Surgical Anatomy of the Ligamentous Attachments in the Superoposterior Scalp Region.

BACKGROUND: Hairline-lowering surgery has become increasingly popular in recent years, but little investigation into the surgical anatomy of the scalp has been performed. OBJECTIVES: The aim of this study was to describe findings based on clinical observation and anatomic study of ligamentous attachments in the superoposterior region of the scalp. METHODS: Six fresh cadaveric heads were dissected to identify connective tissue structures in the superoposterior scalp region. The areas of interest were along the sagittal suture towards the lambda, the obelion, and around the lambdoid suture. The location and dimensions of identified connective tissue attachments were documented with reference to described skeletal landmarks. RESULTS: Three distinct structures could be identified: (1) a cylindrical structure that sits at the posterior end of the sagittal suture with the parietal foramina in its base. This ligamentous structure extends from the pericranium into the galea, causes dimpling in the skin, and contains emissary veins. As this fulfills the criteria for an osseocutaneous retaining ligament, the term "cranial retaining ligament" is proposed. (2) Anterior to this ligament a connective tissue thickening was identified running along the sagittal suture and blending into the ligament, for which the term "sagittal adhesion" is proposed. (3) Another adhesion was identified just superior to the lambdoid suture, posterior to the retaining ligament, for which the term "supralambdoid adhesion" is proposed. CONCLUSIONS: Identification and better understanding of ligamentous structures in the superoposterior scalp allows for a safer and more effective advancement of the scalp in hairline-lowering surgery, which is a benefit to both patients and surgeons.

A Tip for the Reconstruction of Larger Maxillary Defects in Complicated Cleft Patients.

Residual alveolar cleft deficits can be difficult to treat. This is particularly the case in older and multiply operated patients as well as those with large oronasal defects and extensive scar tissue. In large and recalcitrant defects vascularized free tissue transfer should be considered as a definitive procedure. Vascularized free tissue transfer provides a 95% success rate and provides excellent bone for placement of osseointegrated implants for dental rehabilitation (Schwabegger et al., 2004). We feel that the scapula tip has a number of important advantages. These include reduced morbidity from the donor site, good bone quality and contour for implant placement, and a longer pedicle length.

The fate of the free flap pedicle after free tissue transfer to the head and neck area.

OBJECTIVES: Little is understood about what happens to the vascular pedicle following free tissue transfer in the head and neck region. The viability of a free flap completely depends on the vascular supply by its vascular pedicle until neovascularization occurs from surrounding tissues. The aim of this study is to find out how long a vascular pedicle lasts following free tissue transfer in the head and neck region. MATERIALS AND METHODS: Patients were recruited from the Maxillofacial Unit at the Royal Brisbane & Women's Hospital. A Doppler ultrasound was used to map the vascular pedicle immediately postoperatively, at 2weeks, 6weeks, 3months and 6months. RESULTS: Fifty-seven consecutive free flaps underwent colour Doppler ultrasonography at the timepoints described demonstrating the status of the vascular pedicle. All the patients underwent reconstructive head and neck surgery with a wide variety of soft tissue and composite free flaps. CONCLUSION: This study is the first to document the fate of the vascular pedicle over a long time period for a wide variety of head and neck free flaps. This information is important when undertaking revision surgery to the free flap, or planning the vascular supply for a second or third free flap to the head and neck region.

Three-dimensional virtual planning in orthognathic surgery enhances the accuracy of soft tissue prediction.

INTRODUCTION: Throughout the history of computing, shortening the gap between the physical and digital world behind the screen has always been strived for. Recent advances in three-dimensional (3D) virtual surgery programs have reduced this gap significantly. Although 3D assisted surgery is now widely available for orthognathic surgery, one might still argue whether a 3D virtual planning approach is a better alternative to a conventional two-dimensional (2D) planning technique. The purpose of this study was to compare the accuracy of a traditional 2D technique and a 3D computer-aided prediction method. METHODS: A double blind randomised prospective study was performed to compare the prediction accuracy of a traditional 2D planning technique versus a 3D computer-aided planning approach. The accuracy of the hard and soft tissue profile predictions using both planning methods was investigated. RESULTS: There was a statistically significant difference between 2D and 3D soft tissue planning (p < 0.05). The statistically significant difference found between 2D and 3D planning and the actual soft tissue outcome was not confirmed by a statistically significant difference between methods. CONCLUSIONS: The 3D planning approach provides more accurate soft tissue planning. However, the 2D orthognathic planning is comparable to 3D planning when it comes to hard tissue planning. This study provides relevant results for choosing between 3D and 2D planning in clinical practice.

Benign oncocytoma of the trachea.

A 16-year-old girl was referred with a presumed muco-epidermoid carcinoma of the distal trachea, which was diagnosed by bronchoscopic biopsy. She underwent tracheal resection and end-to-end anastomosis. Final pathologic examination of the resected specimen revealed a benign oncocytic adenoma. This neoplasm is composed predominantly of oncocytes and is extremely rare in this location.