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Scalp reconstruction procedures range from those for medical indications to those for cosmetic reasons. Koss et al. made a detailed analysis of trauma-related scalping injuries and their management.[1] The history of scalp reconstruction techniques mirrors that of plastic surgery techniques, including the use of free flaps for very large defects.[2][3][4][5] More typical procedures include incisional and excisional biopsies, excision of benign and malignant tumors, and scalp reduction surgery. Benign lesions of the scalp that are excisable include epidermoid cysts, nevus sebaceous, blue and melanocytic nevi. Malignant lesions that typically undergo excision include basal and squamous cell carcinoma, Bowen disease, Merkel cell carcinoma, and malignant melanoma. Wounds created from these procedures may be small and superficial and amenable to primary closure, but often are large, deep (down to calvaria) and extensive needing more complex closure and covering.  Scalp reconstruction surgery has been used in the past to treat alopecia but is rarely used nowadays, due to advances in hair transplantation. Cosmetic indications are not in the remit of this article and will not be part of the discussion here. Reconstruction of the scalp follows the reconstructive ladder of any other plastic surgical procedure: granulation (secondary intention); primary closure; advancement flap; rotational flap; use of split-thickness skin graft (STSG); or full-thickness skin graft (FTSG); and free flaps. The selection of one or a combination of methods depends on anatomical (skin laxity, wound depth, location) and patient-related factors (smoker, wound care, general health). Traumatic scalp avulsive injuries can occur and be devastating. These can be addressed as above with other defects or require potentially significantly more extensive surgeries both in regards to the number and complexity.[6][7][8], (Copyright © 2022, StatPearls Publishing LLC.)

Teeth serve multiple functions beyond mastication, including shaping the kinetics of phonation, breathing, maintaining a patent airway, and serving as a foundation for the vertical dimensions of the face.[1][2] Certain teeth have specialized roles in types of chewing, with the entire group functioning as a dynamic entity.[3] These critical roles are why the loss of teeth can be so devastating.[4][5], (Copyright © 2022, StatPearls Publishing LLC.)

Head and neck surgeons of all types, like otolaryngologists and oral and maxillofacial surgeons, as well as dentists and dental specialists, like orthodontists, will commonly describe the positions of the maxilla and mandible in three dimensions. The first is in the anterior-posterior plane, often referred to as the AP plane. This view is seen when looking at the patient from a side profile, or radiographically, a sagittal plane. The second is the transverse plane, or looking directly at a patient in frontal view, radiographically synonymous with the coronal plane. The third is vertical, this is appreciated like the AP plane, and best understood when looking laterally at a patient. Retrognathia is a term used to describe an unusual position of the mandible. Retro implies that there is deficient growth and 'gnathia' means about the jaws (particularly mandible). To the specialists above, describing a patient as retrognathic specifically means the patient is deficient in the AP plane of growth. That is, when viewed from the side, the mandible is posterior to and behind where it should be. There is often a vertical component in growth deficiency and sometimes a transverse issue, but they are less critical in thinking about retrognathia unless planning a surgical correction. To summarize, when you describe a patient as retrognathic, it implies the mandible is deficient in growth, particularly in the AP plane. Why does retrognathia matter as a diagnosis? First, to rule out associated syndromes with far-reaching health effects, to recognize and be able to appropriately refer for orthodontic evaluation with possible need for surgery surgical correction, to consider if you are a health care professional who would ever deal with or manage an airway, and to consider the implications in the setting of obstructive sleep apnea., (Copyright © 2022, StatPearls Publishing LLC.)

Hemifacial microsomia is a continuum of congenital deformities involving genetic disruption of the first and second branchial arches.[1] There are many disorders and syndromes linked to hemifacial microsomia. However, the basic theme of the issue is one side of the face being underdeveloped (in rare cases, both sides can be affected). With the spectrum of disease, this can manifest as a slight deviation all the way up to extremely underdeveloped and noticeable, even resulting in severe airway compromise requiring a tracheostomy early in life.[2] Hemifacial microsomia is the second most common birth defect of the head and neck, second only to cleft lip/cleft palate, with an incidence of 1:3500 to 1:4000.[3] Due to the significant variability and spectrum of the disease, there are numerous and confusing classifications. Generally, they are characterized by the O.M.E.N.S. classification; orbital, mandibular, ear, facial nerve, soft tissue, with each item given a score of zero to three depending on the severity.[4] The Pruzanksky and Kaban classification is commonly used to assess the mandible and is broken down into three grades with several subtypes that help delineate the recommended surgical interventions needed.[3] These patients also often manifest with auricular issues, both cosmetically and functionally, with impaired hearing that requires surgical intervention. Though more uncommon, this process can be bilateral, resulting in marked facial issues and failure to develop. Also rare but reported is other internal organ systems being affected, making a comprehensive medical workup necessary in severe cases to rule out further issues.[5] It is critical to understand the pathogenesis of hemifacial microsomia to understand the surgical therapies (generally) and what will be asked of the anesthesia team to best anticipate potential issues and difficulties, especially with airway concerns. A 2020 retrospective review looked at the anesthetic management of 311 hemifacial microsomia pediatric cases to better elucidate these issues. They found that facemask was possible for all except one child, a bilateral case, that required a two-handed mask technique. The success of intubation with video laryngoscopy and fiberoptic techniques was 100%, but the success of direct laryngoscopy was only 79.5%.[6] This illustrates the need to treat these cases as difficult airways and prepare accordingly., (Copyright © 2022, StatPearls Publishing LLC.)