Color Atlas Of Head And Neck Surgery: A Step-by...
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This surgical atlas, featuring a wealth of color photographs, provides detailed step-by-step descriptions of a wide range of open head and neck procedures, including radical and conservative (organ preservation, functional) approaches, aesthetic and reconstructive surgeries with the use of axial and free flaps, and surgery within the narrow confines of the skull base. Individual chapters are dedicated to surgery of the nose and paranasal sinuses, larynx and trachea, thyroid, salivary glands, mandible, face and lips, and neck, the repair of external nose defects, the use of axial and free flaps, and surgical treatment of temporal bone malignancy. The atlas will be a comprehensive practical reference for clinicians in the various specialties involved in head and neck surgery, including otolaryngologists, head and neck surgeons, plastic surgeons, maxillofacial surgeons and surgical oncologists. It will assist practitioners in achieving the high level of competence that is essential owing to the large number of vital structures in the head and neck region.
This surgical atlas, now in its second edition, provides superbly illustrated step-by-step descriptions of a wide range of open head and neck procedures, including radical and conservative approaches, aesthetic and reconstructive surgeries with the use of axial and free flaps, and surgery within the narrow confines of the skull base. Individual chapters are dedicated to surgery of the nose and paranasal sinuses, larynx and trachea, thyroid, salivary glands, mandible, face and lips, and head and neck, the repair of external nose defects, the use of axial and free flaps, and surgical treatment of temporal bone malignancies. The new edition, written by experts from across the world, covers a number of additional topics, such as pediatric head and neck surgery, laser surgery, and robotic surgery. It also features improved surgical photographs, enhanced descriptions of essential procedures, identification of pitfalls, many practical tips and best references available for each procedure to assist readers. The atlas will be a comprehensive practical reference for clinicians in all specialties involved in head and neck surgery, including otolaryngologists, head and neck surgeons, plastic surgeons, maxillofacial surgeons, and surgical oncologists.
This richly illustrated atlas provides a clear and comprehensive step-by-step description of surgical techniques for raising and setting free flaps from different donor sites, to reconstruct damage to the head and neck caused by cancer and trauma. Adopting a highly practical approach, the book describes the indications and technical aspects of each procedure with sets of in-vivo pictures clearly showing the surgical passages. In addition, it discusses microvascular techniques and explores different soft-tissue, perforator and bone flaps, including novel free tissue flaps, presented for the first time in the head and neck field. This book offers invaluable insights into free-flap harvesting and transferring techniques for both residents and experienced specialists in the field of otolaryngology, head and neck, maxillo-facial and plastic surgery.
It is an excellent study of great practical value. The article submitted for my review fills a severe gap in anatomical preparation, especially regarding advanced brain vascular anatomy visualization techniques. The authors show, step by step, how to prepare the specimens for both scientific work and teaching purposes. The excellent and realistic illustration material is a strong side of the paper. Samples shown in the work are of the highest quality. It is an awe-inspiring study. I applied corrosion casting methods in my research, and I realize how complicated the procedure may be. Authors provide a detailed description of the preparation, injection, and preservation of cadaveric heads and outline common challenges during colored silicone injection.
If the age and weight of the animal, as well as the duration of the procedure, have been demonstrated to be determinizing factors for postoperative complications, the direct injury of the structures of the neck through endovascular or surgical procedures are recognized to be a critical source of failure. In order to efficiently improve the techniques, avoid pitfalls and develop new approaches with lower morbidity and mortality, the clinician and/or scientist have to acquire sufficient knowledge of the anatomy of the animal. Unfortunately, the current literature and even the veterinary educational resources lack exact information about detailed anatomy and its possible variations, particularly in the region of the neck. This study gives anatomical reliable landmarks to allow a standardized approach to the neck vessels, with low morbidity and mortality. This study shows that in order to expose the origin of the rCCA, the manubrium sterni can be used to guide the dissection, which should be performed about 1 cm laterally and caudally to the incisura jugularis. There are no relevant variations to expect between animals of the same breed and with similar ages, as we found only variability of a few millimeters between the rabbits. However, the distance between the rCCA and lCCA origins varied between 4 and 12 mm in this study. Thus, the origin of one CCA should not be used to guide the dissection of the second one, and dissection from cranial to caudal is recommended to find the origin of the CCAs. Instead, the SCM can be used to find and follow the CCAs, which run laterally to the caudal part of the muscle and medially to its cranial part. As the muscle plays a key role in head motion, especially rotation and inclination, lesions have to be avoided during dissection, and smooth instruments such as anatomical forceps and vessel loops are of great help for this step of the surgery. Furthermore, the SCM runs laterally to the external jugular vein (EJV), which is at risk of injury while dissecting the lateral part of the muscle. A wet swab provides good protection against sharp instrument manipulation and prevents dryness and weakening of the wall.
On the other hand, Ding et al. already focused on the possible variations concerning the carotid arteries that may impact endovascular approaches in the elastase model [17]. The authors found three main variations of the carotid origins (Figure 1) that can impact catheterizing as well as open surgery. In the present study, both CCAs originate from the BCT according to the Type 1 variation described by Ding et al., with the rCCA originating from the BCT and the lCCA originating from the bifurcation of the BCT and aortic arch. This is also consistent with most of the data shown in the anatomical atlas references [19,20]. Variations of these origins or other uncommon variant arteries may, however, significantly affect the surgery and even impact the testing of endovascular techniques in an aneurysm model. Although rare, these variations have, thus, to be known and taken into consideration while working with such models. Furthermore, some authors experimented with dramatic tracheal necrosis and hemorrhage after endovascular elastase application in order to create an aneurysm [13,52,54], revealing the presence of aberrant superior thyroid arteries or anastomosis from the carotid arteries. This complication can be avoided by proceeding with open procedures, which allows the closure of the variant branches [9,12,33,55,56]. In order to perform safe interventions, anatomical landmarks and specific anatomical descriptions are definitely needed. Surgeons performing an approach to the great neck vessels have to pay special attention to numerous vital structures. The jugular veins, which run directly laterally to the rCCA and cross the right subclavian artery to form the rSCV, are at high risk of damage during the dissection of the proximal part of the CCAs. At the level of the rCCA origin from the BCT, the EJV comes directly in contact with the artery and may be adherent with it. The dissection has to be performed carefully on the side of the artery in order to avoid any damage to the venous wall. Such injuries are often untreatable and may result in the death of the animal. A different, important structure is the vagal nerve, including its laryngeal branches, which run directly with the CCAs and sometimes form the nervous plexus, which can be easily damaged by dissecting the vessels. Such injuries may lead to laryngeal paresis, which appears clinically as postoperative stridor and increases inspiratory effort. According to the severity of the damage, this can elevate intrapulmonary negative pressure with consecutive pulmonary edema, respiratory depression and death. Moreover, as illustrated in our study, the CCAs run along both sides of the trachea and cross above it to join the BCT and aortic arch. The trachea is a rather strong structure. However, direct pressure or traction during the dissection should be avoided in order to ensure correct ventilation during the surgery, and the surgeon should pay attention not to injure the tracheal wall using sharp instruments during the approach. Lastly, the thymus lays just above the proximal rCCA and BCT and may obstruct the dissection of the proximal part of the CCA. So far, injury of the thymus has not been described as a mortal lesion, and it does not seem to cause any relevant morbidities in the postoperative phase. However, swelling and bleeding due to rough manipulation can significantly complicate the dissection, and we recommend preserving the gland as long as possible with the application of a wet swab. 59ce067264
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