Basic flap design.

Basic flap design utilization for reconstruction of head and neck defects requires creativity from the surgeon. Ultimately, the surgeon must closely restore the basic functions and properties of the surgical flap and adjacent tissue. All options within the reconstructive ladder should be considered. When possible, like should be replaced with like (similar tissue) within an esthetic zone. When considering a flap design, the surgeon must remember that the donor site must be closed in an esthetic and functional manner. Finally, knowledge of normal anatomy, the extent of the defect, and the patient is vital for successful outcomes.

Using magnetic resonance imaging for early assessment of submucous cleft palate: a case report.

Surgical correction for submucous cleft palate is generally indicated in the presence of velopharyngeal inadequacy. Clinical assessment of velopharyngeal inadequacy requires that the child is able to produce a connected speech sample, which can yield a delay in treatment decisions that extends through a critical period of speech and language development. A perceptual speech assessment and intraoral examination are traditionally the most important methods of establishing a diagnosis of submucous cleft palate. The purpose of this case report is to demonstrate the use of magnetic resonance imaging as a diagnostic tool to provide early identification and an indication of surgical treatment for an individual born with a submucous cleft palate. The magnetic resonance images indicated a discontinuous levator veli palatini muscle sling arrangement with attachment of the muscle bundles onto the hard palate. Surgery was performed at 16 months and postsurgical speech evaluations demonstrated normal resonance and age-appropriate speech.

Surgical management of facial skin cancer.

Surgical excision is the gold standard for management of cutaneous basal cell carcinoma or squamous cell carcinoma. Surgical management of nonmelanotic facial skin cancer requires preoperative planning and an in-depth understanding of reconstructive techniques, including primary closure, skin grafting, and local tissue flaps. The decision regarding the method of treatment of nonmelanotic skin cancer is highly individualized and depends on patient age, cancer size, histologic subtype, and site. No single therapy or technique can be used in every situation. The goals of treatment include complete removal of the lesion with preservation of normal tissue, function, and cosmesis. In this article we discuss the principles and techniques of surgical excision and reconstruction of site-specific facial skin cancers.

Oral leiomyosarcoma: review of the literature and report of two cases with assessment of the prognostic and diagnostic significance of immunohistochemical and molecular markers.

Leiomyosarcoma of the oral cavity is a very rare tumor that is associated with aggressive clinical behavior and low survival. In this paper, we report two new cases of leiomyosarcoma affecting the mandibular gingiva and mandible of a 35-year-old male and the mandible of a 51-year-old female. Given the difficulty in the histopathologic discrimination between benign and malignant smooth muscle tumors and the absence of reliable histologic parameters for prognostication of leiomyosarcomas, we evaluated the diagnostic and prognostic value of various immunohistochemical and molecular markers. By means of immunohistochemistry and quantitative real-time PCR analysis, we detected protein expression of PCNA, bcl-2, CDK4, p53 and MDM2 in both our cases and MDM2 amplification in our second case. The literature, pertinent to oral leiomyosarcoma and to molecular analysis of smooth muscle tumors, is reviewed.