Description of Clinical Program
Overview
The Division of Head and Neck Surgery offers comprehensive, state of the art reconstructive surgery for congenital, post-traumatic, and cancer treatment-related problems of the head and neck. A full range of surgical procedures are offered by experienced and nationally respected surgeons for problems affecting the face, head, nose, ears, jaws, mouth, and throat that result in functional or aesthetic disabilities.
Program Approach
A multidisciplinary team approach is frequently used to evaluate the nature and severity of the underlying problems in order to determine the optimal treatment approach. Detailed radiological analysis using CT scans, MRI scans, and three-dimensional reconstructions are frequently used to delineate the precise nature of the problem. The surgical team includes physicians with subspecialty training in Facial Plastic Surgery, Microvascular Surgery, Laryngology, and Neuro-otology. Other team members include speech and swallowing therapists who frequently evaluate patients with associated voice or swallowing problems using acoustic analysis, laryngeal stroboscopy, and video swallowing studies. Maxillofacial prosthodontics specialists are available for facial and oral prosthetic rehabilitation, including replacement of missing teeth using dental implants. Patients with facial paralysis are frequently evaluated by audiologists, and neurodiagnostic testing including evoked electromyography is available.
Microcascular Reconstruction
Surgeons within the Division of Head and Neck Surgery have an extensive experience with this method of state of the art reconstructive surgery, carrying a patient load that exceeds that of other medical centers in the Southwestern United States. This is a technically demanding surgical technique during which tissue grafts harvested from the arms, legs, abdomen, and back are transferred to the mouth, throat, or face to replace missing tissues. Candidates for this surgery include patients who require surgery or suffer from the effects of radiation therapy given to treat cancers or tumors of the head and neck, as well as patients with severe traumatic injuries of the face or neck. Areas commonly reconstructed include the jaws and mouth, the throat, and all areas of the face, scalp, and neck. A successful outcome in this type of reconstructive surgery depends upon meticulous suturing of 2- to 3-mm blood vessels using a microscope and sutures that are finer than human hair to re-establish blood flow to the tissue graft. Because of the technically demanding nature of this type of surgery, most medical centers report failure of this type of reconstruction in 5 to 10 % of cases. The UCLA Division of Head and Neck Surgery has achieved a success rate that exceeds 99 % in performing approximately 400 cases of microvascular reconstructive surgery during the 6 years since this program was established, and our institutional success rate currently exceeds that reported by all other medical centers in the world.
Nasal Reconstruction
Team members are experienced with reconstructing nasal injuries or deformities and functional breathing problems arising as a result of a broken nose, previous nasal surgery, treatment of nasal skin cancer, and congenital problems, including the nasal deformity commonly associated with cleft lips. Patients who have suffered a recent broken nose are advised to be evaluated between 5 and 10 days after the injury has occurred, as they may be candidates to undergo reduction of a displaced nasal bone fracture in the office setting, potentially avoiding the need for surgery. Patients with longstanding nasal fractures resulting in a nasal deformity or nasal breathing difficulty may be considered candidates for reconstruction of their problem by means of septorhinoplasty. Patients with an unsatisfactory result after previous nasal surgery may be considered to be candidates for revision surgery by team members.
Facial Bone Reconstruction
Team members are highly skilled and experienced in treating patients who have suffered fractures involving the jaw bones, the cheek bones, the orbital bones, and the skull. Surgery can often be accomplished using incisions which are well hidden by placement inside the mouth, in hair bearing scalp skin, and on the inside of the eyelids, often avoiding visible facial scars. Patients with recent fractures or problems that persist after remote facial fractures are often considered to be candidates for reconstruction.
Skin Cancer Reconstruction
A wide variety of local and regional tissue grafts, bone and cartilage grafts, and skin grafts are referred for reconstruction of open wounds of all areas of the face, head, and neck resulting after excision of skin cancers. These patients are frequently referred by a dermatologist who has already removed or plans to remove a skin cancer by means of Moh's surgery. When hair bearing tissues are removed during the treatment of skin cancer affecting the scalp, missing hair can frequently be replaced using a variety of hair follicle grafts and scalp tissue flaps.
Facial Paralysis Reconstruction
Team members perform variety of procedures to treat patients who suffer from facial muscle paralysis. The initial evaluation often commences with an evaluation to determine the underlying cause of the facial paralysis, and patients with a recent onset facial paralysis are often candidates for nonsurgical medical therapy. For patients who do require reconstructive surgery, a wide variety of surgical procedures are employed, including placement of nerve and muscle grafts to restore facial motion, creating of oral slings to improve lip position and reduce drooling, insertion of eyelid gold weights to improve eyelid closure, and forehead and facelift procedures to improve drooping of the forehead, brows, and cheeks. Patients with incomplete recovery from facial paralysis resulting in twitching of the eyelid or mouth muscles may be treated using injections of Botox into the affected muscles.
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