Three-Dimensional Computed Tomographic Scanning and Major Surgical Reconstruction of the Head and Neck

AbstractRehabilitation of head and neck defects following trauma, oncologic resection, or congenital malformation is a challenging task. Not only is the restoration of three-dimensional form necessary for acceptable cosmesis, but simultaneous restoration of functional speech and swallow is also essential for optimal reconstruction outcomes. While advances in free tissue transfer have allowed surgical reconstruction of head and neck defects once considered inoperable and associated with poor quality of life, not all patients are ideal surgical candidates. As such, nonsurgical solutions to both functional and cosmetic restoration remain a necessary alternative option. Facial prostheses and palatomaxillary obturators have evolved with increasingly biocompatible materials as well as retention systems to address significant defects that challenge the limits of surgical reconstruction.

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Three-Dimensional Spiral Computed Tomographic Angiography of Head and Neck, Abdomen, and Pelvis Initial Clinical Experiences

Investigative Radiology ◽

10.1097/00004424-199406001-00090 ◽

1994 ◽

Vol 29 ◽

pp. S261-S263

Author(s):

FRANZ J. FERSTL ◽

ANNETTE BARKE ◽

STEFFEN KUNZE ◽

ANKE NILLES ◽

ULRICH BLUM ◽

...

Keyword(s):

Head And Neck ◽

Three Dimensional ◽

Computed Tomographic Angiography ◽

Clinical Experiences ◽

Spiral Computed ◽

Computed Tomographic ◽

Tomographic Angiography

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Three-Dimensional Exoscopic Temporal Bone Resections for Advanced Head and Neck Cancer

10.1055/s-0040-1702347 ◽

2020 ◽

Author(s):

Mallory J. Raymond ◽

Roberto M. Soriano ◽

Ryan Belcher ◽

C. Arturo Solares

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Temporal Bone ◽

Neck Cancer ◽

Three Dimensional ◽

Advanced Head

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Faculty Opinions recommendation of Integrated electroanatomic mapping with three-dimensional computed tomographic images for real-time guided ablations.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.10002.466764 ◽

2006 ◽

Author(s):

David Callans

Keyword(s):

Real Time ◽

Three Dimensional ◽

Electroanatomic Mapping ◽

Tomographic Images ◽

Computed Tomographic

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Paclitaxel and Carboplatin Concurrent with Three-Dimensional Conformal Radiotherapy (3D-CRT ) for Treatment of Locally Advanced Squamous Cell Carcinoma of Head and Neck (LA-SCCHN)

Research in Oncology ◽

10.21608/resoncol.2013.453 ◽

2013 ◽

Vol 9 (Issue 1-2) ◽

pp. 27-32

Author(s):

S. Abdelwahab ◽

R. Ghali ◽

M. Elbassiouny ◽

A. Elsayed ◽

A. Mahmoud ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Head And Neck ◽

Squamous Cell ◽

Locally Advanced ◽

Three Dimensional ◽

Conformal Radiotherapy ◽

Advanced Squamous Cell Carcinoma ◽

Three Dimensional Conformal Radiotherapy ◽

3D Crt

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Efficiency Assessment of Multidetector-Row Computed Tomographic Angiography Using Reconstruction With Locoregional Perforator Flaps

Plastic Surgery ◽

10.1177/22925503211024750 ◽

2021 ◽

pp. 229255032110247

Author(s):

Pavlo O. Badiul ◽

Sergii V. Sliesarenko ◽

Nataliia O. Cherednychenko ◽

Olga V. Morgun

Keyword(s):

Perforator Flap ◽

Computed Tomographic Angiography ◽

Surgical Reconstruction ◽

Patient Treatment ◽

Controlled Study ◽

Control Group ◽

Perforator Flaps ◽

Multidetector Row ◽

Computed Tomographic ◽

Tomographic Angiography

Background: Reconstruction with the use of perforator flaps makes it possible to make the skin surface resistant to the influence of mechanical factors and as similar to the lost skin cover as possible. However, while planning any flap, along with the design of the required shape and size, its blood supply should be taken into account to ensure optimal viability. Therefore, the task to precisely determine the topographic–anatomical relationships suitable for the formation of a pedicle of perforators is still relevant. The aim of this study was to increase the efficiency of surgical reconstruction of wound defects by transposition of locoregional perforator flaps. Methods: The authors conducted a retrospective analysis of 72 cases of reconstruction by means of locoregional perforator flaps with vascular pedicle detachment to determine the efficiency of preoperative diagnostic preparation with the help of multidetector-row computed tomographic angiography (MDCT) in the process of reconstruction. Thirty-seven individual cases of surgical interventions were chosen using a case-controlled study from the study group when MDCT with angiography was used for preoperative planning of perforator flaps, as well as 35 control cases similar in terms of important predictive peculiarities with the reconstruction at the same level of difficulty. The patient groups were precisely matched by gender ( P = .950), age ( P = .804), flap area ( P = .192), and type of reconstruction that was performed. Results: In all cases, the location of the perforator with a diameter greater than 1.0 mm was marked. All perforators determined during MDCT scanning were faultlessly localized intraoperatively. The distance between the intraoperative position of the perforator and the position obtained in the result of the examination did not exceed 1 cm. There was no need to change the planned design of the flap intraoperatively. In all cases where MDCT was performed, the duration of the surgical procedure varied from 60 to 150 minutes (average: 120.77 [18.90] minutes) and was reduced by 49.40 minutes (95% CI: 39.17-59.63) compared with the patients who did not undergo preoperative visualization of perforators where the average duration of the operation was 170.17 (19.19) minutes (from 140 to 220 minutes). Among the patients examined by MDCT, surgical complications were noted in 5 cases (13.51%) compared to 14 cases (40.00%) in the control group. Conclusions: The preoperative MDCT for the locoregional perforator flap reconstruction makes it possible to increase the efficiency of patient treatment given the reduction in surgery duration by 49.40 minutes (95% CI: 39.17-59.63) on average and the reduction in the level of postsurgery complications from 40% to 13.5% compared with the group of patients in whom presurgical visualization was not performed ( P = .031).

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Imaging in Propeller Flap Surgery

Seminars in Plastic Surgery ◽

10.1055/s-0040-1715159 ◽

2020 ◽

Vol 34 (03) ◽

pp. 145-151

Author(s):

Shimpei Ono ◽

Hiroyuki Ohi ◽

Rei Ogawa

Keyword(s):

Low Cost ◽

Three Dimensional ◽

Duplex Sonography ◽

Computed Tomographic Angiography ◽

Ease Of Use ◽

Computed Tomographic ◽

Imaging Tool ◽

Preoperative Mapping ◽

Flap Design ◽

Tomographic Angiography

AbstractSince propeller flaps are elevated as island flaps and most often nourished by a single perforator nearby the defect, it is challenging to change the flap design intraoperatively when a reliable perforator cannot be found where expected to exist. Thus, accurate preoperative mapping of perforators is essential in the safe planning of propeller flaps. Various methods have been reported so far: (1) handheld acoustic Doppler sonography (ADS), (2) color duplex sonography (CDS), (3) perforator computed tomographic angiography (P-CTA), and (4) magnetic resonance angiography (MRA). To facilitate the preoperative perforator assessment, P-CTA is currently considered as the gold standard imaging tool in revealing the three-dimensional anatomical details of perforators precisely. Nevertheless, ADS remains the most widely used tool due to its low cost, faster learning, and ease of use despite an undesirable number of false-positive results. CDS can provide hemodynamic characteristics of the perforator and is a valid and safer alternative particularly in patients in whom ionizing radiation and/or contrast exposure should be limited. Although MRA is less accurate in detecting smaller perforators of caliber less than 1.0 mm and the intramuscular course of perforators at the present time, MRA is expected to improve in the future due to the recent developments in technology, making it as accurate as P-CTA. Moreover, it provides the advantage of being radiation-free with fewer contrast reactions.

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Preoperative Use of CT Angiography in Infants With Coarctation of the Aorta

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135116683929 ◽

2017 ◽

Vol 8 (2) ◽

pp. 196-202 ◽

Cited By ~ 8

Author(s):

Kirsten Rose-Felker ◽

Joshua D. Robinson ◽

Carl L. Backer ◽

Cynthia K. Rigsby ◽

Osama M. Eltayeb ◽

...

Keyword(s):

Radiation Dose ◽

Surgical Approach ◽

New Technology ◽

Three Dimensional ◽

Coarctation Of The Aorta ◽

Computed Tomographic Angiography ◽

Great Vessel ◽

Z Score ◽

Computed Tomographic ◽

Tomographic Angiography

Background: Computed tomographic angiography (CTA) and echocardiography (echo) are used preoperatively in coarctation of the aorta to define arch hypoplasia and great vessel branching. We sought to determine differences in quantitative measurements, as well as surgical utility, between modalities. Methods: Infants (less than six months) with both CTA and echo prior to coarctation repair from 2004 to 2013 were included. Measurements were compared and correlated with surgical approach. Three surgeons reviewed de-identified images to predict approach and characterize utility. Computed tomographic angiography radiation dose was calculated. Results: Thirty-three patients were included. No differences existed in arch measurements between echo and CTA ( z-score: −2.59 vs −2.43; P = .47). No differences between modalities were seen for thoracotomy ( z-score: −2.48 [echo] vs −2.31 [CTA]; P = .48) or sternotomy ( z-score: −3.13 [echo] vs −3.08 [CTA]; P = .84). Computed tomographic angiography delineated great vessel branching pattern in two patients with equivocal echo findings ( P = .60). Surgeons rated CTA as far more useful than echo in understanding arch hypoplasia and great vessel branching in cases where CTA was done to resolve anatomical questions that remain after echo evaluation. Two of three surgeons were more likely to choose the surgical approach taken based on CTA (surgeon A, P = .02; surgeon B, P = .01). Radiation dose averaged 2.5 (1.6) mSv and trended down from 2.9 mSv (1.8 mSv; n = 20) to 1.6 mSv (0.5 mSv; n = 7) ( P = .06) with new technology. Conclusion: Although CTA and echo measurements of the aorta do not differ, CTA better delineates branching and surgeons strongly prefer it for three-dimensional arch anatomy. We recommend CTA for patients with anomalous arch branching patterns, diffuse or complex hypoplasia, or unusual arch morphology not fully elucidated by echo.

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