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Plastic and Reconstructive Surgery
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KarthikNRao, RupaMehta, and AmbeshSingh
1 Principles ofHead andNeck
Reconstruction
The problem of reconstructing abnormalities in
the head and neck is distinct. In contrast to other
portions of the body that can occasionally be
temporalised by dressing changes or even let to
heal by secondary purpose without incurring
major repercussions, the immediate or early closure of head and neck deformities is essential for
a variety of reasons. It is crucial to preserve the
patient’s ability to eat and the health of their
digestive system. The face must be reconstructed
in order for a person to express themselves
through facial expression. Finally, by covering
the neck and preserving an unbroken intraoral
seal, life-threatening issues like blowout of the
major vessels in the neck are prevented. Here, we
provide a decision-supporting algorithm for head
and neck reconstruction.
When reconstructing a head and neck deformity, it’s crucial to think about the reconstruction’s objectives and if the alimentary canal, the
face and the neck should be repaired rst or if it’s
K. N. Rao (*) · A. Singh
All India Institute of Medical Sciences,
Raipur, Chhattisgarh, India
R. Mehta (*)
Department of ENT, All India Institute of Medical
Sciences, Raipur, Chhattisgarh, India
possible to also restore the function to the head
and neck’s organs in addition to form. Especially
if they have had cancer surgery, many patients
who need reconstruction may not be in the best of
physical shape. All patients should have their alimentary tract, face and neck integrity restored as
a priority since problems like orocutaneous stulas can impair their ability to eat and can result in
life-threatening scenarios like a carotid artery
blowout. Although free tissue transfer is the
method of reconstruction that is preferred, in
some circumstances, using a straightforward pectoralis major pedicled ap to ll a hole or restore
continuity in the pharynx or oesophagus may be
sufcient to achieve the goal of restoring the
integrity of the alimentary tract for the majority
of patients. In skull base restoration, it is vital to
restore the integrity of the separation between the
cerebral contents and the sinuses and alimentary
system. Additionally, in order to avoid meningoencephalitis and cerebrospinal uid leak, it’s crucial to employ the vascularised tissue to cover
any empty spaces.
It is crucial to think about regaining function
in the head and neck region if the patient can
have signicant surgery. This area is in charge
of several important processes, including speaking, chewing, swallowing and expressing facial
expressions. For instance, since the defect can
be directly repaired, reconstructing a partial
glossectomy defect is not necessary for the
patient’s survival. The neotongue can contact
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023
N. M. Nagarkar et al. (eds.), Atlas of Head Neck and Skull-base Surgery,
https://doi.org/10.1007/978-981-99-6132-0_12
275
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K. N. Rao et al.
the palate when the bulk of the tongue is restored
through free tissue transfer, though, which can
make swallowing easier. Another illustration is
the rehabilitation of speech using methods like
free ileocolon aps or tracheoesophageal punctures. While a person can survive following total
laryngectomy without this operation, recovering
speech can improve communication and quality
of life. Bony deciencies in the mandible must
be repaired with vascularised bone in order to
preserve function and make room for the installation of dental implants. Restoring both function and form should be the aim of head and
neck restoration. There are techniques for repair
that only involve soft tissue, but by restoring the
facial buttresses and enabling oral rehabilitation, utilising a segmented free bular ap can
offer both functional and aesthetic benets. In
the restoration of the soft tissue defect following
total parotidectomy, a de-epithelialised parascapular free ap is used yet another time. Facial
nerve repair after a complete parotidectomy
promotes smile restoration and prevents the
stigma associated with nerve palsy. On a more
limited scale, optimising the cosmetic outcome
after surgery is made possible by designing the
reconstruction while taking into account the
aesthetic subunits of the face and maintaining
these boundaries. The best aesthetic outcome is
achieved when a defect is replaced with the tissue that is equivalent in delicate areas like the
lip and nose. Reconstructive surgery’s objectives can include restoring integrity, function
and shape, but they can also change based on the
patient’s health, coexisting conditions and preferences. To assess the risks of anaesthesia and
surgery and to decide the best course of action,
a complete preoperative evaluation is required.
A pedicled locoregional ap may be utilised to
restore integrity alone in patients with signicant coronary artery disease or other medical
conditions that prevent them from receiving a
free tissue transfer. A young, healthy patient
with a benign tumour, on the other hand, might
be an excellent candidate for a reconstruction
that takes into account the three objectives of
integrity, function and shape. The unique needs
of the patient and the nature of the defect,
including the types and volume of the tissue
involved, will determine the selection of the
reconstruction strategy. Multiple skin paddles
could be required in some situations to cover
both intraoral and extraoral aws.
The various algorithms for reconstruction of
various head and neck defects are given in Figs.1,
2, 3, 4, 5, 6, 7, 8 and 9.
Fig. 1 Reconstructive algorithm for the tongue defects
Plastic and Reconstructive Surgery
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Fig. 2 Reconstructive
algorithm for the buccal
mucosa-only defects
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Fig. 3 Reconstructive
algorithm for the
alveolus-only
defects*With cutaneous
defect- soft tissue ap
for cover– PMMC/DP/
Scalp ap/forehead ap/
second free ap–
FRAFF/FALT
K. N. Rao et al.
Plastic and Reconstructive Surgery
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Fig. 4 Reconstructive
algorithm for the
composite buccal and
alveolar defects
279
Fig. 5 Reconstructive algorithm for the palate and maxillary defects
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Fig. 6 Reconstructive
algorithm for the lower
lip defects
K. N. Rao et al.
Plastic and Reconstructive Surgery
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Fig. 7 Reconstructive
algorithm for the upper
lip defects
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