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Crosetti E, Tos P, Berrone M, Battiston B, Arrigoni G, Succo G. Long-Term Follow-Up of Computer-Assisted Microvascular Mandibular Reconstruction: A Retrospective Study. J Clin Med 2024; 13:3899. [PMID: 38999465 PMCID: PMC11242570 DOI: 10.3390/jcm13133899] [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: 04/29/2024] [Revised: 06/27/2024] [Accepted: 06/28/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Virtual surgical planning has become a well-established practice in head and neck surgery. In oncological surgery, it permits the achievement of safe margins resections and ensures functional reconstructions and optimal esthetic outcomes. This study aimed to evaluate the long-term outcomes after virtually planned mandibular microvascular reconstruction, focusing on functional and esthetic results, as well as health-related quality of life. Methods: A long-term retrospective evaluation of 17 patients with oral cavity malignancy who underwent computer-assisted mandibular resection and reconstruction was performed. Functional and esthetic outcomes were analyzed using the EORTC, QLQ-C30, H&N35, and FACE-Q questionnaires. Results: Time since reconstruction ranged from 7 to 14 years. Patients reported high functional levels on the QLQ-C30 functional scales but lower scores on H&N35. On FACE-Q, patients demonstrated higher appraisal and satisfaction with their smiles compared to their overall facial appearance. Conclusions: In this retrospective case series, patients undergoing computer-assisted mandibular reconstruction for oral malignancies achieved good long-term functional and esthetic outcomes. Although limited by the small sample size, these results support the enduring benefits of virtual planning for mandibular reconstruction. To minimize declines in function and appearance, considerations should include immediate dental implants, enhanced reconstruction of the temporomandibular joint, newer methods of radiotherapy to minimize xerostomia, and oral exercises to prevent trismus.
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Affiliation(s)
- Erika Crosetti
- ENT Clinic-Head and Neck Cancer Unit, San Giovanni Bosco Hospital, 10154 Turin, Italy
| | - Pierluigi Tos
- Hand Surgery-Reconstructive Microsurgery Clinic, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, 20122 Milan, Italy
| | - Mattia Berrone
- ENT Clinic-Head and Neck Cancer Unit, San Giovanni Bosco Hospital, 10154 Turin, Italy
| | - Bruno Battiston
- Hand Surgery and Reconstructive Microsurgery Department, CTO Hospital, A.O.U. Città della Salute e della Scienza, 10126 Turin, Italy
| | - Giulia Arrigoni
- ENT Clinic-Head and Neck Cancer Unit, San Giovanni Bosco Hospital, 10154 Turin, Italy
| | - Giovanni Succo
- ENT Clinic-Head and Neck Cancer Unit, San Giovanni Bosco Hospital, 10154 Turin, Italy
- Department of Oncology, University of Turin, 10127 Turin, Italy
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Kumar VV, Ebenezer S, Viswanath S, Thor A. One-stage prosthodontically driven jaw reconstruction in patients with benign and malignant pathologies: A 7- to 11-year cohort study. Clin Oral Implants Res 2024. [PMID: 38953771 DOI: 10.1111/clr.14322] [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: 01/02/2024] [Revised: 05/28/2024] [Accepted: 06/18/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVES One stage functional jaw reconstruction is defined as the resection and reconstruction of segmental defects in conjunction with the placement of dental implants in an ideal prosthetic position and loaded with a provisional restoration, during one surgical procedure. The aim of the study is to describe clinical outcomes of patients who underwent one stage functional jaw reconstruction. METHODS Patients who underwent one-stage functional jaw reconstruction, from January 2013 to March 2016 were recalled in 2022 and 2023. Planning and execution for the reconstruction utilized either analogue or digital techniques. Outcome parameters recorded were treatment-related outcomes at patient level, implant-related outcomes and patient-reported outcome measures. RESULTS Eighteen patients underwent one-stage jaw reconstruction with a total of 57 implants. Four patients had maxillary and 14 had mandibular reconstructions. Ten patients underwent postoperative radiotherapy. Ten patients were planned using analogue and eight by digital planning. Three patients had partial flap necrosis, three patients had plate fractures, implant loss was seen in one patient and four patients died during the period. A functional prosthesis was provided in 16 out of the 18 patients. CONCLUSION One-stage functional jaw reconstruction is a predictable method for providing rehabilitation with successful outcomes at 7-11 years. However, caution should be exercised when the treatment modality is carried out in patients with malignant pathologies who have undergone radiotherapy.
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Affiliation(s)
- Vinay V Kumar
- Oral Rehabilitation Center, Bangalore, India
- Plastic & Oral and Maxillofacial Surgery, Uppsala University, Uppsala, Sweden
- Division of Surgical Sciences, Department of Odontlogy Maxillofacial Surgery, Uppsala University, Uppsala, Sweden
| | | | | | - Andreas Thor
- Plastic & Oral and Maxillofacial Surgery, Uppsala University, Uppsala, Sweden
- Division of Surgical Sciences, Department of Odontlogy Maxillofacial Surgery, Uppsala University, Uppsala, Sweden
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Kumar VV, Venkat S, Jacob PC, Khemeria G. Rehabilitation of Reconstructed Maxilla Using Denture-Guided Epithelial Regeneration in DCIA Flap: 10-Year Follow-Up. J Maxillofac Oral Surg 2024; 23:639-643. [PMID: 38911398 PMCID: PMC11189883 DOI: 10.1007/s12663-023-01900-z] [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: 01/02/2023] [Accepted: 03/06/2023] [Indexed: 03/29/2023] Open
Abstract
This 10-year follow-up report describes the interdisciplinary comprehensive management of a patient with aneurysmal bone cyst of the maxilla in a 24-year-old patient. The treatment included resection and primary reconstruction with vascularized deep circumflex iliac artery-based composite free flap, implant placement, and peri-implant soft tissue management using denture-guided epithelial regeneration with interim dentures. Definitive management was done using implant-supported cast partial dentures, and the patient followed up for 10 years.
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Affiliation(s)
- Vinay V. Kumar
- Oral Rehabilitation Center, 9 Osborne Road, Sivanchetti Gardens, Bengaluru, KA 560042 India
- Department of Surgical Sciences, Odontology and Maxillofacial Surgery, Medical Faculty, Uppsala University, Uppsala, Sweden
| | - Sainath Venkat
- Department of Maxillofacial Prosthetics, Sri Shankara Cencer Hospital and Research Center, Bengaluru, 560004 India
| | - P. C. Jacob
- Ora Care Dental Clinic, Coles Road, Bengaluru, 560005 India
| | - Gaurav Khemeria
- Oral Rehabilitation Center, 9 Osborne Road, Sivanchetti Gardens, Bengaluru, KA 560042 India
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Jehn P, Korn P, Spalthoff S, Schiller M, Lentge F, Bolstorff I, Tavassol F, Gellrich NC, Rahlf B. Dental rehabilitation in irradiated oral cancer patients using patient-specific dental implants - Clinical outcome and oral health-related quality of life. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101674. [PMID: 37913993 DOI: 10.1016/j.jormas.2023.101674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 10/28/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION Dental rehabilitation in oral cancer patients is essential for good oral health-related quality of life (OHRQoL). Patient-specific dental implants are suitable for treating tumor-related bony defects, resulting in satisfactory OHRQoL. However, knowledge concerning the clinical outcome and OHRQoL following tumor irradiation is lacking. MATERIAL AND METHODS A retrospective analysis was carried out to evaluate clinical outcomes and OHRQoL in eight patients who received patient-specific dental implants and implant-supported dentures after surgical treatment for oral cancer with additional irradiation. OHRQoL assessment was performed using the German long version of the oral health impact profile (OHIP) questionnaire (OHIP-G53). RESULTS Clinical examination revealed successful dental rehabilitation in all the patients with only minor impairments. Restricted stability and function of implants were not observed. OHIP sum-scores of all the patients indicated acceptable OHRQoL, but this varied between patients treated in the upper or lower jaw. Single-item sum-scores concerning the adverse events "difficulty in chewing," "food catching," "sore jaw," "sore spots," and "unclear speech" were detected to be the worst, and pain-related OHIP dimensions demonstrated the highest scores (followed by functional limitation, physical disability, and psychosocial impact) with a worse OHRQoL following lower jaw treatment. Other dimension sum-scores were overall lower and nearly equally distributed in patients. CONCLUSIONS Dental rehabilitation of irradiated oral cancer patients using patient-specific dental implants may be suitable, leading to acceptable OHRQoL. However, implant insertion in the upper jaw seems to be more favorable. Further studies on patient-specific dental implants are warranted to validate the current results.
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Affiliation(s)
- Philipp Jehn
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - Philippe Korn
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Simon Spalthoff
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Marcus Schiller
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Fritjof Lentge
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Inga Bolstorff
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Frank Tavassol
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Nils-Claudius Gellrich
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Björn Rahlf
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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Latifi F, Tabrizi R, Hosseinikordkheili M. How does the Number of Implants Affect Stress Distribution in Fibula Graft at the Posterior of the Mandible? A Finite Element Analysis. J Maxillofac Oral Surg 2023; 22:304-312. [PMID: 37122787 PMCID: PMC10130298 DOI: 10.1007/s12663-022-01743-0] [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: 06/16/2021] [Accepted: 05/26/2022] [Indexed: 10/17/2022] Open
Abstract
Objectives Evidence about the implant protocol and success in the osseous microvascular grafts is not sufficient. Stress distribution around dental implants is one of the important factors determining treatment success. The purpose of this study was to evaluate stress distribution in the bone supporting the implants inserted in the fibula free flap, in patients with large defects in the posterior of the mandible by finite element analysis (FEA). Materials and Methods The CBCT was obtained from one patient with fibula free flap in the posterior of the mandible and also from a 4.1 × 10 mm implant (Zimmer, Zimmer dental, Carlsbad, USA). Two 3D finite models were designed containing three or four implants. The implants were splinted by a suprastructure. Vertical load (300 N) and oblique load (50 N) were applied to the suprastructure. The von Mises stress distribution and the micromotion of implants were evaluated. Results No significant difference was observed between implants micromotion in two models. According to stress distribution analysis and determining maximum stress regions, the model with four implants imposes more stress on titanium components and surrounding bone. Conclusion The stress distribution around the implants of mandibular models with posterior defect that was reconstructed with fibula free flap is better in models with three fixtures versus four fixtures.
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Affiliation(s)
- Fatemeh Latifi
- Department of Oral and Maxillofacial Surgery, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Tabrizi
- Department of Oral and Maxillofacial Surgery, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Shankar RK, Raza FB, Kumar VA. Quality of Life with the Rehabilitation After Partial Mandibulectomy: a Systematic Review. Indian J Surg Oncol 2023; 14:292-300. [PMID: 37324294 PMCID: PMC10267093 DOI: 10.1007/s13193-022-01664-x] [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: 03/25/2022] [Accepted: 10/03/2022] [Indexed: 06/17/2023] Open
Abstract
To evaluate the QoL before and after prosthetic rehabilitation of partial mandibulectomy patients based on the type of surgery, effects of radiation, the type of prosthesis, and to enlist their outcome on the rehabilitation. Literature search as per PICO format was carried out within a time range from January 2000 to June 2021. The review followed PRISMA guidelines and registered with the PROSPERO(CRD42021258472). The focus question was established as per the PICO format (Population, Intervention, Comparison, Outcome). The population involved partial mandibulectomy individuals with prosthetic rehabilitation as an intervention. The outcome, quality of life (QoL), was compared with the pre and post partial mandibulectomy patients rehabilitated with a prosthesis. The search yielded 367 articles and based on the search criteria only 7 articles were suitable for qualitative analysis. Marginal resection of the mandible is less aggressive than segmental resection which provided function, phonation, and esthetics at acceptable levels but the food mixing ability was reduced when resection is accompanied by glossectomy. However, the perceived chewing ability and OHRQoL were not accountable to the extent of surgical excision. An overall increase in the QoL on rehabilitation with acrylic prosthesis depicting satisfactory functionality with a considerable improvement in mastication, speech, and social life. QoL and Denture Satisfaction Index did not differ based on the number of implants in an implant overdenture prosthesis, but the chewing ability was improved. An increase in the number of remaining occlusal units improved the overall QoL. Restoration of the function, psychological comfort, and improvement in esthetics was significant in patients who underwent prosthetic rehabilitation. The QoL between conventional and implant prostheses was observed to be more similar, and the effect of remaining hard and soft tissue structures has a major influence on patient comfort signifying the influence of the extent of surgical excision. Supplementary Information The online version contains supplementary material available at 10.1007/s13193-022-01664-x.
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Affiliation(s)
- R. Kirupa Shankar
- Department of Prosthodontics, Faculty of Dental Sciences, Sri Ramchandra Institute of Higher Education & Research (SRIHER), Porur, Chennai 600116 India
| | - Fathima Banu Raza
- Department of Prosthodontics, Faculty of Dental Sciences, Sri Ramchandra Institute of Higher Education & Research (SRIHER), Porur, Chennai 600116 India
| | - V. Anand Kumar
- Department of Prosthodontics, Faculty of Dental Sciences, Sri Ramchandra Institute of Higher Education & Research (SRIHER), Porur, Chennai 600116 India
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Pamias-Romero J, Saez-Barba M, de-Pablo-García-Cuenca A, Vaquero-Martínez P, Masnou-Pratdesaba J, Bescós-Atín C. Quality of Life after Mandibular Reconstruction Using Free Fibula Flap and Customized Plates: A Case Series and Comparison with the Literature. Cancers (Basel) 2023; 15:cancers15092582. [PMID: 37174048 PMCID: PMC10177401 DOI: 10.3390/cancers15092582] [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: 03/27/2023] [Revised: 04/18/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
A single-center retrospective study was conducted to assess health-related quality of life (HRQoL) in 23 consecutive patients undergoing mandibular reconstruction using the computer-aided design (CAD) and computer-aided manufacturing (CAM) technology, free fibula flap, and titanium patient-specific implants (PSIs). HRQoL was evaluated after at least 12 months of surgery using the University of Washington Quality of Life (UW-QOL) questionnaire for head and neck cancer patients. In the 12 single question domains, the highest mean scores were found for "taste" (92.9), "shoulder" (90.9), "anxiety" (87.5), and "pain" (86.4), whereas the lowest scores were observed for "chewing" (57.1), "appearance" (67.9), and "saliva" (78.1). In the three global questions of the UW-QOL questionnaire, 80% of patients considered that their HRQoL was as good as or even better than it was compared to their HRQoL before cancer, and only 20% reported that their HRQoL had worsened after the presence of the disease. Overall QoL during the past 7 days was rated as good, very good or outstanding by 81% of patients, respectively. No patient reported poor or very poor QoL. In the present study, restoring mandibular continuity with free fibula flap and patient-specific titanium implants designed with the CAD-CAM technology improved HRQoL.
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Affiliation(s)
- Jorge Pamias-Romero
- Service of Oral and Maxillofacial Surgery, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, E-08035 Barcelona, Spain
- CIBBM-Nanomedicine, Noves Tecnologies i Microcirurgia Craniofacial, Vall d'Hebron Institut de Reserca (VHIR), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, E-08035 Barcelona, Spain
| | - Manel Saez-Barba
- Service of Oral and Maxillofacial Surgery, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, E-08035 Barcelona, Spain
- CIBBM-Nanomedicine, Noves Tecnologies i Microcirurgia Craniofacial, Vall d'Hebron Institut de Reserca (VHIR), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, E-08035 Barcelona, Spain
| | - Alba de-Pablo-García-Cuenca
- Service of Oral and Maxillofacial Surgery, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, E-08035 Barcelona, Spain
- CIBBM-Nanomedicine, Noves Tecnologies i Microcirurgia Craniofacial, Vall d'Hebron Institut de Reserca (VHIR), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, E-08035 Barcelona, Spain
| | - Pablo Vaquero-Martínez
- Service of Oral and Maxillofacial Surgery, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, E-08035 Barcelona, Spain
- CIBBM-Nanomedicine, Noves Tecnologies i Microcirurgia Craniofacial, Vall d'Hebron Institut de Reserca (VHIR), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, E-08035 Barcelona, Spain
| | - Joan Masnou-Pratdesaba
- Radiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, E-08035 Barcelona, Spain
| | - Coro Bescós-Atín
- Service of Oral and Maxillofacial Surgery, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, E-08035 Barcelona, Spain
- CIBBM-Nanomedicine, Noves Tecnologies i Microcirurgia Craniofacial, Vall d'Hebron Institut de Reserca (VHIR), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, E-08035 Barcelona, Spain
- Unitat Docent Vall d'Hebron, Facultat de Medicina UAB, Universitat Autònoma de Barcelona, E-08035 Barcelona, Spain
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Rao D, Weyh A, Bunnell A, Hernandez M. The Role of Imaging in Mandibular Reconstruction with Microvascular Surgery. Oral Maxillofac Surg Clin North Am 2023:S1042-3699(23)00002-X. [PMID: 37032176 DOI: 10.1016/j.coms.2023.01.002] [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: 04/11/2023]
Abstract
Imaging plays a critical role in the diagnosis, staging, and management of segmental mandibular defects. Imaging allows mandibular defects to be classified which aids in microvascular free flap reconstruction. This review serves to complement the surgeon's clinical experience with image-based examples of mandibular pathology, defect classification systems, reconstruction options, treatment complications, and Virtual Surgical Planning.
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Affiliation(s)
- Dinesh Rao
- Department of Radiology, University of Florida, College of Medicine, 655 West 8th Street, Jacksonville, FL 32209, USA.
| | - Ashleigh Weyh
- Department of Oral and Maxillofacial Surgery, University of Florida, College of Medicine, 655 West 8th Street, Jacksonville, FL 32209, USA
| | - Anthony Bunnell
- Department of Oral and Maxillofacial Surgery, University of Florida, College of Medicine, 655 West 8th Street, Jacksonville, FL 32209, USA
| | - Mauricio Hernandez
- Department of Radiology, University of Florida, College of Medicine, 655 West 8th Street, Jacksonville, FL 32209, USA
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"Spin" in Plastic Surgery Randomized Controlled Trials with Statistically Nonsignificant Primary Outcomes: A Systematic Review. Plast Reconstr Surg 2023; 151:506e-519e. [PMID: 36442055 DOI: 10.1097/prs.0000000000009937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND "Spin" refers to a manipulation of language that implies benefit for an intervention when none may exist. Randomized controlled trials (RCTs) in other fields have been demonstrated to employ spin, which can mislead clinicians to use ineffective or unsafe interventions. This study's objective was to determine the strategies, severity, and extent of spin in plastic surgery RCTs with nonsignificant primary outcomes. METHODS A literature search of the top 15 plastic surgery journals using MEDLINE was performed (2000 through 2020). Parallel 1:1 RCTs with a clearly identified primary outcome showing statistically nonsignificant results ( P > 0.05) were included. Screening, data extraction, and spin analysis were performed by two independent reviewers. The spin analysis was then independently assessed in duplicate by two plastic surgery residents with graduate-level training in clinical epidemiology. RESULTS From 3497 studies identified, 92 RCTs were included in this study. Spin strategies were identified in 78 RCTs (85%), including 64 abstracts (70%) and 77 main texts (84%). Severity of spin was rated moderate or high in 43 abstract conclusions (47%) and 42 main text conclusions (46%). The most identified spin strategy in the abstract was claiming equivalence for statistically nonsignificant results (26%); in the main text, focusing on another objective (24%). CONCLUSIONS This study suggests that 85% of statistically nonsignificant RCTs in plastic surgery employ spin. Readers of plastic surgery research should be aware of strategies, whether intentional or unintentional, used to manipulate language in reports of statistically nonsignificant RCTs when applying research findings to clinical practice.
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What is the Incidence of Oral Cancer Recurrence in Patients Reconstructed With a Microvascular Free Flap, Endosseous Implants, and an Oral Prosthesis and How Does the Timing of Implant Placement Influence Recurrence? J Oral Maxillofac Surg 2023; 81:120-128. [PMID: 36209893 DOI: 10.1016/j.joms.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/26/2022] [Accepted: 09/06/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE In patients with malignant oral disease, there is concern that immediate implant placement at the time of ablative and microvascular free flap surgery can contribute to tumor recurrence or delay the diagnosis of recurrence. The purpose of this study is to 1) estimate the incidence of recurrence in patients with malignant disease treated with immediate microvascular free flap reconstruction, endosseous implants, and an oral prosthesis, 2) measure and compare the timing of implant placement, immediate versus delayed, and the time to complete oral rehabilitation, and 3) measure the association between the timing of implant placement and tumor recurrence. MATERIALS AND METHODS This is a retrospective cohort study utilizing medical record analysis involving patients with malignant oral cancer undergoing tumor resection and immediate microvascular reconstruction from 1996 to 2019 at the Mayo Clinic, Rochester, MN by the Division of Oral and Maxillofacial Surgery. Additional inclusion criteria comprised of immediate or delayed endosseous implant placement, the fabrication of an oral prosthesis, and a minimum of 2-year follow-up. Data on patient demographics, tumor characteristics, timing of implant placement and prosthesis loading, type of prosthesis, tumor recurrence, or second primary tumor events were analyzed. RESULTS Thirty-three patients with a mean follow-up of 6.4 years were included. Twenty-four patients (72.7%) were diagnosed with squamous cell carcinoma with 3 patients experiencing tumor recurrence. Fifteen patients had immediate implant placement while 18 patients had delayed implant placement. The mean number of days to prosthetic loading of the implants was 680.4 days and 330.1 days for the delayed implant group and immediate implant group, respectively, which was statistically significant (P = .004). The timing of implant placement and the event of a recurrence were not statistically significant (P = .075). CONCLUSION The incidence of recurrence in patients with malignant oral cancer treated with microvascular reconstruction, endosseous implants, and an oral prosthesis was 12.5% with one recurrence occurring beneath the oral prosthesis. Delayed implant placement resulted in a statistically significant delay in the completion of oral rehabilitation compared to immediate implant placement. There was no difference in the incidence of recurrence in the immediate implant group compared to the delayed implant group.
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Salinero L, Boczar D, Barrow B, Berman ZP, Diep GK, Trilles J, Howard R, Chaya BF, Rodriguez Colon R, Rodriguez ED. Patient-centred outcomes and dental implant placement in computer-aided free flap mandibular reconstruction: a systematic review and meta-analysis. Br J Oral Maxillofac Surg 2022; 60:1283-1291. [PMID: 36280538 DOI: 10.1016/j.bjoms.2022.09.006] [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: 06/29/2022] [Accepted: 09/22/2022] [Indexed: 12/31/2022]
Abstract
Computerised surgical planning (CSP) and computer-aided design and manufacturing (CAD/CAM) have been demonstrated to increase surgical accuracy and reduce operative time in free flap mandibular reconstruction, but evidence is lacking as to their impact on patient-centred outcomes. Implant-supported dental prostheses, however, have been associated with improved quality of life outcomes following free flap mandibular reconstruction. We aim to review reported patient-centred outcomes in mandibular reconstruction with CSP and CAD/CAM and determine whether use of these technologies is associated with higher rates of dental implant placement following free flap mandibular reconstruction. On December 20, 2020, a systematic review and meta-analysis were conducted according to PRISMA guidelines for studies reporting quality of life, functional outcomes, and rates of dental implant placement in computer-aided free flap mandibular reconstruction. A random-effects meta-analysis was performed to compare dental implant placement rates between surgeries using CSP and those using conventional freehand techniques. A total of 767 articles were screened. Nine articles reporting patient-centred outcomes and 16 articles reporting dental implant outcomes were reviewed. Of those reporting dental implant outcomes, five articles, representing a total of 302 cases, were included in the meta-analysis. Use of CSP was associated with a significant increase in the likelihood of dental implant placement, with an odds ratio of 2.70 (95% CI 1.52 to 4.79, p = 0.0007). Standardised reporting methods and controlled studies are needed to further investigate the impact of CSP and CAD/CAM technologies on functional outcomes and patient-reported quality of life in free flap mandibular reconstruction. Use of CSP and CAD/CAM technologies is associated with higher rates of dental implant placement in patients undergoing free flap mandibular reconstruction when compared to conventional freehand techniques.
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Affiliation(s)
- Lauren Salinero
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 222 E 41st Street, New York, NY, USA
| | - Daniel Boczar
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 222 E 41st Street, New York, NY, USA
| | - Brooke Barrow
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 222 E 41st Street, New York, NY, USA
| | - Zoe P Berman
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 222 E 41st Street, New York, NY, USA
| | - Gustave K Diep
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 222 E 41st Street, New York, NY, USA
| | - Jorge Trilles
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 222 E 41st Street, New York, NY, USA
| | - Rachel Howard
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 222 E 41st Street, New York, NY, USA
| | - Bachar F Chaya
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 222 E 41st Street, New York, NY, USA
| | - Ricardo Rodriguez Colon
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 222 E 41st Street, New York, NY, USA
| | - Eduardo D Rodriguez
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 222 E 41st Street, New York, NY, USA.
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Virtual Surgical Planning and Customized Subperiosteal Titanium Maxillary Implant (CSTMI) for Three Dimensional Reconstruction and Dental Implants of Maxillary Defects after Oncological Resection: Case Series. J Clin Med 2022; 11:jcm11154594. [PMID: 35956210 PMCID: PMC9369575 DOI: 10.3390/jcm11154594] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/29/2022] [Accepted: 07/31/2022] [Indexed: 11/17/2022] Open
Abstract
Maxillectomies cause malocclusion, masticatory disorders, swallowing disorders and poor nasolabial projection, with consequent esthetic and functional sequelae. Reconstruction can be achieved with conventional approaches, such as closure of the maxillary defect by microvascular free flap surgery or prosthetic obturation. Four patients with segmental maxillary defects that had been reconstructed with customized subperiosteal titanium maxillary implants (CSTMI) through virtual surgical planning (VSP), STL models and CAD/CAM titanium mesh were included. The smallest maxillary defect was 4.1 cm and the largest defect was 9.6 cm, with an average of 7.1 cm. The reconstructed maxillary vertical dimension ranged from 9.3 mm to 17.4 mm, with a mean of 13.17 mm. The transverse dimension of the maxilla at the crestal level was attempted to be reconstructed based on the pre-excision CT scan, and these measurements ranged from 6.5 mm in the premaxilla area to 14.6 mm at the posterior level. All patients were rehabilitated with a fixed prosthesis on subperiosteal implants with good esthetic and functional results. In conclusion, we believe that customized subperiosteal titanium maxillary implants (CSTMI) are a safe alternative for maxillary defects reconstruction, allowing for simultaneous dental rehabilitation while restoring midface projection. Nonetheless, prospective and randomized trials are required with long-term follow-up, to assess its long-term performance and safety.
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Sozzi D, Filippi A, Canzi G, De Ponti E, Bozzetti A, Novelli G. Surgical Navigation in Mandibular Reconstruction: Accuracy Evaluation of an Innovative Protocol. J Clin Med 2022; 11:jcm11072060. [PMID: 35407667 PMCID: PMC8999643 DOI: 10.3390/jcm11072060] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/03/2022] [Accepted: 04/04/2022] [Indexed: 02/01/2023] Open
Abstract
Aim: the purpose of this work is to present an innovative protocol for virtual planning and surgical navigation in post-oncological mandibular reconstruction through fibula free flap. In order to analyze its applicability, an evaluation of accuracy for the surgical protocol has been performed. Methods: 21 patients surgically treated for mandibular neoplasm have been included in the analysis. The Brainlab Vector Vision 3.0® software for surgical navigation has been used for preoperative surgical planning and intra-operative navigation. A post-operative accuracy evaluation has been performed matching the position of mandibular landmarks between pre-operative and post-operative CT scans. Results: the maximal discrepancy observed was included between −3.4 mm and +3.2 mm, assuming negative values for under correction and positive values for overcorrection. An average grade of accuracy included between 0.06 ± 0.58 mm and 0.43 ± 0.68 mm has been observed for every mandibular landmark examined, except for mandibular angles that showed a mean discrepancy value included between 1.36 ± 1.73 mm and 1.46 ± 1.02 mm when compared to preoperative measurements. Conclusion: a satisfying level of accuracy has been observed in the protocol presented, which appears to be more versatile if compared to closed custom-made systems. The technique described may represent a valid option for selected patients, but it cannot be considered for routine activity because of the complexity of the method, the mobility of the jaw, the necessity of surgical navigator and the long surgical learning curve that is required.
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Affiliation(s)
- Davide Sozzi
- O.U. Maxillofacial Surgery, Department of Medicine and Surgery, School of Medicine, ASST-Monza, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy; (A.F.); (A.B.); (G.N.)
- Correspondence:
| | - Andrea Filippi
- O.U. Maxillofacial Surgery, Department of Medicine and Surgery, School of Medicine, ASST-Monza, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy; (A.F.); (A.B.); (G.N.)
- Post-Graduate School of Maxillofacial Surgery, Department of Medicine and Surgery, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Gabriele Canzi
- Maxillofacial Surgery Unit, Emergency Department, ASST-GOM Niguarda, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy;
| | - Elena De Ponti
- Department of Medical Physics, ASST-Monza, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy;
| | - Alberto Bozzetti
- O.U. Maxillofacial Surgery, Department of Medicine and Surgery, School of Medicine, ASST-Monza, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy; (A.F.); (A.B.); (G.N.)
| | - Giorgio Novelli
- O.U. Maxillofacial Surgery, Department of Medicine and Surgery, School of Medicine, ASST-Monza, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy; (A.F.); (A.B.); (G.N.)
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Implant-based dental rehabilitation in head and neck cancer patients after maxillofacial reconstruction with a free vascularized fibula flap: the effect on health-related quality of life. Support Care Cancer 2022; 30:5411-5420. [PMID: 35298715 PMCID: PMC9046363 DOI: 10.1007/s00520-022-06944-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/26/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE To evaluate the effect of implant-based dental rehabilitation (IDR) on health-related quality of life (HRQoL) in head and neck cancer (HNC) patients after reconstruction with a free vascularized fibula flap (FFF). METHODS Eligible patients were identified by retrospectively reviewing the medical records of patients treated in Amsterdam UMC-VUmc. HRQoL data were used from OncoQuest, a hospital-based system to collect patient-reported outcome measures in routine care. Data were used of the EORTC QLQ-C30 and QLQ-H&N 35 before FFF reconstruction (T0) and after completing IDR (T1). Data were statistically analysed with the chi-square test, independent samples t test and linear mixed models. RESULTS Out of 96 patients with maxillofacial FFF reconstruction between January 2006 and October 2017, 57 patients (19 with and 38 without IDR) had HRQoL data at T0 and T1. In the cross-sectional analysis, patients with IDR scored significantly better at T0 and T1 on several EORTC domains compared to the patients without IDR. Weight loss was significantly different in the within-subject analysis between T0 and T1 for patients with IDR (p = 0.011). However, there were no significant differences in the mean changes of all the EORTC QLQ-C30 and EORTC QLQ-H&N35 scores between the defined timepoints for patients with IDR compared to those without. CONCLUSIONS In this study, no differences were found in the course of HRQoL in HNC patients who had undergone IDR after maxillofacial FFF reconstruction, compared to those who had not. Patients should be preoperatively informed to have realistic expectations regarding the outcome of IDR.
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Le JM, Morlandt AB, Gigliotti J, Park EP, Greene BJ, Ying YP. Complications in oncologic mandible reconstruction: A comparative study between the osteocutaneous radial forearm and fibula free flap. Microsurgery 2021; 42:150-159. [PMID: 34792210 DOI: 10.1002/micr.30841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/31/2021] [Accepted: 10/28/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND The osteocutaneous radial forearm free flap (OC-RFFF) has been proposed as a safe and reliable free flap for head and neck reconstruction with low donor site morbidity. The purpose of this study is to compare the late complications (>30 days) associated with using the OC-RFFF versus the free fibula flap (FFF) for mandibular reconstruction following oncologic segmental resection. METHODS We conducted a single-institution, retrospective study composed of patients who underwent oncologic microvascular composite mandibular reconstruction with either the OC-RFFF or FFF. The primary predictor variable was the type of free flap used. The outcome variable was late complication postoperatively (>30 days). RESULTS A total of 93 patients (28, OC-RFFF and 65, FFF) were analyzed. The majority of patients were male (62%) and with AJCC stage T4a disease (72%). Mean hospital length of stay was comparable between the two flap groups (p = .50). OC-RFFF was associated with more late complications (p = .03) compared to FFF. Nonunion occurred in 10.7% of OC-RFFF and 0% of FFF. Partial or complete flap failure was seen in 7.1% and 0% in the OC-RFFF and FFF, respectively. Two-year disease-free survival was comparable in both groups (p > .05). CONCLUSIONS The results of this study suggest that the rate of nonunion and odds of having a late complication were significantly greater in the OC-RFFF compared to the FFF following oncologic mandibular reconstruction. However, flap success, early complications (<30 days), and length of hospital stay were comparable between the two flaps.
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Affiliation(s)
- John M Le
- Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Anthony B Morlandt
- Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jordan Gigliotti
- Department of Oral and Maxillofacial Surgery, McGill University, Montreal, Quebec, Canada
| | - Earl P Park
- Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Benjamin J Greene
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yedeh P Ying
- Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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De Cicco D, Tartaro G, Ciardiello F, Fasano M, Rauso R, Fiore F, Spuntarelli C, Troiano A, Lo Giudice G, Colella G. Health-Related Quality of Life in Oral Cancer Patients: Scoping Review and Critical Appraisal of Investigated Determinants. Cancers (Basel) 2021; 13:cancers13174398. [PMID: 34503208 PMCID: PMC8431462 DOI: 10.3390/cancers13174398] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/26/2021] [Accepted: 08/28/2021] [Indexed: 12/27/2022] Open
Abstract
Simple Summary Oral cancer may strongly impair patients’ quality of life. Huge efforts have been made during recent decades in trying to improve the treatment outcomes in terms of patients’ survival, self-perception, and satisfaction. Consequently, the investigation into health-related quality of life (HRQOL) became an established and worldwide practice. Hundreds of studies tried to clarify which could be the most important variables that impact HRQOL in head and neck cancer patients. However, such a complex topic may be influenced by a multitude of interconnected aspects and several controversies were reported. In this study the current literature was reviewed to identify all those possible sources of bias that may be encountered in trying to correlate HRQOL to patient-specific or disease/treatment-specific aspects. As a result, a list of recommendations was reported to enhance the evidence of future studies. Abstract Background: health-related quality of life (HRQOL) represents a secondary endpoint of medical interventions in oncological patients. Our aim was to highlight potential sources of bias that could be encountered when evaluating HRQOL in oral cancer patients. Methods: this review followed PRISMA-ScR recommendations. Participants: patients treated for oral cancer. Concept: HRQOL assessed by EORTC QLQ-C30 and QLQ-H&N35/QLQ-H&N43. A critical appraisal of included studies was performed to evaluate the accuracy of data stratification with respect to HRQOL determinants. Results: overall, 30 studies met the inclusion criteria, totaling 1833 patients. In total, 8 sociodemographic (SDG) and 15 disease/treatment-specific (DT) HRQOL determinants (independent variables) were identified. The mean number of the independent variables was 6.1 (SD, 4.3)—5.0 (SD, 4.0) DT-related and 1.1 (SD, 1.8) SDG-related variables per article. None of the included papers considered all the identified determinants simultaneously. Conclusions: a substantial lack of evidence regarding HRQOL determinants was demonstrated. This strongly weakens the reliability of the reported findings due to the challenging presence of baseline confounding, selection, and omitted variable biases. The proposed approach recommends the use of further evaluation tools that gather more variables in a single score together with a selection of more homogeneous, reproducible, and comparable cohorts based on the identified baseline confounding.
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Affiliation(s)
- Davide De Cicco
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (D.D.C.); (C.S.); (G.L.G.)
| | - Gianpaolo Tartaro
- Department of Multidisciplinary Medical, Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.T.); (R.R.); (G.C.)
| | - Fortunato Ciardiello
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (F.C.); (M.F.)
| | - Morena Fasano
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (F.C.); (M.F.)
| | - Raffaele Rauso
- Department of Multidisciplinary Medical, Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.T.); (R.R.); (G.C.)
| | - Francesca Fiore
- Department of Internal and Polyspecialist Medicine, A.O.U. “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Chiara Spuntarelli
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (D.D.C.); (C.S.); (G.L.G.)
| | - Antonio Troiano
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (D.D.C.); (C.S.); (G.L.G.)
- Correspondence:
| | - Giorgio Lo Giudice
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (D.D.C.); (C.S.); (G.L.G.)
| | - Giuseppe Colella
- Department of Multidisciplinary Medical, Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.T.); (R.R.); (G.C.)
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Zebolsky AL, Patel N, Heaton CM, Park AM, Seth R, Knott PD. Patient-Reported Aesthetic and Psychosocial Outcomes After Microvascular Reconstruction for Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2021; 147:1035-1044. [PMID: 34292310 DOI: 10.1001/jamaoto.2021.1563] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Aesthetic outcomes are key determinants of psychosocial functioning among surgically treated patients with head and neck cancer (HNC); however, long-term aesthetic outcomes after microvascular free tissue transfer (MFTT) are not well described. Objective To examine risk factors for impaired long-term aesthetic satisfaction and appearance-related psychosocial functioning after HNC ablation with MFTT. Design, Setting, and Participants A cross-sectional, web-based survey was conducted at an academic tertiary care center. A total of 228 individuals who underwent MFTT between January 1, 2015, and December 31, 2019, for treatment of HNC were included. The study was conducted from November 1, 2020, through January 15, 2021. Exposures Head and neck cancer ablation with MFTT. Main Outcomes and Measures Patient-reported outcomes were assessed via Aesthetic FACE-Q scales. The primary objective was aesthetic satisfaction determined by the Satisfaction With Facial Appearance scale. Secondarily, the Appearance-Related Psychosocial Distress, Psychological Function, and Social Function scales were used to assess appearance-related psychosocial functioning. Patients were stratified by demographic, disease, surgical, and postoperative characteristics. Survey scores on a 100-point scale were compared and subjected to univariable and multivariable linear regression. Results A total of 124 of 228 patients (54.4%) completed surveys a median of 34.4 months after MFTT (interquartile range, 22.6-48.8). Most responders (79 [63.7%]) were men with advanced cancer of the oral cavity or skin, reconstructed with anterolateral thigh or osteocutaneous fibula free flaps. Nonresponders had no significant differences in baseline characteristics. The Satisfaction With Facial Appearance score was independently lower among patients who received osteocutaneous flaps (regression coefficient, -10.6 points, 95% CI, -20.4 to -0.8 points) and/or adjuvant (chemo)radiotherapy (regression coefficient, -6.9 points; 95% CI, -13.8 to -0.1 points). Impaired appearance-related psychosocial functioning was independently associated with female sex, a history of anxiety or depression, osteocutaneous flaps, prolonged tube feeding requirements, and any recurrent or persistent disease. After adjustment for covariates, each 1-point increase in the Satisfaction With Facial Appearance score independently estimated improved appearance-related psychosocial functioning as determined by the Appearance-Related Psychosocial Distress scale (regression coefficient, -0.5 points; 95% CI, -0.7 to -0.4 points), Psychological Function scale (regression coefficient, 0.4 points; 95% CI, 0.3 to 0.5 points), and Social Function scale (regression coefficient, 0.4 points; 95% CI, 0.3 to 0.6 points). Conclusions and Relevance The findings of this cross-sectional, web-based survey study suggest that osteocutaneous reconstruction and adjuvant therapy independently increase the risk of poor patient-reported long-term aesthetic satisfaction, which correlated with impaired appearance-related psychosocial functioning. Aesthetic outcomes appear to be a priority to address in patients with HNC undergoing MFTT.
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Affiliation(s)
- Aaron L Zebolsky
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Neil Patel
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of California, San Francisco
| | - Chase M Heaton
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Andrea M Park
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Rahul Seth
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - P Daniel Knott
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
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18
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Long-term outcomes of implant-based dental rehabilitation in head and neck cancer patients after reconstruction with the free vascularized fibula flap. J Craniomaxillofac Surg 2021; 49:845-854. [PMID: 33985871 DOI: 10.1016/j.jcms.2021.03.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 02/27/2021] [Accepted: 03/11/2021] [Indexed: 01/27/2023] Open
Abstract
The study aimed at evaluating, comprehensively, implant-based dental rehabilitation in head and neck cancer patients after maxillofacial reconstruction with a vascularized free fibula flap (FFF). Data were obtained by retrospectively reviewing the medical records of patients treated in Amsterdam UMC-VU Medical Center. Dental implant survival and implant success according to the Albrektsson criteria were analyzed. Additionally, prosthetic-related outcomes were studied, with a focus on functional dental rehabilitation. In total, 161 implants were placed in FFFs, with a mean follow-up of 4.9 years (range 0.2-23.4). Implant survival was 55.3% in irradiated FFFs and 96% in non-irradiated FFFs. Significant predictors for implant failure were tobacco use and irradiation of the FFF. Implant success was 40.4% in irradiated FFFs and 61.4% in non-irradiated FFFs, mainly due to implant failure and non-functional implants. Implant-based dental rehabilitation was started 45 times in 42 patients, out of 161 FFF reconstructions (27.9%). Thirty-seven patients completed the dental rehabilitation, 29 of whom achieved functional rehabilitation. Irradiation of the FFF negatively influenced attainment of functional rehabilitation. For patients with functional rehabilitation, the body mass index varied at different timepoints: FFF reconstruction, 24.6; dental implantation 23.5; and after placing dental prosthesis, 23.9. Functional implant-based dental rehabilitation, if started, can be achieved in the majority of head and neck cancer patients after FFF reconstruction. Actively smoking patients with an irradiated FFF should be clearly informed about the increased risk for implant and prosthetic treatment failure.
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Khadembaschi D, Borgna SC, Beech N, Batstone MD. Outcomes of osseointegrated implants in patients with benign and malignant pathologies of the head and neck: a 10-year single-centre study. Int J Oral Maxillofac Surg 2021; 50:1375-1382. [PMID: 33642153 DOI: 10.1016/j.ijom.2021.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 11/17/2022]
Abstract
The surgical management of head and neck pathologies involving the maxilla and mandible results in significant functional and aesthetic deficits, and ultimately reduced quality of life. Composite free flaps used for reconstruction address many of these deficits and create a foundation for the use of osseointegrated implants to support prosthetic replacement of the dentition. There are few comparative studies examining outcomes of implants in native and reconstructed bone in head and neck cancer patients. The aim of this retrospective cohort study was to compare survival rates and the effects of risk factors between implants placed in native and reconstructed bone. The Kaplan-Meier method estimated cumulative 1- and 5-year implant survival rates of 99.5% and 95% for native bone and 96% and 88% for reconstructed bone. Multivariate Cox regression found an increased risk of implant failure in reconstructed bone (hazard ratio (HR) 9.9, 95% confidence interval (CI) 3.4-29.7, P<0.001). Subgroup analysis of the cohorts found an increased risk of failure in the reconstructed group associated with radiotherapy (HR 6.4, 95% CI 1.8-22.3, P=0.004), current smoking (HR 23.2, 95% CI 2.7-198.6, P=0.004), and previous smoking (HR 9.0, 95% CI 1.1-71.9, P=0.038). There was no effect in the native bone group. Implants placed into reconstructed bone had higher rates of failure, and smoking status and radiotherapy increased the risk of implant failure.
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Affiliation(s)
- D Khadembaschi
- School of Medicine, University of Queensland, Herston, Queensland, Australia.
| | - S C Borgna
- Department of Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - N Beech
- Department of Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - M D Batstone
- Department of Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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20
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Khadembaschi D, Brierly GI, Chatfield MD, Beech N, Batstone MD. Systematic review and pooled analysis of survival rates, success, and outcomes of osseointegrated implants in a variety of composite free flaps. Head Neck 2020; 42:2669-2686. [PMID: 32400954 DOI: 10.1002/hed.26238] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/02/2020] [Accepted: 04/22/2020] [Indexed: 09/19/2023] Open
Abstract
The aim of this review was to provide an update on survival rates of osseointegrated implants into common composite free flaps used for maxillary and mandibular reconstructions and identify factors affecting outcomes. PubMed, Medline, Embase, and Cochrane databases were searched. Included studies reported implant survival by flap type. Results were pooled and survival was estimated with the Kaplan-Meier method. Variables affecting survival were assessed using Cox regression. Thirty-two of the 2631 articles retrieved were included, totaling 2626 implants placed into fibula, iliac crest, scapula, and radial forearm free flaps. Pooled survival showed 94% 5-year survival of implants in fibula and iliac crest with no difference between groups (P = .3). Factors effecting survival included radiotherapy (HR 2.3, 95% CI 1.2-4.6, P = .027) and malignant disease (HR 2.2, 95%CI 1.6-3.1, P < .001). Implant survival appears adequate across common flap types; however, there are limited numbers reported in less common flaps.
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Affiliation(s)
- Darius Khadembaschi
- Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Gary I Brierly
- Department of Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Mark D Chatfield
- Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Nicholas Beech
- Department of Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Martin D Batstone
- Department of Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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21
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Cassoni A, Brauner E, Pucci R, Terenzi V, Mangini N, Battisti A, Della Monaca M, Ciolfi A, Laudoni F, Di Carlo S, Valentini V. Head and Neck Osteosarcoma-The Ongoing Challenge about Reconstruction and Dental Rehabilitation. Cancers (Basel) 2020; 12:cancers12071948. [PMID: 32708374 PMCID: PMC7409227 DOI: 10.3390/cancers12071948] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 12/27/2022] Open
Abstract
Head and Neck osteosarcoma is an uncommon disease. Hitherto, the treatment is surgical resection and survival is influenced by the presence of free margins. However, the dimension of the resection may represent a hurdle for an adequate Quality of Life (QOL). Maxillofacial district is a narrow space where the function, esthetics and patient’s relational skills fit together like the gears of a clock. The functional results depend on the type of reconstruction and prosthetic rehabilitation that are both important to guarantee a good aesthetic result and finally increase the patient’s self-esteem. This study aims to report our experience about head and neck (HN) osteosarcoma focusing the attention on reconstructive and dental-rehabilitative problems. It is a retrospective study all patients were surgically treated in our department. Subjects with histological diagnosis of HN osteosarcoma, treated between 2005 and 2017 were included. The demographic characteristics, surgical treatment, eventually secondary reconstruction and prosthetic rehabilitation, performed in the same department, have been collected. The QOL was assessed through the EORTC QLQ-H&N35 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck 35) questionnaire. Fifteen patients were enrolled, eight received a free flap microsurgical reconstruction. Dental rehabilitation was performed in five cases and a mobile prosthesis was always delivered. Eighteen implants were inserted in fibula bones for three patients; highly porous implants were used.
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Affiliation(s)
- Andrea Cassoni
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome; Via Caserta 6, 00161 Rome, Italy; (A.C.); (E.B.); (V.T.); (N.M.); (M.D.M.); (F.L.); (S.D.C.); (V.V.)
- Oncological and Reconstructive Maxillo—Facial Surgery Unit, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy;
| | - Edoardo Brauner
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome; Via Caserta 6, 00161 Rome, Italy; (A.C.); (E.B.); (V.T.); (N.M.); (M.D.M.); (F.L.); (S.D.C.); (V.V.)
- Implanto-Prosthetic Unit, Policlinico Umberto I, Viale Regina Elena 287b, 00161 Rome, Italy
| | - Resi Pucci
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome; Via Caserta 6, 00161 Rome, Italy; (A.C.); (E.B.); (V.T.); (N.M.); (M.D.M.); (F.L.); (S.D.C.); (V.V.)
- Correspondence: ; Tel.: +6-499-791-46; Fax: +6-499-791-49
| | - Valentina Terenzi
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome; Via Caserta 6, 00161 Rome, Italy; (A.C.); (E.B.); (V.T.); (N.M.); (M.D.M.); (F.L.); (S.D.C.); (V.V.)
| | - Nicolò Mangini
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome; Via Caserta 6, 00161 Rome, Italy; (A.C.); (E.B.); (V.T.); (N.M.); (M.D.M.); (F.L.); (S.D.C.); (V.V.)
| | - Andrea Battisti
- Oncological and Reconstructive Maxillo—Facial Surgery Unit, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy;
| | - Marco Della Monaca
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome; Via Caserta 6, 00161 Rome, Italy; (A.C.); (E.B.); (V.T.); (N.M.); (M.D.M.); (F.L.); (S.D.C.); (V.V.)
| | - Alessandro Ciolfi
- Private Practice, Studio Dentistico Ciolfi, via degli Elci 39, 00172 Rome, Italy;
| | - Federico Laudoni
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome; Via Caserta 6, 00161 Rome, Italy; (A.C.); (E.B.); (V.T.); (N.M.); (M.D.M.); (F.L.); (S.D.C.); (V.V.)
| | - Stefano Di Carlo
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome; Via Caserta 6, 00161 Rome, Italy; (A.C.); (E.B.); (V.T.); (N.M.); (M.D.M.); (F.L.); (S.D.C.); (V.V.)
- Implanto-Prosthetic Unit, Policlinico Umberto I, Viale Regina Elena 287b, 00161 Rome, Italy
| | - Valentino Valentini
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome; Via Caserta 6, 00161 Rome, Italy; (A.C.); (E.B.); (V.T.); (N.M.); (M.D.M.); (F.L.); (S.D.C.); (V.V.)
- Oncological and Reconstructive Maxillo—Facial Surgery Unit, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy;
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22
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Wiedenmann F, Liebermann A, Probst F, Troeltzsch M, Balermpas P, Guckenberger M, Edelhoff D, Mayinger M. A pattern of care analysis: Prosthetic rehabilitation of head and neck cancer patients after radiotherapy. Clin Implant Dent Relat Res 2020; 22:333-341. [DOI: 10.1111/cid.12912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/19/2020] [Accepted: 03/31/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Felicitas Wiedenmann
- Department of Prosthetic Dentistry University Hospital, LMU Munich Munich Germany
| | - Anja Liebermann
- Department of Prosthetic Dentistry University Hospital, LMU Munich Munich Germany
| | - Florian Probst
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery University Hospital, LMU Munich Munich Germany
| | - Matthias Troeltzsch
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery University Hospital, LMU Munich Munich Germany
| | - Panagiotis Balermpas
- Department of Radiation Oncology University Hospital Zurich, University of Zurich Zurich Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology University Hospital Zurich, University of Zurich Zurich Switzerland
| | - Daniel Edelhoff
- Department of Prosthetic Dentistry University Hospital, LMU Munich Munich Germany
| | - Michael Mayinger
- Department of Radiation Oncology University Hospital Zurich, University of Zurich Zurich Switzerland
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23
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Virtual Surgical Planning for Mandible Reconstruction With a Double Barrel Fibula Flap and Immediate Implant Placement. J Craniofac Surg 2020; 31:e41-e43. [PMID: 31449213 DOI: 10.1097/scs.0000000000005842] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This brief clinical report describes our experience with virtual surgical planning in a case of mandibulectomy and mandibular reconstruction with a double barrel vascularized osteofasciocutaneous fibula free flap and immediate implant placement in a case of mandibular ameloblastoma. Fibular segments were positioned to obtain the best result both for masticatory function and for aesthetic facial appearance. Furthermore, in this particular case, as well as being positioned for future masticatory rehabilitation, the implants have served to stabilize the fibula segments in the reconstructive intraoperative phase. A superimposition of programed surgery and 6 months postoperative computed tomography scan was performed and results are presented.
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24
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The Influence of Immediately Loaded Basal Implant Treatment on Patient Satisfaction. Int J Dent 2020; 2020:6590202. [PMID: 32351569 PMCID: PMC7178505 DOI: 10.1155/2020/6590202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 03/24/2020] [Accepted: 03/27/2020] [Indexed: 12/12/2022] Open
Abstract
Background Improving patient satisfaction and quality of life is of great importance when considering the different prosthetic treatment options for patients with severely resorbed residual alveolar ridges. We aimed to evaluate and compare patients' satisfaction when changing from fixed, removable, and/or conventional implant prostheses to basal implant-supported prostheses. Methods Sixty patients with a history of fixed, removable, and/or conventional implant prostheses who received basal implant-supported prostheses (BCS®, IHDE Implant System) were included in this study. Direct interviews were conducted using a four-section questionnaire that covered sociodemographic data, clinical examination, information on previous prostheses, and new implant information. The obtained data were statistically analysed using a Wilcoxon signed-rank test and chi-squared test. Results Patients were predominantly female, partially edentulous, and aged between 40 and 59 years. Patients' general satisfaction with basal implants was very high (7.7 out of 8). Patients' satisfaction with comfort, mastication, speech, and aesthetics significantly improved with the new basal implants. Males aged between 40 and 59 years and patients who had previously used both fixed and removable prostheses were generally the most satisfied. Although some patients had complaints, they still had high satisfaction and would choose the same treatment modality again. Conclusions Basal implant-supported prostheses have a positive impact on oral health and highly increase patients' satisfaction.
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25
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Kumar VV, Rometsch E, Thor A, Wolvius E, Hurtado-Chong A. Segmental Mandibular Reconstruction Using Tissue Engineering Strategies: A Systematic Review of Individual Patient Data. Craniomaxillofac Trauma Reconstr 2020; 13:267-284. [PMID: 33456698 DOI: 10.1177/1943387520917511] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective The aim of the systematic review was to analyze the current clinical evidence concerning the use of tissue engineering as a treatment strategy for reconstruction of segmental defects of the mandible and their clinical outcomes using individual patient data. Methods A systematic review of the literature was conducted using PubMed and Cochrane Library on May 21, 2019. The eligibility criteria included patients in whom segmental mandibular reconstruction was carried out using tissue engineering as the primary treatment strategy. After screening and checking for eligibility, individual patient data were extracted to the extent it was available. Data extraction included the type of tissue engineering strategy, demographics, and indication for treatment, and outcomes included clinical and radiographic outcome measures, vitality of engineered bone, dental rehabilitation, and patient-reported outcome measures and complications. Results Out of a total of 408 articles identified, 44 articles reporting on 285 patients were included, of which 179 patients fulfilled the inclusion criteria. The different tissue engineering treatment strategies could be broadly classified into 5 groups: "prefabrication," "cell culture," "bone morphogenetic protein (BMP) without autografts," "BMP with autografts," and "scaffolds containing autografts." Most included studies were case reports or case series. A wide variety of components were used as scaffolds, cells, and biological substances. There was not a single outcome measure that was both objective and consistently reported, although most studies reported successful outcome. Discussion A wide variety of tissue engineering strategies were used for segmental mandibular reconstruction that could be classified into 5 groups. Due to the low number of treated patients, lack of standardized and consistent reporting outcomes, lack of comparative studies, and low evidence of reported literature, there is insufficient evidence to recommend any particular tissue engineering strategy.
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Affiliation(s)
- Vinay V Kumar
- Plastic and Oral & Maxillofacial Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Andreas Thor
- Plastic and Oral & Maxillofacial Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Eppo Wolvius
- Department of Oral & Maxillofacial Surgery, Erasmus University Center, Rotterdam, the Netherlands
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26
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Abstract
Reconstruction of large craniofacial defects requires several factors to be considered before deciding on the best reconstructive option. This article discusses various factors taken into consideration when deciding on which reconstructive option is ideal for a given patient and defect. For large craniofacial defects, reconstruction using tissue transfer is considered preferentially over obturation, although in select defects obturation using a traditional tooth- or implant-borne prosthetic obturator can be considered a viable option.
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27
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Paré A, Bossard A, Laure B, Weiss P, Gauthier O, Corre P. Reconstruction of segmental mandibular defects: Current procedures and perspectives. Laryngoscope Investig Otolaryngol 2019; 4:587-596. [PMID: 31890875 PMCID: PMC6929581 DOI: 10.1002/lio2.325] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 10/02/2019] [Accepted: 10/21/2019] [Indexed: 11/11/2022] Open
Abstract
Background The reconstruction of segmental mandibular defects remains a challenge for the reconstructive surgeon, from both a functional and an esthetic point of view. Methods This clinical review examines the different techniques currently in use for mandibular reconstruction as related to a range of etiologies, including the different bone donor sites, the alternatives to free flaps (FFs), as well as the contribution of computer‐assisted surgery. Recent progress and the perspectives in bone tissue engineering (BTE) are also discussed. Results Osseous FF allows reliable and satisfying outcomes. However, locoregional flap, distraction osteogenesis, or even induced membrane techniques are other potential options in less favorable cases. Obtaining an engineered bone with satisfactory mechanical properties and sufficient vascular supply requires further investigations. Conclusions Osseous FF procedure remains the gold standard for segmental mandible reconstruction. BTE strategies offer promising alternatives.
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Affiliation(s)
- Arnaud Paré
- Service de Chirurgie Maxillo Faciale Plastique et Brulés, Hôpital Trousseau, CHU de Tours Tours France.,Laboratoire Regenerative Medicine and Skeleton RMeS, France INSERM, U 1229 Nantes France.,UFR Médecine Université de Tours Tours France.,UFR Odontologie Université́ de Nantes Nantes France
| | - Adeline Bossard
- ONIRIS Nantes-Atlantic College of Veterinary Medicine Centre de Rechecherche et D'investigation Préclinique (CRIP) Nantes France
| | - Boris Laure
- Service de Chirurgie Maxillo Faciale Plastique et Brulés, Hôpital Trousseau, CHU de Tours Tours France
| | - Pierre Weiss
- Laboratoire Regenerative Medicine and Skeleton RMeS, France INSERM, U 1229 Nantes France.,UFR Odontologie Université́ de Nantes Nantes France
| | - Olivier Gauthier
- Laboratoire Regenerative Medicine and Skeleton RMeS, France INSERM, U 1229 Nantes France.,ONIRIS Nantes-Atlantic College of Veterinary Medicine Centre de Rechecherche et D'investigation Préclinique (CRIP) Nantes France
| | - Pierre Corre
- Laboratoire Regenerative Medicine and Skeleton RMeS, France INSERM, U 1229 Nantes France.,UFR Odontologie Université́ de Nantes Nantes France.,Service de Chirurgie Maxillo-Faciale et Stomatologie CHU de Nantes Nantes France
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28
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Menapace DC, Van Abel KM, Jackson RS, Moore EJ. Primary vs Secondary Endosseous Implantation After Fibular Free Tissue Reconstruction of the Mandible for Osteoradionecrosis. JAMA FACIAL PLAST SU 2019; 20:401-408. [PMID: 29801119 DOI: 10.1001/jamafacial.2018.0263] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The clinical and financial implications of the timing of dental rehabilitation after a fibula free tissue transfer (FFTT) for osteoradionecrosis (ORN) and osteonecrosis (ON) of the mandible have yet to be established. Objective To compare the outcomes of primary implantation vs secondary implantation after FFTT for ORN and ON of the mandible. Design, Setting, and Participants A retrospective review was conducted of 23 patients at a single tertiary academic referral center undergoing primary implantation or secondary implantation after FFTT for ORN and ON from January 1, 2006, to November 10, 2015. Interventions All patients underwent FFTT with primary implantation (n = 12) or secondary implantation (n = 11). Main Outcomes and Measures Outcomes of FFTT, dental implantation, implant use, diet, speech, and disease-free survival were reviewed. Fixed unit costs were estimated based on the mean cost analysis. Results Twenty-three patients (7 women and 16 men; mean [SD] age, 62.4 [8.2] years [range, 24-81 years]) met the inclusion criteria. Of these, 18 had ORN and 5 had ON. Dental implantation was performed at the time of FFTT for 12 patients and was performed secondarily for 11 patients. There were a mean of 5.2 implants per patient performed, for a total of 121 implants. There was 1 complete flap failure in the primary implantation group. Neither flap nor implant complications were affected by the timing of the implantation. Overall, the implant survival rate was 95% (55 of 58) in the primary implantation group and 98% (62 of 63) in the secondary implantation group. Time from FFTT to abutment placement (primary implantation, 19.6 weeks; secondary implantation, 61.0 weeks) was significantly shorter after primary implantation (P < .001). There was no clinical difference in postoperative complications and implant outcomes for ORN vs ON. Improvement in speech and oral competence in the primary implantation group vs the secondary implantation group was not statistically significant, given an experiment-adjusted P = .001 set as significant (normal speech, 9 vs 3; P = .02; and normal oral competence, 9 vs 3; P = .02). Disease-free survival was 91% (20 of 22 patients) overall. Fixed unit (U) costs were 1.0 U for primary implantation and 1.24 U for secondary implantation. Conclusions and Relevance Patients undergoing primary implantation after FFTT for ORN and ON had a similar rate of complications compared with those undergoing secondary implantation. However, primary implantation allowed a faster return than secondary implantation to oral nutrition and prosthesis use. The fixed unit cost was reduced for those undergoing primary implantation. Although dental implantation was safe and effective in both groups, the decreased time to use and the decreased overall cost should prompt surgeons to consider primary implantation after FFTT for ORN and ON. Level of Evidence 3.
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Affiliation(s)
- Deanna C Menapace
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
| | | | - Ryan S Jackson
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Eric J Moore
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
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29
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Sato N, Koyama S, Mito T, Izumita K, Ishiko R, Yamauchi K, Miyashita H, Ogawa T, Kosaka M, Takahashi T, Sasaki K. Changes in oral health-related quality of life after oral rehabilitation with dental implants in patients following mandibular tumor resection. J Oral Sci 2019; 61:406-411. [PMID: 31341120 DOI: 10.2334/josnusd.18-0234] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Oral rehabilitation with prosthodontic treatment considerably influences the well-being and quality of life of patients after ablative oral tumor surgery. This study evaluated the effects of implant-supported prostheses (ISPs) on oral health-related quality of life (OHRQoL) and chewing ability in 10 patients who requested ISPs after mandibular oral tumor resection. OHRQoL was assessed using the Japanese version of the Oral Health Impact Profile (OHIP-49) before and one year after ISP placement. Chewing ability, including self-assessed masticatory ability and occlusal force, was examined at one year after ISP placement. The initial mean total OHIP-49 score of 65.3 ± 9.79 decreased to 46.0 ± 8.14 at one year after ISP placement. Mean OHIP-49 score decreased in all domains, whereas self-assessed masticatory ability increased within one year of ISP placement. There were no significant differences between prosthesis types with respect to the mean OHIP-49 score or self-assessed masticatory ability. In conclusion, ISP placement improves OHRQoL and the self-assessed masticatory ability. Moreover, the prosthesis type might not significantly affect OHRQoL.
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Affiliation(s)
- Naoko Sato
- Tohoku University Hospital, Maxillofacial Prosthetics Clinic
| | - Shigeto Koyama
- Tohoku University Hospital, Maxillofacial Prosthetics Clinic
| | - Takehiko Mito
- Tohoku University Hospital, Maxillofacial Prosthetics Clinic
| | | | - Risa Ishiko
- Tohoku University Hospital, Maxillofacial Prosthetics Clinic
| | - Kensuke Yamauchi
- Division of Oral and Maxillofacial Surgery, Tohoku University Graduate School of Dentistry
| | - Hitoshi Miyashita
- Division of Oral and Maxillofacial Surgery, Tohoku University Graduate School of Dentistry
| | - Takenori Ogawa
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine
| | - Moe Kosaka
- Tohoku University Hospital, Maxillofacial Prosthetics Clinic
| | - Tetsu Takahashi
- Division of Oral and Maxillofacial Surgery, Tohoku University Graduate School of Dentistry
| | - Keiichi Sasaki
- Division of Advanced Prosthodontics, Tohoku University Graduate School of Dentistry
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30
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Patel SY, Kim DD, Ghali GE. Maxillofacial Reconstruction Using Vascularized Fibula Free Flaps and Endosseous Implants. Oral Maxillofac Surg Clin North Am 2019; 31:259-284. [DOI: 10.1016/j.coms.2018.12.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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31
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Liu G, Guo Y, Zhang L, Wang X, Liu R, Huang P, Xiao Y, Chen Z, Chen Z. A standardized rat burr hole defect model to study maxillofacial bone regeneration. Acta Biomater 2019; 86:450-464. [PMID: 30605772 DOI: 10.1016/j.actbio.2018.12.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/03/2018] [Accepted: 12/30/2018] [Indexed: 12/18/2022]
Abstract
With high incidence rate and unique regeneration features, maxillofacial burr hole bone defects require a specially designed bone defect animal model for the evaluation of related bone regenerative approaches. Although some burr hole defect models have been developed in long bones or calvarial bones, the mandible has unique tissue development origins and regenerative environments. This suggests that the defect model should be prepared in the maxillofacial bone area. After dissecting the anatomic structures of rat mandibles, we found that creating defects in the anterior tooth area avoided damaging important organs and improved animal welfare. Furthermore, the available bone volume at the anterior tooth area was superior to that of the posterior tooth and ascending ramus areas. We then managed to standardize the model by controlling the age, weight and gender of the animal, creating standardized measurement instruments and reducing the variations derived from various operators. We also succeeded in deterring the self-rehabilitation of the proposed model by increasing the defect size. The 6 × 2 mm and 8 × 2 mm defects were found to meet the requirements of bone regenerative studies. This study provided a step-by-step standardized burr hole bone defect model with minimal tissue damage in small animals. The evaluations resulting from this model testify to the in vitro outcomes of the proposed regenerative approaches and provide preliminary screening data for further large animal and clinical trials. Therefore, the inclusion of this model may optimize the evaluation systems for maxillofacial burr hole bone defect regenerative approaches. STATEMENT OF SIGNIFICANCE: Unremitting effort has been devoted to the development of bone regenerative materials to restore maxillofacial burr hole bone defects because of their high clinical incidence rate. In the development of these biomaterials, in vivo testing in small animals is necessary to evaluate the effects of candidate biomaterials. However, little has been done to develop such defect models in small animals. In this study, we developed a standardized rat mandible burr hole bone defect model with minimal injury to the animals. A detailed description and supplementary video were provided to guide the preparation. The development of this model optimizes the maxillofacial bone regenerative approach evaluation system.
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Affiliation(s)
- Guanqi Liu
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, China
| | - Yuanlong Guo
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, China
| | - Linjun Zhang
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, China
| | - Xiaoshuang Wang
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, China
| | - Runheng Liu
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, China
| | - Peina Huang
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, China
| | - Yin Xiao
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, China; Institute of Health and Biomedical Innovation & the Australia-China Centre for Tissue Engineering and Regenerative Medicine, Queensland University of Technology, Brisbane 4059, Australia
| | - Zhuofan Chen
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, China.
| | - Zetao Chen
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University and Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, China.
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32
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Petrovic I, Baser R, Blackwell T, McCarthy C, Ganly I, Patel S, Cordeiro P, Shah J. Long-term functional and esthetic outcomes after fibula free flap reconstruction of the mandible. Head Neck 2019; 41:2123-2132. [PMID: 30761650 DOI: 10.1002/hed.25666] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/25/2018] [Accepted: 01/07/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The goal of this study is to report functional and esthetic outcomes, after fibula free flap (FFF) reconstruction of the mandible for oral cancer, assessed by physicians, nonclinicians, and patients. METHODS Twenty-five long-term survivors from oral cancer after FFF reconstruction were recalled for head and neck examination by surgeons, for photographs and patient-reported outcomes, using EORTC, QLQ-C30, H&N35, and FACE-Q questionnaires. RESULTS Physicians reported 64% restoration of functionality compared to normal. Patients reported high scores on QLQ-C30 but lower scores on H&N35. Esthetic scores were reported higher by clinicians than nonclinicians. The decline in function and appearance was attributed to loss of lower dentition, trismus, malocclusion, xerostomia, and tissue atrophy. CONCLUSION To minimize the decline in function and appearance, immediate dental implants in FFF, better reconstruction of the temporomandibular joint, newer methods of radiotherapy to minimize xerostomia and oral exercises to prevent trismus should be considered.
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Affiliation(s)
- Ivana Petrovic
- Dental Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Raymond Baser
- Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Timothy Blackwell
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Colleen McCarthy
- Plastic and Reconstructive Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ian Ganly
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Snehal Patel
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Peter Cordeiro
- Plastic and Reconstructive Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jatin Shah
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Memorial Sloan Kettering Cancer Center, and Weil Cornell Medical College, New York.,Department of Oncology and Reconstructive Surgery, I.M. Sechenov First Moscow State Medical University, Moscow
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33
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Simultaneous Implant Placement in a Mandibular Defect Reconstructed With a Free Fibula Graft and Fabrication of a Fixed Metal Porcelain Prosthesis. J Craniofac Surg 2018; 29:1307-1311. [PMID: 29570531 DOI: 10.1097/scs.0000000000004526] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
This clinical report presents the multidisciplinary treatment approach for a 23-year-old male patient who underwent a total mandibular reconstruction due to trauma in the past and experienced postoperative complications. For his retreatment, exposed fixation plate was removed and infected bone was debrided and then a free fibula graft augmentation with simultaneous implant placement procedure was performed. After an osseointegration period of 6 months, a screw-retained porcelain fused to metal fixed prosthesis was fabricated and delivered.
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34
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Kumar VV, Srinivasan M. Masticatory efficiency of implant-supported removable partial dental prostheses in patients with free fibula flap reconstructed mandibles: A split-mouth, observational study. Clin Oral Implants Res 2018; 29:855-863. [PMID: 29920778 DOI: 10.1111/clr.13304] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 04/09/2018] [Accepted: 05/22/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of this split-mouth study was to evaluate the masticatory efficiency in patients with segmentally reconstructed mandibles using free fibula flaps, with and without stabilizing osteosynthesis material in-situ during implant placement for rehabilitation with implant-supported removable partial dental prostheses (ISRPDPs). METHODS Ten participants (n = 10; ♀ = 2, ♂ = 8; mean age = 38.1 years) consented to participate in this study. The participants' normal side (Side N) of the mandible served as the control side, for comparing the masticatory efficiency of the segmentally reconstructed and rehabilitated side (Side R). Masticatory efficiency was evaluated using the two-colored chewing gum test, measured as subjective assessment (SA) and electronically evaluated variance of hue (VOH). Data were checked for normal distribution and statistically analyzed with the level of significance set to p < 0.05. RESULTS Thirty-four tissue-level implants were placed in reconstructed mandibles of 10 participants. There was no significant difference observed in the masticatory efficiencies between Side N and Side R, in both subjective and electronic assessments. No implant loss was observed after a post-rehabilitated mean follow-up period of 42.7 months, revealing an implant survival rate of 100%. CONCLUSIONS In patients with surgically reconstructed mandibles, a normal masticatory function can be successfully achieved with a rehabilitation of the reconstructed side with implant-supported removable partial dental prostheses. Implant-supported prostheses should be actively advocated in patients with reconstructive surgeries to restore their masticatory function, extend their food choices, and improve their overall oral health-related quality of life.
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Affiliation(s)
- Vinay V Kumar
- Department of Head and Neck Surgery, Mazumdar Shaw Medical Center, Narayana Health, Bengaluru, India
| | - Murali Srinivasan
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
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35
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Treatment of a mandibular discontinuity defect by using a fibula free flap and an implant-supported fixed complete denture fabricated with a PEKK framework: A clinical report. J Prosthet Dent 2018; 119:1021-1024. [DOI: 10.1016/j.prosdent.2017.07.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/27/2017] [Accepted: 07/27/2017] [Indexed: 12/31/2022]
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36
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Proteome analysis reveals that de novo regenerated mucosa over fibula flap-reconstructed mandibles resembles mature keratinized oral mucosa. Oral Oncol 2018; 78:207-215. [DOI: 10.1016/j.oraloncology.2018.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/15/2018] [Accepted: 01/23/2018] [Indexed: 01/30/2023]
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37
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Assael L. Current Status of Postdoctoral and Graduate Programs in Dentistry. J Dent Educ 2017; 81:eS41-eS49. [PMID: 28765454 DOI: 10.21815/jde.017.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 02/06/2017] [Indexed: 11/20/2022]
Abstract
Advanced dental education has evolved in the context of societal needs and economic trends to its current status. Graduate programs have positioned their role in the context of health systems and health science education trends in hospitals, interprofessional clinical care teams, and dental schools and oral health care systems. Graduate dental education has been a critical factor in developing teams in trauma care, craniofacial disorders, pediatric and adult medicine, and oncology. The misalignment of the mission of graduate dental programs and the demands of private practice has posed a challenge in the evolution of programs as educational programs have been directed towards tertiary and indigent care while the practice community focuses on largely healthy affluent patients for complex clinical interventions. Those seeking graduate dental education today are smaller in number and include more international dental graduates than in the past. Graduate dental education in general dentistry and in the nine recognized dental specialties now includes Commission on Dental Accreditation (CODA) recognition of training standards as part of its accreditation process and a CODA accreditation process for areas of clinical education not recognized as specialties by the American Dental Association. Current types of programs include fellowship training for students in recognized specialties. This article was written as part of the project "Advancing Dental Education in the 21st Century."
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Affiliation(s)
- Leon Assael
- Dr. Assael is Dean Emeritus and Professor, Department of Surgical and Developmental Science, University of Minnesota School of Dentistry.
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Maroulakos G, Nagy WW, Ahmed A, Artopoulou II. Prosthetic rehabilitation following lateral resection of the mandible with a long cantilever implant-supported fixed prosthesis: A 3-year clinical report. J Prosthet Dent 2017; 118:678-685. [PMID: 28461046 DOI: 10.1016/j.prosdent.2017.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/24/2017] [Accepted: 01/24/2017] [Indexed: 11/30/2022]
Abstract
This clinical report describes the prosthetic management of the surgical reconstruction of a patient after mandibular resection. Complete oral rehabilitation was achieved with a maxillary complete denture and a mandibular implant-supported fixed prosthesis with a custom titanium framework and a long unilateral cantilever.
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Affiliation(s)
- Georgios Maroulakos
- Assistant Professor, Department of General Dental Sciences, Marquette University School of Dentistry, Milwaukee, Wis.
| | - William W Nagy
- Professor and Director, Graduate Prosthodontics, Department of Restorative Sciences, Texas A&M University College of Dentistry, Dallas, Texas
| | - Ayman Ahmed
- Clinical Assistant Professor, Department of General Dental Sciences, Marquette University School of Dentistry, Milwaukee, Wis
| | - Ioli I Artopoulou
- Lecturer, Department of Prosthodontics, National and Kapodistrian University of Athens, School of Dentistry, Athens, Greece
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Kumar VV, Ebenezer S, Kämmerer PW, Jacob PC, Kuriakose MA, Hedne N, Wagner W, Al-Nawas B. Implants in free fibula flap supporting dental rehabilitation - Implant and peri-implant related outcomes of a randomized clinical trial. J Craniomaxillofac Surg 2016; 44:1849-1858. [PMID: 27697397 DOI: 10.1016/j.jcms.2016.08.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 07/20/2016] [Accepted: 08/29/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The objective of this study was to assess the difference in success rates of implants when using two or four implant-supported-overdentures following segmental mandibular reconstruction with fibula free flap. METHODS AND DESIGNS This prospective, parallel designed, randomized clinical study was conducted with 1:1 ratio. At baseline, all participants already had segmental reconstruction of mandible with free fibula flap. The participants were randomized into two groups: Group-I received implant-supported-overdentures on two tissue-level implants and Group-II received implant-supported-overdentures on four tissue-level implants. Success rates of the implants were evaluated at 3 months, 6 months and 12 months following implant loading using marginal bone level changes as well as peri-implant indices (Buser et al., 1990). RESULTS 52 patients were randomized into two treatment groups (26 each), out of which 18 patients (36 implants) of Group-I and 17 patients (68 implants) of Group-II were evaluated. One implant in Group-I was lost due to infective complications and one patient in the same group had superior barrel necrosis. There was a statistically significant increase at both time points (p = 0.03, p = 0.04 at 6 months, 12 months) in the amount of marginal bone loss in Group-I (0.4 mm, 0.5 mm at 6 months, 12 months) as compared to Group-II (0.1 mm, 0.2 mm at 6 months, 12 months). There were no clinically significant changes peri-implant parameters between both groups. Peri-implant soft tissue hyperplasia was seen in both groups, 32% of implants at 3-months, 26% at 6-months and 3% at 12-months follow-up. CONCLUSION The results of this study show that patients with 2-implant-supported-overdentures had higher marginal bone loss as compared to patients with 4-implant-supported-overdentures. There were no clinically significant differences in peri-implant soft tissue factors in patients with 2- or 4-implant-supported-overdentures. Hyperplastic peri-implant tissues are common in the early implant-loading phase and tend to decrease over time under appropriate management.
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Affiliation(s)
- Vinay V Kumar
- Head and Neck Institute (Head: Dr. Moni A. Kuriakose), Mazumdar Shaw Cancer Center, Narayana Health, Bommasandra, Bangalore, India; Department of Oral and Maxillofacial Surgery-Plastic Surgery, University Medical Center of Johannes Gutenberg University, Mainz, Germany.
| | - Supriya Ebenezer
- Department of Periodontics, M. R. Ambedkar Dental College & Hospital, Bangalore, India.
| | - Peer W Kämmerer
- Department of Oral and Maxillofacial Surgery-Plastic Surgery, University Medical Center of Rostock University, Rostock, Germany.
| | - P C Jacob
- Head and Neck Institute (Head: Dr. Moni A. Kuriakose), Mazumdar Shaw Cancer Center, Narayana Health, Bommasandra, Bangalore, India.
| | - Moni A Kuriakose
- Head and Neck Institute (Head: Dr. Moni A. Kuriakose), Mazumdar Shaw Cancer Center, Narayana Health, Bommasandra, Bangalore, India.
| | - Naveen Hedne
- Head and Neck Institute (Head: Dr. Moni A. Kuriakose), Mazumdar Shaw Cancer Center, Narayana Health, Bommasandra, Bangalore, India.
| | - Wilfried Wagner
- Department of Oral and Maxillofacial Surgery-Plastic Surgery, University Medical Center of Johannes Gutenberg University, Mainz, Germany.
| | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery-Plastic Surgery, University Medical Center of Johannes Gutenberg University, Mainz, Germany.
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