Hugh F. Biller

Functional evaluation following microvascular oromandibular reconstruction of the oral cancer patient: A comparative study of reconstructed and nonreconstructed patients

Over the past decade, the use of free flap transfers in head and neck surgery has led to remarkable advances in the reliability and the ultimate results of oromandibular reconstruction. Stable and retentive dental restorations have been achieved using enosseous implants placed directly into the vascularized bone flaps. However, the functional assessment of patients who underwent primary mandibular reconstruction with these techniques has not been previously reported. A group of 10 reconstructed and 10 nonreconstructed segmental hemimandibulectomy patients were compared using a battery of tests to assess their overall well‐being, cosmesis, deglutition, oral competence, speech, length of hospitalization, and dental rehabilitation. In addition, objective measures of the masticatory apparatus (interincisal opening, bite force, chewing performance, and chewing stroke) were used to compare these two groups as well as normal healthy subjects and edentulous patients restored with conventional and implant‐borne dentures. The results show a clear advantage for the reconstructed patients in almost all categories. Persistent problems and future directions in oromandibular reconstruction are discussed.

Inverted papilloma: A report of 112 cases

Inverted papilloma is a benign sinonasal tumor which is locally aggressive and has a significant malignant potential. This report updates the experience of the two senior authors, who have treated 112 patients with inverted papilloma at the Mount Sinai Medical Center over a 20‐year period.

Patient survival factors in paranasal sinus mucormycosis.

Analysis of 170 cases of paranasal sinus mucormycosis collected from the literature and 9 cases of our own revealed a 50% mortality for this disease. When analyzed according to decade, survival has increased to 70% in the cases reported from 1970‐1979. There were no significant differences between the survivors and the fatalities when evaluated according to age, sex, laterality, or radiographic findings. There was a markedly poorer prognosis for those patients with hemiplegia, facial necrosis, and nasal deformity. The underlying disease was an important determinant of survival: 75% of patients with no systemic disease, 60% of diabetics, and 20% of patients with other disorders survived. Surgical debridement or radical resection and the use of amphotericin B significantly increased survival. Their combination further enhanced survival, especially in the diabetic.

An analysis of 133 pectoralis major myocutaneous flaps.

Our experience with 133 consecutive pectoralis major island myocutaneous flaps in 126 patients is reviewed. The incidence of complications has been relatively low. Among the 133 flaps used in the head and neck area, 11 flaps (8 percent) failed to accomplish the intended purpose and required secondary repair. The pectoralis major myocutaneous flap with its abundant tissue and excellent blood supply and anatomic proximity provide a simple, reliable, and versatile method of primary reconstruction of various head and neck defects.

The neurofasciocutaneous radial forearm flap in head and neck reconstruction: A preliminary report

The radial forearm free flap has achieved considerable popularity as a reconstructive technique due to its thin, pliable tissue and long vascular pedicle. The successful use of this flap as a carrier of a vascularized nerve to bridge motor nerve gaps and as a sensate flap has not been previously reported in head and neck reconstruction. The superficial branch of the radial nerve was used as a vascularized nerve graft to bridge a facial nerve defect following radical parotidectomy. The medial and lateral antebrachial cutaneous nerves were used to re‐establish sensation in a reconstructed pharyngeal mucosal defect. The published clinical and experimental studies on vascularized nerves and sen‐sate flaps are reviewed in detail.

Quantifying the spread of botulinum toxin through muscle fascia

Botulinum toxin was recently approved for treating several head and neck dystonias. Paralysis of neighboring muscles is the major complication of its use. Spread of toxin from the injected muscle has been suggested as an etiology. This study examines how botulinum toxin crosses muscle fascia by a novel method of quantifying muscular paralysis.

Malignant fibrous histiocytoma of the head and neck.

Review of the literature reveals of 29 cases of fibrous histiocytoma of the deep structures of the head and neck. Three additional cases are reported: a multicentric case involving the submandibular gland with metastases to the lungs; an intraosseous tumor of the mandible locally invasive; and a submental tumor which rapidly recurred after simple excision. A metastatic potential of 22% is established. The history, nomenclature, histopathology and clinical features are reviewed. The value of electron microscopy and tissue culture in arriving at the current diagnosis are stressed. Wide excision is the treatment of choice.

Atlas of regional and free flaps for head and neck reconstruction

Documenting in unprecedented detail the surgical procedures, techniques, and approaches used by the experts, this new atlas/text is the definitive full-color pictorial reference on major flap transfers for reconstructive head-and-neck surgery. The book chronicles three decades of innovations and progress in the field, and presents detailed descriptions of anatomy and anatomical variations, step-by-step guidance on identifying and preparing appropriate donor and recipient sites, and techniques for successfully grafting selected tissue. This one-of-a-kind atlas covers the spectrum of donor sites most frequently used in head-and-neck surgery, and through more than 300 color illustrations and a concise narrative text, the authors provide step-by-step guidance and invaluable technical advice. Each chapter includes the details of normal donor site anatomy as well as anatomic variations, and every section of the book presents the most important options in flap design and the most optimal and desirable application. The text also addresses important topics such as pre- and postoperative care and potential pitfalls and complications

Primary Placement of Osseointegrated Implants in Microvascular Mandibular Reconstruction

The goal of mandibular reconstruction is to rehabilitate the patient by restoring occlusal relationships, lower facial contour, oral continence, and a denture-bearing surface. One of the major advantages of the use of vascularized bone over all other methods of mandibular reconstruction is its ability to achieve dental rehabilitation rapidly. The use of osseointegrated dental implants is a valuable adjunct in oral rehabilitation. It provides the most rigid form of stabilization to withstand the forces of mastication. In situations In which soft tissue reconstruction or the height of the alveolar ridge is not sufficient for a tissue-borne denture, implants offer the most suitable alternative. Mandibular reconstruction with free tissue transfer techniques is Ideally suited for the placement of implants. These can be inserted at the time of mandibular reconstruction. Four months after surgery, when the integration process has occurred, the implants are unroofed, loaded, and ready for prosthetic placement. We will present several representative patients who underwent mandibular reconstruction with microvascular free bone transfer who have been successfully rehabilitated by osseointegrated implants. The process of osseointegration, different types of dental implants, and issues regarding radiation and Implants are discussed. This is the first report of dental rehabilitation by primary placement of dental implants in patients undergoing microvascular mandibular reconstruction.

Inverted papilloma: An analysis of 87 cases

A group of 87 patients with inverted papilloma, a locally aggressive benign sinonasol tumor, were treated over the past 15 years. Selection of therapy depends on an accurate radiographic assessment of the extent of tumor. The tumors local aggressiveness, high rate of recurrence, associated malignancy, and multicentric tendency have led most workers to advocate radical surgical removal of the tumor by lateral rhinotomy and en bloc resection of the ethmoid labyrinth. Radiographic evaluation by computed tomography scanning and magnetic resonance imaging permits identification of a small group of patients who have limited lesions and may be candidates for conservative tumor resection by intranasal or transantral sphenoethmoidectomy.