FACIAL REPAIR

thoughtful Reconstruction

FACIAL REPAIR

thoughtful Reconstruction

Reconstruction of the Skin of the Face and Neck

Overview

One of the more common defects reconstructed is the skin and underlying soft tissue. Skin cancer is the most common form of cancer. While smaller skin cancers can be closed without much reconstruction, Dr. Son considers all aesthetics of the face when treating skin cancers and subsequent defects. Incisions are made in skin creases and skin tension lines that help camouflage scars. Dr. Son also has extensive experience with reconstructing skin cancer defects that require larger transplants of tissue. The wide range of experience allows him to be comfortable with any type of defect of the facial skin.

Being a head and neck surgery specialist, Dr. Son sees cancers and resulting defects from the lips, nose, eyelids, and ears. These are very unique structures in the body that have very specific shapes and functions.

Proceedures

The following is a list of procedures commonly done to repair facial skin defects. Dr. Son can use an individual procedure, a combination of procedures, or a custom reconstruction to the specific defect for patients.

  • Advancement flaps
  • Bilobed flaps
  • Interpositional flaps
  • Pivotal flaps
  • Rotational flaps
  • Rhombic flaps
  • Transposition flaps
  • O to T / O to Z flaps
  • V to Y / Y to V flaps
  • Z-plasties
  • Cervicofacial advancement flap
  • Supraclavicular artery island flap
  • Radial forearm free flap
  • Anterolateral thigh free flap
  • Latissimus dorsi free flap
  • Skin grafts
  • Biologic (i.e. dermal grafts) implants
  • Scar revisions

Lip Reconstruction

Overview

The lips are one of the most noticeable features of the face as well as one with many functions. Lips form words in speech, assist in chewing and manipulating food, prevent drooling and convey non-verbal communication.

The lips have multiple layers including the skin on the outside, the inner mucosa layer, and muscle layer in between. Careful consideration has to be taken for each of these layers in order for the lip to look normal and function properly.

The most common cancers of the lip include squamous cell cancer, basal cell cancer, minor salivary gland cancers and melanoma. Dr. Son is well-versed in treating all of these types of cancers. If lymph nodes need to be removed, Dr. Son can also perform a neck dissection to remove all lymph nodes at high risk for cancer spread during the same surgery.

Proceedures

The following is a list of procedures commonly done to reconstruct the lip.

  • Wedge resection and repair
  • Abbe flap
  • Estalnder flap
  • Karapandzic flap
  • W-plasty
  • Radial forearm free flap with palmaris longus tendon transfer

Tongue Reconstruction

Overview

We use our tongues everyday to help us speak and eat. Taste buds allow us to enjoy (or not enjoy) foods as well as manipulate the food for preparation to swallow. The tongue is a very complex structure made up of many different intrinsic and extrinsic muscles.

The tongue can be divided into 2 parts, the anterior (front) two-thirds and the posterior (back) one-third. These differences can be originated from the different embryonic developments of the 2 parts. These 2 parts have different subsets of function when it comes to swallowing and speech. Even cancers of the tongue differ in type and biology when comparing the 2 parts of the tongue.

Knowing when and how to reconstruct the tongue comes with experience. Dr. Son has performed many procedures to remove tongue cancers as well as complex reconstructions of for these tongue defects. When a large amount of tongue tissue is removed, the volume of tissue removed needs to be replaced with similar tissue so function can be regained.

Proceedures

One of the most effective ways to reconstruct the tongue is with a free flap. Free flaps are transplants from the same patient’s body to another area. The most common types of free flaps used to reconstruct the tongue are the radial forearm free flap (RFFF) and the anterolateral thigh free flap (ALTFF). This type of reconstruction is very specialized with only a handful of surgeons in big cities with experience in this. The surgery involves procuring soft tissue from the forearm or thigh in a way that preserves the blood supply from very specific blood vessels. The reconstructive surgeon then takes this tissue and rebuilds the tongue with this self-transplanted tissue. One of the very specialized portions of this surgery includes connecting blood vessels that are 1-2 millimeters in diameter with suture thinner than human hair under a specialized surgical microscope. This transplanted tissue then gets specialized monitoring while the patient is in the hospital. The surgery is done at a specialty hospital that has trained staff in this specialized postoperative surgical care.

The following is a list of procedures commonly done to reconstruct the tongue.

  • Radial forearm free flap
  • Anterolateral thigh free flap
  • Supraclavicular artery island flap
  • Skin grafts

Jaw (Mandible) Reconstruction

Overview

The mandible or jaw bone is one of most important and complex bones in the body. It is designed in a way to exert over 100 pounds of force. A healthy mandible is essential for people to chew food.

The mandible is a single bone with multiple segments including the condyle, coronoid process, ramus, angle, body, symphesis. The muscles for chewing all insert into the mandible; these muscles include the masseter, temporalis, medial pterygoid, lateral pterygoid. The 16 lower teeth are in individual sockets in the mandible. The nerve that gives sensation to the lower one-third of the face goes through this bone and out near the chin.

Cancers of the oral cavity or mouth can involve the mandible leading to a recommendation to remove a portion of the bone. Sometimes, a partial thickness of the mandible can be saved, but in other instances, a whole segment of the bone needs to be removed making reconstruction a necessary surgery.

Proceedures

One of the most common ways to reconstruct the mandible is with a bony free flap. Free flaps are transplants from the same patient’s body to another area. The most common types of free flaps used to reconstruct the tongue are the osteocutaneous fibula free flap (OCFFF), the osteocutaneous radial forearm free flap (OCRFFF), and a scapula free flap. This type of reconstruction is very specialized with only a handful of surgeons in big cities with experience in this. The surgery involves procuring bony and soft tissue from the lower leg, forearm or back in a way that preserves the blood supply from very specific blood vessels. The reconstructive surgeon then takes this tissue and rebuilds the mandible and any other soft tissue with this self-transplanted tissue. One of the very specialized portions of this surgery includes connecting blood vessels that are 1-2 millimeters in diameter with suture thinner than human hair under a specialized surgical microscope. This transplanted tissue then gets specialized monitoring while the patient is in the hospital. The surgery is done at a specialty hospital that has trained staff in this specialized postoperative surgical care.

The following is a list of procedures commonly done to reconstruct the mandible.

  • Osteocutaneous fibula free flap
  • Osteocutaneous radial forearm free flap
  • Scapula free flap

Orbital Reconstruction

Overview

The nose is a complex 3-dimensional structure with a distinct shape making people’s faces unique. The structure of the nose comes from the nasal bones and associated nasal cartilages within the soft tissue envelope.  The skin of the nose is distinct from the skin of other portions of the face. The inner nasal lining is a combination of regular type skin and mucosa that is similar ot the inside of our mouth. The nose serves multiple purposes including breathing, smelling and humidification of inhaled air.

The eye and area around it have significant functional importance as well as aesthetic impact. The eye provides us sight and the muscles around the eyes, help us move to see around us. The eyelids help protect our eyes from harmful debris. The eyelid and the sphincter-like muscle around the eyelids keep our eyes closed when we sleep to keep them from getting dried out. The lacrimal gland or tear making gland provides the moisture for our eyes. Our eyes live in a bony socket in our skull that protects it from trauma. There are many important nerves and blood vessels that are deep in this eye socket.

Reconstruction of the area around the eyes is a specialized type of surgery that focuses primarily on preserving function of the eye. Skin cancers of this area, maxillary sinus and nasal tumors, and tumors of other structures near the eye require careful removal as well as thoughtful reconstruction in order to preserve adequate vision.

Dr. Son has experience in reconstructing smaller skin cancer defects to more complex reconstruction where the bone as well as soft tissue needs to be reconstructed.

Proceedures

The following is a list of procedures commonly done to repair orbital defects. Dr. Son can use an individual procedure, a combination of procedures, or a custom reconstruction to the specific defect for patients.

  • Tenzel flap
  • Mustarde flap
  • Cervicofacial advancement flap
  • Brow lift
  • Blepharoplasty
  • Tarsorrhaphy
  • Dacrocystorhinoplasty (tear duct repair)
  • Gold/Platinum weight insertion in eyelid
  • Free mucosal graft (from the mouth to the inner eyelid)
  • Cartilage grafts (from the ear to the eyelid)
  • Skin grafts
  • Calvarium bone graft
  • Titanium plate custom orbital reconstruction
  • Osteocutaneous fibula free flap
  • Radial forearm free flap
  • Anterolateral thigh free flap

Nose Reconstruction

Overview

The nose is a complex 3-dimensional structure with a distinct shape making people’s faces unique. The structure of the nose comes from the nasal bones and associated nasal cartilages within the soft tissue envelope.  The skin of the nose is distinct from the skin of other portions of the face. The inner nasal lining is a combination of regular type skin and mucosa that is similar ot the inside of our mouth. The nose serves multiple purposes including breathing, smelling and humidification of inhaled air.

The nose has been historically studied extensively due to its influence of the aesthetics of a place as well as for its functions. Because its cosmetic importance, there are unique ways to reconstruct the nose. Smaller skin cancer defects can be reconstructed with single stage surgeries. However, larger skin cancers and tumors of the nose may need 2-staged surgeries because of the complexities of the anatomy of the nose. Dr. Son has performed reconstruction for small cancer defects to large defects where the large amounts of nasal tissue are removed for tumors.

Proceedures

The following is a list of procedures commonly done to repair facial skin defects. Dr. Son can use an individual procedure, a combination of procedures, or a custom reconstruction to the specific defect for patients.

  • Bilobed flaps
  • Paramedian forehead flap
  • Melolabial flap
  • Reiger flap
  • Cartilage grafts (from the ear to the nose)
  • Nasal septal hinge flap
  • Skin grafts

Throat Reconstruction

Overview

The throat or pharynx is a general area in between what we see in the mouth to the esophagus or food pipe.  The larynx or voice box is also a part of the general throat. The pharynx is divided into the nasopharynx, oropharynx and hypopharynx. In the US, cancers of the oropharynx and hypopharynx are more common than cancers of the nasopharynx, which is common in Asia). These throat areas are important for the function of swallowing and breathing properly.

Surgical removal of tumors in the area is a common option for cancer treatment as well as radiation therapy and/or chemotherapy. When surgery is recommended as the best treatment, reconstruction of the pharynx/larynx may be needed to restore swallowing function. Dr. Son performs these surgical treatments as well as the reconstruction surgeries. Dr. Son works closely with another head and neck surgical oncologist, and if complex reconstruction is needed in the throat, Dr. Son will perform the reconstruction while another surgeon removes the tumor resulting in more efficient and overall better surgery.

Proceedures

The following is a list of procedures commonly done to repair the throat. Dr. Son can use an individual procedure, a combination of procedures, or a custom reconstruction to the specific defect for patients.

  • Radial forearm free flap
  • Anterolateral thigh free flap
  • Pectoralis major flap
  • Supraclavicular artery island flap
  • Deltopectoral flap

Facial Paralysis and Rehabilitation

Overview

The muscles in our face allow us to communicate with non-verbal cues and express emotions. They also are vital in the health of the eye, breathing through the nose as well as lip function to speak, eat and prevent drooling. While we may take this for granted when there is nothing wrong with our face, the handicaps of not having proper facial function is felt when the facial function is compromised by head and neck cancer, strokes, or other reasons.

Dr. Son has experience with static and dynamic reconstruction. Facial paralysis has many causes and the goals of each patient are unique.

Proceedures

The following is a list of procedures commonly done for facial rehabilitation. Dr. Son can use an individual procedure, a combination of procedures, or a custom reconstruction to the specific issues for patients.

  • Blepharoplasty
  • Tarsorrhaphy
  • Gold/Platinum weight insertion in eyelid
  • Brow/forehead lift
  • Nasal valve surgery
  • Alar batton graft
  • Functional rhinoplasty
  • Facial sling
  • Nerve grafts and transfers
  • Skin grafts
  • Gracilis free flap

Nerve Repairs

Overview

There are many important cranial nerves of the head and neck. A head and neck surgical oncologist has the most experience with surgery in the neck to preserve these nerves while removing tumors and lymph nodes. These nerves can provide sensation, move different muscles, or both.

When dealing with cancer surgery, nerves can be sacrificed for the purpose of tumor removal. Although this helps with curing the cancer, there can be consequences for not having a functional muscle or organ. Dr. Son is able to harvest nerves from elsewhere and graft it for the nerve removed. He does this under a specialized microscope and connects the nerve endings with suture that is finer than human hair.

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