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404
Y. M. Agamawi et al.
The pericranium is raised separately as an anteriorly pedicled vascularized ap
for reconstructive purposes as needed. Prior to incising the pericranial ap posteriorly, the supra-pericranial dissection can be carried out posteriorly as far as the
occiput. This would allow the posterior pericranial incision to be placed even further
posteriorly and create an extended pericranial ap that could possibly double the
length of the pericranial ap [44, 45]. The lateral incisions of the pericranial ap are
at the superior temporal line from the posterior incision to the supraorbital rim. The
pericranial ap is then elevated anteriorly from the posterior incision to expose the
supraorbital rims. If the supraorbital foramen are true foramen, then a small osteotome can be used to chisel out the inferior portion of the foramen and convert the
foramen to a notch, which then will release the supraorbital neurovascular bundle
[43]. The coronal and pericranial aps are then further elevated anteriorly and inferiorly to expose the bony mid-face as needed.
Temporoparietal Fascia Flap (TPFF)
As mentioned earlier, the TPF and its blood supply are just deep into the subcutaneous fat layer. Once the appropriate plane just superior to the TPF and the desired
area of TPF is exposed, the distal periphery of the ap from its pedicle can be
sharply incised. The TPFF can then be elevated in a distal to proximal fashion. The
middle temporal artery branch of the STA may be identied, dissected, and preserved if TPFF is to include deep temporal fascia, temporalis muscle, and/or adjacent calvarial bone [32–34]. Once the ap is fully elevated, it can be rotated and/or
tunneled toward the defect for reconstruction. The tunneling may occur through the
defect or a carefully made “keyhole” defect through the superolateral orbit or greater
wing of the sphenoid bone at the zygomaticosphenoid suture line via a drill with a
uted burr [35].
Temporalis Muscle Flap
Similar approach to TPFF, the temporalis muscle is identied, and its overlying
fascia is incised superiorly. Dissection directly on top of the temporalis muscle is
carried inferiorly and anteriorly toward the zygomatic arch and coronoid process.
Being directly on top of the temporalis muscle allows you to preserve the frontal
branch of CN VII and the temporal fat pads. After the temporalis muscle is fully
exposed, the portion needed for reconstruction is elevated from the temporal fossa
in a superior-posterior to inferior-anterior direction. The temporalis muscle ap can
then be rotated and/or tunneled in a similar fashion as the TPFF toward the skull
base defect for reconstruction.
28 Open (Anterior) Skull Base Repair
405
Postoperative Management
Postoperative management after repair of skull base defects should be carefully
streamlined to avoid complications, such as pneumocephalus, graft migration, reactivation of CSF leak, and meningitis. A lumbar drain is often needed to decrease
CSF pressure and allow time for the repair graft to heal. Head of bed elevation may
be required to alleviate nasal congestion. Nasal precautions like no nose blowing,
straining, and sneezing with mouth open are often important. Diet advancement,
pain control, and seizure prophylaxis may be catered to individual patient indications.
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407
Index
A
Abdominal rectus free ap (ARFF), 120
ap features, 116
ap harvest, 116–119
postoperative care and complications, 120
preoperative considerations, 115, 116
wound closure, 119
Alar-facial incision, 250, 251, 253, 254
Ansa cervicalis, 266
Anterolateral thigh ap (ALT)
arterial anatomy, 108, 109
ap design/surgical technique, 111–113
indications/contraindications, 110
instrument/equipment set, 111
neural anatomy, 109, 110
postoperative management, 113
preoperative planning, 110, 111
venous anatomy, 109
Autologous bone grafts, 342
B
Bilobe ap, 12
Buccal branch identication, 230, 231
C
Cavernous sinuses, 376
Cervicodeltopectoral (CDP) ap
advantages, 135
anatomy, 134, 135
arch of rotation, 142
artery dimension, 142
complications, 143
disadvantages, 136
ap harvest, 136–141
nerve dimension, 142
patient history, 134, 139–141, 143, 144
preoperative evaluation, 136
reconstruction, 143
sternocleidomastoid muscle, 142
vein dimension, 142
C-ap, 279
Children’s Hospital of Philadelphia (CHOP)
modication, 296
Cleft lip deformity, see Unilateral cleft
lip repair
Cleft palate repair
anatomy, 289–291
Eustachian tube dysfunction, 299
facial growth, 299
ap design/surgical technique
CHOP modication, 296
Furlow double-opposing
Z-palatoplasty, 296
oral and nasal mucosal aps, 297
orotracheal intubation, 293
principles, 293
submucous cleft, 297
two-ap palatoplasty, 295
Von Langenbeck palatoplasty, 293, 295
incidence, 289
indications/contraindications, 291, 292
instruments/equipment set, 292, 293
oronasal stula, 298
postoperative management, 297
preoperative planning, 292
VPD, 298, 299
Condylar fractures, 310, 311
Coronal approach, 328, 403, 404
Cross-face nerve grafting, 264, 265
Cupid’s bow, 279
peak, 276
© The Editor(s) (if applicable) and The Author(s), under exclusive license to
Springer Nature Switzerland AG 2024
F. Sokoya, A. G. Vincent (eds.), Manual of Head and Neck Reconstruction,
https://doi.org/10.1007/978-3-031-65999-7
409
410
Index
D
Dufourmental ap, 12
E
Endoscopic skull base reconstruction
anatomy
anterior cranial fossa, 374
cavernous sinuses, 376
clivus and posterior cranial fossa, 375
petrous apex, 376
sellar and suprasellar regions, 375
development, 373
indications and contraindications, 376–378
instruments and equipment, 379
intranasal vascularized pedicled aps
nasoseptal ap, 381, 383, 384
PPITF, 384–386
PPMTF, 386, 387
postoperative care, 391
preoperative planning, 378, 379
regional vascularized extranasal aps
pericranial ap, 387, 388
temporoparietal fascial ap, 389, 390
surgical technique, 379–381
Eustachian tube dysfunction, 299
F
Facial artery musculomucosal (FAMM)
ap, 69
Fascia lata
harvesting, 248–250
materials, 247
mimetic function, 247
Facial prosthetics and implants
auricular alloplastic implant
reconstruction, 48–50
auricular prosthetics, 50–53
auricular reconstruction, 47
factors, 44
maxillary/midface reconstruction, 55
nasal reconstruction, 54, 55
ocular implants, 56
orbital prosthesis, 57, 58
orbital reconstruction, 55, 56
overview, 44
PEEK, 45
PHDPE, 45
prosthetic placement, 46
PSI, 45, 46
silicone, 46, 47
titanium, 45
Facial regional aps
anatomy, 18, 19
indications/contraindications, 19–21
instrument/equipment set, 21
melolabial ap, 25
paramedian forehead ap, 21–25
postoperative management, 26
preoperative planning, 21
temporalis muscle ap, 25, 26
temporoparietal fascia ap, 25, 26
Fasciocutaneous ap, 186
Fibula free ap (FFF), 179
anatomy, 172
dissection and elevation, 175, 177, 178
donor site closure, 178
ap design and preparation, 174, 175
indication/contre-indications, 172, 173
instrumentation, 174
postoperative management, 178, 179
preoperative planning, 172, 173
Flaccid paralysis, 230
Free tissue transfer, 346, 347, 403
Frontal sinus outow tract, 340
Frontal sinus reconstruction
alloplastic implants
HAC, 344
MMA, 345
PEEK, 344
porous polyethylene/medpor, 343
titanium mesh, 342, 343
anatomy, 338
autologous bone grafts, 342
crumple zone, 337
evaluation and management
anterior table, 339
cranialization, 340, 341
frontal sinus outow tract, 340
posterior table, 339, 340
free tissue transfer, 346, 347
goals, 338
locoregional aps, 346
open approach, 347, 348
pericranial ap, 345
reconstructive options, 342
Full-thickness skin graft (FTSG), 210, 211
Functional sterno-omohyoid free muscle
transfer
advantage, 258
congenital facial palsy, 257
cross-face nerve grafting, 264, 265
disadvantages, 258
donor muscle, 257
features, 258
ap harvest, 265–267
ap inset, 267–270
Index
411
recipient site preparation, 259–262
sural nerve harvest, 262, 263
G
Gillies approach, 327
Greenstick fractures, 358
H
Hadad-Bassagaisteguy ap (HBF), 381,
383, 384
Head and neck reconstruction, see
Scapular ap
Hydraulic” theory, 355
Hydroxyapatite cement (HAC), 344
I
Iliac crest harvest, 222–225
K
Keen approach, 328
L
Latissimus dorsi muscle, 185, 257
Le Fort I fracture, 331
Le Fort II fracture, 332
L-ap, 280, 282
Lip reconstruction
anatomical subunits, 62, 63
arterial supply, 65
complications, 85, 86
ergotrid ap, 70
FAMM ap, 69
free tissue transfer, 83, 84
function, 65, 66
local aps, 69
Abbe ap, 81–83
alar crescent ap, 75–77
Bernard-von Burow ap, 79–81
bilateral lip advancement ap, 74, 75
Estlander ap, 82
extended Abbe ap, 82, 84
Gillies fan ap, 79
Karapandzic ap, 76–78
stair-step advancement ap, 75, 76
lower lip defects, 71–73
melolabial ap, 71
motor innervation, 64
musculature, 64, 65
perioperative care, 67, 68
primary closure, 69
reconstructive ladder, 66, 67
secondary intention, 68
skin grafting, 69
surface anatomy, 61, 62
upper lip defects, 72, 74
vermillion advancement ap, 68
Local ap
Abbe ap, 81–83
advancement aps, 6–9
alar crescent ap, 75–77
anatomy, 4, 5
Bernard-von Burow ap, 79–81
bilateral lip advancement ap, 74, 75
Estlander ap, 82
extended Abbe ap, 82, 84
Gillies fan ap, 79
indications/contraindications, 5, 6
instrument/equipment set, 6
Karapandzic ap, 76–78
postoperative management, 14
preoperative assessment, 6
rotational ap, 9, 10
stair-step advancement ap, 75, 76
transposition ap, 9, 11–13
Locoregional aps, 346
M
Mandible trauma reconstruction
anatomy, 306
angle and ramus, 308, 309
body, 307, 308
condylar, 310, 311
incidence, 305
instrument/ equipment, 312
mandibular fractures, 305
postoperative management, 314
preoperative planning, 311, 312
surgical technique
endoscopic approach, 313
preauricular approach, 313
retromandibular approach, 313, 314
submandibular approach, 313
transoral approach, 312
symphysis and parasymphysis, 306, 307
Masseteric nerve transfer
buccal branch identication, 230, 231
buccal nerve transection, 233
coaptation, 234
estimation, 231, 232
exposure, 232, 233
location, 230
neurorrhaphy, 233, 234
412
Index
Masseteric nerve transfer (cont.)
smile rehabilitation, 229, 230
tendious layer, 232
trigeminal nerve, 229
Methylene Blue, 279
Methyl methacrylate (MMA), 345
M-ap, 280
Midface trauma reconstruction
anatomy, 318–320
classication, 321, 322
clinical assessment, 323, 324
complications, 333, 334
history, 317, 318
indications and contraindications, 322
instrument/equipment set-up, 324, 325
Le Fort I fracture, 331
Le Fort II fracture, 332
pan facial fractures, 332
pediatric management, 332, 333
preoperative planning, 324
surgical approaches, 325–329
zygomaticomaxillary complex
fractures, 329–331
N
Nasal reconstruction
anatomy, 32, 33
challenges, 32
ap design/surgical technique, 39, 40
indications, 34–38
instrument/equipment set, 39
postoperative management, 40
preoperative planning, 38, 39
Nasolabial fold, 250–252
Neo-tendons, 267
Neurorrhaphy, 268
Non-vascularized autologous bone
grafting (NVABG)
denition, 221
identication, 221
iliac crest, 222–225
O
Orbital trauma reconstruction
anatomy, 356, 357
history, 355, 356
indications/contraindications, 357–359
instruments/setup, 360, 361
postop management, 365–367
preop planning/workup, 359, 360
surgical technique, 361–366
Oronasal stula, 298
Osteocutaneous radial forearm free ap
(OCRFFF)
anatomy, 199–202
complications, 212–215
contraindications, 198, 199
donor site closure, 210
ap design and Harvest, 204–206
FTSG, 210, 211
history, 198, 199
instrumentation/requirements, 203, 204
outcomes, 216
patient positioning, 204
post-operative management, 212
pre-operative planning, 202, 203
prepping and draping, 204
prophylactic plating of radius, 208–210
proximal donor vessel preparation,
207, 208
radius osteotomy, 206, 207
STSG, 210
vascularized soft tissue donor site,
211, 212
Outpatient periocular reanimation
Bell’s palsy, 237
lateral tarsal strip canthoplasty,
238, 241–245
periocular procedures, 237
pretarsal upper eyelid weight
placement, 238–240
P
Pan Facial fractures, 332
Parasymphysis, 306, 307
Patient-specic implant (PSI), 45, 46
Pectoralis major ap
advantages, 95, 96
anatomy, 94, 95
complications, 105
disadvantages, 96
ap harvest, 97–101
patient history, 102
preoperative evaluation, 96, 97
reconstruction, 102
zygomatic arch, 101, 102
Pericranial ap, 345, 387, 388, 403, 404
Petrous apex, 376
Polyether-Ether Ketone (PEEK), 45, 344
Porous high-density polyethylene
(PHDPE), 45
Porous polyethylene/medpor, 343
Posterior pedicle inferior turbinate ap
(PPITF), 384
advantages and limitations, 386
Index
413
ap design and harvest, 385
sphenopalatine artery, 384
surgical challenges, 385
Posterior pedicle middle turbinate ap
(PPMTF), 386, 387
Premaxilla, 276
R
Radial forearm ap (RFF), 131
anatomy, 125, 126
dissection and elevation, 128–130
donor site closure, 129, 130
ap design and preparation, 127, 128
indication/contraindications, 126
instrumentation, 127
postoperative management, 130
preoperative planning, 127
Recipient vessel isolation, 260
Rotation-advancement repair, 276
S
Scapular ap
anatomy, 184–186
dental implants, 193
history, 183
limitations, 193
operative technique
chimeric aps, 189, 191
fascial aps, 190
ap harvest, 187, 188
positioning and marking, 187
preoperative evaluation, 186, 187
tip ap, 188–190
virtual surgical planning, 191–193
Skeletonize, 265
Skull base surgery
anatomy, 396–398
coronal approach and pericranial ap,
403, 404
development, 395
free tissue transfer, 403
goals, 395
instruments and equipment set up, 400
local and regional aps, 401, 402
locoregional and free ap, 401
nonvascular and manufactured grafts, 401
planning
anatomic factors, 400
patients factors, 400
VSP, 399
postoperative management, 405
temporalis muscle ap, 404
TPFF, 404
Split thickness skin grafts (STSG), 210
Static facial suspension
alar-facial incision, 250, 251, 253, 254
inferiorly-based dermal tab, 252, 253
nasolabial fold, 250–253
ribbons, 253, 254
stab incisions, 251, 252
sterno-omohyoid free muscle ap,
253, 255
sub-SMAS elevation, 250, 251
temporalis fascia, 253, 255
Sternohyoid, 266
Submucous cleft, 297
Supercial temporal artery (STA), 397, 402
Supraclavicular ap
anatomy, 160, 161
indications, 162–164
instrumentation, 166
postoperative management, 166
preoperative planning, 165
surgical technique, 166
Sural nerve harvest, 262, 263
Symphysis, 306, 307
T
Temporalis fascia, 253, 255
Temporoparietal fascial ap (TPFF), 389, 390,
402, 404
Titanium, 45
mesh, 342, 343
plate placement, 261
Trapezius ap
anatomy, 145, 147–149
complications, 156, 157
donor site morbidity, 154
ap modications, 145
free aps, 153
history, 146, 147
indications, 155, 156
limitations, 155
lower trapezius ap, 152, 153, 155
operative technique, 149, 150
upper trapezius ap, 151
Two-ap palatoplasty, 295
U
Unilateral cleft lip repair
anatomy, 276, 277
embryologic etiology, 275
indications, 277
instruments/ equipment, 278–279
414
Index
Unilateral cleft lip repai (cont.)
preoperative planning, 278
rotation-advancement repair, 276
surgical technique
closing/suturing, 282, 284, 286
marking, 279–281
postoperative management, 286
surgical steps/incisions, 281, 282
V
Velopharyngeal dysfunction (VPD), 298, 299
Virtual surgical planning (VSP), 399
Von Langenbeck palatoplasty, 293, 295
Z
Zitelli bilobe ap, 12, 13
Zygomatic arch, 327
Zygomatic bone, 319
Zygomatico-frontal (ZF) fractures, 326
Zygomaticomaxillary complex (ZMC)
fractures, 329–331
Zygomatico-sphenoid (ZS) suture, 326