Reconstruction of Head and Neck Defects Using Medial Sural Artery Perforator Free Flap.

AIM: To study the use of medial sural artery perforator (MSAP) free flap in head and neck reconstruction. MATERIAL AND METHOD: This was a prospective study. The patients with cancers of head and neck underwent excision of tumor along with neck dissection, and MSAP free flap was used for reconstruction. RESULTS: The free MSAP flaps were used in 30 patients to reconstruct head and neck soft tissue defects. There were sixteen male and six female patients with the median age of 40 years. The most common site of tumor resection was the tongue (14 cases), followed by buccal mucosa (12 cases), neck skin(2 cases), skin over parotid(1 case) and lip(1 case). Average flap size was 56 cm2. Thickness of the flap ranged from 4 to 8 mm. The length of the vascular pedicle ranged from 8 to 14 cm (12 cm mean) which provides sufficient length during vessel anastomosis. Arterial diameter ranged from 1.0 to 1.5 mm(Average - 1.25 mm) and venous diameter of both veins in pedicle ranged from 1.5 to 2.5 mm(Average - 2 mm) in size. Most flaps were based on two perforators. Primary closure was attained in 11 cases whereas 19 patients required split thickness skin graft(STSG). The average flap harvesting time was 45 min. Flap was failed in two cases. CONCLUSION: MSAP is good alternative to FRAFF in the reconstruction of defect after resection of head and neck cancer.

Reconstruction of Complex Oro-Mandibular Defect Using Free Fibula Flap and Lateral Sural Artery Flap: A Case Series.

Through and through complex oro-mandibular defect usually involves buccal mucosa, mandibular segment, lip, and outer cheek skin. Reconstruction of such extensive three-dimensional defects pose a great challenge to reconstructive surgeons which requires use of two flaps. There are diverse options for such types of defects like use two pedicled flaps, one free flap, one pedicled flap or use of two free flaps. Amongst them the use of dual free flaps is ideal for the reconstruction. Commonly used dual free flaps are free fibula osteocutaneous flap for mandible, buccal mucosal defect and free radial artery flap or antero-lateral flap for cheek defect. The major disadvantages of using these two free flaps include two different sites for flap harvest, more time for harvesting and increased overall surgery time. We present our experience of reconstruction of large oro-mandibular defect using free osteo-cutaneous fibula flap and lateral sural artery free flap from single limb in six patients between January 2019 and December 2020. Minimum follow up was 6 months.

Revisiting the Use of GORE-TEX as an Interpositional Material in Surgical Management of Severe Temporomandibular Joint Ankylosis.

(1) Defining a protocol for management of patients with severe temporomandibular joint ankylosis. (2) Review the results of use of GORE-TEX as an interpositional material in gap arthroplasty. All cases which were treated with surgical intervention for severe TMJ Ankylosis with use of GORE-TEX as an interpositional material have been included. Amongst 40 patients, 11 were male and 29 were female with age group ranging from 4 to 36 years. 22 patients had bilateral ankylosis and 18 patients had unilateral ankylosis needing unilateral condylectomy. In all the patients GORE-TEX was used as an inter-positional material to form a pseudo joint. Postoperative mouth opening was around 3 fingers (3-3.5 cm) for period of 2 years i.e. last follow up. Migration or extrusion of implant was not seen in any of our cases. Use of GORE-TEX as an inter-positional material can prevent recurrences with good restoration of the physiological joint and occlusion.

Novel Program of Using Village Health Workers in Early Detection and Awareness of Head and Neck Cancers: Audit of a Community Screening Program.

Head and neck cancers together (oral cavity, pharynx and larynx) are sixth commonest worldwide and are the commonest cancers in developing countries. The Cancer Project was started in Kheda/Anand, Gujarat, a harvest land of tobacco. The objective of this programme was to indoctrinate the most vulnerable and the least tended upon; the basics of head and neck cancers via the medium of their own kins. Voluntary village health workers were educated and trained to pick up the early signs of head and neck cancers. Oral self examination was taught to them and they went to peripheral villages to screen the population. They would refer suspicious cases to tertiary healthcare centre. The population was enlightened upon the basics of preventable measures, treatment options and rehabilitation facilities for head and neck cancer patients. Knowledge, attitude and practice analysis was done in the population which showed widespread disbelief and false practices. A population of 26,10,432 was surveyed in 1862 villages of which 10,522 (1.1%) individuals successfully quit the habit. The minimally educated workers referred 3309 suspicious individuals to higher centre of which 1890 (57.11%) tested positive for cancer. A lot of resource is put in research and development of rapid diagnosis and complete cure; however such a minimally costing program may help the most in primordial, primary and secondary level of prevention. Such programs should be advocated on the global platform on lines of Breast Self Examination.

Eye Inside Out: Endonasal Endoscopic Reposition of Eye from Nose with Complete Vision Regainment.

Faciomaxillary and ocular trauma is a common entity in most emergency and trauma units. We came across a 68-year-old female patient with a history of bull horn injury over the right eye. Examination revealed an empty orbital socket with unreliable perception of light present. Imaging showed that the eye had displaced posteroinferomedially to be lying in the ethmoid air cells in the nasal cavity. Under nasal endoscopic guidance, the eye was reposited back into the orbital socket and conjunctival sutures were taken to stabilize the position. The patient had vision of counting fingers at 1.5 m on the first postoperative day which improved to 6/24 on last follow-up. Such is the rarity that never before has such a case been described in literature where traumatic displacement of eyeball into the nose has been successfully repositioned by an endonasal endoscope with appreciable regaining of vision. It also further promotes endonasal endoscopic approach in the management of orbital blow out injuries.

Dermatofibrosarcoma protuberans: Rare cause of head and neck swelling.

Dermatofibrosarcoma protuberance of head and neck is a rare neoplasm and accounts for less than one percent of Head and Neck Neoplasm. The objective of this report is to understand etiology, presentation, histopathologic identification and treatment option for this tumour. The goal of current report is to acquaint the clinician with presentation and treatment option for this disease.