otohns.net Conference Coverage AAO-HNSF & OTO Expo 2000

otohns.net Conference Coverage
Annual Meeting of the AAO-HNSF and Oto Expo
Washington, D.C - 2000

"Functional and Cosmetic Midface Reconstruction"
otohns.net International Advisory Board members, Brendan Stack, MD and Neal Futran, MD
Audio/Video Link
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Dr. Brendan Stack: “Hi, I’m Brendan Stack and I’m here with Neal Futran, an Associate Professor of Otolaryngology Head and Neck Surgery at the University of Washington in Seattle. We’re here to talk to Neal a little bit today about one of his courses at the 2000 Academy Meeting of the American Academy of Otolaryngology Head and Neck Surgery here in Washington, D.C. on functional and cosmetic midface reconstruction. I just might add before we talk to Neal that certainly a reconstruction of the midface, in my opinion, is the most challenging reconstruction of the entire head and neck, and Dr. Futran has an extensive experience in this area which is only enhanced by his experience as a board certified oral and maxilla facial surgeon as well as being a microvascular reconstructive surgeon. So Neal, tell us a little bit about your course.”

Dr. Neal Futran: “The midface has become a particular interest of mine particularly because of the complexity of the anatomy. As a microvascular surgeon, the main emphasis has been on the mandible and lower oral cavity for use of these techniques, and as our ability to perfect the techniques has improved over the years, we’ve now used these surgeries to enhance reconstruction of the midface. Traditionally, we’re dealing with problems with dentition as well as lip and cheek support. A lot of the times these defects reach up into the orbit and the cheek so it’s really a much more complex area to reconstruct both from a functional and cosmetic standpoint.”

Dr. Brendan Stack: “Yes, what were some of the particular points that you are trying to teach your audience regarding the nuances of this area?”

Dr. Neal Futran: “First of all, what’s clear is there’s no one single technique that is going to do the job for every patient and my co-instructor, Craig Murakami, who is primarily in facial cosmetic and reconstructive surgery utilizes his skills with the free flap techniques in order to achieve the optimal result.”

Dr. Brendan Stack: “I think one misconception among many practicing otolaryngologists is that a free flap reconstruction of the head and neck can’t be cosmetic by its very nature. What do you think about that?”

Dr. Neal Futran: “Free flaps alone certainly go a long way in order to achieve a functional result and in certain cases alone can achieve ultimate cosmesis but a lot of times we’re dealing with large amounts of tissue which aren’t necessarily similar to the tissue in the midface and so we don’t quite get the degree of cosmesis and esthetic result that we’d like. By using a combination of more of the facial plastic techniques, particularly in the area of rhinoplasty, lip reconstruction, and face lift, that really makes a big difference for these particular patients. Traditionally, a lot of these folks would just get a denture enhanced to try to fill in the defect and that can be very adequate in some cases but as the defects become larger, the combination of techniques using a patient’s own tissues really make a difference. And finally, the ultimate goal in these patients is to get a functional dentition so that they can get back to a regular diet. Clearly in most cases, free tissue transfer with other techniques is the way to go.”

Dr. Brendan Stack: “I think we always want the best for our patients and certainly a functional outcome has a lot to do with quality of life. What do you think we’re able to offer with the microvascular reconstructive technique over a more conventional obturator approach? What’s the bottom line as far as what the patient’s quality of life is after surgery?”

Dr. Neal Futran: “We’ve actually taken a scientific look at this particular study, principally in those patients who have had their tumor removed and have used a traditional prosthesis. As I said, in some cases it’s fine but in order for the patient to speak, swallow, and look appropriate that prosthesis has to be in. With the prosthesis out, the patient can’t swallow, their speech is not good, and their cheeks are sunken in. With free tissue transfer, we get a permanent reconstruction that is there twenty-four hours a day and is ultimately a more physiologic and stable reconstruction over time.”

Dr. Brendan Stack: “Neal, we appreciate you talking to us about midface reconstruction, both functional and cosmetic considerations. Certainly, in my opinion, this represents the state of the art of the head and neck reconstruction.”

Dr. Neal Futran: “It’s certainly getting there and it’s one of the still very unique challenges that is an evolving science and evolving practice, and for those physicians who do participate in the care of these patients, a great area for continued study and advancement.”