PMS. The surgical objective is not only to extirpate the neoplasm but also to safeguard the carotid arterial system which may be displaced by the new growth and thereby become a surgical hazard. A clinical experience illustrates the applicability of this approach.

Parathyroid microautotransplantation and the viscerovertebral angle.

Conservation of physiologic values of circulating parathormone is a surgical objective in those instances in which a hyperfunctional parathyroid state exists as well as in those instances in which cervical evisceration employed as an ablative measure for the management of neoplastic disease threatens to impose postoperative tetany. Because the parathyroid glands may vary in number and in anatomic sites, a predictable and reproducible surgical approach that permits the operator an avenue of access to these structures is used. The viscerovertebral angle provides a surgical modality which facilitates the operative effort. The method has been applied in more than 70 patients.

An introduction to the diagnosis of parathyroid disorders.

The head and neck surgeon must be well acquainted with the embryology and anatomy of the parathyroid glands to facilitate operative localization. In dealing with diseases of this multiple unit single organ system an awareness of the variety of concomitant presentations is necessary in order to surgically manage the diseased glands. Diagnosis and preoperative localization of the parathyroid glands in their hyperfunctional state demand an appreciation of their physiologic interaction with the renal, skeletal, and gastrointestinal systems.

Diagnostic parameters in thyroid disorders.

An understanding of thyroid anatomy and physiology is a necessary prerequisite for interpreting diagnostic test results and managing thyroid disorders. A review of the basic sciences is presented with examples of their relationships to the diagnosis and embryogenesis of thyroid disorders.

Flap reconstruction in major surgery of the head and neck.

The challenging restoration of form and function in radical surgery of the head and neck demands sound concepts and proper execution in reconstruction. Flaps are most frequently employed in reconstruction, following major surgery because of their rich blood supply and cosmetic superiority. Of the many types of flaps known, the midline forhead flap, temporoforehead flap, mastoid-occipital flap, tongue flap, and deltopectoral flap have enjoyed most popularity. The design and application of these flaps are discussed. Our techniques in reconstruction of the oral cavity, hypopharynx, esophagus, nose, Andy-Gump deformities (anterior jaw complex resection), pharyngo-orocutaneous fistulas, and radionecrosis of the mandible are presented.