Operative Techniques in Otolaryngology - Head and Neck Surgery最新文献

Voice and communication are a critical contributor to gender presentation. Various options are available for gender affirming voice care depending on the needs of the patient, and include hormone replacement therapy, voice therapy, and voice surgery. Despite a traditionally poor reputation, more recent literature has shown voice surgery, particularly anterior glottoplasty, to be a low risk and effective treatment for pitch elevation that may be considered as an adjunct to voice therapy.

Feminizing frontal cranioplasty (FFC) is perhaps the most significant, single gender-affirming surgical procedure. It consists of forehead/glabella bone contouring and/or frontal sinus set back, orbital osteoplasty, anterior hairline rounding, hairline or scalp advancement, and brow lifting. The feminizing frontal cranioplasty is a safe and effective means to produce ideal patient results for gender-affirming facial surgery. Herein we describe an open approach to the frontal cranioplasty useful for facial feminization surgery.

Compared to the typical female mandible, the adult male mandible tends to be wider, vertically taller, and has prominence of the angles. As these differences can affect gender perception, transwomen may achieve a smaller, tapered, and feminine lower jaw contour via feminizing mandibuloplasty. Modifications to the mandible and soft tissues are performed via an intraoral incision. Overall, this surgical procedure has a low risk of major complications and patients typically show high rates of postoperative satisfaction.

A feminine face is typically heart-shaped with a prominent malar region and lean midface. This ideal is dependent on both the skeletal architecture and the soft-tissue structures. Cheek augmentation and buccal lipectomy aid in the inverted triangulation between the points of the cheeks and the chin, feminizing the midface. Herein, we describe the anatomy and operative technique for facial feminization of the midface.

Chondrolaryngoplasty (often referred to as a “tracheal shave” by the public) aims to decrease the gender dysphoria associated with the anterior prominence of the thyroid cartilage. The fullness in the anterior neck caused by the “Adam's apple” commonly contributes to misgendering of trans females. Transcervical approaches have traditionally been utilized for resection, although recently, transoral techniques have been described. Complications after transcervical approach chondrolaryngoplasty are uncommon and typically include mild, temporary dysphonia, dysphagia, or scar. It is vital to identify and protect the anterior attachment of the true vocal folds during this procedure to prevent disastrous permanent changes to the voice. Nevertheless, chondrolaryngoplasty remains a highly safe and effective procedure.

There are noticeable differences in the perioral morphology of males and females, a contrast which is particularly apparent in the upper lip. Specifically, the female upper red lip tends to be fuller, with a shorter vertical cutaneous component and more dental show at rest. Familiarity with these differences, aesthetic ideals, and underlying anatomy is critical for the optimal planning of gender-affirming facial surgery. This article will review the evaluation of the perioral area and discuss operative planning. Multiple surgical techniques will be described in detail, including the commonly performed lip lift via a “bullhorn” incision.

Combining published literature, radiographic imaging, and medical illustration, this study aimed to develop an anatomically accurate 3-dimensional (3D) digital model of the human tongue, and to make this model publicly available for education and training purposes. The intrinsic and extrinsic muscles of the tongue were manually segmented from a head and neck CT angiogram of a healthy 29-year-old female. Data derived from published anatomical studies were compiled to provide additional anatomical detail to each tongue muscle. These anatomical details were then incorporated into a model by a 3D medical illustrator. A total of nine muscles were segmented for this study, along with the mandible and the hyoid bone. 3D meshes of the extrinsic muscles of the tongue, intrinsic muscles of the tongue, and the mylohyoid were created from CT angiography segmentation data. These meshes were refined in digital 3D space based off data from peer-reviewed anatomical studies. The final model was then uploaded to a publicly available 3D model repository. The tongue is a complex 3D organ with important roles in swallowing, speaking, and airway protection. By combining radiographic data with published anatomical descriptions, and through the collaboration between neuroradiology, head and neck surgery, and medical illustration, we developed an anatomically accurate, detailed 3D model of the oral tongue, which may serve as a powerful anatomy teaching aid.

The objective of this study was to develop an anatomically accurate three-dimensional (3D) digital model of the soft palate, derived from patient imaging data and peer-reviewed gross and microscopic anatomical studies, and to provide this model publically for educational purposes. A head and neck CT angiography study of a healthy 29-year-old female was segmented by a neuroradiologist and a head and neck cancer surgeon into 3D objects. Peer-reviewed anatomical literature was queried to provide additional anatomical details. These details were then incorporated into the model with the assistance of a 3D medical illustrator. Tissue segmentation derived from CTA provided baseline anatomical structures to model the 5 paired muscles of the soft palate, the paired eustachian tubes, and relevant bony architecture. Twelve peer-reviewed anatomical studies contained sufficient anatomical descriptions to guide refinement of these structures in digital 3D space. The final modeled objects were finalized by a medical illustrator and then uploaded to a publicly available 3D model repository. The soft palate is a dynamic 3D structure that plays an important role in essential functions such as breathing, swallowing, and speaking. By combining tissue segmentation from a normal neck CTA with published anatomical literature, and utilizing multidisciplinary expertise, we developed an anatomically accurate, detailed 3D model of the soft palate, which can serve as a powerful teaching aid for this complex region.

Neck dissection is a commonly performed procedure in the treatment of most head and neck cancers, and principles of neck dissection surgery are used in the surgical treatment of a variety of benign processes as well. Developing a working knowledge of neck anatomy is critical for otolaryngologists in training to navigate through the neck competently and efficiently, whether during neck dissection or other transcervical surgical approaches. With the use of 3-dimensional stereoscopic imaging techniques, neck dissection is herein reviewed with an emphasis on understanding the anatomic relationships of the critical structures within the neck.

Despite the advent of non-surgical treatment options for laryngeal cancer, as well as partial laryngeal surgery for larynx cancer, total laryngectomy remains an important tool in the treatment of larynx cancer and non-functional larynx. With the use of 3-dimensional stereoscopic imaging techniques, total laryngectomy is herein reviewed with an emphasis on understanding the anatomic relationships encountered and considered during this procedure.