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Huo L, Han Z, Jiao Z, Wei X, Xu Q, Ahmed A, Zheng J, Chen M, Yang C. Introduction of temporomandibular joint and skull base combined reconstruction by autogenous bone graft. Clin Oral Investig 2023:10.1007/s00784-023-05065-4. [PMID: 37221432 DOI: 10.1007/s00784-023-05065-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/07/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVE This study introduces the application of autogenous bone graft for the reconstruction of temporomandibular joint (TMJ) and skull base combined defects. MATERIALS AND METHODS Patients treated with autogenous bone grafts for reconstruction of the TMJ and skull base were reviewed. All patients underwent virtual surgical design to confirm the osteotomies of the combined lesion and the selections of autogenous bone graft, fabrication of surgical templates to transfer the plan to actual operation, and reconstruction of autogenous bone graft for the TMJ and/or skull base. Surgical outcomes were assessed by clinical examinations and radiological data. RESULTS Twenty-two patients were involved in this study. Ten patients underwent reconstruction of the skull base by a free iliac or temporal bone graft and preservation of the TMJ. Twelve patients underwent skull base reconstruction by the same methods and total reconstruction of the TMJ by half sternoclavicular joint flap or costochondral bone graft. No severe complications occurred after surgery. The occlusion relationship was stable and similar to that of the preoperative state. The pain and maximal interincisal opening were significantly improved by the 101.2-month follow-up. CONCLUSION Autogenous bone graft is a good alternative for repairing the TMJ and the skull base structure and function. CLINICAL RELEVANCE The study introduced the application of autogenous bone graft for the reconstruction of temporomandibular joint and skull base combined defect, which is a good way to repair the defect and restore the function.
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Affiliation(s)
- Liang Huo
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; National Clinical Research Center of Stomatology, No. 639 Zhi Zao Ju Rd, Shanghai, 200011, China
| | - Zixiang Han
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; National Clinical Research Center of Stomatology, No. 639 Zhi Zao Ju Rd, Shanghai, 200011, China
| | - Zixian Jiao
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; National Clinical Research Center of Stomatology, No. 639 Zhi Zao Ju Rd, Shanghai, 200011, China
| | - Xiang Wei
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; National Clinical Research Center of Stomatology, No. 639 Zhi Zao Ju Rd, Shanghai, 200011, China
| | - Qingyu Xu
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; National Clinical Research Center of Stomatology, No. 639 Zhi Zao Ju Rd, Shanghai, 200011, China
| | - Abdelrehem Ahmed
- Department of Craniomaxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Jisi Zheng
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; National Clinical Research Center of Stomatology, No. 639 Zhi Zao Ju Rd, Shanghai, 200011, China.
| | - Minjie Chen
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; National Clinical Research Center of Stomatology, No. 639 Zhi Zao Ju Rd, Shanghai, 200011, China.
| | - Chi Yang
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; National Clinical Research Center of Stomatology, No. 639 Zhi Zao Ju Rd, Shanghai, 200011, China.
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Muangsiri P, Tanjapatkul R, Sriswadpong P, Jomkoh P, Jirawatnotai S. Indocyanine Green Fluorescence Angiography of the Transverse Cervical Arterial Supply to Clavicle Flaps: An Anatomical Study. Otolaryngol Head Neck Surg 2021; 166:68-73. [PMID: 33784191 DOI: 10.1177/01945998211000432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe the anatomy of the transverse cervical artery and to prove its perfusion to the clavicle using indocyanine green fluorescence angiography as an alternative vascularized bone for head and neck reconstruction. STUDY DESIGN Cadaveric dissection. SETTING Anatomy lab. METHODS Twenty-two necks and shoulders from 11 fresh-frozen cadavers were dissected. The transverse cervical artery diameter, length, emerging point, and the length of clavicle segment harvested were described. Photographic and near-infrared video recordings of the bone's medial and longitudinal cut surfaces were taken prior to, during, and after indocyanine green injection. RESULTS The transverse cervical artery originated from the thyrocervical trunk and emerged at the level of the medial one-third of the clavicle in 22 of 22 (100%) specimens. The average length of the pedicle was 3.6 cm (range, 2.2-4.4 cm), and the mean diameter was 2.5 mm (range, 1.8-3.4 mm). The harvested bone had a mean length of 5.1 cm (range, 4.3-5.8 cm). After injecting the indocyanine green, 22 of 22 (100%) specimens showed enhancement in the periosteum, bony cortex, and medulla. CONCLUSION The middle third of the clavicle can be reliably harvested as a vascularized bone with its perfusion solely from the transverse cervical artery pedicle, as shown by the near-infrared fluorescence imaging. The pedicle was sizable and constant in origin.
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Affiliation(s)
- Pichtat Muangsiri
- Department of Plastic and Reconstructive Surgery, Lerdsin Hospital, Bangkok, Thailand
| | - Rungkit Tanjapatkul
- Department of Plastic and Reconstructive Surgery, Lerdsin Hospital, Bangkok, Thailand
| | - Papat Sriswadpong
- Department of Plastic and Reconstructive Surgery, Lerdsin Hospital, Bangkok, Thailand
| | - Pojanan Jomkoh
- Department of Plastic and Reconstructive Surgery, Lerdsin Hospital, Bangkok, Thailand
| | - Supasid Jirawatnotai
- Department of Plastic and Reconstructive Surgery, Lerdsin Hospital, Bangkok, Thailand
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Temporomandibular joint reconstruction with medial femoral condyle osseocartilaginous flap: a case series. Int J Oral Maxillofac Surg 2020; 50:604-609. [PMID: 33041166 DOI: 10.1016/j.ijom.2020.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/25/2020] [Accepted: 09/21/2020] [Indexed: 11/21/2022]
Abstract
Reconstruction for large-scale temporomandibular joint (TMJ) defects can be challenging. We have used the medial femoral condyle (MFC) osseocartilaginous flap for repair of TMJ defects. The aim of this paper was to describe our technique and to present the preliminary results. The MFC osseocartilaginous flap was used as a free vascularized graft for TMJ defect in four patients who had undergone resection for benign tumor of the TMJ region (n = 2) or TMJ ankylosis (n=2). A computer-assisted technique was used in all cases. Symmetry of the mandible was objectively evaluated by postoperative computed tomography. Complications were recorded during follow-up visits. Lower extremity functional status was assessed by the Lower Extremity Functional Scale (LEFC) questionnaire. The MFC osseocartilaginous flap success rate was 100%; bony union was obtained in all four patients, and normal occlusion was achieved within 6-11 months after surgery. No flap-related complications occurred. All patients were satisfied with their postoperative facial symmetry and oral function. The LEFC score ranged from 72 to 80, indicating normal lower extremity function. Vascularized MFC osseocartilaginous flap appears to be a reliable option for reconstruction of large-scale TMJ defects.
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Liu X, Wan S, Abdelrehem A, Chen M, Yang C. Benign temporomandibular joint tumours with extension to infratemporal fossa and skull base: condyle preserving approach. Int J Oral Maxillofac Surg 2020; 49:867-873. [PMID: 32044186 DOI: 10.1016/j.ijom.2019.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 11/11/2019] [Accepted: 12/24/2019] [Indexed: 11/28/2022]
Abstract
This article introduces a modified surgical approach combining condylotomy with posterior disc attachment release for the resection of large non-malignant masses located in the infratemporal fossa and involving the skull base. This retrospective study included 14 patients treated at Shanghai Ninth People's Hospital, Shanghai Jiao Tong University between January 2010 and December 2016. Clinical evaluations (visual analogue scale (VAS) for pain, maximum inter-incisal opening (MIO), and complications) and radiological findings (magnetic resonance imaging (MRI) and computed tomography (CT)) were collected pre- and postoperatively. All patients had satisfactory surgical exposure and complete resection of the neoplasms. During an average follow-up of 54.8 months, no clinical or radiographic signs of recurrence were reported. MIO increased from 28mm preoperatively to 35.4mm postoperatively (P<0.001). The pain VAS score changed from 5.4 preoperatively to 0.7 postoperatively (P<0.001). Neural function was normal for all patients. Postoperative MRI and CT scans showed a satisfactory disc position and condyle morphology, with no resorption. Three-dimensional reconstruction of the postoperative CT scan also demonstrated healing of the skull base defects. The modified surgical approach combining condylotomy with posterior disc attachment release is suitable for the removal of large non-malignant masses involving the infratemporal fossa and skull base.
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Affiliation(s)
- X Liu
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, and Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - S Wan
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, and Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - A Abdelrehem
- Department of Craniomaxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - M Chen
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, and Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - C Yang
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, and Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China.
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Seth S, Gupta H, Kumar D, Agarwal R, Gupta S, Mehra H, Natu SS, Singh J. Sternoclavicular Graft Versus Costochondral Graft In Reconstruction of Ankylosed Temporomandibular Joint. J Maxillofac Oral Surg 2019; 18:559-566. [PMID: 31624437 DOI: 10.1007/s12663-019-01276-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 08/13/2019] [Indexed: 10/26/2022] Open
Abstract
Introduction The temporo-mandibular joint (TMJ) is a complex anatomical structure that is concerned with mastication, deglutition, and speech. Ankylosis of the TMJ occurs when the condyle gets fused to glenoid fossa by bony or fibrous tissue. It is an incapacitating problem, commonly occurring in children and is usually associated with trauma or infection. Materials and Methods A total of ten patients with written informed consent having TMJ ankylosis (unilateral/bilateral) fulfilling the inclusion criteria were selected for the study and were operated under general anaesthesia with arthrectomy followed by reconstruction of ramal condylar unit with SCG (Group I) or CCG (Group II). Pre-operative and post-operative evaluation assessments were done at regular intervals for maximum mouth opening, range of mandibular movements, and height of ramus. Results Statistical analysis shows that the increase in maximum mouth opening was found 1.1% higher in Group II (75.9%) as compared to Group I (74.9%). The increase in lateral excursion at affected side was found 1.3% higher in Group I (84.6%) as compared to Group II (83.3%). The increase in lateral excursion at non-affected side was found 10.3% higher in Group I (76.9%) as compared to Group II (66.7%). The increase in protrusive movement was found 17.5% higher in Group II (88.9%) as compared to Group I (71.4%). Six months post-operative height of ramus was found 10.5% higher in Group II as compared to Group I. Conclusion The present study concludes the superiority of costochondral graft over sternoclavicular graft in terms of growth and function. Continued deliberation between the two grafts with larger sample size and a longer follow-up with multicentric consensus will be required to draw definitive indications of the two grafts.
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Affiliation(s)
- Sarita Seth
- Department of Oral and Maxillofacial Surgery, BBD College of Dental Sciences, Lucknow, India.,Lucknow, India
| | - Hemant Gupta
- Department of Oral and Maxillofacial Surgery, BBD College of Dental Sciences, Lucknow, India
| | - Deepak Kumar
- Department of Oral and Maxillofacial Surgery, BBD College of Dental Sciences, Lucknow, India
| | - Rashmi Agarwal
- Department of Oral and Maxillofacial Surgery, BBD College of Dental Sciences, Lucknow, India
| | - Sumit Gupta
- Department of Oral and Maxillofacial Surgery, BBD College of Dental Sciences, Lucknow, India
| | - Hemant Mehra
- Department of Oral and Maxillofacial Surgery, BBD College of Dental Sciences, Lucknow, India
| | - Subodh Shankar Natu
- Department of Oral and Maxillofacial Surgery, BBD College of Dental Sciences, Lucknow, India
| | - Jasmeet Singh
- Department of Oral and Maxillofacial Surgery, BBD College of Dental Sciences, Lucknow, India
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Zheng J, Chen X, Jiang W, Zhang S, Chen M, Yang C. An innovative total temporomandibular joint prosthesis with customized design and 3D printing additive fabrication: a prospective clinical study. J Transl Med 2019; 17:4. [PMID: 30602388 PMCID: PMC6317245 DOI: 10.1186/s12967-018-1759-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 12/21/2018] [Indexed: 11/25/2022] Open
Abstract
Background Total temporomandibular joint (TMJ) prosthesis is an effective and reliable method of joint reconstruction. However, there is still an urgent need to design a new TMJ prosthesis because of no commercially available TMJ prosthesis appropriate for the clinical application on the Chinese population. This study was introduced to prospectively confirm the safety and effectiveness of a new TMJ prosthesis with customized design and 3D printing additive fabrication in clinical application. Methods Patients with unilateral end-stage TMJ osteoarthrosis were recruited in this study from Nov 2016 to Mar 2017. Computed tomography scans for all patients were obtained and transformed into three-dimensional (3D) reconstruction models. The customized TMJ prosthesis consisted of three components including the fossa, condylar head, and mandibular handle units, which were designed based on the anatomy of the TMJ and were fabricated using the 3D printing technology. The prominent characters of the prosthesis were the customized design of the fossa component with a single ultra-high-molecular-weight polyethylene and the connection mechanism between the condylar head (Co–Cr–Mo alloy) and mandibular handle components (Ti6Al4 V alloy). The clinical follow-up, radiographic evaluation and laboratory indices were all done to analyze the prosthesis’ outcomes in the clinical application. Results 12 consecutive patients were included in the study. There were no complications (infection of the surgical wound, damage of liver and kidney, displacement, breakage, or loosening of the prosthesis) found after surgery. Pain, diet, mandibular function, and maximal interincisal opening showed significant improvements after surgery. But the lateral movement was limited to the non-operated side and the mandible deviated towards the operated side on opening mouth following surgery. Conclusions The presented TMJ prosthesis is considered an innovative product in TMJ Yang’s system, which is unique compared to other prostheses for the special design and 3D printing additive manufacture. Moreover, the prosthesis is very safe and efficient for clinical use. Trial registration Prospective reports on Chinese customized total temporomandibular joint prosthesis reconstruction cases, ChiCTR-ONC-16009712. Registered 22 Nov 2016, http://www.chictr.org.cn/showproj.aspx?proj=16091
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Affiliation(s)
- JiSi Zheng
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, No. 639 Zhi Zao Ju Rd, Shanghai, 200011, China
| | - XuZhuo Chen
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, No. 639 Zhi Zao Ju Rd, Shanghai, 200011, China
| | - WenBo Jiang
- Center of 3D-printing Translational Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - ShanYong Zhang
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, No. 639 Zhi Zao Ju Rd, Shanghai, 200011, China
| | - MinJie Chen
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, No. 639 Zhi Zao Ju Rd, Shanghai, 200011, China
| | - Chi Yang
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, No. 639 Zhi Zao Ju Rd, Shanghai, 200011, China.
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Chen MJ, Yang C, Zheng JS, Bai G, Han ZX, Wang YW. Skull Base Erosion Resulting From Primary Tumors of the Temporomandibular Joint and Skull Base Region: Our Classification and Reconstruction Experience. J Oral Maxillofac Surg 2018; 76:1345-1354. [PMID: 29406260 DOI: 10.1016/j.joms.2017.11.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/03/2017] [Accepted: 11/29/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE We sought to introduce our classification and reconstruction protocol for skull base erosions in the temporomandibular joint and skull base region. PATIENTS AND METHODS Patients with neoplasms in the temporomandibular joint and skull base region treated from January 2006 to March 2017 were reviewed. Skull base erosion was classified into 3 types according to the size of the defect. RESULTS We included 33 patients, of whom 5 (15.2%) had type I defects (including 3 in whom free fat grafts were placed and 2 in whom deep temporal fascial fat flaps were placed). There were 8 patients (24.2%) with type II defects, all of whom received deep temporal fascial fat flaps. A total of 20 patients (60.6%) had type III defects, including 17 in whom autogenous bone grafts were placed, 1 in whom titanium mesh was placed, and 2 who received total alloplastic joints. The mean follow-up period was 50 months. All of the patients exhibited stable occlusion and good facial symmetry. No recurrence was noted. CONCLUSIONS Our classification and reconstruction principles allowed reliable morpho-functional skull base reconstruction.
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Affiliation(s)
- Min-Jie Chen
- Professor, Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; and National Clinical Research Center of Stomatology, Shanghai, China
| | - Chi Yang
- Professor, Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; and National Clinical Research Center of Stomatology, Shanghai, China.
| | - Ji-Si Zheng
- Resident, Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; and National Clinical Research Center of Stomatology, Shanghai, China
| | - Guo Bai
- Resident, Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; and National Clinical Research Center of Stomatology, Shanghai, China
| | - Zi-Xiang Han
- Resident, Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; and National Clinical Research Center of Stomatology, Shanghai, China
| | - Yi-Wen Wang
- Resident, Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; and National Clinical Research Center of Stomatology, Shanghai, China
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Pedicled Vascularized Clavicular Graft for Anterior Cervical Arthrodesis: Cadaveric Feasibility Study, Technique Description, and Case Report. Spine (Phila Pa 1976) 2017; 42:E1266-E1271. [PMID: 28296812 DOI: 10.1097/brs.0000000000002150] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cadaveric feasibility study. OBJECTIVE To assess the anatomic and technical feasibility of rotating a clavicular segment on a sternocleidomastoid muscle (SCM) pedicle into the ventral cervical spine using a cadaveric model and to provide the first clinical case description of performing this procedure. SUMMARY OF BACKGROUND DATA Reconstruction of the anterior cervical spine in patients with a high risk of pseudoarthrosis may require the use of a vascularized bone graft (VBG). A vascularized clavicular graft rotated on an SCM pedicle would afford all the benefits of a VBG without the added morbidity of free-tissue transfer; however, this technique has not been described. METHODS A multidisciplinary team hypothesized that it would be anatomically and technically feasible to rotate a pedicled clavicular bone graft from the bottom of C2 to the top of T2 via an anterior approach. Five cadavers underwent bilateral anterior neck dissections for a total of 10 clavicular graft assessments. A case report describes the use of a clavicular VBG in a patient with a 3-level corpectomy defect and a history of failed fusion. RESULTS Ten clavicles were rotated on an SCM pedicle. The grafts were either harvested as an entire segment or as the superior two-thirds of clavicle, leaving the inferior one-third in situ with pectoralis attachments intact. All grafts reached from the bottom of C2 to the top of T2. When the entire length of exposed clavicle was mobilized, it could cover five to six levels. The case report highlights technical challenges of this procedure in a living patient and provides the clinical context for its potential utility in the reconstruction of the ventral cervical spine. CONCLUSION This surgical technique is best suited for patients with long-segment cervical defects and an increased risk of pseudarthrosis. Further clinical experience with this technique is required before definitive conclusions can be made. LEVEL OF EVIDENCE 5.
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Mohanty S, Kohli S, Dabas J, Singh C. Novel technique for harvesting the sternoclavicular graft. J Craniomaxillofac Surg 2016; 45:290-294. [PMID: 27939038 DOI: 10.1016/j.jcms.2016.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/28/2016] [Accepted: 11/10/2016] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Originally introduced for mandibular reconstruction more than 40 years ago, the sternoclavicular graft (SCG) has gained widespread popularity for the reconstruction of the ramus-condyle unit (RCU) owing to its anatomic and histological likeness to the normal mandibular condyle. Conventional longitudinal osteotomy design for its harvest has been fraught with considerable complications at the donor site including fracture clavicle and major neurovascular injury. In an attempt to alleviate these ill effects, a new technique for procuring the sternoclavicular graft is presented. MATERIAL AND METHODS A split-thickness cortico-cancellous graft was harvested form the sternal end of the clavicle along with the articular disk with the osteotomy cut oriented parallel to the coronal plane, with limited soft tissue dissection. Donor site complications were assessed in terms of incidence of clavicle fracture, neurovascular injury, pleural tear and radiographic healing as seen in the six-month postoperative chest radiograph. RESULTS 17 patients suffering from unilateral temporomandibular joint ankylosis underwent SCG harvesting for RCU reconstruction following osteoarthrectomy. No adverse events were seen in the intra- and post-operative period in any patient and satisfactory radiographic osseous healing was observed after six months. CONCLUSION The proposed harvest technique for SCG results in reduced donor site morbidity and favourable healing and greater patient comfort.
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Affiliation(s)
- Sujata Mohanty
- Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, MAMC Complex, Bahadur Shah Zafar Marg, New Delhi 110002, India.
| | - Sanchaita Kohli
- Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, MAMC Complex, Bahadur Shah Zafar Marg, New Delhi 110002, India
| | - Jitender Dabas
- Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, MAMC Complex, Bahadur Shah Zafar Marg, New Delhi 110002, India
| | - Chandravir Singh
- Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, MAMC Complex, Bahadur Shah Zafar Marg, New Delhi 110002, India
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Ye ZX, Yang C, Chen MJ, Abdelrehem A. A novel approach to neoplasms medial to the condyle: a condylectomy with anterior displacement of the condyle. Int J Oral Maxillofac Surg 2015; 45:427-32. [PMID: 26748864 DOI: 10.1016/j.ijom.2015.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 09/28/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022]
Abstract
Resecting neoplasms involving the infratemporal space has a high risk of damaging critical nerves and vessels, in addition to joint form and function. The purpose of this study was to introduce a novel approach to lesions medial to the condyle, which comprises a condylectomy with anterior displacement of the condyle. The indications evaluated using digital surgical simulation, the critical surgical technique, and the preliminary clinical effects are presented here. Five cases underwent this approach between January 2006 and December 2014. The common characteristics of the five masses were (1) that they were non-malignant neoplasms involving the posterior-medial region of the condyle; (2) the upper and lower borders were between the skull base and the lingula, while the anterior border did not exceed the coronoid process. All masses were resected successfully with no damage to any critical nerves or vessels. The average follow-up period was 29.8 months (range 6-56 months). There was no recurrence, secondary deformity, or facial paralysis. The average mouth opening improved from an original 27 mm to 34 mm after surgery. The condyles were well fixed, with no resorption, as shown on computed tomography scans.
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Affiliation(s)
- Z-X Ye
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, and Shanghai Key Laboratory of Stomatology, Shanghai, People's Republic of China
| | - C Yang
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, and Shanghai Key Laboratory of Stomatology, Shanghai, People's Republic of China.
| | - M-J Chen
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, and Shanghai Key Laboratory of Stomatology, Shanghai, People's Republic of China
| | - A Abdelrehem
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, and Shanghai Key Laboratory of Stomatology, Shanghai, People's Republic of China; Department of Craniomaxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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