Type:
Educational Exhibit
Keywords:
Head and neck, CT, MR, Treatment effects, Complications, Education and training
Authors:
M. Javier1, J. A. Guzman de Villoria2; 1 Madrid/ES, 2Madrid, Ma/ES
DOI:
10.1594/ecr2013/C-1042
Background
Taking into consideration the wide spectrum of reconstructive techniques available in the field of head and neck surgery,
distortion of normal anatomy and frequent absence of baseline postoperative comparison studies,
the radiologist often faces a difficult task in recognizing “normal” postoperative patterns and not misinterpreting them as disease or vice versa.
Additionally,
postoperative radiation therapy may further obscure the expected appearance of the reconstructed area.
Therefore,
the initial step in evaluating image studies in these patients should include an exhaustive review of clinical history and details of surgery and subsequent comparison with previous images.
The most expected change of myocutaneous flaps is progressive atrophy which translates into fat replacement of muscle and decrease in size of a soft-tissue mass (fig.
1 and fig.
2).
Nevertheless,
it is important to remember that the amount and speed of these changes are variable and depend largely on reconstructive technique,
flap type used in a specific anatomic area,
as well as postradiation changes.
Having in mind that it is infrequent for a local recurrence to develop within the first 4-8 weeks after surgery there are very few indications to perform imaging studies immediately after the procedure.
Most physicians recommend a baseline postoperative study 2 months after the surgery,
when the initial edema and local hemorrhage have most likely disappeared,
followed by subsequent imaging at 4-6 months intervals during the first 1-2 years.
Cross-sectional CT or MR imaging is essential in early detection of these complications.
Contrast-enhanced CT and multiplanar T1- and T2-weighted with T1 fat-suppressed postcontrast MR studies have to be included in any standard protocols.
In this exhibit we will describe different flap types currently used in head and neck reconstruction,
relevant anatomy in preoperative planning and imaging findings helpful in differentiating postoperative changes from malignancy recurrence.