Head and Neck Surgery for General Surgeons

✍ Scribed by Bruce Ashford (editor)

• Publisher: Springer
• Year: 2024
• Tongue: English
• Leaves: 270
• Category: Library

✦ Synopsis

General surgery is the common ancestor of all surgical specialties. Within general surgery, many subspecialty areas of practice have evolved. This book is the first manual recognizing the growing role General Surgeons play in Head & Neck Surgery. From benign to malignant conditions and form ablative to reconstructive challenges, the renowned comprehensive capability of the General Surgeon is well suited to demands of this discipline.

Each chapter details relevant anatomical considerations to enable understanding of this complex regional specialty and the full range of head and neck pathologies with requisite assessment, investigation, surgical and relevant reconstructive techniques.

Written by a multidisciplinary, international team of recognized experts, this textbook is a practical but comprehensive guide for both candidates preparing for final surgery examinations as well as general surgeons requiring an up-to-date source of definitive advice on topics of this regional specialty.

✦ Table of Contents

Foreword
Acknowledgments
Introduction
Contents
1: Imaging in Head and Neck Surgery
1.1 Imaging Modalities
1.2 Trauma
1.3 Neck Spaces: Anatomy of the Suprahyoid and Infrahyoid Neck
1.3.1 Visceral Space
1.3.2 Retropharyngeal Space
1.3.3 Prevertebral Space
1.3.4 Parapharyngeal Space
1.3.5 Carotid Space
1.3.6 Masticator Space
1.3.7 Parotid Space
1.3.8 Buccal Space
1.3.9 Submandibular Space
1.3.10 Sublingual Space
1.4 Evaluation of a Neck Lump
1.4.1 Salivary Gland
1.4.1.1 Tumour
Pleomorphic Adenoma
Warthin Tumour
Mucoepidermoid Carcinoma
Adenoid Cystic Carcinoma
1.4.1.2 Infection/Inflammation
1.4.2 Cervical Lymphadenitis
1.4.3 Thyroid
1.4.3.1 Thyroid Carcinoma
1.4.4 Parathyroid
1.4.5 Branchial Cleft Anomalies
1.4.6 Thyroglossal Duct Cyst
1.4.7 Carotid Body Tumour
1.5 Skin Cancer
1.6 Upper Aerodigestive Tract Neoplasia
1.7 Conclusion
References
2: Thyroid
2.1 Introduction
2.2 The Basics: Essential Anatomy, Embryology and Physiology
2.2.1 Embryology and Anatomy
2.2.1.1 Origin
2.2.1.2 Thyroglossal Duct
2.2.1.3 Thyroid Anatomy
Blood Supply
Superior Thyroid Artery (STA) and External Branch of Superior Laryngeal Nerve
Inferior Thyroid Artery (ITA)
Thyroidea IMA
Venous Drainage
2.2.1.4 Recurrent Laryngeal Nerve (RLN)
Anatomy and Function
Embryology
Arteria Lusoria and the Non-recurrent Laryngeal Nerve
2.2.2 Physiology
2.2.2.1 Thyroid Hormone Synthesis
2.3 Thyroid Nodules and Basic Thyroid Work-up
2.3.1 History and Examination
2.3.1.1 History
Is the Nodule Hyper Functional?
Is the Nodule Malignant?
Is the Nodule Causing Symptoms?
2.3.1.2 Examination
Is the Nodule Hyperfunctional?
Is the Nodule Malignant?
Is the Nodule Causing Symptoms?
2.3.2 Thyroid Biochemistry and Imaging for Nodules
2.3.2.1 Ultrasound for Thyroid Nodules (in Normal or Elevated TSH)
2.3.3 Cytopathology
2.3.3.1 Functional Radionuclide Thyroid Scan (for Low TSH)
MIBG 123 and 131
Technetium 99 Pertechnetate
2.3.4 Multinodular Goitre
2.3.5 Thyroid Cysts
2.4 Malignant Thyroid Conditions
2.4.1 Differentiated Thyroid Cancers (DTC): Papillary, Follicular and Hurthle Cell
2.4.1.1 Risk Factors for DTC
2.4.1.2 Essential Histology
2.4.2 Workup, Management and Surveillance of Differentiated Thyroid Cancers
2.4.2.1 Extent of Thyroidectomy
2.4.2.2 Neck Dissection
2.4.2.3 Postoperative Levothyroxine
2.4.2.4 Systemic Therapy
2.4.2.5 Postoperative Surveillance
2.4.3 Medullary Thyroid Cancer (MTC)
2.4.3.1 Classification
Risk Factors
Essential Histology
2.4.3.2 Workup
2.4.3.3 Treatment and Surveillance
Surgery
Surveillance
2.4.4 Anaplastic Thyroid Cancer (ATC)
2.4.4.1 Histology
2.4.4.2 Workup and Management
2.4.5 Rare Variants
2.4.5.1 Lymphoma
2.4.5.2 Teratoma
2.4.5.3 Thyroid Paraganglioma
2.4.5.4 Squamous Cell Carcinoma of the Thyroid
2.4.5.5 Castle
2.4.6 PET Positive Nodules and Thyroid Gland Metastases
2.4.7 Thyroid Cancer in Pregnancy
2.4.8 Genetic Syndromes Relevant to Thyroid Cancer
2.5 Hyperthyroid Conditions
2.5.1 Graves’ Disease
2.5.1.1 Clinical Manifestations
2.5.1.2 Treatment Options
2.5.2 Neoplastic
2.5.2.1 Toxic Multinodular Goitre (MNG)
2.5.2.2 Toxic Nodule
2.5.3 Preparation for Surgery in Hyperthyroidism
2.5.3.1 Methimazole
2.5.3.2 Carbimazole
2.5.3.3 Propylthiouracil (PTU)
2.5.3.4 Beta-Blockade
2.6 Thyroidectomy: Operative Steps
2.6.1 Preparation
2.6.1.1 Vocal Cord Function
2.6.1.2 Nerve Monitoring
2.6.1.3 Positioning
2.6.2 Stepwise Operative Approach
2.6.2.1 Step 1: Incision and Sub-Platysmal Flaps
2.6.2.2 Step 2: Separation and Mobilisation of the Strap Muscles
2.6.2.3 Step 3: Ligation of the Middle Thyroid Vein and Mobilisation of the Thyroid Lobe
2.6.2.4 Step 4: Ligation of the Superior Pole Vessels
2.6.2.5 Step 5: Identification of the RLN
2.6.2.6 Step 6: Exposure of the Trachea in the Midline at Inferior Border of Gland
2.6.2.7 Step 7: Ligation of Inferior Pole Vessels
2.6.2.8 Step 8: Dissection of the Thyroid from RLN, Ligament of Berry and Superior Parathyroid Gland
2.6.2.9 Step 9: Closure
2.6.3 Postoperative Care
2.7 Thyroidectomy: Management of Complications
2.7.1 Haematoma
2.7.2 RLN Injury/Neuropraxia
2.7.3 Hypocalcaemia
2.7.3.1 Clinical Manifestations
2.7.4 Surgical Site Infection (SSI)
References
3: Parathyroid
3.1 The Importance of Calcium to Life
3.2 A Brief History of Parathyroid Surgery and Related Discoveries
3.3 Parathyroid Embryology
3.4 Parathyroid Anatomy
3.4.1 Macroscopic
3.4.1.1 Superior (‘P4’) Parathyroid Glands
3.4.1.2 Inferior (‘P3’) Parathyroid Glands
3.4.1.3 Blood Supply
3.4.2 Microscopic
3.5 Parathyroid Physiology
3.6 Parathyroid Pathophysiology
3.6.1 Primary Hyperparathyroidism (pHPT)
3.6.2 Secondary Hyperparathyroidism
3.6.2.1 Lithium-Induced Hyperparathyroidism
3.6.3 Tertiary Hyperparathyroidism
3.6.4 Normocalcaemic Hyperparathyroidism
3.6.5 Hyperparathyroidism in Pregnancy
3.6.6 Parathyroid Cysts
3.6.7 Parathyroid Carcinoma
3.6.8 Hypercalcaemic Crisis Due to Hyperparathyroidism
3.7 Men and Other Genetic Parathyroid Conditions
3.7.1 MEN Syndromes
3.7.2 MEN-1
3.7.3 MEN-2A
3.7.4 Familial Hypocalciuric Hypercalcaemia (FHH)
3.7.5 Hyperparathyroidism-Jaw Tumour Syndrome (HPT-JT)
3.7.6 Familial Isolated Hyperparathyroidism (FIHP)
3.8 Epidemiology
3.9 Clinical Evaluation and Diagnostic Work Up of Hyperparathyroidism
3.9.1 Biochemistry
3.9.1.1 Serum Calcium (Ca) Corrected for Albumin
3.9.1.2 Serum Parathyroid Hormone (PTH)
3.9.1.3 24 h Urinary Calcium Excretion
3.9.1.4 Serum 1,25 Dihydroxyvitamin D
3.9.2 Parathyroid Imaging
3.9.3 Other Imaging Studies
3.10 Indications for Surgery [3, 4]
3.10.1 Primary Hyperparathyroidism
3.10.2 Secondary Hyperparathyroidism
3.10.3 Tertiary Hyperparathyroidism
3.11 Consent for Surgery: Expected Benefits and Potential Risks
3.12 Technique for Surgical Parathyroid Exploration
3.12.1 Minimal Access vs. Routine Four Gland Exploration
3.12.2 Image Negative Cases
3.12.3 MEN-1 and Other Familial Syndromes
3.12.4 Secondary Hyperparathyroidism
3.12.5 Parathyroid Incidental to Thyroid Pathology and Surgery
3.12.6 General Principles
3.12.6.1 Incision Appropriate to the Circumstances
3.12.6.2 Maximum Exposure
3.12.6.3 Bloodless and Blood Mitigating
3.12.6.4 Nerves
3.12.6.5 Early Exploration Strategy
3.12.6.6 Scope of Anatomical Exposure
3.12.6.7 Tissue Handling
3.12.6.8 Parathyroid Identification and Preservation of Normal Parathyroids
3.12.7 Use of Frozen Section
3.12.8 Visual Enhancement
3.12.8.1 Mobilisation and Resection
3.12.8.2 Capsular vs. wider Fat Resection
3.12.8.3 Correlation with Pre-Operative Expectations
3.12.8.4 Rapid PTH Assay
3.12.8.5 Weighing the Parathyroid
3.12.8.6 Parathyroid Marking
3.12.8.7 Non-standard Location Strategy
3.12.8.8 Biopsy of Normal Parathyroids
3.12.8.9 One Missing Gland
3.12.8.10 Two Missing Glands
3.12.8.11 Three Missing Glands
3.12.8.12 Malignant Parathyroids and Very Large Parathyroids
3.12.8.13 Clearing One Side Strategy
3.12.8.14 Parathyroid Implantation and Cryopreservation
3.12.8.15 Parathyroids beyond the Scope of Neck Exploration
3.13 Surgical Outcome Measures
3.14 Multi-Disciplinary Care and Ethical Considerations
References
4: Parotid
4.1 Scope of Disease
4.1.1 Benign Salivary Neoplasms
4.1.2 Malignant Salivary Neoplasms
4.1.3 Infectious, Inflammatory, and Miscellaneous Pathologies
4.2 Key Elements of History
4.3 Clinical Examination Pearls
4.4 Investigations and Limitations
4.4.1 Ultrasound
4.4.2 CT and MRI
4.4.3 Scintigraphy
4.4.4 Positron Emission Tomography (PET)
4.4.5 Fine Needle Aspiration Biopsy
4.4.6 Core Needle Biopsy
4.5 Surgical Management and Risks
4.5.1 Antegrade Approach
4.5.2 Retrograde Approach
4.5.3 Focussed Approaches
4.5.4 Deep Lobe and Parapharyngeal Surgery
4.5.5 Postoperative Course and Potential Complications
4.6 Non-Surgical Pathologies and Management
4.6.1 Acute Parotitis
4.6.2 Juvenile Recurrent Parotitis
4.6.3 Sjögren’s Syndrome
4.6.4 Benign Lymphoepithelial Cysts
4.6.5 Granulomatous Sialadenitis
4.6.6 Sialadenosis
References
5: Submandibular and Sublingual Gland
5.1 Introduction
5.2 Key Elements of History
5.3 Clinical Examination Pearls
5.4 Investigations and Their Limitations
5.5 Surgical Management Including Risks
5.5.1 Transcervical Approach
5.5.2 Transoral Approach
5.5.3 Surgical Planning
5.6 Relevant Non-Surgical Management
References
6: Advanced Skin Cancer
6.1 Skin Cancer Biology
6.1.1 NMSC
6.1.1.1 Basal Cell Carcinoma
6.1.1.2 Squamous Cell Carcinoma
6.1.1.3 Merkel Cell Carcinoma
6.1.2 Melanoma
6.2 Surgical Problems in Local Disease
6.2.1 Local Excision Relevant to Anatomy
6.3 Managing Regional Lymph Node Disease and At-Risk Nodal Basins
6.4 Surveillance of High-Risk Cancers
6.5 Immunosuppression and Skin Cancer
6.6 Role of Adjuvant Therapies
6.6.1 Cutaneous Squamous Cell Carcinoma Staging AJCC Eighth Edition
6.6.2 Melanoma Staging AJCC eighth edition
References
7: Local Flaps of the Head and Neck
7.1 Introduction
7.2 History and Examination
7.3 Investigations
7.4 Anatomy
7.4.1 Skin
7.4.2 SMAS
7.4.3 Facial Muscles
7.4.4 Blood Supply
7.4.5 Nerves
7.5 Non-Surgical Management
7.5.1 Topical Creams
7.5.2 Cryotherapy
7.5.3 Photodynamic Therapy
7.5.4 Radiotherapy
7.6 Surgical Management
7.6.1 Excision
7.6.2 Direct Closure
7.6.3 Skin Grafts
7.7 Local Flaps
7.7.1 Scalp
7.7.2 Forehead
7.7.3 Temple
7.7.4 Nose
7.7.5 Lip
7.7.6 Cheek
7.7.7 Ear
References
8: Neck Dissection
8.1 Key Elements of History
8.1.1 Underlying Disease Process
8.1.1.1 Oral Cavity
Occult Disease (N0)
Macroscopic Disease (N1)
Level IIb
Skip Metastasis
8.1.1.2 Cutaneous Squamous Cell Disease
Parotid Positive (P+)
Parotid Negative (P0)
8.1.1.3 Salivary Gland Disease
8.1.2 Previous Medical History
8.1.3 Previous Treatment in the Head and Neck Region
8.1.4 Current Medications
8.2 Clinical Examination Pearls
8.2.1 Targeted Examination
8.2.1.1 Look
8.2.1.2 Feel
8.2.1.3 Move
8.2.1.4 Auscultation
8.2.2 Special Investigations
8.2.2.1 Flexible Nasal Endoscopy (FNE)
8.2.2.2 Image-Guided Biopsies
Core Biopsy
p16 Status
8.3 Investigations and their Limitations
8.3.1 Imaging
8.3.1.1 Ultrasound
8.3.1.2 Computed Tomography (CT)
8.3.1.3 Magnetic Resonance Imaging (MRI)
8.3.1.4 Positron-Emission Tomography (PET)
8.3.1.5 Lymphoscintigraphy
8.3.2 Sentinel Node Biopsy
8.4 Surgical Management
8.4.1 Setup
8.4.1.1 Performing a Selective Neck Dissection Levels I–III
8.4.1.2 Performing a Level II–IV Neck Dissection
8.4.1.3 Level V Neck Dissection
8.4.2 General Surgical Complications
8.4.2.1 Blood Loss
8.4.2.2 Infection
8.4.2.3 Pain
8.4.2.4 Lymphoedema
8.4.2.5 Chyle
8.4.3 Nerve-Related Complications
8.4.3.1 Cervical Branch of the Facial Nerve
8.4.3.2 Marginal Mandibular Nerve
8.4.3.3 Accessory Nerve
8.4.3.4 Lingual Nerve
8.4.3.5 Hypoglossal Nerve
8.4.3.6 Vagus Nerve
8.4.3.7 Phrenic Nerve
8.4.3.8 Branchial Plexus
8.5 Post-Operative Management
8.5.1 Analgesia
8.5.2 Antibiotics
8.5.3 Diet
8.5.4 Drains
References
9: Neck Cysts
9.1 Thyroglossal Duct Cysts
9.1.1 Clinical Presentation
9.1.2 Imaging
9.1.2.1 Ultrasound
9.1.2.2 Cross-Sectional Imaging
9.1.3 Management
9.1.3.1 Surgical Procedure
9.1.3.2 Malignant Risk
9.2 Branchial Cleft Cyst
9.2.1 First Branchial Anomaly
9.2.2 Second Branchial Anomaly
9.2.3 Third Branchial Anomaly
9.2.4 Fourth Branchial Anomaly
9.2.5 Clinical Presentation
9.2.6 Imaging
9.2.6.1 Ultrasound
9.2.6.2 Cross-Sectional Imaging
9.2.7 Management
9.2.7.1 Surgical Procedure
9.3 Ranula
9.3.1 Clinical Presentation
9.3.2 Imaging
9.3.2.1 Ultrasound
9.3.2.2 Cross-Sectional Imaging
9.3.3 Management
9.4 Metastatic Carcinoma Presenting as a Neck Cyst
References
10: Tracheal Surgery and Tracheostomy
10.1 Introduction
10.2 Anatomy of the Trachea
10.2.1 Blood Supply
10.2.2 Lymphatic Drainage
10.3 Primary Tracheal Tumours
10.3.1 Benign Tracheal Neoplasms
10.3.2 Malignant Tracheal Neoplasms
10.3.2.1 Squamous Cell Carcinoma
10.3.2.2 Adenoid Cystic Carcinoma
10.3.2.3 Other Malignant Tracheal Tumours
10.4 Staging of Primary Tracheal Malignancies
10.5 Secondary Tracheal Tumours
10.6 Clinical Presentation
10.6.1 Common Features on History and Examination
10.7 Investigations
10.7.1 Imaging
10.7.1.1 Chest X-Ray
10.7.1.2 Computed Tomography (CT)
10.7.1.3 Magnetic Resonance Imaging (MRI)
10.7.1.4 Positron-Emission Tomography (PET)
10.7.1.5 Ultrasonography
10.7.2 Pulmonary Function Testing
10.7.3 Endoscopic Evaluation and Biopsy
10.8 Management of Tracheal Malignancy
10.8.1 Endoscopic Assessment and Management
10.8.2 Surgical Resection
10.8.3 Airway Management during Tracheal Surgery
10.8.4 Approach
10.8.5 Extent of Resection
10.8.5.1 Tracheal Shave
10.8.5.2 Simple Segmental Tracheal Resection
10.8.5.3 Window Resection and Repair
10.8.5.4 Cricotracheal Resection and Thyrotracheal Anastomosis
Slide
Step-Wise
10.8.6 Principles of Anastomosis
10.8.7 Risks and Complications
10.9 Non-Surgical and Adjuvant Management
10.9.1 Radiotherapy
10.9.2 Chemotherapy
10.9.3 Immunotherapy
10.9.4 Palliative Therapy
10.10 Tracheostomy and Tracheotomy
10.10.1 Procedure
10.10.2 Complications of Tracheostomy
10.10.3 Decannulation
10.11 Conclusion
References
11: Carotid Body Tumours and Paragangliomas
11.1 Introduction
11.2 Key Elements of History
11.3 Clinical Examination Pearls
11.4 Investigations and Their Limitations
11.5 Imaging
11.5.1 CT
11.5.2 MRI
11.5.3 Interventional Radiology
11.6 Surgical Approaches
11.6.1 Carotid Body Tumours
11.6.2 Vagal and Sympathetic Nerve Schwannomas
11.7 Non-surgical Management
References
12: Mucosal Malignancy: Management of the Oral Cavity and Facial Skeleton
12.1 Oral Cavity Anatomy and Function
12.2 Epidemiology
12.3 Risk Factors
12.4 Key Elements of Presentation and History
12.4.1 Allied Health
12.5 Clinical Examination Pearls
12.6 Investigations and their Limitations
12.6.1 Biopsy
12.6.2 Imaging
12.7 Surgical Management Including Risks
12.7.1 Oral Tongue
12.7.2 Buccal Mucosa
12.7.3 Floor of Mouth
12.7.4 Retromolar Trigone
12.7.5 Hard Palate, Upper Alveolus, and Maxilla
12.7.6 Lower Alveolus and Mandible
12.7.7 Mandibulotomy for Access
12.7.8 Surgical Management of the Neck
12.7.9 Reconstruction
12.7.10 Recurrent Disease
12.7.11 Post-Operative Complications
12.8 Relevant Non-Surgical Management
12.8.1 Radiation Therapy
12.8.2 Proton Beam
12.8.3 Cytotoxic Chemotherapy
12.8.4 Targeted Therapy
12.8.5 Immunotherapy
12.8.6 Multidisciplinary Approach
References
13: Mucosal Malignancy: Cancers of the Oropharynx
13.1 Background: Scope of the Problem
13.2 Anatomy of the Oropharynx
13.3 Key Elements of History
13.3.1 Signs and Symptoms of Oropharynx Cancer
13.3.2 Social and Sexual History
13.3.3 Special Consideration of Cancer of Unknown Primary
13.4 Clinical Examination Pearls
13.5 Investigations and Limitations
13.5.1 Biopsy of the Primary Site
13.5.2 Biopsy of a Lymph Node
13.5.3 Histopathology and Immunohistochemistry
13.5.4 Panendoscopy
13.5.5 Imaging
13.6 Management of OPSCC
13.6.1 Management by Clinical Stage
References
14: The Larynx
14.1 Introduction
14.2 Laryngeal Anatomy
14.2.1 Cartilages of the Larynx
14.2.1.1 Unpaired Laryngeal Cartilages
14.2.1.2 Paired Laryngeal Cartilages
14.2.2 Muscles of the Larynx
14.2.3 Laryngeal Innervation
14.2.4 Laryngeal Blood Supply
14.2.5 Laryngeal Lymphatics
14.2.6 Mucosal Structures of the Larynx
14.3 Laryngeal Physiology
14.4 Clinical Voice Assessment
14.5 Examination of the Larynx
14.6 Common Laryngeal Pathologies
14.6.1 Neurological Conditions Affecting the Larynx
14.6.2 Laryngeal Neoplasms
14.6.3 Non-neoplastic Mucosal Lesions
14.6.4 Functional Voice Disorders
14.7 Vocal Fold Palsy
14.8 Laryngeal Dysfunction in Thyroid Disease
14.8.1 Thyroid Pathology Affecting the Larynx
14.8.2 Laryngeal Dysfunction After Thyroid Surgery
14.9 Treatment Options and Recovery Outcomes of RLN and SLN Injuries
14.9.1 Recovery Outcomes
14.9.2 Speech and Language Pathologist (SLP)
14.9.3 Medical Therapy
14.9.4 Surgical Intervention
14.9.5 Superior Laryngeal Nerve Injury
14.10 Current American Thyroid Association (ATA) Guidelines for Voice Assessment
References
15: Vascular Access and Control in Trauma of the Neck
15.1 Background
15.2 Zonal vs. No-zonal Presentation and Classification of Cervical Neck Trauma
15.3 Vascular Head and Neck Anatomy
15.4 Initial Assessment and History
15.5 Clinical Examination
15.6 Investigations
15.7 Surgical Management Including Risks
15.8 Principles of Vascular Surgery in Cases of Penetrating Neck Trauma
15.9 Immediate Control of a Vascular Injury
15.10 The Carotid Arteries
15.10.1 Zone 1 Exposure
15.10.2 Zone 2 Exposure
15.10.3 Zone 3 Exposure
15.11 The Vertebral Arteries
15.12 The Subclavian Arteries
15.13 Venous Injuries in the Neck
15.14 Principles of Vascular Surgery in Cases of Blunt Neck Trauma
References
16: Maxillofacial Trauma for the General Surgeon
16.1 Emergency Management of the Patient with Isolated or Concomitant Maxillofacial Trauma
16.1.1 Basic Dental Anatomy
16.1.2 Dentoalveolar Injuries
16.1.2.1 Classification
16.1.3 Maxillofacial Injuries
16.1.3.1 Frontal Sinus
Relevant Anatomy
Investigations
Management
16.1.3.2 Orbital Fractures
Relevant Anatomy
Investigations
Management
16.1.3.3 Zygoma
16.1.3.4 Nasal Bones
16.1.3.5 Maxillary Fractures
Relevant Anatomy
Investigations
Management
16.1.3.6 Mandibular Fractures
Relevant Anatomy
Investigations
Management
16.1.3.7 Soft Tissue
Relevant Anatomy
References
17: Odontogenic Infections and Deep Neck Collections
17.1 Introduction
17.2 Infection
17.3 Sepsis and Septic Shock
17.4 Aetiology and Microbiology
17.5 Anatomy
17.6 Diagnosis—Management
17.6.1 Clinical Assessment and Work-Up
17.6.2 Treatment
17.7 Specific Deep Neck Space Infections
17.7.1 Actinomycosis
17.7.2 Necrotising Fasciitis
17.7.3 Descending Mediastinitis
17.7.4 Ludwig’s Angina
17.7.5 Lemierre’s Syndrome
17.8 Periorbital and Orbital Cellulitis
17.9 Cavernous Sinus Thrombosis
17.10 Deep Neck Space Infection Pearls
References
18: Regional Flaps for Head and Neck Reconstruction
18.1 Flaps from the Thorax
18.1.1 Pectoralis Major Flap
18.1.1.1 Background and Scope of Reconstruction
18.1.1.2 Anatomical Considerations
18.1.1.3 Landmarks and Flap Design
18.1.1.4 Flap Harvest
18.1.1.5 Donor Site Considerations
18.1.1.6 Potential Complications
18.1.2 Deltopectoral Flap
18.1.2.1 Background and Scope of Reconstruction
18.1.2.2 Anatomical Considerations
18.1.2.3 Landmarks and Flap Design
18.1.2.4 Flap Harvest
18.1.2.5 Donor Site Considerations
18.1.2.6 Potential Complications
18.1.3 IMAP Flap
18.1.3.1 Background and Scope of Reconstruction
18.1.3.2 Anatomical Considerations
18.1.3.3 Landmarks and Flap Design
18.1.3.4 Flap Harvest
18.1.3.5 Donor Site Considerations
18.1.3.6 Potential Complications
18.1.4 Trapezius Muscle Flap
18.1.4.1 Background and Scope of Reconstruction
18.1.4.2 Anatomical Considerations
18.1.4.3 Landmarks and Flap Design
18.1.4.4 Flap Harvest
18.1.4.5 Donor Site Considerations
18.1.4.6 Potential Complications
18.2 Flaps from the Neck
18.2.1 Supraclavicular Flap
18.2.1.1 Background and Scope of Reconstruction
18.2.1.2 Anatomical Considerations
18.2.1.3 Landmarks and Flap Design
18.2.1.4 Flap Harvest
18.2.1.5 Donor Site Considerations
18.2.1.6 Potential Complications
18.2.2 Submental Flap
18.2.2.1 Background and Scope of Reconstruction
18.2.2.2 Anatomical Considerations
18.2.2.3 Landmarks and Flap Design
18.2.2.4 Flap Harvest
18.2.2.5 Donor Site Considerations
18.2.2.6 Potential Complications
18.3 Flaps from the Scalp Region
18.3.1 Temporo-Parietal Fascia Flap
18.3.1.1 Background and Scope of Reconstruction
18.3.1.2 Anatomical Considerations
18.3.1.3 Landmarks and Flap Design
18.3.1.4 Flap Harvest
18.3.1.5 Donor Site Considerations
18.3.1.6 Potential Complications
18.3.2 Temporalis Muscle Flap
18.3.2.1 Background and Scope of Reconstruction
18.3.2.2 Anatomical Considerations
18.3.2.3 Landmarks and Flap Design
18.3.2.4 Flap Harvest
18.3.2.5 Donor Site
18.3.2.6 Complications
18.3.3 Washio Flap
18.3.3.1 Background and Scope of Harvest
18.3.3.2 Anatomical Considerations
18.3.3.3 Landmarks and Flap Design
18.3.3.4 Flap Harvest
18.3.3.5 Donor Site Considerations
18.3.3.6 Potential Complications
18.4 Flaps from the Face
18.4.1 Paramedian Forehead Flap
18.4.1.1 Background and Scope of Reconstruction
18.4.1.2 Anatomical Considerations
18.4.1.3 Landmarks and Flap Design
18.4.1.4 Flap Harvest
18.4.1.5 Donor Site Considerations
18.4.1.6 Potential Complications
18.5 Flaps from the Oral Cavity
18.5.1 Facial Artery Musculomucosal Flap
18.5.1.1 Background and Scope of Reconstruction
18.5.1.2 Anatomical Considerations
18.5.1.3 Landmarks and Flap Design
18.5.1.4 Flap Harvest
18.5.1.5 Donor Site Considerations
18.5.1.6 Potential Complications
18.5.2 Buccinator Flap
18.5.2.1 Background and Scope of Reconstruction
18.5.2.2 Anatomical Considerations
18.5.2.3 Landmarks and Flap Design
18.5.2.4 Flap Harvest
18.5.2.5 Donor Site Considerations
18.5.2.6 Potential Complications
References
19: Free Tissue Transfer for Head and Neck Reconstruction
19.1 Introduction
19.2 Brief History of Free Flaps Relevant to Head and Neck
19.3 Work-Up of Patients/Investigations
19.3.1 Physical Examination
19.3.2 Imaging
19.3.3 Nutrition
19.3.4 Haematology
19.3.5 Flap Selection
19.3.6 Tracheostomy
19.4 Subsite Use of Free Flaps
19.5 Common Soft Tissue Free Flaps
19.5.1 Radial Forearm
19.5.2 Anterolateral Thigh
19.5.3 Latissimus Dorsi
19.5.4 Medial Sural Artery Perforator Flap
19.5.5 Rectus Abdominus
19.6 Common Composite Flaps
19.6.1 Fibula
19.6.2 Deep Circumflex Iliac Artery
19.6.3 Scapula
19.7 Post-operative Management
19.7.1 Intensive Care
19.7.2 Flap Monitoring
19.7.3 Anticoagulation
19.7.4 Antibiotics
19.7.5 Nutrition
19.8 Problems and Potential Complications
19.8.1 Wound Infection and Dehiscence
19.8.2 Flap Ischaemia
19.8.3 Fistula
19.8.4 Carotid Blowout
19.9 Tips and Tricks
19.9.1 Vessel Selection and Orientation
19.9.2 Perforator Based Chimeric Flaps
19.9.3 Reanimation
19.10 Conclusion
References