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There are two types of smiling: without exposure of the teeth (usual smile), and with their exposure (square smile). Performance of the former involves use of the major zygomatic muscle, while the latter is created by the major zygomatic and the depressor labii inferior muscles. The function of the depressor labii inferioris muscle cannot be ignored in facial paralysis reconstruction. A double-muscle transfer using a divided rectus femoris muscle for one-stage reconstruction of both the major zygomatic muscle and the depressor labii inferior muscle is described. The patient suffered facial paralysis caused by an extracranial schwannoma originating from the facial nerve. After the tumor was removed, divided rectus femoris muscle segments were transferred to reconstruct the major zygomatic muscle and the depressor labii inferior muscle. After the pedicle vessel of the muscles was anastomosed to the recipient facial vessel, the long motor nerve of the proximal divided muscle was cross-faced and coapted directly to the prepared contralateral buccal branch. The short motor nerve of the distal muscle segment was sutured to the ipsilateral masseteric nerve. The advantages of divided rectus femoris muscle transfers are that (1) independent muscle contraction can be reconstructed; (2) no tongue or trapezius muscle atrophy occurs because the masseteric nerve is used as the motor source of the labial depressor; (3) only one muscle is sacrificed for muscle grafts; and (4) it is a one-stage reconstruction.

A free full-thickness chondrocutaneous flap from the auricular concha for the repair of large tracheal defects was transferred successfully. The flap is based on the superficial temporal vessels (reversed flow) and the posterior auricular vessels. The advantages of this flap for the repair of tracheal defects are (1) its dissection is easy, (2) thin components of the flap provide a wide postoperative airway, (3) the structure of the reconstructed trachea is made firm by the conchal cartilage with vascularization, (4) the highly vascularized cartilage results in less resorption than a free cartilage graft, (5) the donor site can be repaired easily and is concealed by the remnant auricle, and (6) a long arterial pedicle (reversed flow) can be obtained. The disadvantages are (1) there may be temporary postoperative congestion of the flap, (2) postoperative narrowing of the auriculocephalic sulcus may occur, and (3) a short venous pedicle often requires a vein graft.

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Background: This study was undertaken to assess the efficacy and suitability of an arterial embolization technique for the control of bleeding in advanced head and neck malignancies. Methods: Embolization was performed on 6 patients with advanced head and neck malignancy using various embolic materials for the control of bleeding. The primary tumors were located in the nasopharynx, hypopharynx (n = 2), oral base, face, and external auditory canal. All of these patients had severe anemia and 5 had massive regional hemorrhages. Results:All bleeding was well controlled by the arterial embolization; 2 patients were cured of hypovolemic shock. None of the patients died as a direct result of tumor bleeding, and there were no massive rebleeding cases in our series. Conclusion: Arterial embolization offers an effective, safe, and fast method for controlling bleeding from advanced head and neck malignancies. A good working relationship between the surgeon and the interventional radiologist provides the greatest chance for success in such cases.IntJ Clin Onco11998;3:228-232