The International Federation
          of Head and Neck Oncologic Societies
Current Concepts in Head and Neck Surgery and Oncology 2012



Reconstructive Techniques
            in
 Head and Neck Surgery
                 Jatin P. Shah
Impact of Cancer Ablative
       Surgery of the Oral Cavity
       Aesthetic
       Aesthetic              Functional
                              Functional
       Contour
       Contour            Speech
                          Speech
       Expression
       Expression         Mastication
                          Mastication
       Competence
       Competence         Swallowing
                          Swallowing


               Oral Cripple
               Oral Cripple

2012
Extent of Tissue Loss from
   Cancer Ablative Surgery of the
            Oral Cavity

       Soft Tissue
       Soft Tissue      Bone
                        Bone




         Mobile
         Mobile
          Mobile       Immobile
                       Immobile
          Mobile
2012
2012
Reconstruction of Oral Cavity Goals
            Functional:
       •  Oral Competence
       •  Clarity of speech
       •  Tongue Mobility
       •  Mastication
       •  Bolus Transport
       •    Regurgitation
       •    Aspiration
       •  Tactile Sensations
       •  Taste
2012
Reconstruction of Oral Cavity Goals
            Aesthetics:

       •  Bony Framework
       •  Soft Tissue Contour
       •  Chin Protrusion
       •  Mobility
       •  Oral Competence

2012
       •  Skin Sensation
Oral Cavity
               Soft Tissue Loss


       •  Mucosa
       •  Mucosa + submucosal soft tissue
       •  Mucosa + soft tissue + muscles
       •  Mucosa + soft tissue + muscles + skin
       •  Mucosa + soft tissue + muscles + bone

2012
Oral Cavity
                    Bone Loss
          Maxilla                 Mandible
•  Partial Hard Palate   •  Marginal
•  Total Hard Palate       Mandibulectomy

•  Upper and Lower       •  Ascending Ramus

  Gum Resection          •  Short Segment of Body

                         •  Hemimandibulectomy

                         •  Anterior Arch Resection
 2012
Soft Tissue Reconstruction of Oral Cavity

                 Mucosa



           •  None

           •  Split Skin Graft

           •  Primary Closure


 2012
Soft Tissue Reconstruction of Oral Cavity

    Mucosa and Submucosal Soft Tissue


           •  Skin Graft

           •  Primary Closure

           •  Local Flap


 2012
Skin Graft in
       Floor of Mouth




2012
Soft Tissue Reconstruction of Oral Cavity

        Mucosa, Soft Tissue & Muscles

        •  Skin Graft
        •  Primary Closure
        •  Local Flap
        •  Regional Cutaneous Flap
        •  Myocutaneous Flap
 2012
        •  Radial Forearm Free Flap
Reconstruction of the Face and
              Neck
       •  Local Flaps
       •  Regional Cutaneous Flaps
       •  Regional Myocutaneous Flaps
       •  Free Flaps
         Radial Forearm,
         Anterolateral thigh,

2012
         Rectus Abdominis,
         Latissimus Dorsi etc.
Cervical Flap for Parotid Defect




2012
Cervical Flap for Neck Defect




2012
Delto Pectoral Flap




2012
Pectoralis Myocutaneous Flap




2012
PMMC Flap with Brachytherapy




2012
Vertical Trapezius MC Flap




2012
Microvascular Free Flaps
in Head and Neck Reconstruction

       •  Radial forearm
       •  Anterolateral thigh
       •  Latissimus Dorsi
       •  Rectus abdominis
       •  Fibula
2012
       •  Jejunum
Radial Forearm Free Flap




2012
RFFF for Facial defects




2012
RFFF for Oral Defects




2012
Rectus Abdominis Free Flap




2012
Bone Reconstruction of Oral Cavity

       Upper Alveolus (Palatal)


        •  None (prosthesis)

        •  Microvascular Free Flap



2012
Dental Prosthesis for palatal Defect




2012
Mandibular Defects




2012
Bone Reconstruction of Oral Cavity

Ascending Ramus of the Mandible

       •  None

       •  A.O. Plate

       •  Microvascular Free Flap


2012
Bone Reconstruction of Oral Cavity

         Body of the Mandible

       •  None

       •  A.O. Plate

       •  Free non-vascularized graft
        (short segment)
2012
       •  Microvascular free flap
Bone Reconstruction of Oral Cavity

       Anterior Arch of the Mandible

         •  None

         •  Microvascular free flap




2012
Radial Forearm
       Osteocutaneous Flap




2012
Fibula Free Flap




2012
Fibula Free Flap for Tongue
       and Mandible Reconstruction




2012
Fibula Free Flap for Anteriror
             Arch of Mandible




2012
Dental Implants in Fibula Free Flap




 2012

Reconstructive techniques by J. Shah

  • 1.
    The International Federation of Head and Neck Oncologic Societies Current Concepts in Head and Neck Surgery and Oncology 2012 Reconstructive Techniques in Head and Neck Surgery Jatin P. Shah
  • 2.
    Impact of CancerAblative Surgery of the Oral Cavity Aesthetic Aesthetic Functional Functional Contour Contour Speech Speech Expression Expression Mastication Mastication Competence Competence Swallowing Swallowing Oral Cripple Oral Cripple 2012
  • 3.
    Extent of TissueLoss from Cancer Ablative Surgery of the Oral Cavity Soft Tissue Soft Tissue Bone Bone Mobile Mobile Mobile Immobile Immobile Mobile 2012
  • 4.
  • 5.
    Reconstruction of OralCavity Goals Functional: •  Oral Competence •  Clarity of speech •  Tongue Mobility •  Mastication •  Bolus Transport •  Regurgitation •  Aspiration •  Tactile Sensations •  Taste 2012
  • 6.
    Reconstruction of OralCavity Goals Aesthetics: •  Bony Framework •  Soft Tissue Contour •  Chin Protrusion •  Mobility •  Oral Competence 2012 •  Skin Sensation
  • 7.
    Oral Cavity Soft Tissue Loss •  Mucosa •  Mucosa + submucosal soft tissue •  Mucosa + soft tissue + muscles •  Mucosa + soft tissue + muscles + skin •  Mucosa + soft tissue + muscles + bone 2012
  • 8.
    Oral Cavity Bone Loss Maxilla Mandible •  Partial Hard Palate •  Marginal •  Total Hard Palate Mandibulectomy •  Upper and Lower •  Ascending Ramus Gum Resection •  Short Segment of Body •  Hemimandibulectomy •  Anterior Arch Resection 2012
  • 9.
    Soft Tissue Reconstructionof Oral Cavity Mucosa •  None •  Split Skin Graft •  Primary Closure 2012
  • 10.
    Soft Tissue Reconstructionof Oral Cavity Mucosa and Submucosal Soft Tissue •  Skin Graft •  Primary Closure •  Local Flap 2012
  • 11.
    Skin Graft in Floor of Mouth 2012
  • 12.
    Soft Tissue Reconstructionof Oral Cavity Mucosa, Soft Tissue & Muscles •  Skin Graft •  Primary Closure •  Local Flap •  Regional Cutaneous Flap •  Myocutaneous Flap 2012 •  Radial Forearm Free Flap
  • 13.
    Reconstruction of theFace and Neck •  Local Flaps •  Regional Cutaneous Flaps •  Regional Myocutaneous Flaps •  Free Flaps Radial Forearm, Anterolateral thigh, 2012 Rectus Abdominis, Latissimus Dorsi etc.
  • 14.
    Cervical Flap forParotid Defect 2012
  • 15.
    Cervical Flap forNeck Defect 2012
  • 16.
  • 17.
  • 18.
    PMMC Flap withBrachytherapy 2012
  • 19.
  • 20.
    Microvascular Free Flaps inHead and Neck Reconstruction •  Radial forearm •  Anterolateral thigh •  Latissimus Dorsi •  Rectus abdominis •  Fibula 2012 •  Jejunum
  • 21.
  • 22.
    RFFF for Facialdefects 2012
  • 23.
    RFFF for OralDefects 2012
  • 24.
  • 25.
    Bone Reconstruction ofOral Cavity Upper Alveolus (Palatal) •  None (prosthesis) •  Microvascular Free Flap 2012
  • 26.
    Dental Prosthesis forpalatal Defect 2012
  • 27.
  • 28.
    Bone Reconstruction ofOral Cavity Ascending Ramus of the Mandible •  None •  A.O. Plate •  Microvascular Free Flap 2012
  • 29.
    Bone Reconstruction ofOral Cavity Body of the Mandible •  None •  A.O. Plate •  Free non-vascularized graft (short segment) 2012 •  Microvascular free flap
  • 30.
    Bone Reconstruction ofOral Cavity Anterior Arch of the Mandible •  None •  Microvascular free flap 2012
  • 31.
    Radial Forearm Osteocutaneous Flap 2012
  • 32.
  • 33.
    Fibula Free Flapfor Tongue and Mandible Reconstruction 2012
  • 34.
    Fibula Free Flapfor Anteriror Arch of Mandible 2012
  • 35.
    Dental Implants inFibula Free Flap 2012