Important Aspects of Head and Neck Reconstruction

Learning Objectives: After studying this article, the participant should be able to: 1. Select appropriate local and pedicled flaps for oral cavity reconstruction based on the location and extent of the defect and donor-site characteristics. 2. Understand the functions of the tongue and select the appropriate reconstructive technique based on the size and location of the glossectomy defect. 3. Understand the advantages and disadvantages of treating various maxillectomy defects with prosthetics, soft-tissue pedicled and free flaps, and osteocutaneous free flaps. 4. Conceptualize a reconstructive algorithm for the hypopharynx based on the extent of circumference resected and need to replace external neck skin. 5. Understand advantages of the fibula over other osteocutaneous flaps for mandible reconstruction.

Summary: Head and neck defects are among the most challenging for the reconstructive surgeon because of the intimate relationship between form and function in this anatomical area. Microsurgical techniques have improved outcomes for these procedures by expanding the available reconstructive methods beyond the limitations of traditional pedicled flaps, although the pectoralis flap remains a useful workhorse option. This article reviews current surgical techniques for reconstruction of the oral cavity, maxilla, hypopharynx, and mandible in the cancer patient.