Pediatric free flap reconstruction for head and neck defects.

PURPOSE OF REVIEW: The aim of this study was to review recent literature on the use of pediatric free flap reconstruction for head and neck defects with focus on skull base, congenital deformities, mandibular reconstruction and operative considerations. RECENT FINDINGS: Reconstruction of the skull base depends on the defect size, location, bony involvement, and pedicle length with a variety of flaps to choose from. Free flaps may be used to correct congenital anomalies due to facial clefts and syndromic causes requiring bony and tissue bulk. Preservation of the condyle together with free flap mandibular reconstruction has better growth potential. Delayed repair of mandibular defects may be an option especially for patients with malignancy. Chemotherapy and radiation therapy may inhibit the growth potential of the mandible. The use of running or coupled arterial anastomosis is associated with an increased immediate complication. SUMMARY: Pediatric free flap reconstruction is a reasonable option for various head and neck defects such as skull base, congenital, and mandibular defects.

Late-onset anterolateral thigh free flap failure in buccal carcinoma reconstruction

OBJECTIVE: To report a case of late-onset anterolateral thigh free flap failure in reconstruction of a defect from excision of buccal carcinoma.METHODS:Design: Case ReportSetting: Tertiary Government Training HospitalPatient: OneRESULTS: A 57-year-old man with well-differentiated buccal squamous cell carcinoma underwent wide excision with segmental mandibulectomy, bilateral neck dissection and anterolateral thigh free flap reconstruction. Complete failure of the anterolateral thigh free flap was documented on the 29th post-operative day.CONCLUSION: Late-onset flap failure is mainly non-vascular in etiology. However, flap failure is more likely multifactorial. Frequent follow-up after hospital discharge is recommended to monitor flap viability.

Unilateral pedunculated polyp of the palatine tonsil

@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> To report a benign tonsillar lesion presenting as a pedunculated polyp and discuss its diagnosis and management.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Case Report<br /><strong>Setting:</strong> Tertiary Government Hospital<br /><strong>Patient:</strong> One<br /><strong>RESULTS:</strong> A 14-year-old lad presented with a seven-year history of an elongated right tonsillar mass without  associated  bleeding, pain,  dysphagia or obstructive sleep  apnea.  Physical  examination revealed  a  pedunculated  mass  about  2  x  1  x  0.5cm  in  size  located  in  the  superior  pole.  After unilateral  tonsillectomy, histopathological  examination  revealed  lymphangectatic  lipomatous fibrotic polyp.<br /><strong>CONCLUSION:</strong> Lymphangiomatous polyp of the palatine tonsils  is  an  unusual benign lesion of the head and neck. These  are  commonly  present  as  unilateral,  polypoidal  mass  that  cannot be clinically  differentiated  from  other  benign  tonsillar  lesions. Tonsillectomy  is  the  recommended surgical  approach  for  both  diagnostic  and  therapeutic  purposes.  Histopathological  study  must be done to confirm diagnosis.</p>

Intraoperative distance between the main trunk of the facial nerve and surgical landmarks used in parotidectomy: A prospective study

@#p style=text-align: justify;strongOBJECTIVE:/strong To determine the mean distance of the main trunk of the facial nerve from two commonly employed surgical landmarks (tragal pointer and tympanomastoid suture line) among a sample a Filipino adults undergoing parotidectomy.METHODS:br /Design:/strong Prospective descriptive studybr /strongSetting: /strongTertiary Government Training Studybr /strongSubjects:/strong 22 patients without facial paralysis undergoing surgery for parotid neoplasms were evaluated intraoperatively.RESULTS/strong: The main trunk of the facial nerve was found to be 9.0 mm (standard deviation of 2.8 mm) from the tragal pointer and 6.1 mm (standard deviation of 2.0 mm) from the tympanomastoid suture line.CONCLUSION/strong: The mean distance from the main trunk of the facial nerve to two of the most commonly utilized landmarks in identification of the nerve during parotidectomy was 9.0 mm (standard deviation of 2.8 mm) from the tragal pointer and 6.1 mm (standard deviation of 2.0 mm) from the tympanomastoid suture line. These may serve as reference values for surgeons in safer identification and preservation of the facial nerve during parotidectomy.

Transorbital removal of foreign body in the sphenoid sinus

@#OBJECTIVES: To report a case of foreign lodged within the sphenoid sinus and its extraction.METHODS:Design: Case report Setting: Tertiary Government Hospital Patient: OneRESULTS: An 11-year-old girl was hit in the eye by an unknown object from an improvised slingshot. She had loss of vision of the left eye and headache without loss of consciousness. A plain craniofacial Computed Tomography (CT) scan showed a round opaque foreign body abutting the left sphenoid sinus, left posterior ethmoid cells and medial aspect of the left orbital region with adjacent soft tissue densities extending into the apparently ruptured, irregular left globe. The left posterior part of the lamina papyracea was not visualized probably fractured or ruptured. Transorbital enucleation of the left eye and endoscopy-assisted removal of the foreign body (a glass marble) were performed with no intra-operative and post - operative complications.CONCLUSION:Foreign body of the sphenoid sinus is a rare condition. Adequate imaging is important for localization and planning the optimal surgical approach. Endoscopic guidance may aid in extraction.