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The journal «ONCOSURGERY» 2013, Vol.5, No 3

Concepts and defect-oriented approaches to head and neck reconstruction

Marek Dobke1,2, Ahmed Suliman1,2, Fernando Herrera4, Christopher Reid2, Brittany Yee3, Brian Mailey1,2, Salim Saba1,2

1) Division of Plastic Surgery,
2) Department of Surgery,
3) University of California San Diego, School of Medicine,
San Diego, CA, USA
4) Medical University of South Carolina,
Charlottsville, South Carolina, USA
Contact: Marek Dobke, e-mail:

Over the past thirty years the management of oncologic head and neck defects has evolved with the advent of microsurgical techniques. Extensive two- and three-dimensional cavities can be reliably reconstructed with good functional outcomes including preservation of respiration, phonation, mastication and deglutition.

Advancements in diagnostic imaging have been essential for achieving complete resection with negative oncologic margins, especially of difficult to access tumors. New imaging techniques have made three-dimensional virtual planning possible. These include, computer generated stereolithogra-phic mandibular or midfacial skeletal models, which define skeletal defects and allow for precise prefabrication of orthognathic models, splints and customized modeling for free osseous (e.g., fibular) flaps based on individual defect anatomy. These advancements enable better dental rehabilitation and enhance overall aesthetic outcomes.

Furthermore, advancements in neoadjuvant radio- and chemotherapy have made previously unresectable tumors accessible to extirpation and ultimately reconstruction. Changing paradigms in radiotherapy with the ability to deliver radiation more accurately over smaller fields, and in more concentrated doses, have reduced collateral and biologically unnecessary damage to uninvolved peri-tumor tissue in order to allow for greater success with reconstructive flaps insets and healing.

The most recent addition to the armamentarium of oncologic and reconstructive surgeons has been the surgical robot. This technology appears to reduce resection related morbidity for selected types of tumors (e.g., oropharyngeal). This benefit also extends to harvesting of certain flaps for reconstruction, as compared to open-access approaches.

Reconstructive experiences, in the context of multiple specialty advancements for the management of the head and neck tumors range from post-Mohs’ surgery defects to extensive reconstructions. These often require composite tissue flaps for skeletal support, mucosal lining and soft tissue restoration with reconstitution of the natural barriers that exist between the gastrointestinal and respiratory tracts and skin coverage. Illustrative cases are presented.

Acknowledgements: Presented at the First Interdisciplinary Congress of the Head and Neck Diseases. The Twenty First Century Medicine – Interdisciplinary Approach to Pathology of the Head and Neck. Moscow, May 27-29, 2013.

KEY WORDS: Head and neck reconstruction, concepts, flaps.

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