The British journal of oral & maxillofacial surgery
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Br J Oral Maxillofac Surg · Sep 2010
Communication of the anterior branch of the great auricular nerve with the marginal mandibular nerve: A prospective study of 25 neck dissections.
The great auricular nerve originates from the cervical plexus (C2, 3) and supplies sensation to the lower part of the pinna and the skin overlying the angle of the mandible. We have previously reported an unusual anatomical variant where the anterior division of the great auricular nerve passed into the submandibular triangle and was joined on its deep surface by the marginal mandibular division of the facial nerve. ⋯ This may have clinical implications during operations on the neck, particularly as stimulation of a communicating nerve of the cervical plexus might result in depression of the lip, and could potentially cause the operating surgeon to think that it was a branch of the facial nerve. We think that this finding merits a cadaveric study to evaluate the relation more fully.
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Br J Oral Maxillofac Surg · Sep 2010
Preoperative Doppler assessment of perforator anatomy in the anterolateral thigh flap.
Despite its many evident merits as a donor site, the principal disadvantage of the anterolateral thigh flap is the variability in its vascular anatomy. Preoperative assessment by Doppler of the vascular perforators has been advocated as routine. We report the accuracy of this method, and describe the strategy for rescue where adequate perforators are not evident. ⋯ This overall trend towards false positives was exaggerated in thin thighs, but in the obese there were more false negative results. In 79% of cases explored medially it would have been possible to raise an apparently viable anteromedial thigh flap. As this can be done without extending the incision, it is the option of choice for rescue, although use of more proximal perforators may often be possible.
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Br J Oral Maxillofac Surg · Sep 2010
Patency of the radial artery following intra-luminal cannulation and its influence on potential flap harvest for head and neck reconstruction.
The radial forearm free flap (RFFF) is well-established in head and neck reconstruction, but early potential failure may necessitate a contingency plan, which could include the opposite RFFF if cannulation of the relevant artery at the time of the first operation did not influence its patency. We prospectively studied patients listed for major operations who required radial artery cannulation. They all had perioperative imaging of the radial artery with colour flow duplex before cannulation and at intervals after the cannula had been removed (2h-7 days). ⋯ Thirty-three had patent vessels within 2h of the cannula being removed, and 39/40 at 24h. Patency after removal of the cannula returns rapidly, and is almost always complete by 24h. In most people the contralateral radial forearm could therefore be used to mode of salvage reconstruction if the flap failed early.