Regarding tumour invasion of the mandible from an oral cavity squamous carcinoma:
The pathophysiology of mandibular invasion from an oral cancer alters after radiotherapy.
Which one of the following is not a recognised cause of facial palsy?
Pfeiffer’s syndrome. This is not a cause of facial palsy. The causes of facial palsy can be broadly divided into intracranial, intratemporal and extratemporal. Several patterns of facial nerve dysfunction point to a nonidiopathic cause: simultaneous bilateral facial palsy (Guillain-Barré syndrome, sarcoidosis, pseudobulbar palsy, syphilis, leukaemia, trauma, Wegener’s granulomatosis), unilateral facial weakness slowly progressing beyond 3 weeks (cholesteatoma, facial nerve neuroma, metastatic carcinoma, adenoid cystic carcinoma), slowly progressive unilateral facial weakness associated with facial hyperkinesis (facial nerve neuroma), no return of facial nerve function within 6 months after abrupt onset of palsy (facial nerve neuroma, adenoid cystic carcinoma, basal cell carcinoma), ipsilateral lateral rectus palsy, and recurrent unilateral facial palsy (facial nerve neuroma, adenoid cystic carcinoma, meningioma).
Several viruses have been implicated including Varicella zoster, Herpes simplex and Epstein-Barr. Facial paralysis occurs in 11% of patients with Lyme disease; in 30% of cases, the paralysis is bilateral. AIDS is also an increasingly common cause of bilateral involvement.
Pfeiffer’s syndrome is not associated with facial nerve palsy. This syndrome is characterised by: craniosynostosis (most often of the coronal and lambdoid), and midfacial hypoplasia with receded cheekbones or exophthalmos. Ocular proptosis and hypertelorism, broad thumbs and big toes are other features. The mental capacity of Pfeiffer patients is usually in the normal range.
Neck dissections:
May lead to a hoarse voice postoperatively.
Total glossectomy:
Patients may be able to speak and swallow after an appropriate reconstruction.
Regarding free tissue transfer of the fibula bone:
According to Mathes and Nahai, the fibula bone, like the pectoralis muscle, has a Type V vascular pattern. The length of the pedicle to the fibula flap depends on the site of the proximal osteotomy rather than the length of the peroneal vessels from their origin to the tibial side of the bone. Along the fibula, the pedicle must be dissected in a subperiosteal plane to preserve bone vascularity. Arteria peronea magna is an absolute contraindication to free fibula flap harvest due to the risk of foot devascularisation. The double-barrelled fibula flap configuration was first described by Yoo et al 1; Jupiter et al 2 published their report some 5 years later. The fibula bone has a Mathes and Nahai Type V pattern of circulation; their classification is not limited to muscles and muscle-containing flaps. Unicortical screw fixation of the osteotomised free fibula is recommended over bicortical fixation to safeguard the periosteal blood supply to the bone.
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