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A combined facial, orbital and intracranial resection of extensive basal cell carcinoma arising in the eyelid.

We report a single stage en bloc surgical excision and repair of extensive recurrent basal cell carcinoma arising in the eyelids. It combines the advantages of an en bloc dissection, direct visual evaluation of intracranial extension and immediate reconstruction. A team of surgeons, ophthalmic plastic, neurologic, and plastic, employed both an anterior facial and intracranial approach to excise the tumor.

Aged↗

Facial nerve reconstruction: outcome and failures.

OBJECTIVE: Our study was conducted to assess the outcome of reconstruction of the facial nerve after various resections for parotid neoplasms. METHOD: A 10-year retrospective analysis of 350 primary parotid neoplasms (of which 70 were malignant) and 10 recurrent benign neoplasms involving facial nerve resection in 19 and 2 patients, respectively. Four patients had total resection of the facial nerve and reconstruction with a five-branch assemblage using standard microtechniques. Four patients had reconstruction of the orbital branch only. Twelve patients, of whom three also had a midface branch reconstructed, had reconstruction of the ramus mandibularis. One patient had a direct anastomosis of a partial resection of the main trunk of the nerve. Objective assessment of muscle activity was carried out in the distribution of the reconstructed nerve with a minimum of 18 months follow-up. RESULTS: All four patients with total facial nerve reconstruction had excellent tone in repose. None had purposeful focused movement, and all had mass movement; however, all had good eye closure. None of the patients with mandibular branch grafting alone had useful return of function, but those who had concomitant midface grafting had good return of function of the reconstructed branches. All patients who had orbital grafting had appropriate eye closure. CONCLUSIONS: Facial nerve grafting is effective to rehabilitate gaps in the pes anserinus, even if patients undergo postoperative radiotherapy. Total nerve grafting provides good tone in repose and eye closure, which justifies the procedure. Single-branch grafting is mandatory for the orbital branch, but one can question the use of a single-branch graft for the mandibular branch.

Adult↗

[Complications of reconstructive surgery using free flaps in the maxillofacial region].

The subject of our investigation was a group of twenty-nine patients with cervico-facial malignant neoplasms. The 29 patients, whose ages ranged from 12 to 68, with a mean age of 40, underwent surgery between January 1992 and January 1995. Cranial base and/or maxillo-facial defects were restored by free flap tissue transfer. Thirty-one micro-surgical free flaps were performed and post-operative monitoring was carried out for about 15-20 days. The aim of the present study is to show the importance of clinical semeiology which permits an early diagnosis of post-operative complications. Furthermore, post-operative monitoring of microsurgical free tissue transfer enables an etiological diagnosis and surgical vascular salvage of the flap to be made at the most opportune time. Many Authors report microsurgical transfer success at 95%-96% because timely detection and resolution of complication can minimize flap failure. We report our experience with 31 free flaps performed in 29 patients. Three of the patients needed a second transfer due to the failure of the first. Two underwent free flap transfers, while a pedicle flap was carried out on the other. In fourteen, latissimus dorsi free flaps were used (in 2 cases the procedure had to be performed twice), the forearm and the jejunum were employed in eight patients and the rectus abdominis in one.

Adolescent↗

Intraparotid facial nerve schwannoma in a child.

Neoplasms of the facial nerve presenting as a parotid mass are uncommon. In the absence of a facial palsy their origin from the nerve is usually diagnosed intraoperatively. The majority of these neurogenic neoplasms are schwannomas, with neurofibromas occurring rarely. Although the Schwann cell is the key element in both, they have distinct histopathological characteristics, and their clinical course and management often differs. The first reported case of an intraparotid facial nerve schwannoma in a child in the English literature is presented.

Child↗