Head and Neck Reconstruction

Head and neck reconstruction presents unique challenges to the reconstructive surgeon. Because the head and neck region is so visible, defects of any kind in this area are difficult to hide and the demands on our reconstructive skills are greater than they are elsewhere in the body where cosmesis may be less vital and function less specialized. The head and neck area includes both static and dynamic structures. In addition, it contains organs of special function such as the tongue, the nose, the ears, the lips and the orbital contents including the eyelids.

While bony structures elsewhere in the body are related to structure and load, the bony skeleton of the head and neck area includes these functions but, in addition, includes the jaws which have a very specialized function and unique reconstructive requirements. While reconstruction of specific areas of the head and neck will be discussed in detail there are general principles which apply to all regions. Reconstruction involves a composite reorganization of tissue, often imported from distant sites on the body into a replication of what has been resected. We must therefore start with an analysis of that tissue. The craniofacial skeleton fulfills several functions. It is responsible for the contour of the head and face. As well, it provides protection to vital structures, most notably the brain, Finally the skeletal structures of the upper and lower jaws provide a very specialized functional role, that of mastication, which is unique in the body. The soft tissues of the face are also unique. They comprise external cover, which, in some cases, is specialized, as in the eyelids. The facial muscles provide a unique and very delicate function to animate the face, driven by a complex motor nerve, the facial nerve. This nerve sometimes has to be sacrificed to execute an effective ablation. Apart from external skin cover we frequently also have to replace mucosa. Not infrequently all of the above elements have to be replaced. The principles that guide us are several and basic:

1. We should wherever possible replace excised tissue with like tissue. This generally means local tissue and while this is not always available, we should, whenever possible, use it. Local tissue provides the best match both cosmetically and functionally.

2. Our reconstruction should not interfere with treatment of the patient's presenting illness. If, for example the patient requires some sort of adjuvant therapy, we should ensure that our reconstructive choice will have healed expediently in order not to delay that process.

3. While the simplest treatment is not necessarily the best we should, nevertheless, choose an option that has a reasonable chance to succeed. Technical feasibility alone is not an indication for any procedure.

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