Faculty Bibliography

The platysma myocutaneous flap has seen limited application in the reconstruction of head and neck defects over the past decade. There are anatomical and physiological reasons for this. There has been an emphasis on the anatomical vascular supply and method of preparation of the platysma myocutaneous flap and its use in the oral cavity. This article emphasizes the use of this flap for reconstruction of defects of the base of tongue, hypopharynx, lateral pharyngeal wall, and supraglottis. The criteria for selection of the platysma myocutaneous flap as a method of reconstruction, and the limitations, are outlined. New variations of harvesting the flap based on randomized muscular support are described. Specific complications as seen in our group of patients add certain precautions in the use of the platysma myocutaneous flap.

A very rare case of malignant melanoma of the lower lip was presented. While there are many concepts and techniques for reconstruction of the lower lip including advancement flaps, switching flaps, rotation flaps, and regional flaps from the cheek, upper lip, tongue, forehead, neck, and chest, no single flap is ideal in every instance. Lower lip reconstruction utilizing a modification of bilateral nasolabial flaps has been described. The distinct advantages of utilizing myocutaneous flaps in a Z augmentation manner, including the maintenance of good functional competence of the lower lip, maintenance of adequate oral commissure diameter, and a good cosmetic result, have been demonstrated. While no single technique for reconstruction of the lower lip is ideal for every case, we feel that the method presented here offers a very good option when faced with the challenge of complete reconstruction of the lower lip.

An extraskeletal chondroma occurring over the dorsum of the wrist of a 61-year-old woman is reported. The lobulated tumor is cellular and shows mild-to-moderate nuclear pleomorphism of the chondroid cells. A unique feature is that some tumor cells are univacuolated and multivacuolated owing to accumulation of lipid, mimicking the appearances of lipoblasts.

There is no universally acceptable classification or method of treating congenital vascular lesions of the head and neck. An historical perspective, the hemodynamics of arteriovenous fistulas, and the various modalities of treatment are presented. The importance of superselective angiography in studying these lesions is emphasized. Embolization represents a major advance in the treatment of these patients and cooperation between head and neck surgeon and the vascular radiologist is encouraged. The evaluation and treatment of 66 patients with congenital head and neck vascular lesions are presented. The rationale for various types of treatment is reviewed.

Nineteen arteriovenous fistulas of the external carotid branches in 17 patients were treated by a variety of percutaneous transvascular techniques. There were nine females and eight males; 11 fistulas were traumatic in origin, five were "spontaneous," and three were thought to be congenital. The most frequent presenting symptoms were a bruit and thrill, followed by pulsatile tinnitus, pulsatile mass, headaches, and ocular problems. The symptoms were related to fistula site and venous drainage. The middle meningeal artery was involved most often, followed by the superficial temporal, occipital, internal maxillary, and ascending pharyngeal arteries. All patients except one were successfully cured, including one recurrence. There were no complications, and the hospital stay averaged 3 days.