Immediate alveolar ridge distraction after tooth extraction--a preliminary report

Seven patients with severe periodontitis that had resulted in loss of alveolar ridge bone were treated by tooth extraction followed by immediate insertion of an implant distraction device. After successful distraction and bony healing the implant was used to fit a prosthesis.

Stability of dental implants in microvascular osseous transplants

Microvascular iliac crest and scapula transplants have been used in reconstruction of the lower jaw following tumor surgery. It has only been with the insertion of dental implants that a satisfactory prosthetic rehabilitation of the patient has been achieved. For this study, a follow-up of 38 patients with lower jaw tumors was carried out. The patients had been treated with partial resection of the lower jaw and neck dissection with microvascular iliac crest transplants (n = 20) or microvascular scapula transplants (n = 18); this was followed with dental implants (n = 143) in the region of the transplants or the local lower jaw. One hundred thirty-nine of the 143 dental implants were loaded by prosthetic superstructures. In all patients, the implant situation was evaluated on average 2 years 5 months after implantation. Periotest values, periimplant probing depths, and contact bleeding were registered, and the extent of periimplant bone loss was defined radiographically. The clinical situation in the region of the implant was compared for both types of implants and also with the nonresected lower jaw. The average Periotest values were within the normal range for all groups. In one scapula implant, however, a better average of Periotesting, -3.3, was found compared with implants of the iliac crest with Periotest values of -0.7. A measurement of -2.1 was found for the local lower jaw, similar to that of scapula implants. Pathologic probing depths were found for all three compared groups. The radiographically determined vertical loss of bone was the same for all three groups, on average 1 mm at 27 months postoperatively. The highest incidence of sulcus bleeding was found in the scapula implant group. Thus, it can be stated that the scapula transplants provide a similar transplant site to local lower jaw bone, whereas implants in iliac crest transplants show lesser bony stability. Periimplant soft-tissue conditions are worse for both types of transplants compared with local tissue of the lower jaw.

Computer assisted tumour resection of the skull base: case report

This case report demonstrates computer assisted resection of a skull base tumour after combined chemotherapy and irradiation, in a 40-year-old man with a squamous cell carcinoma of maxilla, zygoma, orbit and skull base. The resection of the skull base was performed with computer assistance after conventional resection of the maxilla, midface, exenteration of the orbit and lymph node dissection. Following combined chemotherapy and irradiation, the original, pretherapeutic tumour extent was marked on the new, presurgical CT scan enabling resection of the skull base with the use of a navigation microscope. Thus planned resection from the presurgical CT could be transposed intraoperatively using the navigation system, and the skull base could be resected with precision.

Vascularized versus non-vascularized nerve transfers: histologic study in rats

From the clinical point of view, the state of vascularized nerve transfers is clearly demonstrated in the literature. This study was carried out to elicit the basic histologic differences between vascularized and non-vascularized nerve transfers in an animal experiment. In 46 rats, the lateral femoral cutaneous nerve was resected, and an interposition with a free (n=23) ischiatic nerve transfer on one side and a vascularized (n=23) ischiatic nerve transfer on the other side was carried out. Three months postoperatively, the rats were sacrificed and 45 nerve transfers and 46 contralateral reference specimen probes were histologically evaluated. A lower degree of nerve fibrosis and vesicular degeneration of the myelin sheath were found in the vascularized nerve transfers, compared to the free non-vascularized transfers. The thickness of the myelin sheaths was less in the free transfers. From a histologic point of view, a lower degree of degenerative changes was seen in the vascularized nerves after transfer.

Navigational precision of drilling tools preventing damage to the mandibular canal

PURPOSE

The use of CT-based intraoperative navigation has greatly improved surgical control in many specialities. In this study the precision of the SMN system (Zeiss, Oberkochen, Germany) for navigated drilling before implant insertion is evaluated.

MATERIAL AND METHOD

One hundred test drillings were carried out on 10 standardized acrylic lower jaw models with the aid of the navigation system after CT scanning. The CT scans were taken using a slice thickness of 1 mm. Then the CT data were transferred to the workstation of the SMN system and referentiation with the help of reference points (fiducials) of the mandibular models for superposition of the acrylic and the CT models were carried out. Referentiation of the model and the drilling were performed by a drilling tool. The limit of drilling was the upper border of the mandibular canal. The aim was to come as near as possible without perforation of the canal roof.

RESULTS

An average drilling depth of 6.23 mm and a mean distance to the mandibular canal of 0.14 mm (s=0.05) was found. In 11 cases the upper border of the canal was perforated. The average penetration of the mandibular canal measured 0.19 mm. Eighty-nine drill holes were accomplished without perforation. The average distance to the alveolar canal measured 0.13 mm.

CONCLUSION

A high precision of CT-based navigation for controlled drilling of mandibles for dental implants was seen.

[Stability of dental implants in microvascular scapula and iliac crest transplants]

STUDY

In this study 24 patients with tumours of the mandible, mandibular resection, neck dissection and reconstruction by microvascular iliac crest (13) or scapula transplants (11) were examined following implantological treatment.

RESULTS

In all patients the implantological examination was performed on average two years and five months after implant insertion. This allowed for observation of periotest values, periimplant probing depth and sulcus bleeding (SBI). Furthermore, the loss of periimplant bone was registered radiologically. In both groups periotest values were normal. In the group with scapular transplants the mean periotest value was -3.2 and in the other group -0.8. Pathological probing depth was registered in both groups and sulcus bleeding was similar. The loss of periimplant crestal bone was similar in both groups, too.

DISCUSSION

It can thus be concluded that perimimplant conditions were equal in both groups two years after implant loading. The stability of implants in scapula transplants was higher than in iliac crest transplants.

An implant to eliminate anchorage loss during molar distalization: a case report involving the Graz implant-supported pendulum

Based on the philosophy of the pendulum appliance, a new non-integrated implant-supported device is presented, the Graz Implant-Supported Pendulum (GISP). It is designed to distalize maxillary first and second molars in adults. It consists of 2 parts: the anchorage plate, which is fixed to the palatal bone via 4 miniscrews, and the removable part, which is a pendulum-type appliance. A finished clinical case is shown, and experiences with the GISP in comparison with other orthodontic implants are discussed. The system can be loaded 2 weeks after surgical placement, actively distalize maxillary molars consecutively, serve as an active anchor unit, and provide stability against rotational movements.

Healing process after alveolar ridge distraction in sheep

OBJECTIVE

Mandibular augmentation by distraction of the alveolar ridge has been in use for several years. Since 1996, a distraction device that remains in the alveolar ridge after distraction has been used by the Department of Oral and Maxillofacial Surgery of Graz University. The distraction device is transformed into a dental implant after the end of the distraction process and can later be used for prosthetic purposes. We aimed to show the application of the device in this animal experiment and to follow the osseous healing process.

STUDY DESIGN

Two distraction implants were inserted into the mandibles of 8 sheep. Distraction of 0.5 mm per day was carried out for 8 days. Two sheep were killed 1, 2, 3, and 6 months after distraction, and the dissected mandibles were examined clinically, radiologically, and histologically.

RESULTS

After the first month of distraction, only slight radiopacity of the distraction gap was found. This increased steadily up to the third month after distraction. The boundary between the distraction fragments and the gap disappeared gradually. Six months after distraction, a homogeneous fine-meshed spongiosa structure was found in the area of distraction. Histologic examination showed desmoid ossification in the distraction gap and a continued increase in osteoid. After 6 months, mature bone was found. Only in the center was the rebuilding process not complete. Six months after distraction, osseointegration of the implants was shown in the region of the screw thread and distraction cylinder.

CONCLUSIONS

The healing process corresponded to that found in long bones, but showed only desmal ossification. Osseous integration of the distraction implants was found 6 months after distraction, although the implants were stable 3 months after distraction.

Vertical alveolar ridge distraction with prosthetic treatable distractors: a clinical investigation

Alveolar ridge distraction is a recent and promising technique for ridge augmentation. Since 1997, a new distraction system incorporating a distraction implant has been in use. It can be used for alveolar ridge distraction and is not removed from the alveolar ridge. Upon completion of the distraction, it remains in the alveolar process for later prosthetic treatment. Thirty-five patients were treated with distraction implants for the correction of alveolar ridge deficiency. In 10 patients with atrophy of the mandible or maxilla, 16 patients with severe defects of the alveolar process after trauma, and 9 patients with localized alveolar ridge defects after single tooth loss, alveolar ridge distraction was carried out with the aid of 62 distraction implants. The distraction implants were loaded by prosthetic superstructures 4 to 6 months after distraction. A clinical and radiologic follow-up was carried out. Periotest values were examined, and peri-implant bleeding and probing depth were registered prior to prosthetic treatment and 3, 6, and 9 months after implant loading. In 29 patients, distraction was carried out without complications or problems. Two distraction implants were lost. In 2 patients distraction was discontinued because of ankylosis of the distraction segment. In 1 patient the alveolar ridge was overcorrected, and another patient experienced a persisting hypoesthesia of the lip. For 5% of the implants, pathologic probing depth of more than 3 mm and sulcus bleeding were registered prior to prosthetic treatment. These observations decreased during the next 9 months. Periotest values were normal before the start of prosthetic treatment. There was a decrease in the Periotest values, thus an increase in implant stability, during the following 9 months. It was concluded that alveolar ridge distraction using distraction implants can be a successful technique for alveolar ridge augmentation with a low rate of complication. Acceptable esthetic and functional results can be achieved by this atraumatic technique of surgery and distraction.

[Histological and histomorphometric results of implantation of dental implants by early and late implantation]

In this study, a histologic and histomorphometric analysis of delayed and immediate-placed implants was performed. An implantation of 16 self-cutting conical titanium screw implants was carried out in 8 beagle dogs. Of these implants, 8 were placed immediately after extraction of the second premolar and 8 implants were placed after 6 months of healing after extraction. For dynamic histomorphometry, fluorochrome bone markers were injected at two different times prior to euthanasia. The specimens were examined macroscopically and microscopically 8 months after implantation. A histologic, dynamic, and static histomorphometry was performed with the aid of different computer programs. A mean surface of osseointegration of 75.7% and a mean soft tissue implant contact surface of 24.2% was seen in immediate-placed implants. For delayed implantation, an osseointegrated surface of 80.7% and a soft tissue covering of 19.3% was examined. The fibrogenic structures in the cervical implant part were more dense and there were more adhesive epithelial elements (hemidesmosomes) around delayed implants. The result of the dynamic and static histomorphometry showed no significant differences in the two groups (P < 0.1). In conclusion, it can be stated that a new steady-state of the soft and hard tissue around dental implants was seen 8 months after implant insertion in both groups. There was a pseudoankylotic healing in the osseous part. The lower level of osseointegration in immediate-placed implants was caused by early resorption of bone in the crestal part. Thus, a larger part of the implant was surrounded by soft tissue and a long epithelial attachment resulted.

Neuronal structure of microvascular transplants with and without neuronal anastomosis

OBJECTIVE

Latissimus dorsi transplants have little neuronal regenerative capacity without neuronal anastomosis. Histologic differences between transplants with and without neuronal anastomosis and 2 distinct types of neurosurgical reanastomosis are highlighted in this study.

PATIENTS AND METHODS

Fifty-four patients with squamous cell carcinomas of the oral cavity (T4) were treated by tumor resection and homolateral neck dissection. The defect was covered with a microvascular latissimus dorsi transplant. In 15 patients, no neuronal anastomoses were performed. In 21 patients, the thoracodorsal nerves were used for microneurosurgical reanastomosis, whereas in 18 patients, the cutaneous branches of the intercostal nerves were used for microneurosurgical reanastomosis. The transplant was examined during surgery and 9 months after surgery by means of a histologic examination of a biopsy specimen. The number of fascicles, the degree of fibrosis, and the myelination were examined. Furthermore, a neurosensory examination was performed 9 months after surgery.

RESULTS

Overall, our patients had an average of 12.1 fascicles during surgery. After surgery, patients without neuronal anastomosis showed an average of 4.9 fascicles, patients with nerve anastomosis to the cutaneous branches of the intercostal nerve showed an average of 6.2 fascicles, and patients with anastomosis to the thoracodorsal nerve showed an average of 9.6 fascicles. In cases of nerve anastomosis, a lesser degree of fibrosis was found, together with good myelinization. The clinical examination showed the best neurosensory function in the transplants with anastomosis to the thoracodorsal nerve and the worst function in those without neuronal anastomosis.

CONCLUSION

Neuronal reanastomosis led to more surviving neuronal structures in the postoperative histologic specimen. The highest density of fascicles was found in the well vascularized thoracodorsal nerve. The neurosensory function agrees with the histologic result.

Advantage of three-dimensional models in intraoral callus distraction

Distraction osteogenesis has become an important method of reconstructing hypoplastic facial bones. Intraoral callus distraction is a great aesthetic improvement, because no visible scars are caused. Precise preoperative planning is necessary, however, because the direction of distraction cannot be influenced postoperatively. Nine three-dimensional (3-D) models were used in three intraoral distraction cases: two patients suffered from unilateral hemifacial microsomia and one from micrognathia after bilateral ankylosis caused by multifocal osteomyelitis in childhood. In each case, models of the head were produced and the distraction was simulated preoperatively. The amount of distraction was 18 mm in the two hemifacial microsomia patients and 18 and 14 mm in the ankylosis case. Extension of distraction in the ankylosis patient was shorter on one side in order to achieve a correct midline position. A slight overcorrection of 3-5 mm was allowed to cover relapse and unpredictable future growth deficiency. Three-dimensional models can supply important information when employed in intraoral callus distraction. They allow anticipation of pitfalls and help to achieve a foreseeable result. Further advantages may be expected with complete 3-D enoral distraction in the future.

Accuracy of cephalometric and video imaging program Dentofacial Planner Plus in orthognathic surgical planning

The prediction of profile changes after surgery poses a problem due to the variability of the soft tissue and the differences in soft-tissue translations relative to osseous changes. This study examined the accuracy of computer predictions of such soft-tissue changes. Twenty-five patients with mandibular retrognathia were examined before and after orthognathic surgery. Changes in soft-tissue reference points were correlated to translations of hard-tissue references in the sagittal and vertical planes, and the measurements from these patients were compared to results predicted in preoperative planning by the cephalometric and video imaging program Dentofacial Planner. In surgical treatment involving advancement of the mandible, the mean operative advancement of the osseous pogonion was 6.06 mm. The corresponding movements of soft-tissue references, expressed as percentages relative to the movement of the osseous pogonion in the sagittal plane, were 98.4% for the soft-tissue pogonion, 93.6% for the soft-tissue menton, and 49.0% for the soft-tissue labrale inferior. The same measurements were carried out in the vertical plane and the changes in soft-tissue references were compared to those predicted in preoperative planning using the Dentofacial Planner. The predicted images were perceived as agreeing with the actual image most frequently in the lip and nasal area, while the highest degree of error was seen in the submental region. An overall predictability of more than 80% can be attained by planning mandibular advancement operations for correction of mandibular retrognathia using the Dentofacial Planner.

Stereolithography versus milled three-dimensional models: comparison of production method, indication, and accuracy

Computed tomography (CT) based three-dimensional (3-D) lifelike models have proved to be of great value, especially in craniomaxillofacial surgery. They improve and facilitate diagnosis, therapeutic planning, model operations, and definitive treatment in tumor surgery, traumatology, dysgnathia, alveolar atrophy, and congenital and asymmetrical malformations. From 1988 to 1998, 760 stereolithography (STL) and milled 3-D models were employed in our department. These two production methods have become the msot commonly used approaches, and the question as to which is preferable is the subject of controversy in the literature. Using two test models the STL and the milling method were compared with regard to production method and accuracy, and the resulting differences in indications for their use are discussed. The limiting factor for increased accuracy is the distance between each pair of CT scans. Milled models show a higher precision compared to STL models within the CT-scan plane, but the more the measurements deviate from this plane (becoming oblique) the more inaccurate the data becomes. STL exhibits greater deviations, but the inaccuracy is randomly distributed. The mean variation from the original was 0.81 mm for STL and 0.54 mm for milled models. Although 90% of the milled and 80% of the STL values are within a deviation of +/- 1 mm, it should be noted that maximum deviations of 3.15 mm in milled models and 2 mm in STL have been shown. Both methods are sufficiently accurate for clinical use. In standard cases involving the upper and lower jaw, malar bone, orbita, and calvaria the shorter production time and lower costs make milled models preferable. In special cases, in which hollows and fine structures play a major role (e.g., those involving the skull base, paranasal sinuses, inner ear, and mandibular canal), STL is indicated.

Review of severe osteoradionecrosis treated by surgery alone or surgery with postoperative hyperbaric oxygenation

We reviewed 41 patients with osteoradionecrosis of the mandible. Each patient was treated by radical resection followed by external beam irradiation. The diagnosis of infected osteoradionecrosis was confirmed clinically, radiologically, and histologically. After operation had failed, 20/41 were given hyperbaric oxygen (HBO) as in 'salvage' treatment. Daily sessions of HBO 2.5 ATA for 60 minutes (mean: 29 sessions) were given. The other 21 patients were treated by operation and antibiotics alone. HBO group (n = 20): The overall success rate for HBO after operation had failed was 13/20. Repeated debridement as first-line treatment followed by postoperative HBO was successful in 12/19. In seven of 19 patients, partial mandibulectomy and microvascular transplantation were required as second-line treatment, and this was successful in five. Primary partial mandibulectomy and microvascular transplantation followed by HBO was successful in 1 patient. Non-HBO group (n = 21): Repeated debridement was successful in 10/11 patients. Partial mandibulectomy was required as second-line treatment in the remaining one. In the other 10, partial mandibulectomy and microvascular transplantation were successful as first-line treatment in four. In the remaining six, further surgical intervention became necessary and were successful for 5-17 months (mean: 13). With a success rate of 13/20, we do not recommend HBO for the treatment of osteoradionecrosis.

Three-dimensional planning of alveolar ridge distraction by means of distraction implants

OBJECTIVE

In recent years, three-dimensional (3D) CT-based planning methods have increasingly been implemented in oral and maxillofacial surgery. Alveolar ridge distraction is accomplished by unidirectional distraction devices which in turn must be positioned optimally in all three dimensions. It is the aim of this study to demonstrate 3D planning of alveolar ridge distraction by means of distraction implants.

PATIENTS AND METHODS

In 1997, nine patients were treated with distraction implants for a deficient alveolar ridge. A CT-scan-based 3D milled model of the facial skull was prepared for each patient to enable preoperative diagnosis and operative planning.

RESULTS

Exact preoperative diagnosis of the alveolar ridge defect and atrophy was enabled by the 3D polyurethane model. Correct positioning of the distraction implants and predictability of the course of distraction was facilitated by preoperative planning according to the 3D model.

CONCLUSION

Three-dimensional planning according to a milled model is an indispensable aid to positioning of distraction implants and therefore to directed augmentation of the alveolar ridge. Correct distractor positioning is vital for optimal subsequent prosthetic treatment.

[Microsurgical bone replacement]

Microvascular bone transplantation has become a routine procedure. The iliac crest, scapula, and fibula are the most common donor sites. These are used for reconstruction of tumor-related defects or after osteoradionecrosis. But additional indications have been developed as defects after trauma, extreme atrophy, or hemifacial microsomia. In the future, three-dimensional techniques will improve transplantation surgery and will enable the prefabrication of transplants.

Scanning electron microscopical analysis of laser-treated titanium implant surfaces--a comparative study

Design and surface qualities of titanium implants are of vital importance for long-term stability following implantation. Four different implant surfaces treated individually were analyzed with special attention focused on laser surface treatment. Surfaces with machine roughness, titanium spray coating, treated by aluminum oxide and treated by laser were examined individually. Evaluation of the surface was carried out by electron microscope examination and mechanical profilometry. The EDS analysis determined the degree of contamination of the implant surface. Electron microscope examination showed that the titanium plasma spray as well as the laser-treated implants have optimum surface qualities: a secondary and tertiary structure with micro-roughness of 10 mm and roughness ranging from 0.5 to 4 mm. The least contamination was found for machine rough surfaces as well as those treated by laser. The other implants showed contamination corresponding to the method of surface treatment. In summary the optimal surface structure with the least contamination was found for the laser-treated titanium surface. Similar surface purity was found for the machine rough surfaces. An optimal structure was also achieved by the titanium plasma spray method, however, at the cost of surface purity.

Vascularized transplantation of the long thoracic nerve for sensory reinnervation of the lower lip

Microsurgical techniques have improved functional and morphological reconstruction of the face in recent years. An important factor is the re-establishment of neuronal function. The aim of this study was a follow-up of the regeneration of sensation in the inferior alveolar nerve after partial resection of a tumour and reconstruction with a vascularized long thoracic nerve graft. Five patients were examined in monthly intervals to assess the degree of re-establishment of sensation. Pressure and pain responses were elicited as early as three months postoperatively, sense of touch and vibration were found after five months, and sensitivity to temperature after seven months postoperatively. In four patients nine months postoperatively, sensory qualities in the region of the mental nerve were identical on both sides. The vascularized long thoracic nerve is therefore an adequate nerve graft for covering defects as a result of resection of the inferior alveolar nerve patients with tumours.

A comparison of growth impairment and orthodontic results in adult patients with clefts of palate and unilateral clefts of lip, palate and alveolus

OBJECTIVE

To evaluate and compare the long-term aesthetic and functional results of surgical and orthodontic treatment in patients with cleft palate and unilateral cleft lip, palate, and alveolus.

DESIGN

30 patients with unilateral cleft lip, palate, and alveolus and 30 patients with isolated cleft palate, mean age of 18.9 years, were evaluated by cephalometric and model analysis a mean of 1.5 years after orthodontic treatment. In each group the surgical treatment has been similar.

RESULTS

Model analysis: The sum of every mesiodistal tooth diameter in the maxilla and in the mandible was recorded according to the Bolton analysis. Twenty patients with unilateral cleft lip, palate and alveolus had relatively large upper dental arches and nine had relatively large lower dental arches. Twenty-two patients with cleft palates had large upper dental arches and seven had large mandibular arches. Eleven patients with unilateral cleft lip, palate, and alveolus and 18 patients with cleft palate had a negative space supply (the sum of the mesiodistal tooth diameters compared with the sagittal length of the alveolar ridge) in the region of the lateral teeth. All patients had persistent transverse space deficits that were increased on the side of the cleft in patients with cleft lip, palate, and alveolus. These unilateral transversal space deficits were recorded in 22 patients with unilateral cleft lip, palate, and alveolus and in 8 patients with isolated cleft palate. Sagittal measurements were reduced in 26 patients with unilateral cleft lip, palate, and alveolus and in 23 patients with cleft palate alone. The alveolar midline of the maxilla and the mandible were displaced in 25 patients with unilateral cleft lip, palate, and alveolus and in 19 patients with isolated cleft palate. Lateral cephalometric analysis: The lateral cephalograms taken at the same time as the models showed a mean SNA of 76.8 degrees and a NL-NSL angle of 8.7 degrees, indications of a tendency towards maxillary retrognathia in patients with unilateral cleft lip, palate, and alveolus. Patients with cleft palate had a mean SNA of 79.6 degrees and NL-NSL angle of 8.1 degrees. The anterior facial vertical index was within normal limits in patients with cleft lip, palate, and alveolus (44% vs 56%). An anterior facial height index of 42% compared with 58% in patients with isolated cleft palate indicated a slight reduction in midface height with an increase in the lower face as a consequence.

CONCLUSION

Orthodontic and surgical treatment can result in satisfactory results on model analysis. However, there is specific growth impairment of the maxilla 1.5 years after termination of orthodontic treatment and this influences the final cephalometric analysis, particularly in patients with cleft lip, palate, and alveolus.

Histologic results of neuronal anastomosis of the microvascular latissimus dorsi transplant

Latissimus dorsi transplants have little neuronal regenerative capacity without neuronal anastomosis. Histologic differences between transplants with and without neuronal anastomosis and two distinct types of neurotization are highlighted in this study. Eighteen patients after tumor resection and defect coverage with a latissimus dorsi transplant were examined preoperatively and postoperatively by means of a biopsy for histologic examination. The number of fascicles, degree of scarring, myelinization, and fibrosis were examined. All patients had a mean of 11.8 fascicles preoperatively. Patients without neuronal anastomosis showed an average of 5.0 fascicles, patients with nerve anastomosis to the cutaneous branches of the intercostal nerve showed an average of 6.2 fascicles, and patients with anastomosis to the thoracodorsalis nerve showed an average of 9.2 fascicles postoperatively. In cases of nerve anastomosis, a lesser degree of fibrosis was found, together with good myelinization. Neuronal reanastomosis led to more vital neuronal structures in the postoperative histologic specimen. The highest density of fascicles was found in the case of the well-vascularized thoracodorsalis nerve.

Neuronal anastomosis of the cutaneous ramus of the intercostal nerve to achieve sensibility in the latissimus dorsi transplant

PURPOSE

The return of sensory qualities in microvascular free myocutaneous transplants is of great importance in oral and maxillofacial surgery, because such sensations are responsible for improved speech and chewing. This study evaluated the results of neuronal anastomosis of sensory nerves in free microvascular anastomosed myocutaneous flaps.

PATIENTS AND METHODS

Anastomosis of the lateral cutaneous ramus of the intercostal nerve and the greater auricular nerve was performed to reestablish sensibility of the latissimus dorsi transplant. All patients had undergone tumor surgery because of an oral carcinoma and had been treated with a free microvascular myocutaneous latissimus dorsi transplant. Clinical follow-up was performed at monthly intervals postoperatively, and pain, temperature, and pressure sensations were tested, as well as 2-point discrimination and vibration perception.

RESULTS

Only 1 patient showed no sensibility in the transplant. In all other patients, pressure and pain sensations were elicited first. Next, slight touch, vibration, and sharp and blunt discrimination recovered. Thermal stimuli were sensed by only 1 patient.

CONCLUSION

Improved sensation of a latissimus dorsi transplant can be achieved by sensory nerve anastomosis.