Neck rejuvenation by direct anterior medial cervicoplasty: the modified zigzag-plasty according to Tschopp.

BACKGROUND: Conventional cervicofacial rhytidectomy has become the standard treatment of skin excess of the ageing neck. However, some patients want to avoid an extensive surgical procedure, especially if the anterior neck is the predominant problem zone. OBJECTIVE: To report on the efficacy and safety of a zigzag-shaped skin excision combined with platysma plication. METHODS AND MATERIALS: We present a retrospective case review series of six female patients. Skin excess was marked preoperatively using the skin pinching technique, then transferred to a zigzag-shaped area and finally excised using the method according to Tschopp, which is described. Patients were followed up for at least 1 year. RESULTS: All patients (age: 55-82 years, median: 65 years) were very satisfied with the results. On an overall patient satisfaction scale of 1-10 (1 being the best), the scars were graded on average 1.85 (median: 2) 1 year after surgery. No scar hypertrophy, functional impairment, nerve damage or other serious complications were observed. CONCLUSION: In selected patients, the direct anterior zigzag-shaped excision poses an effective, safe and easy surgical option for both skin excess and fat excess and platysma banding. The technique is easily reproducible, with low morbidity and high patient satisfaction.

Monophasic synovial sarcoma of posterior pharyngeal wall: a rare case report with unique reconstruction using lateral trapezius flap.

Synovial sarcoma is a rare entity to be encountered in the head and neck region and is always a challenge in terms of diagnosis, treatment planning and reconstruction of the surgical defect. In our case, we faced a similar challenge for diagnosis and also have ventured for lateral trapezius flap as a new reconstructive option for such bulky tumour defects. We hereby present a 25-year old male patient with monophasic synovial sarcoma of posterior pharyngeal wall. The radiological and clinicopathological features along with various diagnostic tests and treatment options are discussed.

The Horizontal Neck Lift.

The horizontal neck lift is a procedure involving direct excision of a horizontally oriented ellipse of skin from the neck. This procedure was developed for neck rejuvenation in patients with significant horizontal creases and excess skin of the middle and lower neck, areas that often cannot be adequately addressed with traditional techniques. This article describes the procedure, indications, patient counseling, and postoperative care in detail from the senior author's (H. M.) experience.

The Difficult Neck in Facelifting.

As the popularity and acceptance of facial and cervical rejuvenation procedures grows, surgeons are increasingly encountering patients with less favorable anatomical characteristics for rhytidectomy. These patients will typically display an obtuse cervicomental angle, underprojected chin, excess cervical adiposity, and platysmal banding, in addition to ptotic submandibular glands, tenacious jowls, and prejowl volume deficits. Recognition of these problems and the correct application of available techniques to address the difficult neck in facelifting are critical in maximizing success.

[Cervical lift: An update]. / Le lifting cervical : évolutions récentes.

The neck is an aesthetic unit for which a rejuvenation request is sometimes very targeted or ore often encompassed in a global surgical project of face-lift. To obtain a long lasting outcome, the plastic surgeon has to make a full, detailed, and exhaustive analysis of the neck in order to choose the best indication within the multiple surgical tools. A full clinical examination is the key point, every aspects are outlined. The numerous surgical choices are described, illustrated, and sometimes revisited in the light of targeted anatomical studies. A didactic and graduated way is used to explain the recent evolutions of the surgical tools of the cervical lifting. Complications and insufficiencies in outcomes must be identified and explained. Finally, we illustrate this development by clinical cases. The surgical improvement of the cervical region is, for us, centered on the reconstruction of a cervical retaining structure: the Cervico-Mandibular Angle Suspensor (CMAS) ligament. This element makes it possible to understand and integrate the large number of technical proposals for cervical lifting.

[Face-lift surgery in ambulatory]. / Lifting cervicofacial en ambulatoire.

OBJECTIVE: The proposal is to demonstrate that facelift surgery is particularly suitable for the care in ambulatory. METHODS: Between 2010 and 2016, 246 patients were operated for a facelift in ambulatory. RESULTS: No major complication arose in this series (241). Among the patients, 98% expressed their satisfaction and would accept again this intervention in ambulatory. CONCLUSION: The facelift can be realized in ambulatory with complete safety. The rate of satisfaction shows a very strong support of the patients for the ambulatory care.

[Incisions and baseline operative technique of cervicofacial lifting]. / Incisions et technique opératoire de base du lifting cervicofacial.

Cervicofacial lifting is one of the most iconic procedure of plastic surgery and is about hundred years old. In the following chapters of this report, numerous technical points will be specify. A baseline reliable and reproducible technique, appealing to the largest possible audience is presented in order to begin this surgery in optimum conditions. Pre- and postoperative management is also exposed. The aim of this chapter is to precise incisions and baseline operative technique of cervicofacial lifting, with description of SMAS and platysma suspensions as well as complementary procedures like liposuccion and lipofilling. This chapter will lay the foundation of more complex elements that will be described in the various following chapters.

[Care and optimal management of the face- and neck-lift patients]. / Prise en charge et gestion des patients demandeurs d'un lifting cervico-facial.

Surgical and case management for patients demanding a face- and neck-lift are very important. The purpose of this paper is to help the plastic surgeons with information and recommendations useful for the best medical care of patients requiring a face- and neck-lift. The first consultation is the most important contact with the patient. The preoperative discussion helps to define patient demands and to evaluate eventual contraindications for surgery. The clinical exam and patient requirements are useful in the construction of the therapeutic proposition. This proposition is then confronted with patients' expectations and demands. The confrontation between the surgical proposition and patients' expectations allows to evaluate if it is appropriate, or not, to operate. At the end of the first consultation, the patient receives the information sheets of the French Plastic Surgery Society (SOFCPRE) according to the proposed surgical treatment. The second consultation makes it possible to verify the pertinence of the surgical act, to reiterate the preoperative recommendations, to confirm that the information given to the patient was well understood and to obtain the written consent from the patient. The written consent should include the fact that the patient received the information sheets of the SOFCPRE, that they were read and understood, and that the surgeon has transmitted the necessary information in order for the patient to take an informed and free decision to pursue with the surgery. The follow-up after surgery is as important as the surgery itself. In some cases, cosmetic gestures can be performed in the following months to obtain the best results possible and the highest satisfaction. The face- and neck-lift is an "adventure" for the patients and the postoperative difficulties should not be underestimated. However, the caring and professional support of the plastic surgeon and the support of someone of the patients' entourage can help the patient overcome this stage, and obtain a maximum benefit after this operation.

Transverse cervical vessels as recipient vessels in oral and maxillofacial microsurgical reconstruction after former operations with or without radiotherapy.

BACKGROUND: The purpose of this study was to investigate the reliability and outcome of using the transverse cervical vessel (TCV) as a recipient vessel for microvascular reconstruction in patients whose vessels in the neck region are unavailable because of previous surgery or radiotherapy. METHODS: Between January 2012 and August 2014, secondary head and neck reconstruction was performed using the TCV as a recipient vessel in eight patients who had undergone previous neck dissection and radiation therapy (n = 5). Five patients had a recurrent carcinoma, one had undergone an operation for scar release and two had been treated surgically for a second primary cancer. The anterolateral thigh flap (ALT), anteromedial thigh flap (AMT), and fibular flap were used for the reconstruction. Clinical data were recorded for each patient. RESULTS: All of the ipsilateral transverse cervical arteries were found to be free of disease. The second free flap was revascularized using the TCVs (n = 6) or the external (n = 1) or internal (n = 1) jugular vein. The free flaps used for the reconstruction included the ALT flap (n = 6), AMT flap (n = 2), and fibular flap (n = 1). All of the flaps survived without vascular events, and the patients healed without major complications. The mean follow-up time was 11 months. One patient died of distant metastases during follow-up. CONCLUSIONS: In patients who have previously undergone neck surgery with or without radiotherapy, the TCVs are reliable and easily accessible recipient vessels for microsurgical reconstruction in the oral and maxillofacial region. If the transverse cervical vein is unavailable, the internal or external jugular vein should be dissected carefully to serve as an alternative for microvascular anastomoses.

Reconstruction of cervical scar contracture using axial thoracic flap based on the thoracic branch of the supraclavicular artery.

PURPOSE: Cervical scar contracture causes both physical and psychological distress for burn patients. Many pedicle flaps or skin grafting have been suggested for reconstruction of cervical scar contracture with variable results in the literature. The authors present the axial thoracic flap based on the thoracic branch of the supraclavicular artery (TBSA) for reconstruction of cervical scar contracture. METHODS: Postburn scar contractures in anterior neck region of 66 patients had been reconstructed with the axial pattern thoracic flaps based on the TBSA, including 1 expanded and 10 nonexpanded pedicle flaps, and 9 expanded and 46 nonexpanded island pedicle flaps, during 1988 through 2012. After removing and releasing the cervical scar contracture, the flap was designed in the thoracic region. The axial artery of the flap is the TBSA bifurcating from the intersection point of sternocleidomastoid muscle and omohyoid muscle with several concomitant veins as the axial veins. The flap can be designed in a large area within the borders of the anterior border of the trapezius muscle superiorly, the middle part of the deltoid muscle laterally, the midsternal line medially, and the level 3 to 4 cm below nipples inferiorly. After incisions were made along the medial, inferior, and lateral border, dissection was performed toward the pedicle. Donor site was closed directly in expanded cases and with skin grafting in nonexpanded cases. RESULTS: Cervical scar contractures were repaired with good functional and cosmetic results in 64 cases among this cohort. Flap tip necrosis in other 2 cases, caused by postoperative hematoma, was repaired by skin grafting. The color and texture of all flaps were fitted with those of the surrounding skin. The donor sites all healed primarily. The flap sensation in the thoracic region regained in the early stage postoperatively and that in cervical area recovered completely after 6 months according to the report of the patients. CONCLUSION: With reliable blood supply based on the dissection of cadavers, axial flap based on the TBSA is a good option for reconstructing severe cervical scar contracture.

Bipedicles chest flap: a novel technique for the reconstruction of anterior neck defect.

This paper presents our surgical technique and the results of using bipedicled superior chest flaps for head and neck reconstructions. The study design consisted of a case series of surgical technique. The study was conducted at tertiary referral centers with otorhinolaryngology-head and neck surgery departments. In seven patients, we used bipedicled superior chest flaps for reconstruction of anterior cutaneous neck defects due to surgery for the recurrence of laryngopharyngeal carcinoma. The largest flap size was 45 × 14 cm. All donor sites were closed primarily with advancement in the lateral part and split thickness skin grafts in the superior midline of chest. The highest point of reconstruction was in the hypopharynx internally and hyoid externally. All flaps survived without major complications. A bipedicled upper chest flap can reliably cover the skin defects that create following salvage total laryngectomies in patients with advanced stage tumors with skin involvement.

Submandibular gland excision: long-term clinical outcome in 139 patients operated in a single institution.

In transcervical resection of the submandibular gland for benign lesions, only a limited risk of damage to neural structures can be accepted and a cosmetically satisfactory result is mandatory. In this retrospective case series, we evaluated 139 patients operated over a 10-year period and completed long-term clinical follow-up of 113 of these patients after a median of 81 months. In all patients, the operation was effective. We found a 4.3 % risk of reoperation for wound infection or postoperative hematomas and an 18.7 % risk of early paresis of the marginal branch of the facial nerve, which decreased to 2.7 % on long-term follow-up. We found a 4.4 % risk of permanent lingual nerve paresis, and no patients had damage to the hypoglossal nerve. Xerostomia was found in 22.1 % of the patients and could be quantified by the easily performed biscuit test. Only 2.5 % reported an unsatisfactory cosmetic result and all scars were ≤ 6 on the Vancouver Scar Scale. Problems with scarring were more common if there had been postoperative infection. We continue to use the lateral transcervical approach as standard in our institution for patients who cannot be managed by gland-sparing procedures.

[Lifting of the oval face--LOV: technical note]. / Lifting de l'ovale du visage--LOV: note technique.

OBJECTIVE: The authors describe a rejuvenation surgical technic of cervical area ptosis. It is called LOV for "Lifting of the Oval of Visage". LOV is realised under local anaesthesia, lasts about 40 minutes. In this study, post-operative results are evaluated after one year. MATERIAL AND METHODS: retrospective study with anonymous questionnaire measuring patient's satisfaction, operated between january 2011 and december 2011, by the same surgeon in the department. RESULTS: 43/45 questionnaires were analyzed, 40 females (93%) and 3 males (7%). Average age was 56 years, with a range of 51 years to 66 years. Our satisfaction ratings values after surgery were: very good: 32 (74.4%), good: 8 (18.6%), intermediate: 2 (4.6%), unsatisfied: 1 (2.3%), will not undergo LOV again: 1 (2.3%), would not recommend LOV to a friend: 2 (4.6%), recommend LOV to a friend: 37 (86%). The only complication (2.3%) was an unilateral hypoesthesia earlobe. CONCLUSION: LOV is simple and effective. It is a surgical alternative in the treatment of cervical area ptosis. Performed under local anesthesia, this short procedure responds to complaints of patients: safe rejuvenation and natural looking. Since 2008, LOV is performed in our department. Recruitment is most often "word of mouth", as confirmed by 86% of patients who would "recommend it to a friend". In cosmetic procedure, we should always keep in mind "a good result is measured to good patient satisfaction".

Submental liposuction versus formal cervicoplasty: which one to choose?

PURPOSE: Esthetic rejuvenation of the submental area is a fairly common concern of patients seeking cosmetic surgery. There are several techniques used to obtain esthetic results. A common dilemma is the proper determination as to which procedure, liposuction versus formal cervicoplasty, is more appropriate. This manuscript describes the factors involved in the aging process of the submental area, as well as the inherent advantages of formal cervicoplasty over liposuction. MATERIALS AND METHODS: A comprehensive review of the intrinsic and extrinsic aging process is described, and advantages and disadvantages of liposuction as well as cervicoplasty are detailed. RESULTS: On the basis of the specific factors leading to the fullness of the anterior neck/submental area, proper rejuvenation technique must include platysmaplasty, in addition to liposuction. Isolated liposuction is only beneficial in an isolated group of cosmetic patients. CONCLUSIONS: Formal cervicoplasty, including open liposuction and platysmaplasty, is a superior operation compared with isolated liposuction of the submental area. Whereas liposuction does have a role in cosmetic surgery of the submental area, it is not a comprehensive procedure and does not address all of the anatomic components leading to submental fullness.

Direct cervicoplasty.

The sagging neck, or "turkey gobbler" deformity, is one of the more common reasons that patients present to facial plastic surgeons. Although many of these patients might be best improved by a full rhytidectomy with periauricular incisions, skin flap undermining, and platysmal tightening, there are some patients who do not wish to undergo a full rhytidectomy. Some of these patients may be reasonably well served by a direct cervicoplasty or submentoplasty. The advantages of this approach include shorter operative time, faster recovery, and lower complication rates. The primary disadvantage is an anterior cervical incision that may be visible under some conditions. This article will review the options for skin incisions as well as technical details that may lead to a successful rejuvenation of the submental region.

The web lift and posterior pull for the aging face.

There are many factors that contribute to the aging neck. We have recently begun employing a percutaneous suture spanning the submentum combined with a posterior platysma pull. We present our initial results with this technique. In this retrospective study, subjects underwent the combined procedure with and without concomitant rhytidectomy. Cephalometric analysis was used to compare the preoperative cervicomental angle (CMA) and hyomental distance (HMD) with postoperative values at 4 weeks. Subjects also were queried on their postoperative satisfaction. Twenty-five subjects were included in this study. At 4 weeks postoperatively, we achieved significant reductions in the average CMA (134.8 versus 122.8, p = 0.002). The postoperative HMD significant increased an average of 1.9 cm (8.5 versus 10.4, p = 0.009). We achieved a 92.3% satisfaction score at 33 weeks (range = 25 to 44). The combination of a percutaneous suture across the submentum and a posterior platysma pull is a safe and effective method of addressing the many facets of the aging neck. Our initial results are easily reproducible and entail minimal morbidity to the patient.

Managing the neck in the era of the short scar face-lift.

A recent trend in rhytidectomy has included the introduction of various short incision techniques, particularly the S-lift, the minimal access cranial suspension lift, and other short scar methods. However, this trend has not been without a criticism that these minimally invasive techniques might be limited in what might be achievable by such surgery. As with more traditional face-lift surgery, the management of the neck often presents as the most challenging aspect of the procedure when using short scar techniques. This article will present a brief history of cervical rhytidectomy and relevant surgical anatomy, as well as the authors' algorithmic approach to surgical assessment and management of the neck, the short incision operative techniques, and potential complications. In the authors' experience, attention to both the selection criteria and operative modifications in the execution of short scar techniques are critical to optimizing outcomes in cervical rejuvenation.

Lower face-lift with extensive neck recontouring.

Difficult anatomy and advanced aging continue to pose a challenge to the face-lift surgeon. We present a thorough analysis of the patient with respect to relevant vascular anatomy, as well as our techniques used to address advanced cases, including compartment communication and submental suspension platysmaplasty.

[Traditional transcutaneous approaches in head & neck surgery]. / Grundlagen und klinische Bedeutung der klassischen transzervikalen Chirurgie von Kopf-Hals-Tumoren - Teilresektionen, Laryngektomie, Rekonstruktionstechniken, Rettungschirurgie.

The treatment of laryngeal and hypopharyngeal malignancies remains a challenging task for the head and neck surgeon as the chosen treatment modality often has to bridge the gap between oncologically sound radicality and preservation of function. Due to the increase in transoral laser surgery in early tumor stages and chemoradiation in advanced stages, the usage of traditional transcutaneous approaches has decreased over the recent past. In addition, the need for a function-sparing surgical approach as well as highest possible quality of life has become evident. In view of these facts, rationale and importance of traditional transcutaneous approaches to the treatment of laryngeal and hypopharyngeal malignancies are discussed in a contemporary background. The transcutaneous open partial laryngectomies remain a valuable tool in the surgeon's armamentarium for the treatment of early and advanced laryngeal carcinomas, especially in cases of impossible laryngeal overview using the rigid laryngoscope. Open partial laryngetomies offer superior overview and oncologic safety at the anterior commissure, especially in recurrencies. In select advanced cases and salvage settings, the supracricoid laryngectomy offers a valuable tool for function-preserving but oncologically safe surgical therapy at the cost of high postoperative morbidity and a very demanding rehabilitation of swallowing. In hypopharyngeal malignancies, the increasing use of transoral laser surgery has led to a decline in transcutaneous resections via partial pharyngectomy with partial laryngectomy in early tumor stages. In advanced stages of tumors of the piriform sinus and the postcricoid area with involvement of the larynx, total laryngectomy with partial pharyngectomy is an oncologically safe approach. The radical surgical approach using circumferent laryngopharyngectomy with/without esophagectomy is indicated in salvage cases with advanced recurrences or as a primary surgical approach in patients where chemoradiation does not offer sufficient oncologic control or preservation of function. In cases with impending reconstruction, fasciocutaneous free flaps (anterolateral thigh flap, radial forearm flap) seem to offer superior results to enteric flaps in cases where the cervical esophagus is not involved leading to better voice rehabilitation with fewer complications and postoperative morbidity. In salvage situations, the Gastroomental Free Flap has proven to be a valuable tool. In conclusion, the choice of a surgical treatment modality is influenced by the patient's anatomy, tumor size and location as well as the surgeon's personal expertise.

A Multidisciplinary Approach to Penetrating Neck Trauma in a Patient with Self-Inflicted Gunshot Injuries to Zones 1-3 of the Neck.

Penetrating neck trauma comprises 5%-10% of all traumatic injuries in adults and carries up to a 10% mortality rate for those affected. Management of penetrating neck trauma can be challenging and often requires a multidisciplinary approach. A case of penetrating neck trauma via self-inflicted gunshot wound to zones 1-3 of the neck in an intoxicated, suicidal 60-year-old man is presented. Immediately after stabilization by the trauma surgery team, surgical reconstruction using a pectoralis major pedicled myocutaneous flap was completed by the plastic and reconstructive surgery team. The patient's hospital course was complicated by injury to the left phrenic nerve, oropharyngeal swallowing dysfunction, and left diaphragmatic dysfunction. The trauma team initiated prompt multidisciplinary responses to each of these complications as they arose by involving the plastic and reconstructive surgery, otolaryngology, gastroenterology, and speech language pathology teams. Early involvement of the physical medicine and rehabilitation, psychiatry, dietary, and pharmacy teams allowed for early optimization and monitoring of the patient's mobility, psychological, and nutritional statuses. The timely initiation of multidisciplinary care in this patient's case allowed for the patient to not only to survive a potentially fatal penetrating neck trauma, but to be discharged to a rehabilitation facility with an independent level of function. Given the complications due to severe penetrating neck trauma of zones 1-3 in this case, it is essential for early involvement of the appropriate subspecialty teams in order to achieve the best possible outcome for the patient.