Neck dissection for head and neck malignancies with concurrent carotid endarterectomy.

Head and neck malignancies share similar risk factors as carotid artery stenosis and these can often present together. Patients who require external beam radiotherapy are at a higher risk of developing significant worsening stenosis. The workup of the oncologic patient often includes computed tomography, which can reveal underlying carotid artery stenosis, offering an opportunity to address both conditions in one operation and prevent the need for a complicated carotid endarterectomy (CEA) in irradiated and previously operated tissue. It was postulated that these two operations can be combined safely. The surgical protocol, surgical technique, and outcomes of a case series of four patients with head and neck cancer who underwent neck dissection and CEA for carotid artery stenosis during the same operation is presented. CEA was performed safely, simultaneously with neck dissection. CEA did not affect the surgical outcomes or postoperative course of the patients, and no minor or major complications were observed related to this procedure. Carotid endarterectomy performed by a vascular surgeon can be safely combined with oncologic neck dissection in the same procedure to avoid future complications in head and neck cancer patients.

Modified Lip Revision Surgery for the Severe Whistle Lip Deformity in Bilateral Cleft Lip.

PURPOSE: Whistle deformity is a sequela of primary surgical repair of the bilateral cleft lip that leads to a vertical tissue deficiency and a nonfunctional orbicularis oris muscle in the medial portion of the upper lip. This sequel is significantly limiting functionally and esthetically. We propose a complete labial revision with a secondary cheiloplasty of Mulliken and a submucosal inferiorly based flap in the central tubercle to increase the volume at this usually deficient area. METHODS: We present our series of 9 patients with whistle deformity who underwent our modified technique. Width and length lip measurements were analyzed pre- and postoperatively. RESULTS: There was a significant decrease in the width of the philtrum (mean 18.7% and 37% measured at the columella base and Cupid's apexes, respectively), an increase in the labial length (mean 11.2%), and improvement of the shape and volume of the vermilion in its middle third. All patients reported a very good to excellent improvement in the function and shape of their lips. CONCLUSIONS: The addition to a complete revision cheiloplasty of our inferiorly based submucosal flap technique solved in a single operation the function of the orbicularis oris and the normal labial anatomy with good functional outcomes in all cases and improved esthetic results.

Flattening of the orbital lower eyelid fat as a long-term outcome after surgical treatment of orbital floor fractures.

Our aim was to report the incidence of asymmetry of the lower eyelid (that manifests itself as flattening of the eyelid fat) as a long-term complication of the surgical approach of unilateral fractures of the orbital floor. We retrospectively reviewed the aesthetic appearance of the lower eyelid in 43 patients after repair of such fractures. Long-term asymmetry seen as asymmetrical flattening of the eyelid fat was evaluated and graded qualitatively as mild, moderate, and severe. We studied its relations to the surgical approach, patient's age and sex, and postoperative time; 20 of the 43 had flattening of the lower eyelid fat. There were significantly more patients with flattening of the fat after a transconjunctival approach than after transcutaneous ones (p=0.03). We found a statistical likelihood of the development of flattening of the fat when patients were between 40 and 60 years old at the time of operation (p=0.006). Increasing age at the time of the study was related to increased severity (p=0.0019), with the greatest significance over 55 years old (p=0.006). We found no relation to patients' sex, or duration of operation. To our knowledge this is the first time that flattening of the eyelid fat has been described as a long-term complication after a particular approach to orbital floor fractures. The transconjunctival incision was more likely to be associated with this long-term outcome. Patients over 40 years old are also at risk of developing flattening, and this is more severe when the patient is over 55. A short follow-up period is not sufficient for the evaluation of the aesthetic outcome of traditional approaches to fractures of the orbital floor in the lower eyelid.