Cosmetic Techniques and Reconstruction Becoming Integral to Head and Neck Surgery

In addition to reconstructive surgery, the patient may need cosmetic touch-ups or enhancements at some point in the future because of the way incisions heal, said Dr. Stack. Postoperative radiation treatment can also cause tissue damage, which may eventually need to be surgically revised, he said.

Some patients may also require osseointegrated implants and dental prostheses for dental restoration, although an oral surgeon and maxillofacial prosthodontist generally performs these procedures, said Dr. Stack.

Parotid Disease

While patients with head and neck cancer may require reconstructive surgery, those with parotid disease may benefit cosmetically from incisions most often used for facelifts, said Dr. Terris.

To help minimize scarring in patients who need parotidectomy, surgeons can cut in front of the ear and then behind it into the hairline to access the gland. We used to make the incision continue down on the neck, which could produce an obvious scar, Dr. Terris said.

For this procedure, surgeons may also consider using a harmonic scalpel, which uses frictional energy to break down proteins and seal tissue and blood vessels, said Dr. Terris.

Harmonic scalpel technology may eventually be used in other facial surgeries because the tool allows the surgeon to dissect and ligate vessels in one cut, he explained. It could also be useful for neck dissection and laryngectomy, he added.

Sinus Tumors

To help maintain cosmesis when approaching tumors in the skull base sinuses, surgeons can use facial degloving, which avoids the use of open incisions, said Dr. Terris.

This procedure involves creating an incision under the lip and gum and pulling the facial skin above the nose and sinuses allowing access to these areas, said Dr. Terris. Once tumors are removed, the skin is placed in its original position using absorbable sutures, he explained.

The skull base is increasingly being approached endoscopically, added Dr. Stack.

Also of mention is endoscopic image-guided sinus surgery, which allows head and neck surgeons to remove tumors of the nose and sinuses without open facial incisions, said Dr. Stack.

Endoscopic sinus surgery has essentially replaced making incisions on the face to access tumors in the nasal and sinus passages, agreed Dr. Terris.

Facial Trauma

A degloving approach can also be used for patients with facial injuries from car accidents and other trauma, said Dr. Terris. Facial degloving initiated through the lip and gum area or further out in the cheek area can create access to facial fractures without creating open surgery incisions, he explained.