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Head and Neck Reconstruction

Facial Plastic Surgery

Facial plastic reconstructive surgery is a specialized field of plastic surgery that focuses on restoring or improving the form and function of the face after trauma, post cancer surgery, congenital abnormalities, or other conditions.

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Maxillofacial Trauma:

Maxillofacial trauma refers to injuries or trauma affecting the maxilla (upper jaw), mandible (lower jaw), face, and associated structures such as the cheekbones, nose, and orbits (eye sockets). These injuries can result from a variety of causes, including accidents, falls, sports injuries, assaults, or motor vehicle accidents. Facial fractures can range from minor fractures that require minimal intervention to severe injuries that may lead to significant functional and cosmetic deformities if not properly treated.

  • Facial Fractures:

Nasal fractures: The nose is one of the most commonly fractured facial bones. Nasal fractures often result from blunt force trauma to the face, such as a punch or a fall. Symptoms may include swelling, bruising, tenderness, difficulty breathing through the nose, and deformity of the nasal bridge.

Maxillary fractures: The maxilla, or upper jaw, can sustain fractures due to high-impact injuries to the face. Fractures of the maxilla may involve the bones around the cheeks and eye sockets (zygomatic bones) as well. Symptoms may include pain, swelling, difficulty opening the mouth, misalignment of the teeth, and facial numbness.

Mandibular fractures: The mandible, or lower jaw, is susceptible to fractures, particularly at the angle or body of the jaw. Mandibular fractures often result from direct trauma to the jaw, such as a punch or a motor vehicle accident. Symptoms may include pain, swelling, difficulty chewing or speaking, malocclusion (misalignment of the teeth), and a visible deformity of the jawline.

Orbital fractures: The bones surrounding the eye socket (orbit) can fracture due to blunt trauma to the face. Orbital fractures may cause symptoms such as swelling and bruising around the eyes, double vision, decreased eye movement, sunken appearance of the eye, and numbness of the cheek or forehead.

Le Fort fractures: These are severe fractures that involve the maxilla and may extend into the orbit, nasal bones, or other facial structures. Le Fort fractures are typically caused by high-velocity trauma, such as motor vehicle accidents or falls from significant heights. These fractures can result in significant facial deformity, difficulty breathing, and impaired vision or eye movement.

Diagnosis of facial fractures typically involves a thorough physical examination, imaging studies such as X-rays, CT scans. Treatment of facial fractures aims to restore normal function and appearance while minimizing complications. Depending on the severity and location of the fracture, treatment options may include:

  • Observation and pain management for minor fractures that do not require surgical intervention.
  • Nasal packing or septal surgery for nasal fractures to correct deformities and improve breathing.
Soft tissue injuries:

Soft tissue injuries of the face can range from minor cuts and bruises to more severe injuries such as lacerations, contusions, abrasions, and avulsions.

Complications of soft tissue injuries of the face may include infection, scarring, loss of sensation or function, asymmetry, and psychological distress due to changes in appearance. Prompt and appropriate management of these injuries by Plastic Surgeon is essential for achieving satisfactory aesthetic and functional outcomes while minimizing the risk of complications.

Scalp Reconstruction

Scalp area extends from supraorbital margin anteriorly to superior nuchal line posteriorly. It consists of 5 layers :skin, subcutaneous tissue, muscle aponeurosis, loose areolar tissue and pericranium. 

Scalp defects arise due to trauma, infection, tumor resection, burns, or congenital deformities. Scalp defects can vary in size, depth, and complexity, and their reconstruction often requires careful planning and consideration of functional and aesthetic outcomes.

Reconstruction of scalp defects aims to restore the natural contour, hair growth, and sensation of the scalp while minimizing visible scarring and deformity.

 

Various reconstructive options include:

  • Primary Closure:

Small scalp defects may be closed directly using sutures to bring the edges of the wound together. This technique is often used for linear or elliptical defects that are easily approximated without undue tension on the surrounding tissues.

  • Skin Grafts:

Skin grafting involves harvesting a thin layer of skin from another area of the body (donor site) and transplanting it to cover the scalp defect. Skin grafts can be split-thickness or full-thickness, depending on the depth of the defect. This technique is suitable for larger defects where primary closure is not feasible or when there is insufficient local tissue for flap reconstruction.

  • Local Flaps:

Local flaps involve mobilizing adjacent tissue with intact blood supply to cover the scalp defect. Various flap designs, such as rotation flaps, advancement flaps, and transposition flaps, can be used depending on the location and size of the defect. Local flaps offer the advantage of providing like-for-like tissue coverage and maintaining hair follicles and sensation in the reconstructed area.

  • Regional Flaps:

Regional flaps utilize tissue from adjacent anatomical regions, such as the forehead, neck area, or occiput, to reconstruct scalp defects. These flaps are based on vascular pedicles and can be advanced or rotated into the defect site while preserving vascular supply. Regional flaps are particularly useful for larger defects or those involving complex contours of the scalp.

  • Free Flaps:

Free tissue transfer involves harvesting tissue, along with its blood supply, from a distant site of the body (donor site) and transferring it to the scalp defect using microsurgical techniques. Free flaps provide a versatile option for complex reconstructions where local or regional tissue is inadequate or compromised.

  • Tissue Expanders :

Tissue expanders play a crucial role in scalp reconstruction by providing additional tissue for addressing complex defects and achieving optimal functional and aesthetic outcomes.They offer a solution by gradually stretching the surrounding skin and soft tissues to create additional tissue for covering the defect

Tissue expanders offer several advantages in scalp reconstruction:

  • Increased availability of tissue for covering large scalp defects.
  • Preservation of hair-bearing tissue and natural scalp contour.
  • Minimization of donor site morbidity and scarring compared to traditional flap harvesting techniques.
  • Improved aesthetic outcomes by matching the color, texture, and contour of the surrounding scalp tissue. Ear reconstruction

Congenital deformities

Congenital deformities of the ear, also known as congenital ear anomalies or malformations, are structural abnormalities present at birth that affect the shape, size, position, or function of one or both ears. These anomalies can range from mild variations in ear shape to more significant deformities that impact hearing and overall facial appearance. Congenital ear deformities occur during fetal development and may result from genetic factors, environmental influences, or a combination of both.

 

Some common congenital ear deformities include:

  • Microtia:

Microtia is a congenital condition characterized by underdevelopment or absence of the external ear (pinna). It can range from mild forms, where the ear is smaller than usual, to severe forms, where the ear is completely absent. Microtia can occur unilaterally (affecting one ear) or bilaterally (affecting both ears) and may be associated with hearing loss.

  • Prominent ears:

Prominent ears, also known as bat ears or prominent auricles, are characterized by ears that protrude prominently from the head. This deformity is often caused by abnormal development or positioning of the ear cartilage during fetal development. Prominent ears can affect self-esteem and may be corrected through surgical procedures such as otoplasty.

  • Cryptotia:

Cryptotia, also known as hidden ear or buried ear, is a congenital deformity where the upper portion of the ear is buried beneath the skin of the scalp. In cryptotia, the cartilage of the upper ear (helix) is often fused with the scalp, resulting in a partially or completely hidden appearance. Surgical correction typically involves releasing the buried ear cartilage and reshaping it to a more normal position.

  • Constricted ear:

Constricted ear deformity, also known as “lop ear” or “cup ear,” is characterized by a malformed ear that appears smaller and has a flattened or cup-shaped appearance. This deformity is caused by incomplete or abnormal folding of the ear cartilage during fetal development. Surgical correction may involve reconstructive procedures to reshape the ear and improve its appearance.

  • Stahl's ear:

Stahl’s ear, also known as “elf ear” or “Spock ear,” is characterized by an extra fold or point in the upper portion of the ear, giving it a distinctive pointed appearance. Stahl’s ear deformity is caused by abnormal folding or fusion of the ear cartilage during fetal development. Surgical correction may involve reshaping the ear cartilage to create a more natural contour.

  • Constricted ear:

Constricted ear deformity, also known as “lop ear” or “cup ear,” is characterized by a malformed ear that appears smaller and has a flattened or cup-shaped appearance. This deformity is caused by incomplete or abnormal folding of the ear cartilage during fetal development. Surgical correction may involve reconstructive procedures to reshape the ear and improve its appearance.

  • Other less common deformities:

Other less common congenital ear deformities include accessory tragus (extra skin tag or nodule near the ear), preauricular sinus (small pit or dimple near the ear), and anomalies affecting the ear canal or middle ear structures.

Acquired deformities:

Acquired deformities of the ear refer to structural abnormalities or alterations in the shape, size, position, or function of the ear that develop later in life as a result of trauma, injury, surgery, disease, or other external factors.

  • Traumatic ear deformities:

Traumatic ear deformities can occur as a result of various types of trauma or injury to the ear, including lacerations, avulsions, burns, or fractures. These injuries may cause significant damage to the ear’s structure, resulting in deformities such as asymmetry, loss of tissue, or distortion of the ear’s natural contours. Treatment for traumatic ear deformities often involves surgical repair or reconstruction to restore the ear’s appearance and function.

  • Keloid or hypertrophic scars:

Keloid and hypertrophic scars are abnormal growths of scar tissue that can develop in response to ear piercing, injury, or surgery involving the ear. These raised, thickened scars may extend beyond the boundaries of the original wound and can cause cosmetic deformity, itching, pain, and discomfort. Treatment options for keloid and hypertrophic scars may include corticosteroid injections, laser therapy, silicone gel sheeting, or surgical excision followed by scar revision.

  • Ear lobe deformities:

Prolonged or repetitive wearing of heavy earrings or improper piercing techniques can lead to acquired deformities of the earlobe, such as stretching, tearing, or elongation of the earlobe hole. In some cases, the weight of heavy earrings can cause the earlobe to sag or elongate, resulting in a drooping or ptotic appearance. Surgical procedures such as earlobe repair or earlobe reduction may be performed to correct earring-related deformities and restore a more natural earlobe contour.

  • Tumor or skin lesion excision:

Surgical removal of tumors, skin lesions, or growths involving the ear may result in acquired deformities or defects that require reconstruction. Depending on the size and location of the excised tissue, reconstructive procedures such as skin grafting, local tissue flaps, or cartilage grafting may be used to restore the ear’s appearance and function.

Plastic surgeons specializing in ear reconstruction can provide comprehensive evaluation and treatment options tailored to each patient’s specific needs.

Lip Reconstruction

The lips play a crucial role in facial aesthetics, speech, eating, and expressions. When they are damaged or deformed, it can .significantly impact an individual’s quality of life.

 

 Various causes which require lip reconstruction:

  • Trauma:

Accidents, burns, animal bites, or other traumatic injuries can result in damage to the lips, ranging from minor lacerations to extensive tissue loss.

  • Cancer:

Lip cancer, often associated with excessive sun exposure, can necessitate the removal of a portion or the entirety of the lip, leaving a defect that requires reconstruction.

  • Congenital Defects:

Some individuals are born with cleft lip or other congenital anomalies that may require surgical correction.

  • Disease:

Conditions such as infections or autoimmune diseases can also affect the lips, leading to deformities or tissue loss.

The goals of lip reconstruction are not only aesthetic but also functional. 

Plastic Surgeons aim to recreate a natural-looking lip that allows for normal speech, eating, and facial expressions. The specific approach to lip reconstruction depends on the extent of the defect, the location, and the individual’s unique anatomy.

 

Several techniques may be employed in lip reconstruction:

  • Primary Closure:

For minor defects or injuries, simply suturing the wound edges together restore the continuity of the lip.

  • Local Tissue Flaps:

In cases where there is a moderate amount of tissue loss, nearby tissue may be mobilized and rotated or advanced to cover the defect. This can involve adjacent skin or mucosal tissue.

  • Regional Flaps:

In more complex cases, tissue from neighbouring regions such as the cheek or forehead may be used to reconstruct the lip. These flaps retain their own blood supply and can be tunneled to the defect site.

  • Microvascular Free Tissue Transfer:

For extensive defects, particularly those involving both the upper and lower lips, tissue may be harvested from another part of the body, such as the forearm or thigh, and transferred to the lip using microsurgical techniques. This allows for the recreation of a more natural appearance and function.

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