Background In certain patients there is an imbalance between the volume of the anterior neck and the mandibular confines that require reductional sculpting and repositioning of the hyoid to optimize neck lifting procedures. Objectives A quantitative volumetric analysis of impact of the management of supraplatysmal and subplatysmal structures of the neck by comparing surgical specimen was performed to determine the impact of reduction on cervical contouring. Methods In 152 patients undergoing deep cervicoplasty, the frequency of modification of each surgical maneuver and amount of supraplatysmal and subplatysmal volume removed was measured in cubic centimeters using a volume displacement technique. Results The mean volume of total volume remove from the supraplatysmal and subplatysmal planes during deep cervicoplasty was 22.3 cm3 with subplatysmal volume representing 73%. Subplatysmal volume was reduced in 152 patients. Deep fat was reduced in 96% of patients with mean volume of 7 cm3, submandibular glands (76%) with mean volume 6.5cm, anterior digastric muscles (70%) with mean volume 2cm3, peri-hyoid fascia (32%) with mean volume <1cm3 and mylohyoid reduction (14%) with mean volume < 1cm3 in the series. The anterior digastric muscles were plicated to reposition the hyoid in 34% of cases. Supraplatysmal fat reduction was 6.3 cm3 in 40% of patients. Conclusions The study provides a comprehensive analysis of the impact of volume modification of the central neck during deep cervicoplasty. This objective evaluation of neck volume may help guide clinicians in the surgical planning process and provide a foundation for optimizing cervicofacial rejuvenation techniques.
Posterior pharyngeal wall augmentation has been advocated for patients having velopharyngeal dysfunction with a small coronal gap. Nonautogenous augmentation has not been accepted widely because of migration or extrusion of alloplastic implants and resorption of injected materials. Autogenous posterior pharyngeal wall augmentation has been performed for decades by Italian surgeons. A retrospective study was conducted to evaluate the efficacy of this procedure. Autogenous posterior pharyngeal wall augmentation, using a rolled superiorly based pharyngeal myomucosal flap, was performed on 14 patients, between November of 1989 and June of 1992, who fulfilled two criteria: velopharyngeal dysfunction unresponsive to speech therapy and a small (< 20 percent) coronal gap on velopharyngeal nasendoscopy. Of these, 3 patients had prior prosthetic velopharyngeal management, including 2 patients with Robin sequence. All patients were evaluated preoperatively and 3 months postoperatively with recorded (audio-videotape) perceptual, nasendoscopic, and fluoroscopic standardized speech and airway evaluations. The tapes were used for construction of a randomized master tape that was presented in blinded fashion and random order to three skilled raters for independent assessment of numerous perceptual and instrumental parameters of speech. The raters were uninvolved in the care of the patients or this study, and their intraobserver and interobserver reliabilities were known. Preoperatively, the majority of patients had nasal turbulence. All patients had variable degrees of hypernasality ranging from intermittent to pervasive. Parameters rated included (1) resonance (hypernasality, hyponasality, mixed), (2) auditory nasal emission (including nasal turbulence), and (3) visual characteristics regarding velopharyngeal closure. The visual parameters consisted of questions about whether a pharyngeal bulge was present or absent, descriptions of posterior pharyngeal wall movements with speech, level of closure, completeness of velopharyngeal closure, and quantitative descriptions of the percentage of velopharyngeal closure postoperatively. Examiners were instructed to look for a static and/or dynamic projection or bulge (i.e., Passavant's ridge) and, if a bulge was present, whether the level of velopharyngeal closure was on the same plane as the neoposterior pharyngeal bulge. Results of the extramural judgments of these parameters showed that there was no statistically significant tendency for patients' speech to be rated as more normal after the augmentation procedure than before it. We conclude that (1) autogenous posterior pharyngeal wall augmentation does not result in speech improvement and (2) autogenous posterior pharyngeal wall augmentation does not impair the nasal airway.
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