ABOHNS Plastic Surgery Within the Head and Neck key terms

A locoregional skin flap shaped like a keystone, based on one or more perforating vessels, that advances over a defect while preserving an intact subcutaneous pedicle; commonly used to close moderate facial and scalp defects after tumor excision.

A transposition flap constructed as a parallelogram adjacent to a rhombus-shaped defect, closed by moving the flap into the defect after a 60-degree angle incision; redistributes tension away from the primary closure line.

A double transposition flap in which two lobes share a pedicle, allowing a defect to be closed by recruiting tissue from successively more distant areas; classically used for nasal tip and alar defects where local laxity is limited.

An axial or random pattern flap raised from skin adjacent to the nasolabial fold and rotated or interpolated to reconstruct nasal alar, sidewall, or upper lip defects; may be used as a superiorly or inferiorly based pedicle.

An axial pattern flap based on the supratrochlear vessels that is interpolated in stages to resurface large nasal defects, typically requiring division and inset two to three weeks after the initial transfer.

A three-dimensional block of tissue supplied by a single source artery and its accompanying veins; the concept guides flap design by defining the vascular territory that can be reliably captured on a pedicle.

A flap supplied by vessels that pierce muscle or fascia to reach the skin, allowing the skin paddle to be harvested without the underlying muscle; examples include the anterolateral thigh and deep inferior epigastric perforator flaps.

Surgical transfer of a vascularized tissue block from a donor site to a distant recipient site with microvascular anastomosis of its artery and vein to recipient vessels, restoring perfusion independent of a local pedicle.

A fasciocutaneous free flap based on the radial artery and its venae comitantes, valued for thin, pliable skin and a long pedicle; commonly used for oral cavity, pharyngeal, and soft tissue head and neck defects.

A perforator-based free flap harvested from the lateral thigh, supplied by descending branches of the lateral circumflex femoral artery; provides a long pedicle and large skin paddle with optional muscle or fascia for composite head and neck defects.

A bone-containing free flap based on the peroneal artery that supplies up to 25 cm of fibula with an associated skin paddle; used for mandibular and maxillary reconstruction, with osteotomies allowing contouring to the dental arch.

A titanium plate, often with locking screws, used to bridge a segmental mandibular defect; may be used alone as a load-sharing or load-bearing device or combined with bone grafts or free flaps to restore continuity and contour.

Resection of a full-thickness segment of the mandible, usually for tumor or osteoradionecrosis, that interrupts bone continuity and generally requires reconstruction to restore occlusion, contour, and function.

Resection of the alveolar or lingual cortex of the mandible while preserving the inferior border and continuity of the bone; used for tumors of the floor of mouth or gingiva with limited bone invasion.

Devitalization and nonhealing bone necrosis following radiation therapy, often presenting with exposed bone, pain, and fistula; management ranges from conservative care to resection and vascularized bone reconstruction.

Removal of cervical lymph node levels I through V with preservation of one or more nonlymphatic structures such as the spinal accessory nerve, internal jugular vein, or sternocleidomastoid muscle; used for regional control of head and neck malignancy.

Removal of a defined subset of cervical lymph node levels based on the primary tumor's drainage pattern, such as levels I through III for oral cavity cancer, while preserving uninvolved levels.

Identification and removal of the first draining lymph node or nodes using radiotracer and/or blue dye, then pathologic examination to stage the regional basin without a full dissection; increasingly used in oral cavity melanoma and selected squamous cell carcinoma.

The eleventh cranial nerve, which traverses the posterior triangle of the neck to supply the trapezius; at risk during level II and V dissection, and injury causes shoulder droop and impaired abduction.

A branch of the facial nerve that courses near the mandibular angle and supplies the depressors of the lower lip; at risk during submandibular dissection or mandibular trauma, with injury causing asymmetric lower lip function.

Intraoperative use of electromyographic electrodes to detect mechanical or electrical stimulation of facial nerve branches, helping the surgeon identify and preserve the nerve during parotid, skull base, and temporal bone surgery.

A horizontal osteotomy of the maxilla above the tooth roots that separates the lower maxilla from the midface, allowing advancement, impaction, or repositioning; used in orthognathic and midface trauma reconstruction.

A pyramidal midface fracture passing through the nasal bones, medial orbital walls, and inferior orbital rims to the pterygomaxillary junction, separating the central midface from the cranial base and lateral facial skeleton.

A craniofacial disjunction fracture extending through the nasofrontal suture, medial and lateral orbital walls, and zygomatic arches, separating the entire midface from the cranial base.

A fracture involving the zygoma at its four articulations, producing malar depression, orbital floor disruption, and possible trismus; commonly termed a tripod fracture and treated with open reduction and internal fixation.

Fracture of the orbital floor or medial wall with an intact orbital rim, often causing diplopia, enophthalmos, or restricted gaze from muscle entrapment; repair is considered for persistent motility deficit or significant volume change.

A pediatric orbital floor fracture in which a hinged bone fragment returns to position and entraps inferior rectus or periorbital tissue, producing marked restriction and a high risk of permanent ischemic injury; requires urgent release.

Premature fusion of one or more cranial sutures, restricting skull growth perpendicular to the fused suture and producing characteristic head shapes; may be isolated or part of a syndromic condition requiring cranial vault remodeling.

Surgical reshaping and forward repositioning of the frontal bone and orbital rims to increase intracranial volume and correct forehead and orbital deformity, typically performed in infancy for craniosynostosis affecting the coronal sutures.

Asymmetric flattening of the occiput from external molding forces during infancy with open sutures and a parallelogram head shape; managed with repositioning and helmet therapy rather than surgery.

Congenital failure of fusion of the facial processes producing a lip defect, with or without a palatal defect that impairs feeding, speech, and middle ear function; managed by staged surgical repair and multidisciplinary care.

Placement of autogenous bone into a cleft alveolar defect, usually before eruption of the permanent canine, to provide bony support for the tooth, close oronasal fistula, and stabilize the maxillary arch.

Inadequate closure of the velopharyngeal port during speech, causing hypernasality and nasal emission; may follow cleft palate repair and is treated with speech therapy or surgical procedures such as sphincter pharyngoplasty.

A locally destructive, rarely metastasizing cutaneous malignancy arising from basal keratinocytes, most often on sun-exposed head and neck skin; treated with excision, Mohs surgery, or other destructive modalities based on risk features.

A technique in which tumor is excised in stages with complete peripheral and deep margin examination of frozen sections, maximizing tissue conservation and cure rates for high-risk or cosmetically sensitive facial skin cancers.

A malignant neoplasm of keratinizing epidermis associated with ultraviolet exposure, chronic wounds, and immunosuppression; on the head and neck it carries risk of nodal metastasis, so high-risk lesions require margin-controlled excision and nodal evaluation.

A malignancy of melanocytes with rising incidence and potential for lymphatic and hematogenous spread; head and neck lesions are staged by Breslow thickness, ulceration, and mitotic rate, with sentinel node biopsy for appropriate candidates.

Surgical alteration of the nasal skeleton and soft tissue envelope to improve airway function, contour, or proportions; may be performed with endonasal or external approaches and with structural grafting techniques.

A cartilage graft placed between the upper lateral cartilage and the nasal septum to widen the internal nasal valve angle, straighten the dorsum, and improve airway patency after dorsal reduction.

The narrowest region of the nasal airway, bounded by the upper lateral cartilages and septum internally and by the alar rim externally; collapse or narrowing here causes obstruction amenable to spreader or alar grafting.

Surgical facial rejuvenation that elevates and repositions ptotic skin and soft tissue of the face and neck, with techniques varying in the plane of dissection and the degree of superficial musculoaponeurotic system manipulation.

A continuous fibromuscular layer investing the facial mimetic muscles and connecting to the superficial cervical fascia; its manipulation and suspension are central to face and neck lifting procedures.

An accumulation of blood within tissue planes or a closed space; in the neck after surgery it can rapidly compromise the airway, and in the face after rhytidectomy it is the most common early complication requiring evacuation.

Partial or complete obstruction of breathing passages from edema, hematoma, secretions, or loss of pharyngeal tone; a time-critical postoperative emergency in head and neck surgery requiring prompt assessment and airway control.

Creation of a surgical opening in the anterior trachea to establish a secure airway, used for prolonged ventilation, upper airway obstruction, or protection after extensive head and neck resection.

A lateral skull base approach through the mastoid and labyrinth that provides direct access to the cerebellopontine angle and internal auditory canal, sacrificing hearing on the operated side while avoiding cerebellar retraction.

Escape of cerebrospinal fluid through a dural defect into the nasal cavity, ear, or wound; after skull base surgery it increases the risk of meningitis and may require repair with vascularized tissue such as a nasoseptal flap.

A minimally invasive corridor to the ventral skull base and sinonasal cavity through the nostrils, often combined with a vascularized nasoseptal flap for dural reconstruction and avoidance of facial incisions.