Reconstructive surgery is, in its broadest sense, the use of surgery to restore the form and function of the body, although otolaryngologists, maxillo-facial surgeons and plastic surgeons do reconstructive surgery on congenitally deformed ears, faces after trauma and to reconstruct the head and neck after cancer. The common feature is that the operation attempts to restore the anatomy or the function of the body part to normal.
Head & Neck Tumor Reconstruction
Head and neck tumors can lead to devastating cosmetic and functional deficits with resultant psychological, physical, and nutritional detriment. Reconstruction of such defects continues to be an extremely demanding challenge for plastic surgeons who aim to restore form and function with minimal surgical morbidity. Successful reconstruction requires a team approach, which includes a medical oncologist, ablative surgeon, and reconstructive surgeon, for careful preoperative assessment and development of a treatment plan. Important considerations include tumor stage and prognosis; patient age, sex, body habitus, and functional status; available reconstructive donor sites; and the psychosocial make-up of the patient.
Microtia (pinna) Reconstruction
Microtia is a congenital deformity where the pinna (external ear) is underdeveloped. A completely undeveloped pinna is referred to as anotia. Because microtia and anotia have the same origin, it can be referred to as microtia-anotia. Aural atresia is the underdevelopment of the middle ear and canal and usually occurs in conjunction with microtia. Atresia occurs because patients with microtia may not have an external opening to the ear canal, though. However, the cochlea & other inner ear structures are usually present. Candidacy for atresia surgery is based on the hearing test (audiogram) & CT scan imaging.
Facial nerve reconstruction
Paralysis of the facial nerve is a cause of significant functional and aesthetic compromise. Functional concerns primarily involve adequate protection of the eye, with a real risk of exposure keratitis if not properly addressed. In addition, swallowing, drooling, and speech difficulties may arise. Microsurgical repair of the damaged facial nerve (7th cranial nerve) is the most effective procedure for restoring motor function (voluntary movement) of the face. Reconstruction is indicated in patients who have experienced acute disruption or transection of the nerve from an accident, trauma, resection during extirpation of tumors, or inadvertent division during surgery. The ultimate goal of reanimation surgery is to restore spontaneous animation and a balanced natural smile. The most critical factor in achieving good post-operative facial function is early identification and repair.
Reconstruction of the skull base
Skull base surgery has rapidly evolved into a highly specialized surgical discipline over the past 25 years. The development of reliable reconstructive procedures has greatly facilitated the ability to remove tumors that previously were not considered resectable or were partially excised to avoid serious complications. Reliable separation of the intracranial contents from the extracranial spaces is the key consideration in skull base reconstruction. This consideration is particularly important for cases in which dural resection or carotid artery dissection has been performed in conjunction with tumor extirpation involving the sinonasal tract or nasopharynx. The skull base reconstruction surgeons use state-of-the-art techniques to provide restoration of form and function for patients who might otherwise be left with a deficit.