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Plastic surgery of the head and neck

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					   PLASTIC
 SURGERY OF
THE HEAD AND
  THE NECK
 Division of Plastic Surgery
  Department of Surgery
   University of Ibadan.
                               1
04/08/03                                                      2




   Head and neck anomalies

           Congenital: neck lesions, craniofacial
                                   lesions

                          Infection
                           Tumour
                           Trauma
                    Head and neck surgery; Plastic Surgery,
                            University of Ibadan
04/08/03                                             3




                                            Cystic
                                           hygroma




           Head and neck surgery; Plastic Surgery,
                   University of Ibadan
04/08/03                                             4




                                          Thyroglossal
                                              cyst




           Head and neck surgery; Plastic Surgery,
                   University of Ibadan
04/08/03                                             5




           Head and neck surgery; Plastic Surgery,
                   University of Ibadan
04/08/03                                                6
                      Clefts

    Failure of mesodermal merging.
    Failure of fusion of facial processes
Incidence:
1:600-1400
1:1100-2800 (Nigeria)

              Head and neck surgery; Plastic Surgery,
                      University of Ibadan
04/08/03                                                              7




        Theories in the
      formation of clefts


 Classical theory (Dursy, His)
 Once epithelial contact is established,
 mesodermal penetration completes the
 fusion process


 Mesodermal penetration theory
 (Pohlmann, Veau)
 No free ends of facial process, there is
 bilaminar membrane with seams
 demarcating the major processes,
 mesoderm penetrates and smoothes
 out the seams,




                            Head and neck surgery; Plastic Surgery,
                                    University of Ibadan
04/08/03
           Etiological factors                   8



           Radiation: microcephaly
           Infection: toxoplasmosis, rubella,
           CMV
           Maternal idiosyncracies
              phenylketonuria disorder, diabetes
              (oculoauriculovertebral OAV
              spectrum)
           Chemicals: vitamin deficiency states,
              excess Vit A, isotretinoin (clefts,
              microsomia),
              thalidomide, diazepam (cleft palate,
              OAV) and University of Ibadan Surgery,
                   Head neck surgery; Plastic
04/08/03                                                9



  Classification of
  craniofacial anomalies


           Clefts
           Synostosis
           Hypoplasias

              Head and neck surgery; Plastic Surgery,
                      University of Ibadan
04/08/03                                                 10



           CLASSIFICATION OF
                CLEFTS


           American cleft palate
           association

            Tessier
               Head and neck surgery; Plastic Surgery,
                       University of Ibadan
04/08/03                                                          11

     Clefts:             types and nomenclature
    Complete
    unilateral cleft
    of primary
    palate:
    nose,lip, gingiva, premaxilla

                   Point of division:
                   Foramen incissura

    Cleft of
    secondary
    palate: hard and soft
    palate,uvula
                        Head and neck surgery; Plastic Surgery,
                                University of Ibadan
04/08/03                                             12




           Head and neck surgery; Plastic Surgery,
                   University of Ibadan
04/08/03                                             13




                Unoperated cleft lip




           Head and neck surgery; Plastic Surgery,
                   University of Ibadan
04/08/03                                                        14




       Tessier’s
     classification
        of clefts




                      Head and neck surgery; Plastic Surgery,
                              University of Ibadan
04/08/03                                                              15
           Clefts: treatment
Type of cleft             Timing                          Method


Cleft of          Rule of 10s:                          Rotation
                  Age=10weeks                           advancement
primary
                  Wt =10 Ib,                            flap repair
palate            Hb =10 G/dl                           (Millard)

Cleft of          Age=6 months                          Langenbeck’s
                                                        Advancement flap
secondary                                               Furlow
palate        Head and neck surgery; Plastic Surgery,
                      University of Ibadan
04/08/03                                               16




           Hypoplasia
              Van der
              Muelen
           classification
             Head and neck surgery; Plastic Surgery,
                     University of Ibadan
04/08/03                                             17




           Head and neck surgery; Plastic Surgery,
                   University of Ibadan
04/08/03                                          18



           Craniosynostosis:
             pathogenesis
           Abnormal tensile forces
           transmitted to the dura from an
           anomalous cranial base through
           key ligamentous attachments

           Fetal head constraints

           Sutural abnormality

           Shunt decompression of
           hydrocephalus Surgery,
                 Head and neck surgery; Plastic
                         University of Ibadan
04/08/03                                             19




           Head and neck surgery; Plastic Surgery,
                   University of Ibadan
04/08/03                                                                      20




           Craniosynostoses
                              Skull shape                 Abnormally closed
                                                          suture
      Trigonocephaly      Triangular                      Metopic

      Scaphocephaly       Boat shaped                     Sagittal

      Turricephaly        Skull height                    Basal

      Oxycephaly          Pointed head                    Coronal


                     Head and neck surgery; Plastic Surgery,
                             University of Ibadan
04/08/03                                                            21




      Scaphocephaly




           Turricephaly




                          Head and neck surgery; Plastic Surgery,
                                  University of Ibadan
04/08/03                                             22




           Head and neck surgery; Plastic Surgery,
                   University of Ibadan
04/08/03                                             23




           Head and neck surgery; Plastic Surgery,
                   University of Ibadan
04/08/03                                                  24



      Craniosynostosis:
     functional problems


           Intracranial hypertension
           Visual impairment
           Neuropsychiatric disorders




                Head and neck surgery; Plastic Surgery,
                        University of Ibadan
04/08/03                                               25

           Infections
    Boils/pimples
    Gingivitis
    Apical abscess
    Ludwig’s angina
    Cancrum oris
             Head and neck surgery; Plastic Surgery,
                     University of Ibadan
04/08/03                                                               26



    Cancrum oris
 Stage     Pathologic process                    Treatment


 Acute     Inflammation,                         i.v. antibiotics, fluid
           Gangrene,                             replacement,
                                                 correction of anaemia,
           Demarcation
                                                 malnutrition

 Chronic   Defects, Fibrosis,                    release of trismus,
           Contracture,                          contractures and
           Trismus                               closure of defects

                Head and neck surgery; Plastic Surgery,
                        University of Ibadan
04/08/03                                                27
       Cancrum oris: chronic stage




              Head and neck surgery; Plastic Surgery,
                      University of Ibadan
04/08/03                                                    28




                   Tumours
       Soft tissue
           skin: SCC, BCC, MM, Cylindroma
                  lipomas, haemangiomas,
           soft tissue sarcomas
           salivary gland: mixed parotid tumour,
                                     adenocarcinoma.
           gingival: epulis, adenocarcinoma
                  Head and neck surgery; Plastic Surgery,
                          University of Ibadan
04/08/03                                             29




            Tumours
  Odontogenic tissue:
     Cysts
     ameloblastoma

           Head and neck surgery; Plastic Surgery,
                   University of Ibadan
04/08/03                                             30




            Tumours
  Bony tissue
     Fibrous dysplasia
     Burkitt’s lymphoma
     Osteosarcoma

           Head and neck surgery; Plastic Surgery,
                   University of Ibadan
04/08/03                                                 31


             Mandibular osteosarcoma:
           Preoperative, and postoperative




               Head and neck surgery; Plastic Surgery,
                       University of Ibadan
04/08/03                                                32




           Trauma Aetiology
       RTA,
       sports,
       burns,
       human and animal bite,
       gunshot

              Head and neck surgery; Plastic Surgery,
                      University of Ibadan
04/08/03                                                  33



           Trauma Clinical
              features:
       Look for associated head injury,
       Airway compromise,
       Lacerations,
       Fractures
       Other associated injuries


                Head and neck surgery; Plastic Surgery,
                        University of Ibadan
04/08/03                                               34




    Trauma Investigations:
       Blood investigations
       Appropriate X-ray,
       CT scan
       Other XRays

             Head and neck surgery; Plastic Surgery,
                     University of Ibadan
04/08/03                                                     35




           Patient with a gun shot head injury




                   Head and neck surgery; Plastic Surgery,
                           University of Ibadan
04/08/03                                                      36




             Plain Xray
           should include
            an AP and a
             lateral view



                    Head and neck surgery; Plastic Surgery,
                            University of Ibadan
04/08/03                                             37




           Head and neck surgery; Plastic Surgery,
                   University of Ibadan
04/08/03                                              38




 CTscan
 of same
  patient




            Head and neck surgery; Plastic Surgery,
                    University of Ibadan
04/08/03                                                    39
           Trauma Treatment:
    Treat shock,
    Antitetanus,
    Airway maintenance,
    Antibiotics.
    for soft tissue: 6/0 nylon or prolene for
    skin; remove stitches in five days. If
    mucosa is involved stitch with 5/0 or 4/0
    chromic catgut.
    flap should be transferred if bone is
    exposed. For fractures use closed or
                  Head and neck surgery; Plastic Surgery,
    internal fixation as necessary.
                          University of Ibadan
04/08/03                                                40




    Trauma Complications:
       wound infection,
       nerve conduction disorders,
       ocular problems,
       brain damage,
       CSF rhinorrhoea
              Head and neck surgery; Plastic Surgery,
                      University of Ibadan
04/08/03                                                 41



           Cervical swelling:
                lipoma




               Head and neck surgery; Plastic Surgery,
                       University of Ibadan
04/08/03                                              42




                                               Cervical
                                               swelling




           Head and neck surgery; Plastic Surgery,
                   University of Ibadan
04/08/03                                                43




           Parotid swelling




              Head and neck surgery; Plastic Surgery,
                      University of Ibadan

				
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