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Khattak YR, Ghaffar N, Gulzar MA, Rahim S, Rafique F, Jan Z, Iqbal S, Ahmad I. Can growing patients with end-stage TMJ pathology be successfully treated with alloplastic temporomandibular joint reconstruction? - A systematic review. Oral Maxillofac Surg 2024; 28:529-537. [PMID: 37733214 DOI: 10.1007/s10006-023-01180-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023]
Abstract
INTRODUCTION The use of alloplastic total temporomandibular joint reconstruction (TMJR) in growing patients is controversial, mainly due to immature elements of the craniomaxillofacial skeleton. The aim of this systematic review was to evaluate the use of alloplastic TMJR in growing patients, focusing on the patient's clinical presentation, surgical and medical history and efficacy of alloplastic TMJR implantation. MATERIALS AND METHODS The literature search strategy was based on the Population, Intervention, Comparator, Outcomes and Study type (PICOS) framework. We searched Pubmed, Google Scholar, Dimension, Web of Science, X-mol, Semantic Scholar and Embase to January 2023, without any restriction on the type of publication reporting alloplastic TMJR in growing patients (age ≤ 18 years for boys and age ≤ 15 years for girls). RESULTS A total of 15 studies (case reports: 09, case series: 02, cohort studies: 04) met the inclusion criteria, documenting 73 patients of growing age from 07 countries. Thirty-eight (~ 52%) cases were female. The mean ± SD (range) age and follow-up of patients in all studies was 13.1 ± 3.2 (0-17) years and 34.3 ± 21.5 (7-96) months, respectively. A total of 22 (30%) patients were implanted with bilateral alloplastic TMJR. Over half of the studies (n = 10) were published in the last 3 years. All patients underwent multiple surgeries prior to implantation of alloplastic TMJR. In extreme cases, patients underwent a total of 17 surgeries. Different types of studies reporting inconsistent variables restricted our ability to perform quality assessment measures for evidence building. CONCLUSIONS Clinical experience with alloplastic TMJR in growing patients is limited to cases showing poor prognosis with other types of reconstruction. Nevertheless, studies show promising results for the use of alloplastic TMJR in growing patients, highlighting the need for well-controlled prospective studies with long-term follow-up.
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Affiliation(s)
| | | | | | - Sundas Rahim
- Peshawar Medical and Dental College, Peshawar, Pakistan
| | | | - Zainab Jan
- Institute of Radiotherapy and Nuclear Medicine (IRNUM), Peshawar, Pakistan
| | - Shaheen Iqbal
- Institute of Radiotherapy and Nuclear Medicine (IRNUM), Peshawar, Pakistan
| | - Iftikhar Ahmad
- Institute of Radiotherapy and Nuclear Medicine (IRNUM), Peshawar, Pakistan.
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Todd AR, Fitzpatrick S, Cawthorn TR, Fraulin FO, Robertson Harrop A. Iliac Crest Bone Graft Harvest for Alveolar Cleft Repair: A Systematic Review Comparing Minimally Invasive Trephine and Conventional Open Techniques. Plast Surg (Oakv) 2024; 32:78-85. [PMID: 38433788 PMCID: PMC10902489 DOI: 10.1177/22925503221088840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Background: In the course of developing a standardized pathway for alveolar cleft repair, we conducted a systematic review comparing minimally invasive trephine with conventional open technique for iliac crest bone graft harvest in a pediatric population. Methods: A systematic review was conducted of studies comparing open with minimally invasive trephine techniques in pediatric populations undergoing alveolar cleft repair. Exclusion criteria included reviews, case series, editorials, abstracts, and those with adult-only populations. Data were compiled with outcome variables selected a priori. Results: Of 422 manuscripts screened, five met criteria. These comprised 257 patients (116 open, 141 trephine). Average age was 11 years. Patients undergoing trephine harvest had reduced length of stay (1.0-5.0 days trephine vs 1.25-5.4 days open), time to unassisted ambulation (16-46 hours vs 20-67 hours open), and less postoperative narcotic use (0.31 mg/kg vs 1.64 mg/kg IV morphine). Volume of cancellous bone was reported as 2.53 mL for open versus 1.22 mL for trephine in one study, and trephine graft was supplemented with demineralized bone in 54% of cases in another study. The use of anesthetic adjuncts was inconsistent but had a significant effect on postoperative pain and ambulation. Conclusions: Compared to open techniques, the minimally invasive trephine bone graft harvest is associated with a shorter time to discharge, slightly lower infection rates, and reduced opioid use. The possible benefits of trephine harvest must however be balanced against the risk of insufficient graft harvest. Finally, the choice of perioperative analgesic adjuncts significantly impacts patient outcomes regardless of the technique employed.
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Affiliation(s)
| | | | | | - Frankie O.G. Fraulin
- University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - A. Robertson Harrop
- University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital, Calgary, Alberta, Canada
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Okoturo E. Genetic determinants of periosteum-mediated craniofacial bone regeneration: a systematic review. Arch Craniofac Surg 2023; 24:251-259. [PMID: 37584066 PMCID: PMC10766501 DOI: 10.7181/acfs.2023.00381] [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: 07/21/2023] [Revised: 07/21/2023] [Accepted: 08/01/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Periosteum-mediated bone regeneration (PMBR) is a recognized method for mandibular reconstruction. Despite its unpredictable nature and the limited degree to which it is understood, it does not share the concerns of developmental changes to donor and recipient tissues that other treatment options do. The definitive role of the periosteum in bone regeneration in any mammal remains largely unexplored. The purpose of this study was to identify the genetic determinants of PMBR in mammals through a systematic review. METHODS Our search methodology was designed in accordance with the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. We conducted a quality assessment of each publication, and evaluated the differences in gene expression between days 7 and 15. RESULTS A total of four studies satisfied the inclusion criteria. The subjects and tissues examined in these studies were Wistar rat calvaria in two studies, mini-pigs in one study, and calves and mice in one study. Three out of the four studies achieved the necessary quality score of ≥ 3. Gene expression analysis showed increased activity of genes responsible for angiogenesis, cytokine activities, and immune-inflammatory responses on day 7. Additionally, genes related to skeletal development and signaling pathways were upregulated on day 15. Conclusions: The results suggest that skeletal morphogenesis is regulated by genes associated with skeletal development, and the gene expression patterns of PMBR may be characterized by specific pathways.
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Affiliation(s)
- Eyituoyo Okoturo
- Division of Head & Neck Cancer Oral, Department of Maxillofacial Surgery, Lagos State University Teaching Hospital (LASUTH), Lagos, Nigeria
- Molecular Oncology Program, Medical Research Centre, Lagos State University College of Medicine (LASUCOM), Lagos, Nigeria
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Lai Y, Chuanqing M, Zhiyu C, Chengyong W, Meng L, Jing L, Chen WH. Comparison of two preserved cartilage iliac crest cortical-cancellous bone blocks graft harvesting techniques in children: A prospective, double-blind, randomized clinical trial. J Craniomaxillofac Surg 2023; 51:716-722. [PMID: 37821308 DOI: 10.1016/j.jcms.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/06/2023] [Accepted: 09/30/2023] [Indexed: 10/13/2023] Open
Abstract
PURPOSE To compare donor-site morbidity for alveolar bone grafting results following cartilage-preserving outer and inner cortico-cancellous iliac crest (OCIC and ICIC) bone block grafting in children. MATERIALS AND METHODS Patients were randomly divided into two groups and prospectively reviewed. In the OCIC and ICIC groups, cortico-cancellous bone blocks were harvested at outer and inner iliac crest respectively. Patient characteristics and surgical parameters were compared; pain intensity and duration, lateral femoral cutaneous nerve (LFCN) injury, gait disturbance, scar and contour satisfaction were analysed postoperatively. RESULTS Forty-nine consecutive patients (OCIC, 24; ICIC, 25) were included. There were no significant differences in patient characteristics or donor-site surgical parameters. The mean pain score on the first post-operative day was significantly lower in the OCIC group (3.75±1.70) than in the ICIC group (5.20±2.08) (p=0.012). The pain duration was similar in the two groups (median: 5 days). Temporary LFCN injury only occurred in 3 patients in the ICIC group. Postoperatively, the duck and circle gaits were observed in the OCIC and ICIC groups, respectively. There were no significant differences in the claudication duration, scar and contour satisfaction between the groups. CONCLUSION OCIC bone graft harvesting is marginally advantageous in children due to less early postoperative donor-site pain and a lower risk of nerve damage.
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Affiliation(s)
- Yongzhen Lai
- Department of Oral and Cranio-maxillofacial Science, Fujian Medical University Union Hospital, No. 28, Xinquan Road, Fuzhou City, 350001, Fujian Province, China; Stomatological Key Laboratory of Fujian College and University, Fuzhou, China
| | - Mao Chuanqing
- Department of Oral and Cranio-maxillofacial Science, Fujian Medical University Union Hospital, No. 28, Xinquan Road, Fuzhou City, 350001, Fujian Province, China
| | - Cai Zhiyu
- Department of Oral and Cranio-maxillofacial Science, Fujian Medical University Union Hospital, No. 28, Xinquan Road, Fuzhou City, 350001, Fujian Province, China
| | - Wang Chengyong
- Department of Oral and Cranio-maxillofacial Science, Fujian Medical University Union Hospital, No. 28, Xinquan Road, Fuzhou City, 350001, Fujian Province, China
| | - Lu Meng
- Department of Oral and Cranio-maxillofacial Science, Fujian Medical University Union Hospital, No. 28, Xinquan Road, Fuzhou City, 350001, Fujian Province, China
| | - Liu Jing
- Department of Stomatology, Fujian Maternal and Child Health Hospital, No 18 Dao Shan Road, Fuzhou City, 350001, Fujian Province, China
| | - Wei Hui Chen
- Department of Oral and Cranio-maxillofacial Science, Fujian Medical University Union Hospital, No. 28, Xinquan Road, Fuzhou City, 350001, Fujian Province, China.
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Kawabata H, Okuno K, Tamura D, Higuchi C, Goldfarb CA. Donor Foot Morbidity Following Nonvascularized Toe Phalanx Transfer Utilizing a New Reconstruction Technique. J Pediatr Orthop 2023:01241398-990000000-00318. [PMID: 37400088 DOI: 10.1097/bpo.0000000000002465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
BACKGROUNDS Nonvascularized toe phalanx transfer is an accepted surgical option for short and hypoplastic digits in congenital hand abnormalities. However, one of the criticisms of this technique is the donor site morbidity. The purpose of this study was to evaluate donor foot morbidity after nonvascularized toe phalanx transfer using a new donor site reconstruction technique. METHODS We retrospectively reviewed 116 nonvascularized toe phalanx transfers in 69 children between 2001 and 2020 in whom the donor foot was reconstructed with a new technique using iliac osteochondral bone graft with periosteum. Feet treated with an isolated donor proximal phalanx of the fourth toe were selected and morbidity was assessed both subjectively and objectively at a minimum of 2 years after surgery. Motion, stability, and alignment of the metatarsophalangeal joint were clinically evaluated. The relative length of the fourth toe to the third toe was measured on a roentgenogram. The satisfaction of the parents for overall function and appearance was evaluated using a visual analog scale. RESULTS Ninety-four operated feet in 65 patients, including 43 boys and 22 girls, were included. The right foot was evaluated in 52 patients and the left foot in 42 patients. The mean age at operation was 2 years and the mean follow-up period was 7.6 years. Motion at the metatarsophalangeal joint was good at 69% with an average extension of 45 degrees and flexion of 25 degrees. Stability and alignment were good at 95% and 84%, respectively. Only 4 toes had gross instability and 4 toes with poor alignment required revision surgery. Sixty-two toes (66%) maintained proportional length and 9 toes were graded as short. Parental satisfaction was high for appearance as well as function. CONCLUSIONS This newly described technique of using iliac osteochondral bone graft with periosteum to reconstruct toe phalanx donors provided satisfactory results. The function and appearance of the donor foot after a nonvascularized toe phalanx transfer was well preserved. LEVEL OF EVIDENCE Level IV; therapeutic.
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Affiliation(s)
- Hidehiko Kawabata
- Department of Orthopaedic Surgery, Osaka Rehabilitation Hospital for Children, Higashisumiyoshi-ku, Osaka
| | - Kyoko Okuno
- Department of Orthopaedic Surgery, Osaka Rehabilitation Hospital for Children, Higashisumiyoshi-ku, Osaka
| | - Daisuke Tamura
- Department of Rehabilitation Medicine, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Chikahisa Higuchi
- Department of Rehabilitation Medicine, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Charles A Goldfarb
- Department of Orthopaedic Surgery, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO
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Hashemi S, Ferraz Dos Santos B, Chiasson G. Does the Transversus Abdominis Plane Block Reduce Morbidity Following Iliac Crest Bone Harvest in Pediatric Patients With Alveolar Clefts? Cleft Palate Craniofac J 2023; 60:93-97. [PMID: 34787013 DOI: 10.1177/10556656211055008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The purpose of this study is to determine whether a Transversus Abdominis Plane (TAP) block can reduce donor site morbidity among pediatric patients undergoing iliac crest bone grafting for repair of their alveolar cleft. DESIGN This retrospective cohort study was carried out at the Division of Dentistry at the Montreal Children's Hospital. Medical charts of patients who underwent alveolar cleft bone grafting between January 2011 and January 2021 were reviewed and they were divided into two groups, intraoperative TAP block and intraoperative local anesthesia infiltration (control group). The outcomes measured were patients' post-operative pain at the donor site, in-hospital narcotics requirements and length of stay. RESULTS A total of 66 patients were included. There were no significant differences in pain scale among the TAP group and control group [1.9 (SD 2.5) and 1.3 (SD 2.1), respectively (p = 0.23)]. The mean length of stay for both groups was 1 day. Interestingly, there was a significant higher proportion of patients who required in-hospital opioids (morphine) in the TAP block group when compared to the control group (p = 0.03). CONCLUSIONS The results of our study suggest there may be no role for a TAP block in reducing pain and improving opioid stewardship.
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Affiliation(s)
- Sina Hashemi
- Resident Department of Oral and Maxillofacial Surgery, 5620McGill University, Montreal, Canada
| | - Beatriz Ferraz Dos Santos
- Division of Dentistry, 10040Montreal Children's Hospital, Montreal, Canada.,Faculty of Dentistry, 54473MUHC, McGill University, Montreal, Canada
| | - Geneviève Chiasson
- Department of Oral and Maxillofacial Surgery, McGill University Health Center, Montreal Children's Hospital, Faculty of Dentistry, 54473MUHC, McGill University, Montreal, Canada
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"Improved Success Rate with Corticocancellous Block Compared to Cancellous-only Trephine Technique in Alveolar Bone Grafting from the Iliac Crest". Plast Reconstr Surg 2022; 150:387e-395e. [PMID: 35671445 DOI: 10.1097/prs.0000000000009352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Alveolar bone grafting is an important component of cleft lip and palate treatment, with iliac crest as the most common donor site. Although studies have attempted to quantify alveolar bone graft resorption, few have directly compared the outcomes of graft techniques. This study compared the long-term success rates of corticocancellous block to trephine cancellous-only alveolar bone grafting from the iliac crest. METHODS A retrospective review of all cleft lip and palate patients undergoing alveolar bone grafting over 14 years was performed. Power analysis was performed to determine sample size. Data including patient demographics, surgical technique, need for repeat grafting, complications, length of hospitalization, and follow-up were collected. Statistical analyses of outcomes were performed based on initial graft technique. RESULTS A total of 106 initial operations met criteria, with 73 using trephine technique, 30 utilizing corticocancellous block, and 3 undergoing open cancellous harvest. The overall regraft rate was 40% with an average follow-up of 43.5 months. Patients with corticocancellous block grafting had significantly lower rates of repeat grafting compared to trephine technique (16.7% vs. 47.9%, p<0.001). There was no significant difference in complications rates or length of admission between treatment groups. CONCLUSIONS The use of corticocancellous block alveolar bone grafting demonstrated significantly higher success rates when compared to cancellous-only trephine techniques with no difference in complication rates. Although this must be weighed against the minor disadvantages of open iliac harvest, surgeons should consider incorporating en bloc corticocancellous bone to optimize outcomes in alveolar bone grafting.
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Evaluation of the Proximal Tibia as a Donor Site of Cancellous Bone for Intraoral Grafting Procedures-A Retrospective Study. J Clin Med 2022; 11:jcm11061493. [PMID: 35329821 PMCID: PMC8953495 DOI: 10.3390/jcm11061493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/02/2022] [Accepted: 03/07/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Autogenous bone grafts remain the “gold standard” in maxillofacial reconstructive procedures. The objective of this study was to evaluate the proximal tibia as a donor site of cancellous bone for bone grafting procedures of the mandible on the basis of intraoperative parameters and clinical observations. Methods: The study was based on a medical record search of 40 patients who underwent surgical procedures because of benign pathological lesions of the jaws resulting in 3-wall bone defects of the mandible and qualified for surgical removal of the lesion with simultaneous bone grafting of the defect with autogenous cancellous bone harvested from the proximal tibia. Results: The use of the proximal tibia for bone grafting procedures enables large amounts of cancellous bone (15.09 cc in average) to be obtained. The procedure is characterized by a low risk of early and late complications, which include excessive bleeding, wound infection, lengthy healing time, scars, a loss of sensation around the scars, aching, a dip in bone, swelling and tenderness. Conclusions: The ability to obtain large amounts of cancellous bone and a low risk of intra- and postoperative complications make the proximal tibia an attractive donor site for the bone grafting procedures in maxillofacial surgery.
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Systematic review of pediatric mandibular arteriovenous malformations. Int J Pediatr Otorhinolaryngol 2021; 150:110942. [PMID: 34673419 DOI: 10.1016/j.ijporl.2021.110942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 09/28/2021] [Accepted: 10/12/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The management of arteriovenous malformations (AVMs) can be challenging in the pediatric population. It is of utmost importance to keep in mind various management options as these lesions can have disastrous outcomes. This is a systematic review of the treatment AVMs describing the current practices so that practitioners can be aware of what is currently reported in the literature. The challenges of AVM management can be mitigated when approaching these patients through a multidisciplinary team-based approach. METHODS A systematic review of the literature was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to gain insight into pediatric mandibular AVMs. Demographics, arterial involvement, clinical symptoms, imaging, treatment, complications, follow-up, and outcomes were reviewed. RESULTS 63 articles were included in the systematic review with 106 distinct cases. The age range was from 3 to 17 years with a mean of 12 years. 51% of the patients were female. The most common clinical presentation was emergency hemorrhage (37.4%), swelling or edema (33.0%), and persistent bleeding (31.9%). The most common CT findings were osteolytic changes and radiolucencies (60.8%). With regards to treatment, 56.6% of patients had embolization alone and 34.9% were treated with embolization in combination with other surgical treatments. Of the patients who had surgical resection of the lesion, 50% had resection followed by reconstruction, 23.7% had curettage of the lesion, and 13.2% had resection/curettage then immediate reimplantation of the mandible segment. The most common complications after intervention included bleeding in 17.9% of patients and infection in 8.3% of patients. 89.5% of patients were clinically cured without recurrence at follow-up. CONCLUSION Diagnosing AVMs can be difficult as they have variable clinical and radiographical presentations. Although rare, because of risk of massive hemorrhage, it is important for healthcare professionals to be aware of this pathology. Many surgical techniques, routes of embolization, embolic material, and other experimental therapies have been described and this review shows that the most cases had embolization as a part of the treatment. The role of therapies targeted at the molecular level still needs to be further explored.
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Postoperative Morbidity and Complications in Elderly Patients after Harvesting of Iliac Crest Bone Grafts. MEDICINA-LITHUANIA 2021; 57:medicina57080759. [PMID: 34440965 PMCID: PMC8401410 DOI: 10.3390/medicina57080759] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 07/23/2021] [Accepted: 07/25/2021] [Indexed: 02/01/2023]
Abstract
Background and objectives: In oral and maxillofacial operations, the iliac crest is a commonly used donor site from which to harvest bone for augmentation prior to dental implantation or for reconstruction of jaw defects caused by trauma or pathological lesions. In an aging society, the proportion of elderly patients undergoing iliac crest bone grafting for oral augmentation is growing. Although postoperative morbidity is usually moderate to low, the age and health of the patient should be considered as risk factors for complications and delayed mobilization after the operation. The aim of this retrospective study was to evaluate the postoperative morbidity and complications in elderly patients after the harvesting of iliac crest bone grafts for oral surgery. Material and Methods: Data were collected from a total of 486 patients (aged 7–85) who had a surgical procedure that included the harvesting of iliac crest bone grafts for intraoral transplantation. All patients were operated on between 2005 and 2021 in the Department for Oral and Maxillofacial Surgery of the University Hospital in Aachen, Germany. As parameters for postoperative morbidity and complications, gait disturbances, hypesthesia of cutaneous nerves, incision hernias, iliac crest fractures, delayed wound healing, and unfavorable scar formation at the donor site were all evaluated. Results: The study was performed with 485 patients due to the exclusion of one patient as the only one from whom grafts were taken from both sides. When younger and older patients were compared, neither gait disturbances (p = 0.420), nor hernias (p = 0.239), nor fractures (p = 0.239), nor hypesthesia (p = 0.297), nor wound healing delay (p = 0.294), nor scar problems (p = 0.586) were significantly different. However, the volume of the graft was significantly correlated with the duration of the hospital stay (ρ = 0.30; p < 0.01) but not with gait disturbances (ρ = 0.60; p = 0.597). Additionally, when controlling for age (p = 0.841), sex (p = 0.031), ASA class (p = 0.699), preexisting orthopedic handicaps (p = 0.9828), and the volume of the bone graft (p = 0.770), only male sex was associated with the likelihood of suffering gait disturbances (p = 0.031). Conclusions: In conclusion, harvesting bone grafts from the anterior iliac crest for intraoral augmentation is a safe procedure for both young and elderly patients. Although there is some postoperative morbidity, such as gait disturbances, hypesthesia, scar formation, or delayed wound healing at the donor site, rates for these minor complications are low and mostly of short duration. Major complications, such as fractures or incision hernias, are very rare. However, in our study, the volume of the bone graft was associated with a longer stay in hospital, and this should be considered in the planning of iliac crest bone graft procedures.
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Pediatric Mandible Reconstruction: Controversies and Considerations. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3285. [PMID: 33425597 PMCID: PMC7787291 DOI: 10.1097/gox.0000000000003285] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 11/25/2022]
Abstract
Mandibular reconstruction in pediatric patients has some unique considerations. The method of reconstruction has to factor in the growth potential of the neo-mandible, the native mandible, and the donor site. The condyle is considered the main growth center of the mandible. Current literature indicates that fibula, iliac crest, and scapula osseous flaps do not have the ability to grow. Costochondral grafts exhibit growth because of the costal cartilage component, although the growth is unpredictable. Preservation of the mandibular periosteum can result in spontaneous bone regeneration. Fibula bone harvest in a child mandates close follow-up till skeletal maturity, to monitor for ankle instability and valgus deformity. Dental rehabilitation maintains occlusal relationships, which promotes normal maxillary development. Elective hardware removal should be considered to facilitate future dental implant placement and possible revision procedures. After completion of growth, if occlusion or symmetry is not satisfactory, secondary procedures can be performed, including distraction osteogenesis, orthognathic-type bone sliding operations, and segmental ostectomy.
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Narukawa M, Suzuki O, Mayahara M, Imamura E, Takagi Y, Funae T, Makino Y, Ohki R, Nakamura M. Resorption analysis of deproteinized cancellous bovine bone. Dent Mater J 2020; 39:760-765. [PMID: 32404567 DOI: 10.4012/dmj.2019-240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Commercially available deproteinized cancellous bovine bone (DPBB) has been indicated as non-absorbable bone filling materials. Stoichiometric hydroxyapatite (HA) was not resorbed by osteoclasts while calcium-deficient and carbonate-rich apatite converted from octacalcium (OCP hydrolysate) was resorbed by osteoclasts. We analyzed the chemical composition of DPBB and compared the tissue reactions around two materials after implanting into mouse bone marrow. X-ray diffraction analysis and Fourier transform infrared spectroscopy showed that DPBB was a carbonate-rich apatite. Micro-CT analysis indicated the massive bone formation on both materials at 2 weeks, then gradually resorbed. At 12 weeks, osteoclasts were directly attached to both materials. The ultrastructure of ruffled borders on DPBB was identical to osteoclasts resorbing normal bone while ruffled border on OCP hydrolysate showed irregular shape. These results indicated that DPBB was the absorbed material and that the structure of ruffled border of osteoclasts might be regulated by the size or orientation of HA.
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Affiliation(s)
- Masayuki Narukawa
- Department of Oral Anatomy and Developmental Biology, Showa University School of Dentistry
| | - Osamu Suzuki
- Division of Craniofacial Function Engineering, Tohoku University Graduate School of Dentistry
| | - Mitsuori Mayahara
- Department of Oral Anatomy and Developmental Biology, Showa University School of Dentistry
| | - Eisaku Imamura
- Department of Oral Anatomy and Developmental Biology, Showa University School of Dentistry.,Division of Oral Surgery, Yokohama General Hospital
| | - Yoshitoki Takagi
- Department of Oral Anatomy and Developmental Biology, Showa University School of Dentistry
| | - Takashi Funae
- Department of Oral Anatomy and Developmental Biology, Showa University School of Dentistry
| | - Yuusuke Makino
- Department of Oral Anatomy and Developmental Biology, Showa University School of Dentistry
| | - Retsu Ohki
- Department of Oral Anatomy and Developmental Biology, Showa University School of Dentistry
| | - Masanori Nakamura
- Department of Oral Anatomy and Developmental Biology, Showa University School of Dentistry
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Bone Augmentation Techniques for Horizontal and Vertical Alveolar Ridge Deficiency in Oral Implantology. Oral Maxillofac Surg Clin North Am 2020; 31:163-191. [PMID: 30947846 DOI: 10.1016/j.coms.2019.01.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Bone deficiency is the major obstacle in implant dentistry. Guided bone regeneration (GBR) with particulate bone and barrier membranes has been the primary surgical technique used to regenerate alveolar bone for dental implant therapy. This procedure has been used in implant dentistry for more than 30 years and continues to be developed and refined for more predictable surgical outcomes. This article reviews GBR and alternative ride expansion procedures and reviews the use of various particulate graft materials. Alveolar distraction osteogenesis, used as an augmentation technique, is also presented.
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14
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Perioperative Outcome Differences Between Pain Management Protocols in Cleft Alveolar Bone Grafting. J Craniofac Surg 2019; 31:230-233. [PMID: 31821211 DOI: 10.1097/scs.0000000000005934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Postoperative hip pain is commonly reported after anterior iliac crest harvest for alveolar bone grafting. The goal of this study is to describe our institution's experience and examine the efficacy of our pain management protocols. METHODS A retrospective review was performed by abstracting demographic, operative, and pain management data from January 2011 to April 2013. Paired t-tests and Fisher exact tests were used to examine differences when comparing 2 groups, while ANOVA was used to examine difference between the 3 protocols for harvest and pain management: trapdoor technique and local anesthetic injection (TD+LAI), TD and pain catheter (TD+PC), and split crest and LAI. RESULTS Eighty-four patients, 52 males (61.9%), averaging 8.8 years old (±2.9) were included. Postoperatively, 17 (71%) patients in the PC group received IV narcotics compared to 27 (45%) in those without a PC (P = .03). When comparing all 3 protocols, no significant difference was found in IV morphine usage or duration of IV morphine treatment. In subgroup analysis, when patients in the groups TD+PC versus TD+LAI were examined, those in the TD+PC group had significantly shorter hospital stays and were more likely to go home postoperative day 1 (P = .03; P = .04). CONCLUSIONS Overall, patients tolerated alveolar bone grafting well regardless of harvest technique or pain management approach. While indwelling PCs did not significantly decrease IV morphine usage, these patients had significantly shorter lengths of stays.
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Saha A, Shah S, Waknis P, Bhujbal P, Aher S, Vaswani V. Comparison of minimally invasive versus conventional open harvesting technique for iliac bone graft in secondary alveolar bone grafting in cleft palate patients: a systematic review. J Korean Assoc Oral Maxillofac Surg 2019; 45:241-253. [PMID: 31728331 PMCID: PMC6838348 DOI: 10.5125/jkaoms.2019.45.5.241] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/05/2019] [Accepted: 01/09/2019] [Indexed: 11/18/2022] Open
Abstract
This study evaluated and compared the donor site morbidity following minimally invasive and conventional open harvesting of iliac bone for secondary alveolar bone grafting in cleft palate patients. A thorough electronic search of PubMed, Google Scholar, EMBASE, and an institutional library and manual search of various journals was done; Inclusion criteria: 1) full-text articles using a minimally invasive or conventional open harvesting technique for iliac bone for secondary alveolar grafting in cleft palate patients and 2) articles published between January 1, 2001 and June 30, 2017 and Exclusion criteria: 1) articles published in languages other than English, 2) case reports, case series, animal studies, in vitro studies, and letters to the editor, and 3) full-text article unavailable even after writing to the authors. Preliminary screening of 274 studies excluded 223 studies for not meeting the eligibility criteria. Of the remaining 51 studies, 19 were removed for being duplicates. Of the remaining 32 studies, 15 were excluded after reading the abstract. Of the 17 studies that were left, 2 were excluded because they were in a language other than English, and 2 were excluded because the study group did not mention cleft palate patients. Thus, 13 studies providing results for a total of 654 patients were included in this qualitative synthesis. Minimally invasive bone graft harvest techniques are better than the conventional open iliac bone harvest method because they offer shorter operative time, decreased requirement for pain medications, less pain on discharge, and a shorter hospital stay.
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Affiliation(s)
- Aditi Saha
- Department of Oral and Maxillofacial Surgery, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, India
| | - Sonal Shah
- Department of Oral and Maxillofacial Surgery, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, India
| | - Pushkar Waknis
- Department of Oral and Maxillofacial Surgery, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, India
| | - Prathamesh Bhujbal
- Department of Oral and Maxillofacial Surgery, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, India
| | - Sharvika Aher
- Department of Oral and Maxillofacial Surgery, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, India
| | - Vibha Vaswani
- Department of Oral and Maxillofacial Surgery, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, India
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Sales P, Oliveira-Neto O, Torres T, de Lima F. Effectiveness of dental implants placed in bone graft area of cleft Patients. Int J Oral Maxillofac Surg 2019; 48:1109-1114. [DOI: 10.1016/j.ijom.2019.01.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/24/2018] [Accepted: 01/29/2019] [Indexed: 10/27/2022]
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Liu Q, Shao Z, Shang Z. Mandibular reconstruction using the deep circumflex iliac artery free flap: effect of the length of bone harvested on donor site morbidity. Br J Oral Maxillofac Surg 2019; 57:778-781. [PMID: 31350030 DOI: 10.1016/j.bjoms.2019.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 07/10/2019] [Indexed: 11/17/2022]
Abstract
The aim of this study was to assess the amounts of pain and morbidity that are associated with the length of the harvested anterior iliac bone graft (cm), and their effect on the contour of the donor site and activities of daily life. A total of 62 patients who had mandibular reconstruction using an iliac bone graft were enrolled in this study at the Wuhan University Hospital. The same surgical standards were used throughout. We divided the patients into two groups depending to the length of the graft (<9cm or 9cm or more). The amount and duration of the pain, the time necessary to walk normally, abnormalities of sensation, contour of the donor site, length of the scar, and the patients' satisfaction with the donor site were evaluated, and outcomes in the two groups compared. The worst pain after operation (p=0.001) the length of the scar (p=0.001), and the time needed before the patients were able to walk (p=0.001) differed significantly between the two groups. There was no significant difference between the two groups regarding other complications. The anterior iliac crest might still be considered to be an ideal donor site for large mandibular defects.
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Affiliation(s)
- Q Liu
- Department of Oral and Maxillofacial and Head and Neck Oncology, School and Hospital of Stomatology, Wuhan University, #237 Luoyu Road, Wuhan, 430079, China
| | - Z Shao
- Department of Oral and Maxillofacial and Head and Neck Oncology, School and Hospital of Stomatology, Wuhan University, #237 Luoyu Road, Wuhan, 430079, China.
| | - Z Shang
- Department of Oral and Maxillofacial and Head and Neck Oncology, School and Hospital of Stomatology, Wuhan University, #237 Luoyu Road, Wuhan, 430079, China
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Complications Associated With Anterior Iliac Bone Grafting for the Reconstruction of Dentoalveolar Defects. J Craniofac Surg 2019; 30:980-984. [PMID: 30807477 DOI: 10.1097/scs.0000000000005331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study is to evaluate donor- and recipient-site complications of iliac bone grafting for the reconstruction of atrophic jaws.Our study includes 86 consecutive patients with atrophic jaws who underwent iliac bone grafting surgery. At the donor site, hematoma, infection, paresthesia, chronic pain, prolonged gait disturbance, fracture of the ilium, and esthetic concerns; at the recipient site, hematoma, infection, prolonged pain, graft exposure, graft loss, and loss of the implants were evaluated.Grafting was successfully performed in all patients. The mean follow-up period was 35 months. Prolonged gait disturbance (20.9%) and paresthesia (9.3%) were the most frequently observed donor-site complications. At the recipient site, hematoma (8.1%), infection (12.8%), prolonged pain (11.6%), partial graft exposure (33.7%), total graft exposure (7%), partial graft loss (17.4%), and total graft loss (5.8%) were observed.Reconstruction of atrophic jaws can be achieved successfully with iliac bone grafting. However, there are possible donor- and recipient-site complications that have to be taken into consideration.
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Amin K, Khor WS, Rosich-Medina A, Beale V. Alveolar Bone Grafting: Donor Site Review of 100 Consecutive Cases in Cleft Lip and Palate. Cleft Palate Craniofac J 2017; 54:137-141. [DOI: 10.1597/15-180] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective Review of patients who underwent secondary alveolar bone grafting for total inpatient stay, postoperative complications, and postoperative analgesic requirements. Design Retrospective analysis of medical records. Setting Tertiary care center as part of a regional cleft lip and palate network. Patients All patients who underwent secondary alveolar bone grafting from the iliac crest. Interventions Local anesthetic was infiltrated overlying the anterior iliac crest. An incision was made to conform to the future skin crease and avoid muscle dissection. The cartilaginous cap was incised and raised, and cancellous bone was then harvested. The cavity was packed with hemostatic cellulose and closed in layers. All patients received postoperative antibiotics. All patients were prescribed regular paracetamol (acetaminophen) and ibuprofen if there were no contraindications. Oral morphine was available when requested. Main Outcome Measures Length of stay, postoperative analgesic requirements, and postoperative donor site and oral complications. Results From 100 consecutive patients, 92 (92%) of the patients were discharged the day after surgery; one (1%) patient required four nights of monitoring for postoperative pyrexia of unknown origin. All patients received regular paracetamol, and the majority (86%) did not require oral morphine. Complications included seroma (4%), superficial donor site abscess (1%), postoperative pyrexia of unknown origin (2%), gingival bleeding (2%), and oral infection (2%). Conclusion The findings suggest that donor site pain may be well controlled with simple, regular analgesia. Children tolerated this procedure well and were safely discharged the day after surgery. Alveolar bone grafting from the iliac crest was found to have low complication rates.
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Affiliation(s)
- Kavit Amin
- Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Wee Sim Khor
- Royal Manchester Children's Hospital, Manchester, United Kingdom
| | | | - Victoria Beale
- Royal Manchester Children's Hospital, Manchester, United Kingdom
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Indications of Free Grafts in Mandibular Reconstruction, after Removing Benign Tumors: Treatment Algorithm. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e845. [PMID: 27622113 PMCID: PMC5010336 DOI: 10.1097/gox.0000000000000832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 06/01/2016] [Indexed: 11/25/2022]
Abstract
Background: Mandibular reconstruction has been the subject of much debate and research in the fields of maxillofacial surgery and head and neck surgery. Materials and Methods: A retrospective observational study was undertaken with 14 patients diagnosed with benign tumorous pathologies and who underwent immediate mandibular resection and reconstruction at the Hospital del Salvador Maxillofacial Surgery Unit and Dr. Rodrigo Fariña’s private clinic between the years 2002 and 2012. We propose a treatment algorithm, which is previous teeth extractions in area that will be removed. Results: Fourteen patients underwent surgery, and a total of 40 dental implants were installed in 6 men and 8 women, the mean age of 33.5 (age range, 14–58 y). Reconstruction with iliac crest bone graft, and rehabilitation following this protocol (average of reconstruction was 8.7 cm), was successful with no complications at all in 12 patients. One patient had a minor complication, and the graft was partially reabsorbed because of communication of the graft with the oral cavity. This complication did not impede rehabilitation with dental implants. Another patient suffered the total loss of the graft due to infection because of dehiscence of oral mucosa and great communication with the mouth. Another iliac crest free graft reconstruction was undertaken 6 months later. Conclusions: The scientific evidence suggests that mandibular reconstruction using free grafts following the removal of benign tumors is a biologically sustainable alternative. The critical factor to improve the prognosis of free grafts reconstruction in benign tumors is to have good quality soft tissue and avoid communication with the oral cavity. For this, it is vital to do dental extractions before removing the tumor.
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Okoturo E, Ogunbanjo OV, Arotiba GT. Spontaneous Regeneration of the Mandible: An Institutional Audit of Regenerated Bone and Osteocompetent Periosteum. J Oral Maxillofac Surg 2016; 74:1660-7. [PMID: 26970145 DOI: 10.1016/j.joms.2016.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 02/11/2016] [Accepted: 02/11/2016] [Indexed: 12/16/2022]
Abstract
PURPOSE Childhood mandibular lesions are frequently benign; this allows for a conservative surgical approach to their management. Two of the most common approaches for reconstruction of acquired mandibular defects in adolescents are vascularized and nonvascularized osseous flaps or grafts. A third, less commonly used treatment option often used in developing parts of the world that some Western centers are considering as part of their treatment algorithm is spontaneous bone regeneration. This study reports on the authors' experiences with spontaneous bone formation of the resected young mandible. It also attempts to quantify any relation between spontaneous bone regeneration and an aging osteocompetent periosteum. PATIENTS AND METHODS This was a retrospective study based on consecutive data collated from records of the oral and maxillofacial surgery departments from 2 tertiary institutions. Eligible patients were no older than 18 years and had benign mandibular neoplasms. The surgical procedure was mandibulectomy with subperiosteal dissection and intermaxillary fixation. Regenerated bone evaluation was by clinical examination and periodic panoramic radiographs. RESULTS Sixteen consecutive cases with mandibular lesions were seen at the 2 institutions, 8 of which met the inclusion criteria. The average age was 10.75 years. The predominant pathology was unicystic ameloblastoma. All cases exhibited spontaneous bone regeneration, with 2 cases exhibiting "incomplete" bone regeneration. CONCLUSION Immediate reconstruction can be delayed to allow for spontaneous bone regeneration of defects in young patients. In the absence of regeneration, secondary reconstruction can be considered. Although the literature reports more young patients with bone regeneration than adults, increasing age during childhood and adolescence might not necessarily indicate a decrease in periosteal bone-regenerating potential.
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Affiliation(s)
- Eyituoyo Okoturo
- Senior Lecturer and Chief, Division of Head and Neck Surgical Oncology, Department of Oral and Maxillofacial Surgery, Lagos State University College of Medicine and Teaching Hospital, Ikeja, Lagos, Nigeria.
| | - Olabode V Ogunbanjo
- Senior Lecturer and Consultant, Department of Oral and Maxillofacial Surgery, Lagos State University College of Medicine and Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Godwin T Arotiba
- Professor and Consultant, Department of Oral and Maxillofacial Surgery, College Of Medicine University Of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
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Posnick JC, Gray JA. Is It Safe to Re-Harvest the Anterior Iliac Crest to Manage Le Fort I Interpositional Defects in Young Adults With a Repaired Cleft? J Oral Maxillofac Surg 2015; 73:S32-9. [DOI: 10.1016/j.joms.2015.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 04/09/2015] [Indexed: 11/26/2022]
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Clarke A, Flowers MJ, Davies AG, Fernandes J, Jones S. Morbidity associated with anterior iliac crest bone graft harvesting in children undergoing orthopaedic surgery: a prospective review. J Child Orthop 2015; 9:411-6. [PMID: 26438166 PMCID: PMC4619364 DOI: 10.1007/s11832-015-0698-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/19/2015] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Autologous iliac crest bone grafting is an integral part of many orthopaedic surgical procedures. Several studies have documented morbidity and prolonged pain following iliac crest bone graft harvesting in adults; however, in children there is a paucity of information. The purpose of the present study was to quantify the degree of pain and morbidity associated with anterior iliac crest graft harvesting in children undergoing non-spinal orthopaedic surgery. METHODS Patients were prospectively enrolled prior to orthopaedic surgery. A patient self-reported visual analogue score was used to record pain at specified time points following surgery. In addition, the patients were reviewed at 2 and 6 weeks, 3 months and 1 year after surgery to record any complications. RESULTS Data was collected on 33 patients (34 graft sites). Only one patient (2.94 %) had a complication, namely an injury to the lateral femoral cutaneous nerve. This resolved 3 months after surgery. 89 % of patients had no pain at the iliac crest graft harvest site 3 months after surgery. The three patients who had pain at 3 months had visual analogue scores of 1.0, 1.1 and 1.3, respectively. CONCLUSION This series reveals a very low complication rate and minimal iliac crest graft harvest site pain in children undergoing non-spinal orthopaedic surgery. In addition, the pain experienced is short-lived.
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Affiliation(s)
- A Clarke
- Department of Orthopaedics, Sheffield Children's Hospital, Sheffield, UK
| | - M J Flowers
- Department of Orthopaedics, Sheffield Children's Hospital, Sheffield, UK
| | - A G Davies
- Department of Orthopaedics, Sheffield Children's Hospital, Sheffield, UK
| | - J Fernandes
- Department of Orthopaedics, Sheffield Children's Hospital, Sheffield, UK
| | - S Jones
- Department of Orthopaedics, Al Ahli Hospital, Doha, Qatar.
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Theologie-Lygidakis N, Chatzidimitriou K, Tzerbos F, Kolomvos N, Iatrou I. Development of surgical techniques of secondary osteoplasty in cleft patients following 12 years experience. J Craniomaxillofac Surg 2014; 42:839-45. [DOI: 10.1016/j.jcms.2013.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 09/05/2013] [Accepted: 12/17/2013] [Indexed: 11/16/2022] Open
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Vura N, Reddy K R, R S, G R, Kaluvala VR. Donor site evaluation: anterior iliac crest following secondary alveolar bone grafting. J Clin Diagn Res 2014; 7:2627-30. [PMID: 24392424 DOI: 10.7860/jcdr/2013/7501.3632] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 10/14/2013] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The use of autogenous bone graft for Secondary alveolar bone grafting is well established in the treatment of cleft lip and palate patients. AIMS AND OBJECTIVES To evaluate post-operative morbidity of anterior iliac crest graft after secondary alveolar bone grafting in cleft patients. MATERIAL AND METHODS Forty patients during the period from July 2008 to March 2013, who underwent secondary alveolar bone grafting by harvesting graft from anterior iliac crest in Mamata Dental Hospital, Khammam, Andhra Pradesh, India are included in the present study. Unilateral and bilateral cleft patients who had undergone secondary alveolar bone grafting (SABG) with anterior iliac crest as their donor site have been selected and post- operative complications from the surgery were evaluated with the help of a questionnaire which included pain, gait disturbances, numbness and scar problems (infection, irritation). RESULTS Patients who were operated gave maximum score for pain as 8 on visual analogue scale. No pain was observed in any of the cases after 8 days, gait disturbances were seen in all patients (limping) for 2-6 days, there was no post-operative numbness with all the patients returning to their routine in 6- 15 days and 90% of the patients gave a satisfied response towards scar. CONCLUSION From the results in our study the morbidity after harvesting bone from iliac crest was found to be moderate to low, which had minimal complications and were well tolerated and greater acceptance from the patient.
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Affiliation(s)
- Nandagopal Vura
- Professor, Department of Oral and Maxillofacial Surgery, Mamata Dental College , Khammam, India
| | - Rajiv Reddy K
- Reader, Department of Oral and Maxillofacial Surgery, Mamata Dental College , Khammam, Andhrapradesh, India
| | - Sudhir R
- Reader, Department of Oral and Maxillofacial Surgery, Mamata Dental College , Khammam, Andhrapradesh, India
| | - Rajasekhar G
- Professor and Head, Department of Oral and Maxillofacial Surgery, Mamata Dental College , Khammam, Andhrapradesh, India
| | - Varun Raja Kaluvala
- Post Graduate, Department of Oral and Maxillofacial Surgery, Mamata Dental College , Khammam, Andhrapradesh, India
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Iatrou I, Theologie-Lygidakis N, Tzerbos F, Schoinohoriti O. Oro-facial tumours and tumour-like lesions in Greek children and adolescents: An 11-year retrospective study. J Craniomaxillofac Surg 2013; 41:437-43. [DOI: 10.1016/j.jcms.2012.11.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Revised: 11/13/2012] [Accepted: 11/14/2012] [Indexed: 10/27/2022] Open
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Kupfer P, Abbott MM, Abramowicz S, Meara JG, Padwa BL. Cost Differences Between the Anterior and Posterior Approaches to the Iliac Crest for Alveolar Bone Grafting in Patients With Cleft Lip/Palate. J Oral Maxillofac Surg 2012; 70:685-9. [DOI: 10.1016/j.joms.2011.04.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 04/15/2011] [Accepted: 04/19/2011] [Indexed: 11/16/2022]
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Theologie-Lygidakis N, Telona P, Michail-Strantzia C, Iatrou I. Treatment of central giant-cell granulomas of the jaws in children: Conservative or radical surgical approach? J Craniomaxillofac Surg 2011; 39:639-44. [DOI: 10.1016/j.jcms.2010.11.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 10/11/2010] [Accepted: 11/26/2010] [Indexed: 11/26/2022] Open
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Dimitriou R, Mataliotakis GI, Angoules AG, Kanakaris NK, Giannoudis PV. Complications following autologous bone graft harvesting from the iliac crest and using the RIA: a systematic review. Injury 2011; 42 Suppl 2:S3-15. [PMID: 21704997 DOI: 10.1016/j.injury.2011.06.015] [Citation(s) in RCA: 533] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Bone grafting is a commonly performed surgical procedure to augment bone regeneration in a variety of cases in orthopaedic and maxillofacial surgery. Autologous bone graft remains to be the 'gold standard' and the iliac crest to be the most common harvesting site. The intramedullary canal of long bones represents another potential site for large volume of autologous bone graft harvesting and is recently being used as an alternative donor site. However, harvesting of autologous bone graft is associated with morbidity and a number of complications. The aim of this systematic review was to collect and summarise the existing data on reported complications after harvesting autologous bone from the iliac crest (anterior and posterior) and the long bone intramedullary canal using the RIA device. We searched the PubMed Medline and Ovid Medline databases, from January 1990 to October 2010, to retrieve all relevant articles. A total of 92 articles (6682 patients) were included in the analysis. Overall, the complication rate following RIA was 6% (14 complications in 233 patients) and 19.37% after iliac crest bone graft harvesting (1249 complications in 6449 patients). The rate of each of the reported complications was assessed and, when the donor site was properly documented, comparison within the anterior and posterior iliac crest donor sites was performed. Although the difference of the overall morbidity rates between the two harvesting sites was not statistically significant (p=0.71); the rates of certain complications were found to significantly differ when anterior or posterior iliac crest was used. The rates of infection (p=0.016), haematoma formation (p=0.002), fracture (p=0.017), and hyperthrophic scar (p=0.017) were significantly higher when the donor site was the anterior iliac crest compared to the posterior iliac crest; whereas the rates of chronic donor site pain (p=0.004) and sensory disturbances (p=0.003) were significantly lower. The incidence of bone graft harvesting related complications can be reduced further if certain principles are followed depending on the performed harvesting methods; but overall the use of RIA device as harvesting method seems a promising alternative with a low complication rate.
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Affiliation(s)
- Rozalia Dimitriou
- Department of Trauma and Orthopaedic Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Microvascular bone grafting: A new long-term solution for intraosseous arteriovenous malformations of the mandible in children. J Craniomaxillofac Surg 2011; 39:431-4. [DOI: 10.1016/j.jcms.2010.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 04/07/2010] [Accepted: 05/14/2010] [Indexed: 11/19/2022] Open
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Reply. Plast Reconstr Surg 2010. [DOI: 10.1097/prs.0b013e3181ef91bb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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