Individualized Surgical Management in the Head and Neck Region

The surgical management of malignant tumors or in the head and neck region often leads to functional and esthetic defects that impair the quality of life of the patients. Reconstruction can be solved with prostheses in these cases, but various types of microsurgical free flaps can provide a better clinical outcome. Not only head and neck cancer and related surgical interventions, but also trauma and congenital cranio-maxillofacial deformities can result in appearance, which may impair the socialization or social integration of the patient. These special cases indicate special consideration and surgical techniques. The aim of the current thesis is to present the importance of the individualized surgical management through special cases

Nőgyógyászati daganatok esetén jelentkező szinkrón tumorok együlésben való ellátása három eset kapcsán

A daganatos betegek kivizsgálása során a második tumor előfordulási esélye 15,2%, a harmadik tumoré 1,3%. A közlemény célja felhívni a figyelmet arra, hogy a szinkrón tumorok együlésben történő sebészi ellátása megfelelő szakmai háttérrel a betegek számára kifejezett előnyökkel jár. Az irodalomban nem találhatók protokollok a többes tumorok ellátására, többségében esetismertetések állnak rendelkezésre iránymutatásul. A dolgozatban részletezésre kerül a betegségek preoperatív stádiuma, a kivizsgálási protokoll, a műtét, valamint a szövettani eredmény. A közlemény bemutatja egy hármas tumor – szeméremtest-, rectum-, sigmatumor –, egy nagy kiterjedésű colontumor és endometrium-adenocarcinoma ellátását nyitott műtét során, valamint egy neoadjuváns kezelésen átesett betegnél rectum- és szinkrón endometrium-adenocarcinoma minimálinvazív műtétjét. A bemutatott három eset is bizonyítja, hogy a betegeknek kifejezetten előnyös az együlésben való műtéti megoldás, nem beszélve a költséghatékonyságról. A közleménynek nem témája a műtét utáni vagy adjuváns kezelés megvitatása, ennek eldöntése egyéni elbírálás alapján a kórházak multidiszciplináris szakbizottságainak feladata

Surgical Management of Progressive Hemifacial Atrophy With De-Epithelialized Profunda Artery Perforator Flap

Progressive hemifacial atrophy (PHA) is a rare disorder characterized by slow, unilateral atrophy of the soft tissues and bones of the craniofacial region. The defect becomes more pronounced with age, leading to esthetic and functional deficits. However, the proper timing and method of surgical reconstruction are still debated. The correction of this defect markedly influencing the quality of life of the patient can be achieved with less invasive to more invasive surgical approaches. A 21-year-old female patient with hemifacial atrophy and extensive alopecia presented to our clinic. Considering the body type and the expectations of the patient, a profunda artery perforator flap was applied for the reconstruction and esthetic improvement of the facial region. The facial asymmetry attenuated after the reconvalescence period. This case shows that in the up-to-date surgical treatment of severe PHA, the use of microvascular free flaps may provide a better approach when trying to achieve an acceptable esthetic result. This is the first time that a profunda artery perforator flap was used to restore facial asymmetry caused by PHA

An anterolateral thigh chimeric flap for dynamic facial and esthetic reconstruction after oncological surgery in the maxillofacial region: a case report

Abstract Background The surgical management of malignant tumors in the head and neck region often leads to functional and esthetic defects that impair the quality of life of the patients. Reconstruction can be solved with prostheses in these cases, but various types of microsurgical free flaps can provide a better clinical outcome. Case presentation In this case report, the tumor and parts of the involved facial muscles and nerve were excised surgically from a 42-year-old patient after a third relapse of basal cell carcinoma in the left midface. The tissue defect was reconstructed with an anterolateral thigh chimeric type I fascio-myocutaneous flap, where the facial palsy was restored with a segmental branch of the femoral nerve and the involved mouth corner elevator muscles for the segmented vastus lateralis muscle. The 6-month follow-up revealed a good esthetic outcome, the soft tissue defect reconstruction with good functional activity of the reconstructed facial nerve and with acceptable mimic movements. There has been no subsequent recurrence. Conclusions It is concluded that the chimeric type I anterolateral fascio-myocutaneous free flap can offer a good option for the esthetic and functional reconstruction of an extensive tissue defect in the maxillofacial region

Plasztikai sebészet és fej-nyak sebészet együttműködése nem szokványos esetek ellátása kapcsán, Veszprém, 2010–2015

INTRODUCTION: Handling problems in the head and neck region often requires a close cooperation between allied professions, just as in the challenging cases presented by us. Cases and methodology: With the first patient, we performed a radical surgery on the left side of the face due to recidivious basal cell carcinoma, followed by reconstruction using a Type I chimeric anterolateral thigh flap (ALT), while in the case of the second patient, we carried out a radical surgery on the right side of the face due to epithelial carcinoma and reconstruction with a Type I chimeric thoracodorsal flap. With our third patient, a reconstructive operation was performed due to left-sided congenital hemifacial microsomia, using a profunda artery perforator (PAP) flap. The fourth patient, due to the loss of the right hemi mandible as a result of an injury, went through a reconstructive procedure designed with Computer-Aided Design and Computer-Aided Manufacturing (CAD-CAM) technology, using a fibula free flap. RESULTS: All chosen reconstructive methods proved to be efficient and safe solutions in handling the problems. CONCLUSION: Through the cases presented, we intend to raise awareness of the importance of cooperation between maxillofacial and plastic surgery as well as of the ever-growing range of reconstructive opportunities through the flaps used

Kettős DIEP lebenyek egyoldali emlőrekonstrukcióban [Double DIEP flaps for unilateral breast reconstruction]

DIEP flap is a reliable option for autologous breast reconstruction after mastectomy. Previously performed lower median laparotomy can cause some difficulties in cases when more volume is needed than the DIEP flap harvested from one side can provide. We performed breast reconstruction using double hemi-DIEP flaps in three of the cases discussed. All patients recovered without complications and had a good aesthetic outcome. This method offers a safe opportunity and broadens the spectrum of breast reconstruction