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1.
Artigo em Inglês | MEDLINE | ID: mdl-37948552

RESUMO

Background: Facial reanimation flaps often add bulk and produce single-vector smiles, and multivector flaps frequently require challenging intramuscular dissection. Objective: To evaluate the effectiveness of sterno-omohyoid flap (SOHF) transfer for dual-vector smile reanimation by measuring upper dental show and oral commissure movement. Methods: SOHF transfers from 2017 to 2020 were retrospectively evaluated using eFACE and Emotrics software. Results: Four patients with flaccid and one with nonflaccid facial paralysis were identified (four females and one male, median age: 39 years (range: 38-65); two acoustic neuromas, two congenital, one temporal bone fracture). Median follow-up was 20 months (range: 14-26). All flaps received masseteric nerves and two had additional cross-face grafts. Four developed contraction [median time to contraction: 5.5 months (range: 3-10)]. Mean oral commissure excursion and dental exposure improvements were 7.6 ± 4.0 mm (p = 0.03) and 2.9 ± 1.8 mm (p = 0.05), respectively. Dynamic, smile, and midface-smile eFACE improvements were 20.3 ± 6.8 (p = 0.007), 25.5 ± 14.5 (p = 0.03), and 50.5 ± 12.0 mm (p = 0.004) points, respectively. Mean SOHF mass was 14 ± 1.7 g. Conclusion: The SOHF is a small flap that provides dual-vector smile reanimation in flaccid and nonflaccid facial paralysis.

2.
J Oral Maxillofac Surg ; 81(2): 248-253, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36528082

RESUMO

PURPOSE: A planned neck dissection was traditionally considered for a large nodal disease after definitive chemoradiation, yet controversy exists for the human papilloma virus-positive oropharyngeal squamous cell carcinoma (HPV OPSCC). We aimed to measure the frequency of persistent occult neck disease in planned neck dissection for HPV OPSCC presenting with a large (≥3.0 cm) nodal burden. METHODS: We designed a retrospective cohort study at a single tertiary referral institution. The study population was sampled from 2006 to 2018 and subjects with HPV OPSCC and adenopathy ≥3.0 cm. Inclusion criteria encompassed subjects who completed primary chemoradiation therapy (CRT) or primary radiation therapy (RT), and subsequently underwent a planned neck dissection. We excluded subjects who did not complete therapy or had less than 1-year follow-up. Our primary predictor variable was the size of cervical adenopathy on presentation (3.0-3.9 cm, 4.0-4.9 cm, 5.0-5.9 cm, and ≥6.0 cm). Our primary outcome of interest was the presence of disease based on the histopathology review. Other variables included the demographics, primary treatment with CRT or RT, and post-treatment clinical or radiographic evidence of disease. Chi-square testing was used to compare rates of persistent disease, with varying sizes of cervical adenopathy on presentation. The alpha level for statistical significance was set at 0.05. RESULTS: A total of 86 subjects were analyzed, with forty-one females and forty-five males, ranging from 36 to 77 years (mean 54.6 years). From the total study sample, 35% showed persistent disease, and 67% of those subjects had occult disease at the time of planned neck dissection. Greater than 20% of subjects had persistent disease when the nodal burden was ≥3.0 cm at presentation. Furthermore, there was a statistically significant difference in the rates of persistent microscopic disease among subjects with nodal burden of different sizes based on chi-square testing (P = .01, χ2 = 10.66). CONCLUSIONS: Our data suggest that subjects with HPV OPSCC presenting with a nodal burden ≥3.0 cm are likely to have 23% chance of persistent occult neck disease after primary CRT or RT. These findings may support the routine treatment of these subjects with a planned neck dissection after initial therapy to confirm or surgically complete disease eradication.


Assuntos
Carcinoma de Células Escamosas , Neoplasias de Cabeça e Pescoço , Linfadenopatia , Neoplasias Orofaríngeas , Infecções por Papillomavirus , Masculino , Feminino , Humanos , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Esvaziamento Cervical , Papillomavirus Humano , Estudos Retrospectivos , Carcinoma de Células Escamosas/cirurgia , Carcinoma de Células Escamosas/patologia , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/patologia , Estadiamento de Neoplasias , Linfadenopatia/patologia , Linfadenopatia/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgia , Neoplasias Orofaríngeas/cirurgia
3.
Mil Med ; 2022 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-36106512

RESUMO

Herein, we present a unique case of Sjögren's syndrome (SS) first presenting as facial palsy, as well as a literature review of case reports describing SS-associated facial paralysis. A PubMed search for papers containing the keywords Sjögren's syndrome or Sjögren's disease, as well as facial paralysis, facial paresis, facial palsy, or Bell's palsy, was performed. Articles not in English and cases of SS not involving facial paralysis were excluded. Appropriate articles were reviewed for patient demographics and symptoms of SS, including laterality of facial paralysis, cranial nerve involvement, and comorbid diseases. House-Brackmann grades were annotated based on either assignment by individual case reports or the authors' descriptions when sufficient details were present. Of 43 peer-reviewed articles found, 14 were both in the English language and provided adequate information on a total of 16 patients with facial paralysis and SS diagnosis. Ultimately, SS and other systemic autoimmune disorders should be considered in the differential diagnosis of patients presenting with insidious onset facial paralysis.

4.
Otolaryngol Head Neck Surg ; 166(1): 151-157, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-33784203

RESUMO

OBJECTIVE: To examine the demographics of Bell's palsy and determine how House-Brackmann (HB) grade at nadir and electroneuronography (ENoG) results correlate with HB grade after recovery and development of synkinesis. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary care military medical center. METHODS: Patients with acute Bell's palsy and adequate follow-up, defined as 6 months or return to HB grade I function, were included. Demographic information, HB scores at nadir and recovery, and ENoG results were collected. RESULTS: A total of 112 patient records were analyzed. Ages ranged from 8 to 87 years with peaks at 21 to 25 and 61 to 65 years. Among patients, 16.3% reached a nadir at HB II, 41.9% at HB III, 5.4% at HB IV, 16.3% at HB V, and 20.1% at HB VI. The overall recovery rate was 73.2% to HB I function, 17.0% to HB II, and 9.8% to HB III. The chance of recovery to HB I decreased as the severity of paralysis increased (rs = -1.0, P < .0001). Mean time to recovery to HB I was 6 weeks. Greater degeneration on ENoG suggested worse recovery (rs = 0.62, P = .01). Patients with HB V and VI were most likely to develop synkinesis. CONCLUSION: More severe paralysis increased the chance of recovery to HB II or III function. The granularity of this study provides prognostic insights that may inform the counseling of patients with Bell's palsy with respect to prognosis and recovery timeline.


Assuntos
Paralisia de Bell/diagnóstico , Paralisia de Bell/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Eletrodiagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Recuperação de Função Fisiológica , Estudos Retrospectivos , Índice de Gravidade de Doença , Distribuição por Sexo , Adulto Jovem
5.
J Craniofac Surg ; 32(7): e668-e670, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34705370

RESUMO

ABSTRACT: Frontal cranioplasty in gender affirmation surgery requires precise identification of the borders of the frontal sinus in order to reduce brow prominence effectively and avoid complications. Several approaches to this have been described in the literature, but many techniques are imprecise or logistically cumbersome. Custom 3D-printing of cutting guides is an emerging modality that offers a method of identifying the frontal sinus accurately and rapidly. We herein present the results of 5 transgender woman who underwent type 3 frontal cranioplasty with the assistance of 3D-printed custom cutting guides. Our preliminary analysis suggests that the use of custom 3D-printed cutting guides is safe and would likely be cost-effective for many surgeons.


Assuntos
Impressão Tridimensional , Crânio , Feminino , Humanos
6.
Facial Plast Surg ; 37(6): 716-721, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34587642

RESUMO

Orthognathic surgery performed in conjunction with orthodontic treatment is commonly performed to correct skeletal irregularities and realign the maxillomandibular relationship to improve occlusal function and facial esthetics. A thorough understanding of soft tissue esthetics, skeletal and occlusal relationships, and surgical techniques is required to obtain successful results. Surgical techniques have evolved greatly throughout history, as technological advances such as virtual surgical planning have become available and widely used to obtain predictable movements with minimized complications. The aim of this article is to review the orthognathic surgical procedures of the mandible, with particular attention to the indications, contraindications, preoperative assessment, surgical technique, and possible complications encountered.


Assuntos
Cirurgia Ortognática , Procedimentos Cirúrgicos Ortognáticos , Cefalometria , Estética Dentária , Ossos Faciais , Humanos , Mandíbula/cirurgia
7.
Facial Plast Surg ; 37(6): 692-697, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34500489

RESUMO

The majority of Graves' ophthalmopathy, or thyroid eye disease, can be managed medically; however, in refractory or severe cases, surgical intervention with orbital decompression may be necessary. The majority of the published literature is retrospective in nature, and there is no standardized approach to orbital decompression. The purpose of this review is to evaluate the various surgical approaches and techniques for orbital decompression. Outcomes are ultimately dependent on individual patient factors, surgical approach, and surgeon experience.


Assuntos
Oftalmopatia de Graves , Descompressão Cirúrgica , Oftalmopatia de Graves/cirurgia , Humanos , Procedimentos Cirúrgicos Oftalmológicos , Órbita/diagnóstico por imagem , Órbita/cirurgia , Estudos Retrospectivos
8.
Facial Plast Surg ; 37(6): 703-708, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34530468

RESUMO

Orthognathic surgery is a complex type of facial surgery that can have a profound impact on a patient's occlusal function and facial aesthetics. Close collaboration between the maxillofacial surgeon and an orthodontist is required, and the surgical team must have a strong foundation in facial analysis and firm understanding of the maxillofacial skeleton to achieve surgical success. Herein, we review the maxillary LeFort I osteotomy as it pertains to orthognathic surgery, with particular attention to the indications, contraindications, preoperative assessment, surgical technique, and possible complications encountered.


Assuntos
Cirurgia Ortognática , Procedimentos Cirúrgicos Ortognáticos , Face , Humanos , Maxila/cirurgia
9.
Facial Plast Surg ; 37(6): 698-702, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34521150

RESUMO

Calvarial defects are commonly encountered after neurosurgical procedures, trauma, and ablative procedures of advanced head neck cancers. The goals of cranioplasty are to provide a protective barrier for the intracranial contents, to restore form, and prevent syndrome of the trephined. Autologous and alloplastic techniques are available, each with their advantages and drawbacks. A multitude of materials are available for cranioplasty, and proper timing of reconstruction with attention to the overlying skin envelope is important in minimizing complications.


Assuntos
Procedimentos de Cirurgia Plástica , Humanos , Crânio/cirurgia , Transplante Autólogo
10.
Facial Plast Surg ; 37(6): 728-734, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33878796

RESUMO

The mandibular condyle is an integral structure in the temporomandibular joint (TMJ) serving not only as the hinge point for mandibular opening, but also facilitating mandibular growth and contributing to facial aesthetics. Significant compromise of the TMJ can be debilitating functionally, psychologically, and aesthetically. Reconstruction of the mandibular condyle is rarely straightforward. Multiple considerations must be accounted for when preparing for condylar reconstruction such as ensuring eradication of all chronically diseased or infected bone, proving clear oncologic margins following tumor resection, or achieving stability of the surrounding architecture in the setting of a traumatic injury. Today, there is not one single gold-standard reconstructive method or material; ongoing investigation and innovation continue to improve and transform condylar reconstruction. Herein, we review methods of condylar reconstruction focusing on autologous and alloplastic materials, surgical techniques, and recent technological advances.


Assuntos
Côndilo Mandibular , Articulação Temporomandibular , Humanos , Mandíbula , Côndilo Mandibular/cirurgia , Articulação Temporomandibular/cirurgia
11.
Facial Plast Surg ; 37(6): 735-740, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33878799

RESUMO

Alloplastic facial transplantation has become a new rung on the proverbial reconstructive ladder for severe facial wounds in the past couple of decades. Since the first transfer including bony components in 2006, numerous facial allotransplantations across many countries have been successfully performed, many incorporating multiple bony elements of the face. There are many unique considerations to facial transplantation of bone, however, beyond the considerations of simple soft tissue transfer. Herein, we review the current literature and considerations specific to bony facial transplantation focusing on the pertinent surgical anatomy, preoperative planning needs, intraoperative harvest and inset considerations, and postoperative protocols.


Assuntos
Traumatismos Faciais , Transplante de Face , Procedimentos de Cirurgia Plástica , Face/cirurgia , Traumatismos Faciais/cirurgia , Humanos
12.
Ann Otol Rhinol Laryngol ; 130(10): 1112-1115, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33629593

RESUMO

OBJECTIVE: Tracheal stenosis can have a variety of presentations, severities, causes, and be a difficult condition to treat. Some patients demonstrate recurrent stenosis after multiple endoscopic treatments and are either poor candidates for open procedures or do not desire open surgery. We sought to evaluate low-dose postoperative external beam radiotherapy (EBRT) as a novel therapy for patients with recurrent tracheal stenosis refractory to endoscopic therapies. METHOD: We performed a retrospective review of patients with recurrent tracheal stenosis who underwent EBRT in addition to endoscopic dilation. We compared the number of endoscopic procedures required in the 6 months before EBRT to the number required in the 6 months after EBRT. RESULTS: Six patients met criteria for inclusion in our study. The cause of stenosis was variable among the study population. In the 6 months leading up to EBRT, patients underwent an average 6.2 endoscopic procedures. This dropped to an average 1.9 procedures in the 6 months following EBRT (P < .001). CONCLUSION: Herein, we show that low-dose postoperative external beam radiotherapy (EBRT), a novel therapy for patients with recurrent tracheal stenosis refractory to endoscopic therapies, is effective in decreasing the frequency of endoscopic dilations. LEVEL OF EVIDENCE: 4.


Assuntos
Estenose Traqueal/radioterapia , Adulto , Endoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
13.
Facial Plast Surg ; 37(6): 759-770, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33588473

RESUMO

Midface reconstruction has been a consistent challenge for reconstructive surgeons even with the significant advances in technology and technique achieved over the recent years. A meticulous preoperative assessment of the patient is required to properly assess the defect or anticipated defect, determine proper reconstructive surgical plan, and discuss expected functional and aesthetic outcomes with the patient. For years we have employed local flaps, regional flaps, obturators, alloplastic implants, free flaps, or a combination of the previously mentioned techniques to address complex midface reconstruction. Free flap reconstruction in the midface requires special considerations for the pedicle, flap selection, and flap design to ensure an optimal outcome. The introduction of virtual surgical planning for reconstruction has enhanced patient outcomes to include advances in immediate dental rehabilitation at the time of free flap surgery. Postoperative considerations including quality of life, functional and aesthetic outcomes, and management of complications will also be discussed.


Assuntos
Retalhos de Tecido Biológico , Procedimentos de Cirurgia Plástica , Estética Dentária , Face/cirurgia , Humanos , Qualidade de Vida , Estudos Retrospectivos
14.
Facial Plast Surg Aesthet Med ; 23(4): 283-288, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32856954

RESUMO

Background: Many surgeons refuse to perform elective nasal surgery in active smokers, but little literature exists that addresses the risks of doing so; we sought to quantify the differences in outcomes after nasal surgery among smokers, previous smokers, and nonsmokers by measuring complication rates, revision rates, and improvement in Nasal Obstruction Symptom Evaluation (NOSE) scores. Methods: We performed a single institution retrospective review of patients undergoing nasoseptal surgery. Specifically, we noted demographic characteristics, smoking status, surgery type, and pre- and postoperative NOSE scores. We compared NOSE scores, complication rates, and revision rates among current smokers, previous smokers, and never smokers. Results: Five hundred thirty patients were included for complication and revision rate analysis; there was no difference in complication or revision rates among patients of different smoking categories. Two hundred ninety-one patients completed pre- and postoperative NOSE scores. Scores for all surgeries and in all smoking categories improved postoperatively (p < 0.001). There was a difference in NOSE score change among surgical groups, with rhinoplasty resulting in the greatest improvement (p = 0.044). There was no difference in NOSE score improvement across smoking categories. Conclusion: Active smokers benefit from surgical intervention and can expect a similar improvement in nasal breathing to their nonsmoking counterparts if they meet indications for and undergo nasal surgery.


Assuntos
Septo Nasal/cirurgia , não Fumantes , Complicações Pós-Operatórias/etiologia , Reoperação/estatística & dados numéricos , Rinoplastia , Fumantes , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
15.
Ann Otol Rhinol Laryngol ; 130(7): 843-847, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33228400

RESUMO

OBJECTIVES: To present a method to reconstruct the midface using the fibula as both a microvascular free flap and as a free cortex graft. METHODS: 22-year-old male presented with bilateral maxillary odonotogenic myxoma. Bilateral total maxillectomy defects were reconstructed using an osteocutaneous fibula free flap. The nasomaxillary buttresses were augmented using free cortex grafts to provide additional soft tissue projection and lateral nasal support. RESULTS: The patient received dental implants at 10 months postoperatively and resumed a normal diet. His midface height, nasal and maxillary projection were adequate. At 36 months post-treatment he has no evidence of disease recurrence or resorption of the free bone grafts. CONCLUSION: The fibula free flap can be used to provide additional support to a patient's reconstruction by means of free cortex grafts. The patient has had successful restoration of pyriform aperture, nasal projection, mastication, and dental restoration using a single donor site.


Assuntos
Fíbula/transplante , Retalhos de Tecido Biológico , Neoplasias Maxilares/cirurgia , Mixoma/cirurgia , Humanos , Masculino , Procedimentos de Cirurgia Plástica/métodos , Adulto Jovem
16.
Laryngoscope ; 131(5): E1510-E1513, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33037821

RESUMO

OBJECTIVE: A paucity of data exists regarding surgical outcomes for patients undergoing total laryngectomy for a dysfunctional larynx. Herein, we present the largest study evaluating the method of closure on postoperative fistula rate and swallowing ability. METHOD: We performed a retrospective review of patients undergoing total laryngectomy for a dysfunctional larynx after primary radiation or chemoradiation therapy for laryngeal carcinoma from 1998 to 2020. Demographic information, operative details, length of hospitalization, fistula formation, method of fistula treatment, and need for enteral feeding 6 months after surgery were analyzed. RESULTS: A total of 268 patients were included. Flaps were performed in 140 (52.2%) patients, including radial forearm free flaps (RFFF), pectoralis flaps, and supraclavicular flaps. Sixty-four (23.9%) patients developed postoperative fistulas. There was no significant difference in the fistula rate between flap and primary closure methods (P = .06). However, among patients who had a flap, RFFF had a significantly lower fistula rate (P = .02). Significantly more patients who had initial closure with a pectoralis flap required an additional flap for fistula repair than those who underwent RFFF or primary closure (P < .05). Last, whereas 87 patients (32.5%) required an enteral feeding tube 6 months after surgery, significantly fewer patients who underwent RFFF were feeding tube-dependent (P = < .0001). CONCLUSION: Herein, we present the largest study of outcomes after total laryngectomy for dysfunctional larynx. Postoperative fistula rates are high, 23%; however, the majority of patients, 67%, will not require long-term enteral support. The RFFF is an excellent option demonstrating the lowest rates of postoperative fistula and enteral feeding tube dependence. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E1510-E1513, 2021.


Assuntos
Quimiorradioterapia/efeitos adversos , Fístula Cutânea/epidemiologia , Laringectomia/efeitos adversos , Procedimentos de Cirurgia Plástica/métodos , Complicações Pós-Operatórias/epidemiologia , Lesões por Radiação/cirurgia , Idoso , Idoso de 80 Anos ou mais , Carcinoma/complicações , Carcinoma/diagnóstico , Carcinoma/patologia , Carcinoma/terapia , Fístula Cutânea/etiologia , Fístula Cutânea/terapia , Nutrição Enteral/estatística & dados numéricos , Feminino , Humanos , Neoplasias Laríngeas/complicações , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/terapia , Laringe/efeitos dos fármacos , Laringe/patologia , Laringe/efeitos da radiação , Laringe/cirurgia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Lesões por Radiação/etiologia , Procedimentos de Cirurgia Plástica/efeitos adversos , Estudos Retrospectivos , Retalhos Cirúrgicos/transplante , Resultado do Tratamento
17.
Laryngoscope ; 131(5): E1476-E1480, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33044014

RESUMO

OBJECTIVE: No surgical or radiotherapeutic treatment guidelines exist for oligometastatic head and neck squamous cell carcinoma (oHNSCC), and only recently have interventions with curative intent been studied. Herein, we sought to elucidate survival rates among patients with oHNSCC to determine if treatment with curative intent is warranted in this population. STUDY DESIGN: Retrospective chart review. METHODS: We retrospectively reviewed cases of oHNSCC treated between March 1998 and March 2018. Fisher's exact test was used to compare patients treated with radiotherapy (RT) to those who underwent surgical excision and to compare outcomes of patients with oligometastases at the time of initial presentation to those that developed oligometastatic disease after primary treatment. RESULTS: Eighty one patients with metastases to the lungs, ribs, pelvis, vertebral column, liver, clavicle, and sternum were included. Overall, 32 patients (40%) were alive 5 years post-treatment. The site of metastasis, the modality of treatment, and the time of development of oligometastatic disease did not significantly affect 5-year survival. CONCLUSION: Herein, we demonstrate that multi-modality treatment of oHNSCC is warranted for some patients with an estimated 40% 5-year survival. Aggressive treatment of the primary and regional sites is necessary in addition to treatment of the metastatic site and incurs a survival benefit compared to patients with metastatic HNSCC treated with systemic therapy alone. oHNSCC should be approached separately from polymetastatic disease. Patients should be counseled about the possibility for long-term survival, and aggressive initial treatment with the intention for cure should be considered in this population. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E1476-E1480, 2021.


Assuntos
Neoplasias de Cabeça e Pescoço/terapia , Recidiva Local de Neoplasia/epidemiologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/terapia , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Idoso , Tomada de Decisão Clínica , Intervalo Livre de Doença , Feminino , Neoplasias de Cabeça e Pescoço/mortalidade , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/prevenção & controle , Guias de Prática Clínica como Assunto , Radioterapia Adjuvante/normas , Radioterapia Adjuvante/estatística & dados numéricos , Carcinoma de Células Escamosas de Cabeça e Pescoço/mortalidade , Carcinoma de Células Escamosas de Cabeça e Pescoço/secundário , Procedimentos Cirúrgicos Operatórios/normas , Taxa de Sobrevida
18.
Semin Plast Surg ; 34(4): 260-264, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33380911

RESUMO

Historically, nasoseptal surgery favoring functional considerations has compromised aesthetic ones, and vice versa, but modern techniques have evolved that allow symbiotic achievement of both goals. Nasoseptal surgery is among the most commonly performed plastic surgical procedures in the United States, and while it is generally well tolerated, there are a few surgical and aesthetic complications of which to be aware. Herein, we review surgical techniques that improve the nasal airway and nasal aesthetics in a top-down approach with a discussion of possible ensuing complications.

19.
Semin Plast Surg ; 34(4): 265-271, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33380912

RESUMO

Radiation therapy plays a critical role in the treatment of malignancies involving the head and neck. Although the therapeutic effects of ionizing radiation are achieved, normal tissues are also susceptible to injury and significant long-term sequelae. Osteoradionecrosis of the temporal bone (ORNTB) is among the many complications that can arise after therapy. ORNTB is a debilitating and potentially lethal condition that continues to challenge patients and treating physicians. Herein, we review the pathophysiology, presentation, work-up, and management of ORNTB.

20.
Semin Plast Surg ; 34(4): 293-298, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33380916

RESUMO

Microvascular free tissue transfer is the standard in the complex head and neck reconstruction with success rates greater than 95%. Free tissue transfer allows for more versatility in reconstructing complex defects with better tissue match. Failures, however, do occur and subsequent free tissue transfer might not be an option due to either the patients' health or in a vessel depleted neck. In these challenging salvage scenarios, the head and neck reconstructive surgeon must turn to regional flaps for reconstruction. Here, we review multiple regional flap options for salvage head and neck reconstruction.

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