ABPS Plastic Surgery Within the Head and Neck key terms

Region of the midface drained by valveless facial veins communicating with the cavernous sinus, so infection there can spread intracranially. It spans the upper lip, nose, and medial cheek.

Vein draining the medial canthus and side of the nose, connecting the facial vein to the ophthalmic veins. Because these connections lack valves, infection can travel retrograde toward the orbit and cavernous sinus.

Clot formation within the cavernous sinus, usually from spread of facial or orbital infection. It presents with fever, proptosis, ophthalmoplegia, and cranial nerve deficits and is a surgical emergency requiring antibiotics and drainage.

Fracture disrupting the zygoma at its four articulations: zygomaticofrontal, zygomaticomaxillary, zygomaticotemporal, and zygomaticosphenoid. It causes malar flattening, orbital dystopia, and often trismus or infraorbital numbness.

Classification of midface fractures by level of bony disruption: I is transverse above the tooth roots, II is pyramidal through the maxilla and nose, and III is craniofacial disjunction separating the entire midface from the skull base.

Fracture of the orbital floor or medial wall with an intact orbital rim, caused by a blow to the globe that raises intraorbital pressure. It may cause enophthalmos, diplopia, and entrapment of inferior rectus or orbital fat.

Orbital floor fracture in which a hinged bone fragment springs back into place, trapping orbital tissue. It occurs mainly in children and can cause marked bradycardia, nausea, and restricted eye movement from the oculocardiac reflex.

Trigeminovagal reflex in which traction on extraocular muscles or orbital contents produces bradycardia, nausea, and hypotension. It is classically seen with muscle entrapment in pediatric orbital fractures and during strabismus surgery.

Simultaneous fractures involving the upper, middle, and lower thirds of the facial skeleton. Treatment follows a sequence of restoring the facial width, then projection, then height, typically beginning with stable upper and lower landmarks before the midface.

Premature fusion of one or more cranial sutures, restricting skull growth perpendicular to the fused suture and producing characteristic head shapes. It may be isolated or part of a syndrome such as Apert or Crouzon.

Cranial remodeling procedure in which the frontal bone and superior orbital rims are reshaped and moved forward to expand the anterior cranial vault. It is used for coronal synostosis and syndromic craniosynostosis with orbital retrusion.

Asymmetric flattening of the occiput from sustained pressure on one side of the head, usually without suture fusion. It is distinguished from lambdoid synostosis by a parallelogram head shape and ipsilateral ear displacement.

Midface advancement achieved by separating the entire midface from the cranial base at the nasofrontal, zygomatic, and pterygomaxillary junctions. It corrects midface hypoplasia with exorbitism in syndromic craniosynostosis.

Transfer of composite tissue with its vascular pedicle divided and reattached to recipient vessels by microvascular anastomosis. In head and neck reconstruction, common examples include the radial forearm, fibula, and anterolateral thigh flaps.

Pedicled regional flap based on the pectoral branch of the thoracoacromial artery, used to reconstruct large oral cavity, mandibular, and pharyngeal defects. It is reliable but bulky and limited in reach above the midface.

Skin or soft-tissue flap supplied by a named vessel that perforates the deep fascia, allowing muscle to be spared at the donor site. The anterolateral thigh and deep inferior epigastric perforator flaps are common examples.

Pedicle flap based on the submental branch of the facial artery, used for oral cavity and facial defects. It provides thin, hairless skin with good color match but risks oncologic compromise in node-positive necks.

Staging procedure in which the first draining lymph node is identified by radiotracer and dye and removed for histologic evaluation. It is used in head and neck melanoma and selected oral cavity squamous cell carcinoma to avoid elective neck dissection.

Measured depth of a melanoma from the granular layer of the epidermis to the deepest tumor cell, reported in millimeters. It is the strongest predictor of prognosis and guides margins and sentinel node biopsy.

Staged excision in which the entire peripheral and deep margin is examined microscopically while the patient waits, allowing maximal tissue conservation. It is favored for high-risk basal cell carcinoma, recurrent tumors, and tumors in cosmetically sensitive areas.

Malignant neoplasm of basal keratinocytes, most often on sun-exposed facial skin. It is locally destructive with a pearly, telangiectatic appearance and rarely metastasizes, but morpheaform subtypes can be aggressive.

Malignant tumor of keratinizing epidermal cells, often arising from actinic damage or chronic wounds. In the head and neck it can metastasize to regional nodes, and high-risk features include perineural invasion and immunosuppression.

Six-grade clinical scale grading facial nerve function from normal (I) to total paralysis (VI). It accounts for resting tone, forehead motion, eye closure, and mouth movement and is used to track recovery and outcomes.

Idiopathic acute peripheral facial nerve paralysis of sudden onset, typically unilateral and self-limited. Diagnosis is clinical after excluding other causes, and treatment includes corticosteroids and eye protection.

Surgical opening of the bony fallopian canal to relieve pressure on the facial nerve, used in selected cases of traumatic paralysis or progressive palsy. Timing and indications depend on whether the nerve is intact and on electrodiagnostic findings.

Surgical closure of the lip and nostril deformity, usually performed around three to six months of age using techniques such as Millard rotation-advancement. Goals include lip continuity, symmetric Cupid's bow, and nasal symmetry.

Surgical closure of the palatal defect, typically at nine to twelve months of age, using techniques that reposition the levator veli palatini sling. The aim is separation of oral and nasal cavities and normal speech development.

Failure of the soft palate and pharyngeal walls to close the nasopharynx during speech, producing hypernasality and nasal air escape. It may follow cleft palate repair and is assessed by speech evaluation and nasendoscopy.

Placement of cancellous bone into the cleft alveolar defect, usually before eruption of the permanent canine. It stabilizes the maxillary arch, supports the tooth root, and closes an oronasal fistula.

Surgical procedure creating a tissue bridge from the posterior pharyngeal wall to the soft palate to narrow the velopharyngeal port. It treats velopharyngeal insufficiency but can cause obstructive sleep apnea or hyponasality.

Rhytidectomy technique in which dissection proceeds beneath the superficial musculoaponeurotic system to release and reposition the midface and jawline as a composite unit. It spares the facial nerve but risks injury to the great auricular nerve and parotid duct.

Fibromuscular layer of the face continuous with the platysma that invests the facial muscles and separates the subcutaneous fat from the deep plane. It is the key surgical plane in facial rejuvenation and parotid surgery.

Sensory nerve from the cervical plexus that ascends over the sternocleidomastoid to supply the ear and parotid region. It is the most commonly injured nerve in facelift surgery, causing numbness of the lower ear and lobe.

Branch of the facial nerve running near the mandibular angle deep to the platysma, supplying depressors of the lower lip. It is at risk in submental dissection, neck dissection, and jaw surgery, causing lower lip asymmetry.

Measures to prevent deep vein thrombosis and pulmonary embolism, including early ambulation, compression devices, and pharmacologic anticoagulation. Risk is stratified by procedure length, malignancy, and patient factors in head and neck surgery.

Validated tool that assigns points for patient and surgical risk factors to estimate venous thromboembolism risk and guide prophylaxis. Higher scores prompt pharmacologic anticoagulation combined with mechanical measures.

Multimodal perioperative pathway emphasizing preoperative counseling, opioid-sparing analgesia, early feeding, and early mobilization to shorten length of stay. It is increasingly applied to head and neck free flap reconstruction.

Process of disclosing a procedure's nature, risks, benefits, and alternatives, including no treatment, so the patient can decide voluntarily. It requires decision-making capacity and documentation and is central to surgical ethics.

Obligation of a physician to act in the patient's best interest rather than for personal gain. It underlies truth-telling, confidentiality, and appropriate management of conflicts of interest in surgical practice.