Ligation Of Facial Artery Research Articles

Efficacy of Platysma Myocutaneous Flap in Advanced Oral Submucous Fibrosis – A Prospective Study

Abstract Introduction: Platysma myocutaneous flap used for intraoral reconstruction is an axial-pattern flap based on the submental branch of the facial artery; however, its vascular anatomy is complex in nature. Its efficacy in the reconstruction of oral defects following oral cancer resection is well established, even after facial artery ligation. The aim of this study is to evaluate the efficacy of platysma myocutaneous flap in oral submucous fibrosis (OSMF) patients. Materials and Methods: The study included 85 OSMF patients (Grades III and IV). Platysma myocutaneous flap was used for the reconstruction of fibrotomy defects in all patients. All patients were followed up for a period of up to one year. Mouth opening was the chief parameter evaluated intraoperatively and postoperatively. The complications such as flap dehiscence, partial skin loss, tip necrosis, haematoma and paraesthesia at the donor site were also recorded. Results: The mean mouth opening value (in mm) increased from 13.00 ± 1.93 and 6.50 ± 2.35 to 32.72 ± 5.19 and 31.20 ± 4.77 at the end of one year in Grade III and IV groups, respectively. A gradual improvement in pain score was noted. Only minor complications occurred in 8.2% patients. Major flap loss was not seen in our series. Discussion: Proper dissection plane, avoiding muscle tearing during flap elevation, maintaining adequate pedicle, creating a tunnel of sufficient width and proper intraoral flap orientation are the major factors affecting flap success rates. Our study demonstrated that the platysma myocutaneous flap is a promising and effective option for reconstructing buccal mucosa defects in OSMF patients.

Five-Segment Mandibular Osteotomy: A Novel Approach to the Correction of Complex Post-Traumatic Mandibular Deformities.

Post-traumatic mandibular malocclusion is a complex condition that poses a significant challenge to reconstructive surgeons. The malocclusion that ensues from bilateral condylar and parasymphseal fractures presents a particular challenge as it leads to bilateral posterior shortening and lingual tilting of dental arch leading to a combination of open anterior bite, crossbite, overbite, underbite, and/or facial asymmetry. The complexity of such malocclusion requires intricate freedom of movement of the mandibular arch that can be achieved by performing a 5-segment mandibular osteotomy. This is a case series of 9 adult patients with significant post-traumatic mandibular malocclusion who were treated with 5-segment mandibular osteotomy technique. This article details the demographics, surgical technique and outcomes in this cohort of patients. All 9 patients in this series had condylar fracture as part of the index mandibular trauma. They have a common post-traumatic deformity of the mandibular arch due to shortening of the vertical mandibular height in the fracture site and variable degrees of lingual tilting leading to crossbite. The 5-segment mandibular osteotomy provided an adequate correction of dental and facial deformities in all 9 patients. One patient had a relapse of the dental malocclusion that required postoperative rescue orthodontics. Furthermore, one patient had a significant postoperative hemorrhage that required a facial artery ligation. Post-traumatic mandibular malocclusion is a complex deformity that poses a great challenge to practicing surgeons. Five-segment mandibular osteotomy is a technique that provides ample degrees of movement of mandibular segments that is necessary to correct such deformity.

Arteriovenous Malformation of Upper Lip - a short cure for gross deformity

Aim: To evaluate the safety and success of facial artery ligation alone in arteriovenous malformation of upper lip in non-affording patients. Methodology: This prospective study was conducted at Department of Plastic surgery, on 11 consecutive patients with recurrent upper lip arteriovenous malformation who couldn’t afford angioembolization and frequent hospital visits for staged procedures. We did debulking of lesion after facial artery ligation and cosmetic lip correction. Results: Total 11 patients (9 males and 2 females) were included in this study. Majority of patients showed satisfactory results with facial artery ligation alone. One patient lost the follow up. No significant complication was noted in any patient. No recurrence was noted at 6 months and 1 year follow-up. Patient satisfaction rate remained 8.6±0.96 as per VAC. Conclusion: facial artery ligation alone provides an easy and approachable option for arteriovenous malformation where cost affordability for angioemboization and repeated hospital visits are main limitations. Keywords: Arteriovenous malformation, endovascular embolization, debulking, recurrence, cosmetic

A novel technique of arterial blood flow modification in intra-arterial chemoradiotherapy of maxillary sinus squamous cell carcinoma.

Intra-arterial chemoradiotherapy via a superficial temporal artery is reportedly a useful organ-preserving treatment for maxillary sinus squamous cell carcinoma. This study aimed to determine whether blood flow modification facilitates sufficient drug delivery to the entire carcinoma via the maxillary artery alone, even for advanced tumors. A retrospective study of 10 patients who were diagnosed with locally advanced carcinoma (4 [40%] at stage T3, 5 [50%] at T4a, and 1 [10%] at T4b) from August 2016 to July 2018, with tumor blood flow from both the maxillary and facial arteries, was conducted. Patients underwent intra-arterial chemoradiotherapy, which involved chemotherapy with weekly cisplatin administration (40 mg/m2) and radiotherapy (70 Gy/35 fr), with facial artery ligation. The success rate of blood flow modification, as well as its therapeutic effects and safety, were evaluated, with a median follow-up period of 14.4 months (range: 12.3-35 months). The blood flow surrounding the tumor was changed from both the maxillary and facial arteries to the maxillary artery alone in all patients. A median of 9 chemotherapy courses (range: 8-10) were administered; the median total cisplatin dose was 350 mg/m2 (range: 320-360 mg/m2). Radiotherapy of 70 Gy/35 fr was used to treat all patients. Grade 3 oral mucositis (80%) and irradiation field dermatitis (40%) were observed. In all patients, complete response was achieved, and local recurrence was not observed for at least 1 year. Simplifying the blood flow around the tumor facilitates more standardized intra-arterial chemoradiotherapy via a superficial temporal artery procedure.

Preservation of the Facial Artery during Submandibular Gland Resection: Preoperative Sonographic Assessment of Facial Artery

Received March 3, 2015 Revised April 17, 2015 Accepted May 1, 2015 Address for correspondence Dong Jin Lee, MD, PhD Department of OtorhinolaryngologyHead and Neck Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-ro, Yeongdeungpo-gu, Seoul 150-950, Korea Tel +82-2-829-5216 Fax +82-2-842-5217 E-mail djlee@hallym.or.kr Background and ObjectivesZZThe traditional surgical method for submandibular gland resection includes ligation of facial artery. In this study, we used ultrasound preoperatively and tried to preserve the facial artery if facial artery passed on an extra-glandular course with a glandular branch. Subjects and MethodZZPatients undergoing submandibular gland resection either because of submandibular gland tumor or submandibular gland stone were prospectively included. Preoperative sonographic assessment was done to evaluate the intra-glandular or extra-glandular course of facial artery. For the cases with extra-glandular course with a glandular branch of facial artery, we tried to preserve facial artery by ligation of the glandular branch. ResultsZZA total of 34 cases were included in this study. Among them, 6 cases (17%) hadfacial artery passing on an extraglandular course with glandular branching. For these 6 cases, we easily could find the facial artery and glandular branch in the operative field and were able to preserve the facial artery. For the remaining 28 cases, however, the facial artery penetrated through the submandibular gland, thus we opted for the ligation of facial artery rather than preserving it to minimize bleeding or trauma during the surgery. There were no statistic difference between two groups with respect to clinical and surgical variables. ConclusionZZExtra-glandular course of facial artery was easily assessed by preoperative ultrasound. In those cases, we could preserve facial artery easily without bleeding or trauma to the submandibular gland by ligation of glandular branch. As facial artery is animportant vessel for reconstruction and facial rejuvenation, it is preferable to preserve this artery if the course of this artery makes it possible to preserve. Korean J Otorhinolaryngol-Head Neck Surg 2015;58(8):558-62

Nasolabial flap reconstruction in oral cancer

BackgroundThe nasolabial flap is a simple flap used for reconstructing small intraoral defects created after the excision of malignant tumors.MethodsA retrospective analysis of 26 cases of oral cancer treated with primary excision and nasolabial flap reconstruction was carried out. In 22 cases, the excision was combined with neck dissection and facial artery ligation.ResultsGood cosmetic and functional results were obtained in almost all cases. Wound dehiscence developed in three patients, while one patient developed a persistent orocutaneous fistula. Disease recurrence occurred in one patient.ConclusionsThe nasolabial flap is a good flap for the reconstruction of small oral defects after excision of primary tumors and results in good overall cosmetic and functional outcome.

Place du lambeau nasogénien dans les reconstructions du plancher buccal

Subject. – Oral cavity cancers represent 30% of the cephalic extremity tumors. Their resection requires in the majority of the cases a reconstruction by soft tissue. The reconstruction must be simple by bringing some reliable, hairless, thin, resistant tissue to radiation therapy, with a limited morbidity and an acceptable scar ransom. Purpose. – The purpose of our study is to define the place and the limits of nasolabial flap in the reconstruction of the anterior floor of the mouth after tumoral resection compared to the other surgical and microsurgical techniques. Material and method. – We retrospectively studied patients with oral cancerous lesions of the anterior floor of the mouth reconstructed by nasolabial flap between 1997 and 2002. The patients benefited from a surgical resection of the tumor by respecting the safety margins, with an immediate reconstruction allowing the restoring of the oral functions. We tried to describe the limits of this flap and discussed its modalities of vascularization. Results. – Fifty-three flap procedures were performed on 47 patients; forty-one have received a unilateral and 6 a bilateral nasolabial flap. The majority of tumors were squamous cell carcinomas (50 cases). The average age of patients were 64.8 years (45–78 years) with 40 men (75%) and 13 women (25%). A radical neck lymph nodes dissection with facial artery ligation was realized for 21 patients (15 ipsilateral and 3 bilateral) without affecting the outcome. As complications, we noted one complete necrosis and two partial necrosis of the flap, two postoperative wound complications with dehiscence as well as a massive local recurrence of initial tumor in one patient. Conclusion. – The nasolabial flap represents a simple functional and morphological option to other pedicled or microsurgically anastomosed flaps for the reconstruction of intermediate-sized mouth floor defects.

Marginal mandibulectomy: Oncologic and nononcologic outcome

Background and Objectives: Marginal mandibulectomy (MM) has been shown to provide an oncologically sound technique with preservation of function and cosmesis. We reviewed our experience with MM and analyzed oncologic and nononcologic complications. Patients and Methods: Retrospective review of patients, with clinical and/or radiological evidence of tumor attached to the mandible without cortical erosion, who underwent vertical, horizontal, or oblique marginal mandibulectomy. Data collection included demographics; tumor characteristics; clinical and radiologic relation to the mandible; surgical technique, with attention to neck dissection and facial artery ligation; radiation therapy; osteoradionecrosis (ORN); fractures; and recurrence. Results: Twenty-five patients underwent MM. Primary tumors included oral cavity (22), oropharynx (1), and metastatic neck tumor abutting the inferior/lateral border of the mandible (2). Two patients had local recurrence. Both had close soft tissue margins. Local control rate was 92%. Of 11 patients who had postoperative radiation to the primary site, 4 (36.4%) developed ORN, resulting in fractures in the mandibulectomy site in 2 of them. Two other patients developed early postoperative fractures: 1 patient had had previous radiation, and 1 patient had neck dissections with bilateral facial artery ligation and periosteal stripping. This poor technique led to necrosis of the remaining anterior mandible even before starting radiotherapy. Salvage segmental mandibulectomy was required in both patients. Conclusions: MM provides an oncologically sound approach to tumors abutting the mandible. Careful attention to preservation of the remaining periosteum and facial arteries will prevent immediate postoperative complications. However, ORN is an important long-term complication that should be taken into account. (Am J Otolaryngol 2003;24:61-63. Copyright 2003, Elsevier Science (USA). All rights reserved.)

The nasolabial flap revisited as an adjunct to floor-of-mouth reconstruction.

Composite free tissue reconstruction for floor-of-mouth defects are thought of as single-stage procedures. However, postoperative wound complications often require additional soft-tissue coverage to salvage the initial reconstruction. Nasolabial flaps interpolated into the oral cavity offer an expedient solution to soft-tissue deficits encountered during complicated floor-of-mouth reconstructions. The records of 39 patients undergoing free tissue reconstruction, from July 1995 to December 1999 at Shands Hospital and the Gainesville VA Medical Center, for floor-of-mouth defects were reviewed. Six patients developed postoperative wound complications that compromised the initial reconstruction. In all patients, inferiorly based nasolabial flaps were used to provide additional soft-tissue coverage and wound closure. Radiation therapy and facial artery ligation did not affect the outcome. Complete wound healing and salvage of the initial reconstruction was achieved in all 6 patients.