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Moraschini V, Louro RS, Son A, Calasans-Maia MD, Sartoretto SC, Shibli JA. Long-term survival and success rate of dental implants placed in reconstructed areas with extraoral autogenous bone grafts: A systematic review and meta-analysis. Clin Implant Dent Relat Res 2024; 26:469-481. [PMID: 38450931 DOI: 10.1111/cid.13319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/22/2024] [Accepted: 02/22/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE To evaluate the long-term survival and success rates of implants placed in reconstructed areas using microvascularized or non-microvascularized extraoral bone grafts. MATERIALS AND METHODS An electronic search was performed in five databases and in gray literature for articles published until June, 2023. The eligibility criteria comprised observational studies (prospective or retrospective) and clinical trials, reporting survival and success rates of implants placed in extraoral bone grafts. A meta-analysis (implant failure) was categorized into subgroups based on the type of bone graft used. The risk of bias within studies was assessed using the Newcastle-Ottawa Scale. RESULTS Thirty-one studies met the inclusion criteria. The mean follow-up time was 92 months. The summary estimate of survival rate at the implant level were 94.9% (CI: 90.1%-97.4%) for non-vascularized iliac graft, 96.5% (CI: 91.4%-98.6%) for non-vascularized calvaria graft, and 92.3% (CI: 89.1%-94.6%) for vascularized fibula graft. The mean success rate and marginal bone loss (MBL) were 83.2%; 2.25 mm, 92.2%; 0.93 mm, and 87.6%; 1.49 mm, respectively. CONCLUSIONS Implants placed in areas reconstructed using extraoral autogenous bone graft have high long-term survival rates and low long-term MBLs. The data did not demonstrate clinically relevant differences in the survival, success, or MBL of grafts from different donor areas or with different vascularization. This systematic review was registered in INPLASY under number INPLASY202390004.
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Affiliation(s)
- Vittorio Moraschini
- Department of Periodontology, School of Dentistry, Veiga de Almeida University, Rio de Janeiro, Brazil
- Department of Oral Surgery, School of Dentistry, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Rafael Seabra Louro
- Department of Oral Surgery, School of Dentistry, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Andrea Son
- Department of Implant Dentistry, School of Dentistry, Guarulhos University, São Paulo, Brazil
| | | | | | - Jamil Awad Shibli
- Department of Implant Dentistry, School of Dentistry, Guarulhos University, São Paulo, Brazil
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Ostrander BT, Meller L, Harmon M, Archambault K, Kristallis T, Hammer D, Orosco RK. Free flap jaw reconstruction with dental implantation: A single-institution experience. Head Neck 2024; 46:1370-1379. [PMID: 38420709 PMCID: PMC11090705 DOI: 10.1002/hed.27683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/13/2024] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND We sought to review our institution's experience with dental implant placement in free flap jaw reconstruction to determine factors impacting restoration of dental occlusion. METHODS Exactly 48 patients underwent free flap jaw reconstruction with or without dental restoration from 2017 to 2022. Primary outcome was achievement of restored dental occlusion after jaw free flap reconstruction. RESULTS A total of 48 patients with a mean age of 59.8 ± 16.4 years underwent jaw reconstruction from 2017 to 2022. Ten patients (20.8%) received osteointegrated dental implants. Two patients received a temporary dental prosthesis, 12 ± 4 months after initial reconstruction. Three patients received a final prosthesis, with a mean time to final prosthesis of 17.7 ± 12.4 months. Five patients did not receive any prosthesis despite placement of implants. CONCLUSION A minority of patients received dental implant placement with free flap jaw reconstruction and only a small subset of these received a definitive dental prosthesis.
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Affiliation(s)
- Benjamin T. Ostrander
- Department of Otolaryngology-Head and Neck Surgery, University of California San Diego Health, San Diego, California, USA
- Moores Cancer Center, University of California San Diego Health, La Jolla, California, USA
| | - Leo Meller
- Department of Otolaryngology-Head and Neck Surgery, University of California San Diego Health, San Diego, California, USA
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Matthew Harmon
- Department of Otolaryngology-Head and Neck Surgery, University of California San Diego Health, San Diego, California, USA
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Katya Archambault
- Moores Cancer Center, University of California San Diego Health, La Jolla, California, USA
| | - Thanos Kristallis
- Moores Cancer Center, University of California San Diego Health, La Jolla, California, USA
| | - Daniel Hammer
- Department of Otolaryngology-Head and Neck Surgery, University of California San Diego Health, San Diego, California, USA
- Department of Oral and Maxillofacial Surgery, Naval Medical Center San Diego, San Diego, California, USA
| | - Ryan K. Orosco
- Department of Surgery, Division of Otolaryngology, University of New Mexico, Albuquerque, New Mexico, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, USA
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Sriram S, Njoroge MW, Lopez CD, Zhu L, Heron MJ, Zhu KJ, Yusuf CT, Yang R. Optimal Treatment Order With Fibula-Free Flap Reconstruction, Oncologic Treatment, and Dental Implants: A Systematic Review and Meta-Analysis. J Craniofac Surg 2024; 35:1065-1073. [PMID: 38666786 DOI: 10.1097/scs.0000000000010127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 02/05/2024] [Indexed: 06/04/2024] Open
Abstract
Head and neck cancer (HNC) patients benefit from craniofacial reconstruction, but no clear guidance exists for rehabilitation timing. This meta-analysis aims to clarify the impact of oncologic treatment order on implant survival. An algorithm to guide placement sequence is also proposed in this paper. PubMed, Embase, and Web of Science were searched for studies on HNC patients with ablative and fibula-free flap (FFF) reconstruction surgeries and radiotherapy (RTX). Primary outcomes included treatment sequence, implant survival rates, and RTX dose. Of 661 studies, 20 studies (617 implants, 199 patients) were included. Pooled survival rates for implants receiving >60 Gy RTX were significantly lower than implants receiving < 60 Gy (82.8% versus 90.1%, P =0.035). Placement >1 year after RTX completion improved implant survival rates (96.8% versus 82.5%, P =0.001). Implants receiving pre-placement RTX had increased survival with RTX postablation versus before (91.2% versus 74.8%, P <0.001). One hundred seventy-seven implants were placed only in FFF with higher survival than implants placed in FFF or native bone (90.4% versus 83.5%, P =0.035). Radiotherapy is detrimental to implant survival rates when administered too soon, in high doses, and before tumor resection. A novel evidence-based clinical decision-making algorithm was presented for utilization when determining the optimal treatment order for HNC patients. The overall survival of dental prostheses is acceptable, reaffirming their role as a key component in rehabilitating HNC patients. Considerations must be made regarding RTX dosage, timing, and implant location to optimize survival rates and patient outcomes for improved functionality, aesthetics, and comfort.
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Affiliation(s)
- Shreya Sriram
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
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Nham TT, Koudougou C, Piot B, Corre P, Bertin H, Longis J. Prosthetic rehabilitation in patients with jaw reconstruction by fibula free flap: A systematic review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101735. [PMID: 38072231 DOI: 10.1016/j.jormas.2023.101735] [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: 10/08/2023] [Revised: 12/03/2023] [Accepted: 12/07/2023] [Indexed: 05/01/2024]
Abstract
This systematic review aimed to evaluate the dental prosthetic rehabilitation (DPR) in patients after jaw reconstruction with fibula free flap. Four databases were searched from January 2000 to January 2023. Of the 2507 studies identified, 36 observational studies were included. Cancer was the most common surgical indications for jawbone resection with 58.3 % of cases followed by benign tumours which representing 24 %. The DPR rate was estimated at 51.6 % across the studies (ranging from 38 % to 55 % depending on the benign or malignant nature of the tumors). Implant-supported prostheses represented 58.9 % of cases of which 66.9 % were fixed and 33.1 % were implant-stabilized overdentures. Virtual surgical planning (VSP) was used in 20 % of studies and aimed to improve the position of the grafted fibula, quality, and aesthetics of DPR and to decrease ischemia and the operating time. One in two authors performed DPR 12 months after jaw reconstruction. If implant survival rate reached 93 % in non-irradiated fibula, it fell to 38 %, 55 %, and 77 % if implantation occurred in the 12, 17, and 24 months after radiotherapy, respectively. Various parameters should be better investigated in further studies including the typology of the prostheses (implant-supported vs removable), the use of VSP, and the optimal time for DPR taking into account the characteristics of the tumor, the size of bone defect, and the need for external irradiation therapy.
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Affiliation(s)
- Thanh-Thuy Nham
- Nantes Université, CHU Nantes, Service de chirurgie maxillo-faciale et stomatologie, F-44000 Nantes, France
| | - Carine Koudougou
- Nantes Université, CHU Nantes, Service de chirurgie maxillo-faciale et stomatologie, F-44000 Nantes, France
| | - Benoit Piot
- Nantes Université, CHU Nantes, Service de chirurgie maxillo-faciale et stomatologie, F-44000 Nantes, France
| | - Pierre Corre
- Nantes Université, CHU Nantes, Service de chirurgie maxillo-faciale et stomatologie, F-44000 Nantes, France; Nantes Université, Oniris, UnivAngers, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, UMR 1229, F-44000 Nantes, France
| | - Hélios Bertin
- Nantes Université, CHU Nantes, Service de chirurgie maxillo-faciale et stomatologie, F-44000 Nantes, France; Nantes Université, UnivAngers, CHU Nantes, INSERM, CNRS, CRCI2NA, F-44000 Nantes, France.
| | - Julie Longis
- Nantes Université, CHU Nantes, Service de chirurgie maxillo-faciale et stomatologie, F-44000 Nantes, France
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Yusa K, Ishikawa S, Suzuki N, Kunii S, Okuyama N, Hemmi T, Iino M. Clinical evaluation of bone quality of particulate cancellous bone and marrow, and implant prosthetic rehabilitation. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:101862. [PMID: 38561138 DOI: 10.1016/j.jormas.2024.101862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/29/2024] [Indexed: 04/04/2024]
Abstract
This study aimed to subjectively evaluate bone quality in the particulate cancellous bone and marrow (PCBM) graft area and to assess the survival rates of implants. A retrospective review was conducted based on patient age, sex, diagnosis, reconstructed site, number of implants, prosthetic type, and duration of follow-up. Images from computed tomography (CT) before implant insertion were obtained and used in this study. We selected a 4.0-mm diameter × 8.0-mm length region of interest in the implant placement area, and measured the CT attenuation value. No significant correlations were seen between CT attenuation values and implant survival rates in the maxilla and mandible. On the other hand, CT attenuation values and implant survival rates were significantly lower in patients with malignancy than in non-malignant cases. Placing implants in PCBM grafted bone requires a full understanding of bone quality before surgery and drilling to ensure primary stability, along with consideration of soft tissue management and maintenance programs.
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Affiliation(s)
- Kazuyuki Yusa
- Department of Dentistry, Oral and Maxillofacial-Plastic and Reconstructive Surgery Faculty of Medicine, Yamagata University, Yamagata, Japan.
| | - Shigeo Ishikawa
- Department of Dentistry, Oral and Maxillofacial-Plastic and Reconstructive Surgery Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Nagiko Suzuki
- Department of Dentistry, Oral and Maxillofacial-Plastic and Reconstructive Surgery Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Shunsuke Kunii
- Department of Dentistry and Oral Surgery, Okitama Public General Hospital, Yamagata, Japan
| | - Naoki Okuyama
- Department of Dentistry, Oral and Maxillofacial-Plastic and Reconstructive Surgery Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Tomoharu Hemmi
- Department of Dentistry, Oral and Maxillofacial-Plastic and Reconstructive Surgery Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Mitsuyoshi Iino
- Department of Dentistry, Oral and Maxillofacial-Plastic and Reconstructive Surgery Faculty of Medicine, Yamagata University, Yamagata, Japan
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Liu YB, Wu D, Wang JY, Lun XH, Dai W. Meta-analysis of the survival rate and postoperative infection rate of primary and secondary implants after vascularized fibula transplantation for reconstruction of jaw defects. Int J Implant Dent 2023; 9:51. [PMID: 38108942 PMCID: PMC10728391 DOI: 10.1186/s40729-023-00514-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 11/18/2023] [Indexed: 12/19/2023] Open
Abstract
OBJECTIVES Vascularized fibula flap transplantation is the most effective and common method to repair the jaw defects. In addition, implantation is the first choice to restore dentition on the graft fibula. Implants are usually implanted at least 6 months after fibula transplantation. Primary implantation of implants during surgery can restore the dentition earlier, but whether this method can achieve the same restorative effect as secondary implantation is still uncertain. This article aims to compare the survival rate and complications between primary and secondary implantation through meta-analysis. METHODS This meta-analysis was conducted according to PRISMA protocol and the Cochrane Handbook of Systematic Reviews of Interventions. According to the inclusion and exclusion criteria, we selected the PubMed, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), Chinese BioMedical Literature Database (CBM) according to established inclusion and exclusion criteria. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies. Meta-analysis was conducted to compare the survival rate and postoperative infection rate of primary and secondary implantation. RESULTS Seven studies were involved in our research, involving 186 patients. Five of the studies detailed implant success in 106 patients (primary implantation 50, secondary implantation 56), and four studies documented infection after implantation in 117 patients (primary implantation 52, secondary implantation 65); the survival rate of the primary implantation was 93.3%, and the incidence of postoperative infection was 17.3%. The survival rate of the secondary implantation was 93.4%, and 23.1% had postoperative infection. Meta-analysis showed that there was no significant difference in the survival rate between primary implantation and secondary implantation, OR = 0.813 (95% CI 0.383-1.725, P = 0.589 > 0.05), and there was no significant difference in the incidence of postoperative infection, OR = 0.614 (95% CI 0.239-1.581, P = 0.312 > 0.05). CONCLUSIONS Based on the results of this study, the research found no significant difference in the survival rate or infection rates between primary and secondary implantation. After appropriate indications selection, primary implantation can be used to reconstruct the dentition with less waiting time, reduce the impact of radiotherapy, and bring a higher quality of life for patients.
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Affiliation(s)
- Yi-Bo Liu
- Department of Oral and Maxillofacial-Head and Neck Surgery, School of Stomatology, Tianjin Medical University, Tianjin, China
| | - Di Wu
- Department of Oral and Maxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, Nanjing North Street No.117, Shenyang, 110000, Liaoning, China
| | - Jun-Yi Wang
- Department of Oral and Maxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, Nanjing North Street No.117, Shenyang, 110000, Liaoning, China
| | - Xiao-Han Lun
- Department of Oral and Maxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, Nanjing North Street No.117, Shenyang, 110000, Liaoning, China
| | - Wei Dai
- Department of Oral and Maxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, Nanjing North Street No.117, Shenyang, 110000, Liaoning, China.
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Lombardo G, D'Agostino A, Nocini PF, Signoriello A, Zangani A, Pardo A, Lonardi F, Trevisiol L. Clinical outcomes and periodontal conditions of dental implants placed in free fibula flaps (FFF): a retrospective study with a mean follow-up of 6 years. Clin Oral Investig 2023; 27:7737-7751. [PMID: 37917356 PMCID: PMC10713700 DOI: 10.1007/s00784-023-05364-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/24/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVES Up-to-date literature regarding long-term success of implant rehabilitations after microvascular reconstructions with free fibula flap (FFF) is still very scarce. This study aimed to evaluate clinical outcomes, especially related to oral hygiene conditions, of patients rehabilitated with this technique. MATERIALS AND METHODS A total of 25 patients who underwent maxillofacial reconstructive surgery with FFF were retrospectively evaluated for soft tissues conditions, oral hygiene habits, and implant survival and success, assessed with a mean follow-up of 6 (range 2-15) years after loading. RESULTS Fourteen patients received full-arch fixed prostheses and 11 removable bar-supported overdentures. At the follow-up evaluation, 52% of prostheses did not allow proper accessibility for oral hygiene. Overall prosthetic survival was 100%, and implant survival and success were respectively 93.6% and 72%. Prevalence of peri-implantitis was 29% at implant level and that at patient level 96%. CONCLUSIONS Six-year clinical outcomes of this study reveal that poor oral hygiene practices and compliance by patients who underwent maxillofacial reconstruction with FFF are significantly associated with peri-implant disease. CLINICAL RELEVANCE Findings of the present study underline the need by clinicians for a careful assessment, in reference to a specific implant therapy, of patient's prosthetic accessibility for oral hygiene procedures.
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Affiliation(s)
- Giorgio Lombardo
- Dentistry and Maxillo-Facial Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Antonio D'Agostino
- Dentistry and Maxillo-Facial Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Pier Francesco Nocini
- Dentistry and Maxillo-Facial Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Annarita Signoriello
- Dentistry and Maxillo-Facial Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.
| | - Alessandro Zangani
- Dentistry and Maxillo-Facial Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Alessia Pardo
- Dentistry and Maxillo-Facial Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Fabio Lonardi
- Dentistry and Maxillo-Facial Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Lorenzo Trevisiol
- Dentistry and Maxillo-Facial Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology (DIPSCOMI), University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
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Xu Y, Li Y, Xiao W, Yue J, Xue L, Li L, Xu Z, Sun J. Virtual surgical planning/3D printing assisted fibula osteoseptocutaneous flap combined with anterolateral thigh flaps for extensive composite oromandibular defects reconstruction: a retrospective study of case series. Front Bioeng Biotechnol 2023; 11:1273318. [PMID: 38026888 PMCID: PMC10656737 DOI: 10.3389/fbioe.2023.1273318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Oromandibular tumors or osteoradionecrosis often lead to extensive composite defects encompassing intraoral, bone and extraoral tissues. A single flap cannot simultaneously offer sufficient bone and soft tissue. The combination of free flaps could be a prospective approach to overcome the challenge. The study aims to assess the efficacy of virtual surgical planning (VSP) and 3D printing assisted fibula osteoseptocutaneous flap (FOSCF) combined with anterolateral thigh flaps (ALT) in reconstructing extensive composite defects in the oromandibular region. A retrospective analysis was conducted on 8 patients who underwent reconstruction using FOSCFs combined with ALTs. Post-surgical excision of the lesions, we obtained mean values for the defects of intraoral soft tissue, bone, extraoral soft tissue, namely, being 42.7 cm2, 96 mm, and 68.9 cm2. The mean surgical procedures took 712.5 min. A total of 16 flaps were harvested and transplanted for the 8 patients, with all successfully surviving. Postoperatively, complications manifested as localized intraoral infections in 2 cases, intermuscular vein thrombosis in another 2 cases, and pulmonary infections in 2 patients. Two patients unfortunately experienced tumor recurrence, at 12 and 3 months post-operation respectively. For the surviving 6 patients, the average follow-up period was 12.2 months. Regarding patient satisfaction, one expressed dissatisfaction with the contour of the mandible, and two exhibited moderate trismus. Objective assessments identified 1 case of oral incontinence and 2 cases where external flap contractures were observed. All 8 patients experienced restoration of masticatory function and were able to consume a soft diet within a month post-surgery. VSP/3D printing assisted FOSCFs combined with ALTs can be performed safely to reconstruct the extensive composite tissue defects in our study, with desirable esthetic and functional results, and it is a reliable option in selecting patients with defects involving multiple tissue types. However, the benefits of this method needed more cases to validate.
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Affiliation(s)
- Yaoxiang Xu
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
- School of Stomatology, Qingdao University, Qingdao, China
- Dental Digital Medicine and 3D Printing Engineering Laboratory of Qingdao, Qingdao, China
- Shandong Provincial Key Laboratory of Digital Medicine and Computer-Assisted Surgery, Qingdao, China
| | - Yali Li
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wenlin Xiao
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
- School of Stomatology, Qingdao University, Qingdao, China
| | - Jin Yue
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
- School of Stomatology, Qingdao University, Qingdao, China
| | - Lingfa Xue
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
- School of Stomatology, Qingdao University, Qingdao, China
| | - Li Li
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
- School of Stomatology, Qingdao University, Qingdao, China
- Dental Digital Medicine and 3D Printing Engineering Laboratory of Qingdao, Qingdao, China
- Shandong Provincial Key Laboratory of Digital Medicine and Computer-Assisted Surgery, Qingdao, China
| | - Zexian Xu
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
- School of Stomatology, Qingdao University, Qingdao, China
- Dental Digital Medicine and 3D Printing Engineering Laboratory of Qingdao, Qingdao, China
- Shandong Provincial Key Laboratory of Digital Medicine and Computer-Assisted Surgery, Qingdao, China
| | - Jian Sun
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
- School of Stomatology, Qingdao University, Qingdao, China
- Dental Digital Medicine and 3D Printing Engineering Laboratory of Qingdao, Qingdao, China
- Shandong Provincial Key Laboratory of Digital Medicine and Computer-Assisted Surgery, Qingdao, China
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Camolesi GCV, Veronese HRM, Celestino MA, Blum DFC, Márquez-Zambrano JA, Carmona-Pérez FA, Jara-Venegas TA, Pellizzon ACA, Bernaola-Paredes WE. Survival of osseointegrated implants in head and neck cancer patients submitted to multimodal treatment: a systematic review and meta-analysis. Support Care Cancer 2023; 31:641. [PMID: 37851170 DOI: 10.1007/s00520-023-08088-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 09/27/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE To investigate the survival rate in implants placement in irradiated and non-irradiated bone in patients undergoing head and neck cancer (HNC) treatment. We focused on the consequences of the main complications, such as osteoradionecrosis and peri-implantitis. METHODS An electronic search conducted by PRISMA protocol was performed. Full texts were carefully assessed, and data were assimilated into a tabular form for discussion and consensus among the expert panel. The quality assessment and the risk of bias are verified by Joanna Briggs Institute checklist (JBI) and The Newcastle-Ottawa Scale (NOS), and Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) assessment tool. RESULTS A total of 452 records were identified in the based on our PICOs strategy and after screening, 19 articles were included in the descriptive analysis of the review. Totaling 473 implants placed in irradiated and non-irradiated bone, and 31.6% of the patients were over 60 years of age. 57.9%) performed implant placement in a period of 12 months or more after the ending of radiotherapy. Only 5 studies had a follow-up period longer than 5 years after implant placement, of which three were used for the meta-analysis. In the meta-analysis of 5-year survival rate, analysis of implants in irradiated bone was assessed; a random effect model was used and a weighted proportion (PP) of 93.13% (95% CI: 87.20-99.06; p < 0.001), and in the 5-year survival rate, analysis of implants in non-irradiated bone was analysed; a fixed effect model was used and a weighted proportion (PP) of 98.52% survival (95% CI: 97.56-99.48, p < 0.001). CONCLUSIONS Survival rates of implants placed in irradiated bone are clinically satisfactory after a follow-up of 5 years, with a fewer percentage than in implants placed in non-irradiated bone after metanalyses performed.
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Affiliation(s)
- Gisela Cristina Vianna Camolesi
- Oral Medicine, Oral Surgery, and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, University of Santiago de Compostela, 15782, Santiago de Compostela, Spain.
| | | | | | - Davi Francisco Casa Blum
- Department of Oral and Maxillofacial Surgery, Atitus Education, Passo Fundo, Rio Grande Do Sul, Brazil
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Nayak VV, Slavin B, Bergamo ETP, Boczar D, Slavin BR, Runyan C, Tovar N, Witek L, Coelho PG. Bone Tissue Engineering (BTE) of the Craniofacial Skeleton, Part I: Evolution and Optimization of 3D-Printed Scaffolds for Repair of Defects. J Craniofac Surg 2023; 34:2016-2025. [PMID: 37639650 PMCID: PMC10592373 DOI: 10.1097/scs.0000000000009593] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 06/25/2023] [Indexed: 08/31/2023] Open
Abstract
Bone tissue regeneration is a complex process that proceeds along the well-established wound healing pathway of hemostasis, inflammation, proliferation, and remodeling. Recently, tissue engineering efforts have focused on the application of biological and technological principles for the development of soft and hard tissue substitutes. Aim is directed towards boosting pathways of the healing process to restore form and function of tissue deficits. Continued development of synthetic scaffolds, cell therapies, and signaling biomolecules seeks to minimize the need for autografting. Despite being the current gold standard treatment, it is limited by donor sites' size and shape, as well as donor site morbidity. Since the advent of computer-aided design/computer-aided manufacturing (CAD/CAM) and additive manufacturing (AM) techniques (3D printing), bioengineering has expanded markedly while continuing to present innovative approaches to oral and craniofacial skeletal reconstruction. Prime examples include customizable, high-strength, load bearing, bioactive ceramic scaffolds. Porous macro- and micro-architecture along with the surface topography of 3D printed scaffolds favors osteoconduction and vascular in-growth, as well as the incorporation of stem and/or other osteoprogenitor cells and growth factors. This includes platelet concentrates (PCs), bone morphogenetic proteins (BMPs), and some pharmacological agents, such as dipyridamole (DIPY), an adenosine A 2A receptor indirect agonist that enhances osteogenic and osteoinductive capacity, thus improving bone formation. This two-part review commences by presenting current biological and engineering principles of bone regeneration utilized to produce 3D-printed ceramic scaffolds with the goal to create a viable alternative to autografts for craniofacial skeleton reconstruction. Part II comprehensively examines recent preclinical data to elucidate the potential clinical translation of such 3D-printed ceramic scaffolds.
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Affiliation(s)
- Vasudev V Nayak
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Blaire Slavin
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Edmara TP Bergamo
- Department of Prosthodontics and Periodontology, University of São Paulo - Bauru School of Dentistry, Bauru, SP, Brazil
- Biomaterials Division - NYU College of Dentistry, New York, NY, USA
| | - Daniel Boczar
- Department of Surgery, University of Washington, Seattle, WA USA
| | - Benjamin R. Slavin
- DeWitt Daughtry Family Department of Surgery, Division of Plastic Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Christopher Runyan
- Department of Plastic and Reconstructive Surgery, Wake Forest School of Medicine; Winston-Salem, NC, USA
| | - Nick Tovar
- Biomaterials Division - NYU College of Dentistry, New York, NY, USA
- Department of Oral and Maxillofacial Surgery, New York University, Langone Medical Center and Bellevue Hospital Center, New York, NY, USA
| | - Lukasz Witek
- Biomaterials Division - NYU College of Dentistry, New York, NY, USA
- Department of Biomedical Engineering, NYU Tandon School of Engineering, Brooklyn, NY, USA
| | - Paulo G. Coelho
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL, USA
- DeWitt Daughtry Family Department of Surgery, Division of Plastic Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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11
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Oldén A, Wamalwa AO, Jonsson EL, Thor A, Lorenzo AR. Factors Affecting Complete Oral Rehabilitation in Patients With Vascularized Free Fibula Flap Mandibular Reconstruction: A 10-Year Retrospective Study. J Craniofac Surg 2023; 34:1635-1639. [PMID: 37485965 DOI: 10.1097/scs.0000000000009543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 05/20/2023] [Indexed: 07/25/2023] Open
Abstract
The fibula is the preferred bone flap for mandibular reconstructions due to its many advantages, including the possibility to insert dental implants. All patients who received a mandibular reconstruction with a vascularized free fibula flap at the Uppsala University Hospital between 2009 and 2019 were retrospectively examined regarding the proportion of implant insertion and factors that affected implant outcome. Forty-one patients had 42 fibula flap reconstructions. Eleven patients (27%) received dental implants and 8 (20%) completed dental rehabilitation. Patient death and cancer recurrence were the main reasons for not receiving implants. The survival rates of implants placed in irradiated and nonirradiated fibulas were 15% and 76%, respectively. Less than 20% of reconstructed patients received an implant-supported prosthesis. Implants placed in an irradiated fibula should be considered at high risk for implant loss.
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Affiliation(s)
- Alexandra Oldén
- Department of Surgical Sciences, Odontology & Maxillofacial Surgery, Uppsala University
| | - Alex O Wamalwa
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital
| | - Eva Lindell Jonsson
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital
- Department of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala, Sweden
| | - Andreas Thor
- Department of Surgical Sciences, Odontology & Maxillofacial Surgery, Uppsala University
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital
| | - Andrés Rodriguez Lorenzo
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital
- Department of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala, Sweden
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12
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Zhang X, Xiao T, Yang L, Ning C, Guan S, Li X. Application of a vascularized bone free flap and survival rate of dental implants after transplantation: A systematic review and meta-analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101401. [PMID: 36717020 DOI: 10.1016/j.jormas.2023.101401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/08/2023] [Accepted: 01/26/2023] [Indexed: 01/30/2023]
Abstract
PURPOSE As maxillofacial surgical techniques have advanced, vascularized bone free flap transplantation has become the standard treatment for repairing maxillofacial defects. In this meta-analysis, we summarize the survival rates of implants after VBFF surgery for maxillary and mandibular reconstructions and investigate the factors affecting patient outcomes. METHODS The PubMed, Embase, and Wanfang databases were searched up to May 31, 2022. The results of the treatment effect are presented as the risk ratio or odds ratio, using 95% confidence intervals. Statistical significance was calculated at α = 0.05 (two-tailed z tests). RESULTS 35 studies were included in our analysis. The results revealed a 3-year and 5-year implant survival rate of 95.2% and 85.4% in VBFFs, respectively. The location of jaw defects (maxilla or mandible) or timing of implantation was not found to have a statistically significant influence on the survival rate. However, statistically significant differences were observed in the failure of implants placed in irradiated bone tissue. CONCLUSIONS Statistically significant differences were not found in the implant survival rate between simultaneous and delayed implantation, or between maxillary and mandibular defects. However, dental implants placed in irradiated flaps tended to have a lower survival rate than those surgically placed in non-irradiated flaps.
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Affiliation(s)
- Xingkui Zhang
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Hebei Medical University and Hebei Key Laboratory of Stomatology, Shijiazhuang 050017, China
| | - Tiepeng Xiao
- Department of Oral Orthodontics, The Second Affiliated Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Lei Yang
- Department of Epidemiology and Statistics, School of Public Health, Hebei Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang 050017, China
| | - Chunliu Ning
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Hebei Medical University and Hebei Key Laboratory of Stomatology, Shijiazhuang 050017, China
| | - Shuai Guan
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Hebei Medical University and Hebei Key Laboratory of Stomatology, Shijiazhuang 050017, China
| | - Xiangjun Li
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Hebei Medical University and Hebei Key Laboratory of Stomatology, Shijiazhuang 050017, China.
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13
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Sozzi D, Cassoni A, De Ponti E, Moretti M, Pucci R, Spadoni D, Canzi G, Novelli G, Valentini V. Effectiveness of Resective Surgery in Complex Ameloblastoma of the Jaws: A Retrospective Multicenter Observational Study. Cancers (Basel) 2022; 14:cancers14194608. [PMID: 36230531 PMCID: PMC9559477 DOI: 10.3390/cancers14194608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022] Open
Abstract
Ameloblastoma is a rare, benign, odontogenic tumor of epithelial origin, characterized by locally aggressive, expansive growth. Treatment is controversial due to the risk of relapse. The aim of this multicenter retrospective study was to evaluate the effectiveness of complete resection in cases of complex ameloblastoma, which is considered at a higher risk of recurrence. Patients who met at least one of these criteria were included: recurrence, soft-tissue involvement, complete erosion of internal/external cortical walls with involvement of the inferior margin of the mandible, and invasion of the maxillary sinus or nasal cavity. Demographic data, tumor site, type of surgery, histological features, and follow-up information were collected for each patient. The cohort included 55 patients with a mean follow-up of 108 ± 66 months. A multivariate logistic model was used to evaluate variables independently associated with relapse. There were six soft-tissue or maxillary sinus relapses, with a recurrence rate of 10.9%. Most of them arose in patients previously treated. The statistical analysis identified the maxillary location as a fundamental relapse risk factor. En bloc resection with large surgical safety margins seemed to be effective in preventing the relapses. However, complete resection was less effective in preventing recurrences in the soft tissues or maxillary sinus.
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Affiliation(s)
- Davide Sozzi
- Maxillofacial Surgery Unit, ASST Monza—San Gerardo Hospital, 20900 Monza, Italy
- Department of Medicine and Surgery, School of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, Italy
- Correspondence: ; Tel.: +39-039-233-3535 or +39-039-233-3538; Fax: +39-039-233-3536
| | - Andrea Cassoni
- Oncological and Reconstructive Maxillofacial Surgery Unit, Policlinico Umberto I of Rome, 00161 Rome, Italy
- Department of Oral Maxillofacial Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Elena De Ponti
- Department of Medical Physics, ASST Monza—San Gerardo Hospital, University of Milano Bicocca, 20900 Monza, Italy
| | - Mattia Moretti
- Maxillofacial Surgery Unit, ASST Monza—San Gerardo Hospital, 20900 Monza, Italy
- Postgraduate School of Maxillofacial Surgery, University of Milan, 20122 Milan, Italy
| | - Resi Pucci
- Department of Oral Maxillofacial Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Davide Spadoni
- Maxillofacial Surgery Unit, ASST Santi Paolo e Carlo—Ospedale San Paolo, 20142 Milan, Italy
| | - Gabriele Canzi
- Maxillofacial Surgery Unit, Emergency Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Giorgio Novelli
- Maxillofacial Surgery Unit, ASST Monza—San Gerardo Hospital, 20900 Monza, Italy
- Department of Medicine and Surgery, School of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, Italy
| | - Valentino Valentini
- Oncological and Reconstructive Maxillofacial Surgery Unit, Policlinico Umberto I of Rome, 00161 Rome, Italy
- Department of Oral Maxillofacial Sciences, Sapienza University of Rome, 00185 Rome, Italy
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14
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Kang YF, Ding MK, Qiu SY, Cai ZG, Zhang L, Shan XF. Mandibular Reconstruction Using Iliac Flap Based on Occlusion-Driven Workflow Transferred by Digital Surgical Guides. J Oral Maxillofac Surg 2022; 80:1858-1865. [DOI: 10.1016/j.joms.2022.07.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 10/16/2022]
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15
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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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16
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Multidisciplinary Approach for Full-Mouth Rehabilitation of a Young Adult Patient with Ameloblastoma. Case Rep Dent 2021; 2021:8694775. [PMID: 34712499 PMCID: PMC8548147 DOI: 10.1155/2021/8694775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/11/2021] [Accepted: 09/29/2021] [Indexed: 11/17/2022] Open
Abstract
Ameloblastoma is a benign but locally invasive neoplasm of the odontogenic epithelium that tends to grow slowly in the mandible or maxilla. It can be highly destructive to the surrounding dental anatomy and can cause death by progressive spread to nearby vital structures in rare cases. Marginal resection is the most effective method of eliminating the tumor, but treatment can further contribute to oral and dental deformity and malfunction. This clinical report describes the dental rehabilitation of a young adult patient diagnosed with ameloblastoma and underwent preliminary marsupialization, segmental mandibulectomy, and fibula free flap reconstruction, followed by mandibular dental implant placements. Orthodontic and rapid palatal expansion for maxillary arch correction was also performed. The treatment goal of regaining dental function and a satisfactory appearance was accomplished.
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17
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Khadembaschi D, Russell P, Beech N, Batstone MD. Osseointegrated implant survival, success and prosthodontic outcomes in composite free flaps: A 10-year retrospective cohort study. Clin Oral Implants Res 2021; 32:1251-1261. [PMID: 34352129 DOI: 10.1111/clr.13822] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 06/24/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate implant survival, success and prosthodontic outcomes in a variety of composite free flaps. MATERIAL AND METHODS A retrospective analysis of patient records was used for data collection of implants placed into flaps. Free flap donor sites included fibula, iliac crest, scapula, medial femoral condyle and radial forearm. Kaplan-Meier survival curves were used to estimate survival. Cox regression was used to assess variables affecting survival, and binary logistic regression was utilised to determine effect of variables on prosthodontic outcomes. RESULTS There were 150 implants placed into 45 fibula, 98 implants into 29 iliac crest, 62 implants into 22 scapula, 6 implants into 3 medial femoral condyle and 2 implants in radial forearm composite free flaps. There was no difference in survival or success between or within the various flaps. Active smoking, increasing age, male gender and radiotherapy were associated with implant failure. Of patients completing prosthodontic rehabilitation, 93% were successful. There was no difference in likelihood of failure between different flap types. Fixed implant-supported dentures were associated with poor oral hygiene compared with removable designs (OR2.9, 95%CI 1.1-7.8, p = .03). CONCLUSIONS There is adequate survival and success of implants in common flaps. Caution is required when planning implants in patients exposed to radiotherapy and smokers. Ability to maintain adequate oral hygiene is an important prosthetic design consideration.
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Affiliation(s)
- Darius Khadembaschi
- School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Peter Russell
- Metro North Oral Health Centre, Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Nicholas Beech
- School of Medicine, University of Queensland, Herston, Queensland, Australia.,Department of Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Martin D Batstone
- School of Medicine, University of Queensland, Herston, Queensland, Australia.,Department of Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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18
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Abstract
ABSTRACT Bilateral cleft lip and palate (CLP) patients commonly require surgical management to treat maxillary hypoplasia following the primary repair. Rarer is the CLP patient who also presents with a missing premaxillary segment. Here the authors present the case of a 19-year-old female with a history of bilateral CLP who demonstrated significant maxillary hypoplasia in addition to a large premaxillary defect. To correct this deformity, LeFort I advancement with fibular reconstruction of the maxilla and dental implant placement was performed as a single surgical procedure. The authors discuss the advantages of undergoing this single-staged operation. By utilizing virtual surgical planning (VSP) and incorporating a multidisciplinary team within the operating room, the patient was able to successfully undergo maxillary reconstruction and dental implant placement in a single operation.
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19
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Li YY, Xu ZM, Zhang SC, Tao BQ, Xiang DW, Liu WW. Mandibular Reconstruction Using Free Fibular Flap Graft Following Excision of Calcifying Epithelial Odontogenic Tumor. J Craniofac Surg 2021; 32:e167-e171. [PMID: 33705062 DOI: 10.1097/scs.0000000000006955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT The calcifying epithelial odontogenic tumor (CEOT) is a rare benign odontogenic tumor, which usually presents with distension of affected tissues. Radiologically, the lesions are often associated with an unerupted tooth and may have spot calcification shadows. The authors report a case of a CEOT in a 48-year-old male involving the right mandibular jaw bone and mentum soft tissues. The authors performed hemimandibulectomy and enucleation followed by reconstruction of the mandible using a vascularized free fibular flap through a digital surgical technique in order to restore the patient's facial symmetry and prepare the area for functional restorations. The case illustrates who the free fibular flap graft can be used for satisfactory mandibular reconstruction and restoration of the morphology and functions.
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Affiliation(s)
- Yu-Yang Li
- Department of Dental Implantology.,Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Changchun, China
| | - Zhi-Min Xu
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Jilin University
| | - Shi-Chen Zhang
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Jilin University.,Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Changchun, China
| | - Bo-Qiang Tao
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Jilin University.,Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Changchun, China
| | - Dan-Wei Xiang
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Jilin University.,Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Changchun, China
| | - Wei-Wei Liu
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Jilin University
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20
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Weber M, Wehrhan F, Deschner J, Sander J, Ries J, Möst T, Bozec A, Gölz L, Kesting M, Lutz R. The Special Developmental Biology of Craniofacial Tissues Enables the Understanding of Oral and Maxillofacial Physiology and Diseases. Int J Mol Sci 2021; 22:ijms22031315. [PMID: 33525669 PMCID: PMC7866214 DOI: 10.3390/ijms22031315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 11/21/2022] Open
Abstract
Maxillofacial hard tissues have several differences compared to bones of other localizations of the human body. These could be due to the different embryological development of the jaw bones compared to the extracranial skeleton. In particular, the immigration of neuroectodermally differentiated cells of the cranial neural crest (CNC) plays an important role. These cells differ from the mesenchymal structures of the extracranial skeleton. In the ontogenesis of the jaw bones, the development via the intermediate stage of the pharyngeal arches is another special developmental feature. The aim of this review was to illustrate how the development of maxillofacial hard tissues occurs via the cranial neural crest and pharyngeal arches, and what significance this could have for relevant pathologies in maxillofacial surgery, dentistry and orthodontic therapy. The pathogenesis of various growth anomalies and certain syndromes will also be discussed.
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Affiliation(s)
- Manuel Weber
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (F.W.); (J.R.); (T.M.); (M.K.); (R.L.)
- Correspondence: ; Tel.: +49-9131-854-3749
| | - Falk Wehrhan
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (F.W.); (J.R.); (T.M.); (M.K.); (R.L.)
- Private Office for Maxillofacial Surgery, 91781 Weißenburg, Germany
| | - James Deschner
- Department of Periodontology and Operative Dentistry, University of Mainz, 55131 Mainz, Germany;
| | - Janina Sander
- Private Office for Oral Surgery, 96049 Bamberg, Germany;
| | - Jutta Ries
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (F.W.); (J.R.); (T.M.); (M.K.); (R.L.)
| | - Tobias Möst
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (F.W.); (J.R.); (T.M.); (M.K.); (R.L.)
| | - Aline Bozec
- Department of Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany;
| | - Lina Gölz
- Department of Orthodontics, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany;
| | - Marco Kesting
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (F.W.); (J.R.); (T.M.); (M.K.); (R.L.)
| | - Rainer Lutz
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (F.W.); (J.R.); (T.M.); (M.K.); (R.L.)
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21
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Li R, Meng Z, Zhang Y, Shan X, Wang Y, He Y. Soft Tissue Management: A Critical Part of Implant Rehabilitation After Vascularized Free-Flap Reconstruction. J Oral Maxillofac Surg 2020; 79:560-574. [PMID: 33279473 DOI: 10.1016/j.joms.2020.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 11/08/2020] [Accepted: 11/08/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE Implant rehabilitation after jaw reconstruction is challenging, and postoperative peri-implantitis is common. Our aim was to present our management protocol for implant rehabilitation after vascularized free-flap reconstruction and report the outcomes of soft tissue management. METHODS This retrospective cohort study included patients who received vascularized free-flap reconstruction, implant rehabilitation, apical reposition flaps (ARFs), and free gingival grafts (FGGs) at Peking University School and Hospital of Stomatology from January 1, 2009 to January 1, 2020. We assessed the association of age, gender, primary disease, flap choice, number and position of implants, timing of ARFs and FGGs, fixation stent use, and restoration type with the occurrence of peri-implantitis. Probing pocket depth, bleeding on probing, and marginal bone loss of the implants were measured as well. The data were analyzed by descriptive statistics, Kaplan-Meier statistics, and Cox regression analysis. RESULTS In total, 19 patients with 65 implants were included. The implants were placed immediately or 7 to 44 months after reconstruction of the jaw with fibular (n = 17) or iliac flaps (n = 2). ARFs and FGGs were performed 0 to 11 months later. No implants were lost. The mean probing pocket depth, bleeding on probing, and marginal bone loss at 26.6 ± 16.8 months were 3.5 ± 0.9 mm, 70.4 ± 35.1%, and 0.6 ± 0.4 mm, respectively. The incidence of peri-implantitis was 32.3%, showing no significant associations with the gender, age, primary disease, flap choice, number and position of implants, timing of ARFs and FGGs, use of a fixation stent, and type of restoration based on the adjusted multivariate model (P > .05). CONCLUSIONS Soft tissue management helps generate firmly attached keratinized mucosa around the implants, leads to a more precise impression, and reduces peri-implant bone loss. It should be considered as a critical part of implant rehabilitation after vascularized free-flap reconstruction.
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Affiliation(s)
- Ruiliu Li
- Resident, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Zhaoqiang Meng
- Attending Doctor, Special Dental Care Clinic, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yi Zhang
- Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xiaofeng Shan
- Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yang Wang
- Associate Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yang He
- Associate Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
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[Postoperative position change of fibular bone after reconstruction of maxillary defect using free fibular flap]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2020. [PMID: 33047733 PMCID: PMC7653421 DOI: 10.19723/j.issn.1671-167x.2020.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To investigate the position change of the fibular bone after maxillary reconstruction by free fibular flap and to analyze the factors affecting the position change. METHODS Patients who underwent maxillary reconstruction by free fibular flap in the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from November 2012 to November 2016 were enrolled in this study. CT scans 1 week and 1 year postoperatively were collected and stored in DICOM format. The ProPlan CMF software was used to reconstruct the CT scans and separate the maxilla and each segment of the fibular flap. The Geomagic Control software was used to measure the long axis direction vector of each fibular segment. And the position change direction was recorded. The patients were divided into groups according to the use of the fibula or titanium plate to reconstruct the zygomaticmaxillary buttress. RESULTS A total of 32 patients were enrolled. Among them, 21 were in the titanium plate group and 11 in the fibula bone group. The angle between the long axis of the fibular segment and the X axis in the X-Y plane was 95.65°±53.49° and 95.53°±52.77°, 1 week and 1 year postoperatively, and there was no statistical difference (P>0.05). The angle between the long axis of the fibular segment and the X axis in the X-Z plane was 96.88°±69.76° and 95.33°±67.42°, respectively, with statistical difference (P=0.0497). The angular changes of the long axis of the fibular segment in the titanium plate group and the fibular bone group were 3.23°±3.93° and 1.94°±1.78°, respectively, and the angular changes in the X-Z plane were 6.02°±9.89° and 3.27°±2.31°, respectively. There was no significant difference between the groups (P>0.05). The long axis changes of the fibular segment in the X-Y plane for reconstruction of the anterior alveolar, posterior alveolar, and buttress were 3.13°±3.78°, 2.56°±3.17°, and 5.51°±4.39°, respectively. There was a statistical difference (P = 0.023) between the posterior and buttress. In the X-Z plane, theses were 4.94°±4.75°, 5.26°±10.25°, 6.69°±6.52°, respectively. There was no statistical difference among the three groups (P>0.05). The main positional deviation directions of the titanium plate group and the fibular bone group were interior and superior sides, and there was no statistical difference between the two groups (P>0.05). CONCLUSION One year postoperatively, the position of the free fibular flap was changed compared with 1 week postoperatively. The position of the free fibular flap was mainly changed to the interior and superior sides.
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Dental Implant Survival in Vascularized Bone Flaps: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2020; 146:637-648. [PMID: 32459736 DOI: 10.1097/prs.0000000000007077] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Maxillofacial reconstruction with vascularized bone restores facial contour and provides structural support and a foundation for dental rehabilitation. Routine implant placement in such cases, however, remains uncommon. This study aims to determine dental implant survival in patients undergoing vascularized maxillary or mandibular reconstruction through a systematic review of the literature. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the literature was queried for implant placement in reconstructed jaws using Medical Subject Headings terms on PubMed, Embase, and Cochrane platforms. Weighted implant survivals were calculated for the entire cohort and subcohorts stratified by radiotherapy. Meta-analyses were performed to estimate effect of radiation on implant osseointegration. RESULTS Of 3965 publications identified, 42 were reviewed, including 1084 patients with 3636 dental implants. Weighted implant survival was 92.2 percent at a median follow-up of 36 months. Survival was 97.0 percent in 269 implants placed immediately in 60 patients versus 89.9 percent in 1897 delayed implants placed in 597 patients, with follow-up of 14 and 40 months, respectively. Dental implants without radiotherapy exposure had better survival than those exposed to radiation (95.3 versus 84.6 percent; p < 0.01) at a median follow-up of 36 months. Meta-analyses showed that radiation significantly increased the risk of implant failure (risk ratio, 4.74; p < 0.01) and suggested that implants placed before radiotherapy trended toward better survival (88.9 percent versus 83.4 percent, p = 0.07; risk ratio, 0.52; p = 0.14). CONCLUSIONS Overall implant survival was 92.2 percent; however, radiotherapy adversely impacted outcomes. Implants placed before radiotherapy may demonstrate superior survival than implants placed after.
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Nguyen TTH, Eo MY, Myoung H, Kim MJ, Kim SM. Implant-supported fixed and removable prostheses in the fibular mandible. Int J Implant Dent 2020; 6:44. [PMID: 32778982 PMCID: PMC7417466 DOI: 10.1186/s40729-020-00241-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 06/23/2020] [Indexed: 11/17/2022] Open
Abstract
Background To restore the health-related quality of life (HRQoL) of patients who underwent jaw resection and reconstruction surgery, dental rehabilitation is an essential procedure and also one of the most challenging for oral and maxillofacial surgeons. Even though recent studies have reported the possibility and reliability of dental implant rehabilitation with the fibula free flap (FFF), clinical reports of long-term follow-up cases are scarce. We herein reported seven cases of FFF reconstruction and implant rehabilitation. We also discussed implant planning strategy and surgical techniques. Methods From 2012 to 2019, seven patients were treated with FFF reconstructive jaw surgery combined with dental implant installation and fabrication of implant-supported prostheses at Seoul National University Dental Hospital, Seoul, Korea. Patient characteristics and FFF treatment results were collected. Records of dental implants were analyzed clinically and radiologically. Results Among the seven patients in this report, there were three males and four females, with an average age of 54.4 years. A total of 39 implants were placed in the fibular bone. The mean follow-up period after implant installation was 24 months. Five implants failed and were removed 3 months after installation. The implant success rate was 87.2%. Marginal bone loss at 12 months after loading was 0.23 ± 0.18 mm on the mesial side and 0.25 ± 0.26 mm on the distal side. Conclusion With the challenges present in FFF-reconstructed patients, an implant-supported prosthesis is a reliable option for stable and functional oral rehabilitation. The implant-supported prosthesis on the FFF has great results regarding restoration of function (mastication, swallowing, and speaking), appearance, and overall HRQoL. Collaboration between surgeons and prosthodontists is essential for a satisfying outcome.
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Affiliation(s)
- Truc Thi Hoang Nguyen
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Mi Young Eo
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Hoon Myoung
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Myung-Joo Kim
- Department of Prosthodontics, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Soung Min Kim
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
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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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Study of Treatment Methods for Surrounding Soft Tissues of Implants Following Mandibular Reconstructions with Fibula-Free Flaps. Dent J (Basel) 2020; 8:dj8030067. [PMID: 32635391 PMCID: PMC7559181 DOI: 10.3390/dj8030067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/24/2020] [Accepted: 07/01/2020] [Indexed: 11/24/2022] Open
Abstract
In maxillofacial reconstruction implant treatment, unsatisfactory soft tissue treatment of the area around the implant may lead to inflammation. As a result, appropriate soft tissue treatment is critical. To the best of our knowledge, there are no studies that compare the different tissue treatment methods available. Hence, in this study, we compare three soft tissue treatment methods around implants after mandibular reconstruction is achieved with a fibula-free flap. Out of 33 patients who underwent mandible reconstruction using fibula-free flaps between 2006 and 2015, 5 were selected for this study. A total of 17 implants were used for treatment by the final prosthetics of the five patients. Three soft tissue treatment methods with free gingival graft (FGG) were evaluated, namely, installing a splint in a modified abutment to protect the wounded area during a palatal mucosa transplant (method 1), installing a splint or dentures to a locator abutment (method 2), and the use of screw-in fixed dentures (method 3). The method that could guarantee the widest keratinized mucosa was the screw-in fixed denture method. The results of our study indicated that employing screw-in fixed dentures for FGG may be a useful soft tissue treatment for mandible reconstruction implants.
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Alberga JM, Vosselman N, Korfage A, Delli K, Witjes MJH, Raghoebar GM, Vissink A. What is the optimal timing for implant placement in oral cancer patients? A scoping literature review. Oral Dis 2020; 27:94-110. [PMID: 32097511 PMCID: PMC7818452 DOI: 10.1111/odi.13312] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Oral cancer patients can benefit from dental implant placement. Traditionally, implants are placed after completing oncologic treatment (secondary implant placement). Implant placement during ablative surgery (primary placement) in oral cancer patients seems beneficial in terms of early start of oral rehabilitation and limiting additional surgical interventions. Guidelines on the ideal timing of implant placement in oral cancer patients are missing. OBJECTIVE To perform a scoping literature review on studies examining the timing of dental implant placement in oral cancer patients and propose a clinical practice recommendations guideline. METHODS A literature search for studies dealing with primary and/or secondary implant placement in MEDLINE was conducted (last search December 27, 2019). The primary outcome was 5-year implant survival. RESULTS Sixteen out of 808 studies were considered eligible. Both primary and secondary implant placement showed acceptable overall implant survival ratios with a higher pooled 5-year implant survival rate for primary implant placement 92.8% (95% CI: 87.1%-98.5%) than secondary placed implants (86.4%, 95% CI: 77.0%-95.8%). Primary implant placement is accompanied by earlier prosthetic rehabilitation after tumor surgery. CONCLUSION Patients with oral cancer greatly benefit from, preferably primary placed, dental implants in their prosthetic rehabilitation. The combination of tumor surgery with implant placement in native mandibular bone should be provided as standard care.
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Affiliation(s)
- Jamie M Alberga
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nathalie Vosselman
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anke Korfage
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Konstantina Delli
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerry M Raghoebar
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Pelissier E, Desoutter A, Chaux-Bodard AG. Peri implant bone resorption on microvascular free fibula flap: a radiographic retrospective study. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2020. [DOI: 10.1051/mbcb/2020007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction: As the vascularization of the microvascular free fibula flap enables to maintain an osteogenic potential, osseointegrated implants have a 86% to 99% success rate. Thus, only few studies consider peri-implant bone resorption (PIBR). The aim of the study was to radiologically evaluate PIBR on fibula flaps. Materials and methods: Data were retrospectively collected. Gender, age, reason for interruptive mandibulectomy, previous radiotherapy, number of implants placed on the reconstruction, length and number of segments of the reconstruction, height of resorption were collected for each patient. Measurements were made on panoramic radiograph. Results: 85 clinical reports were reviewed for 39 retained. Peri-implant bone resorption was observed in 21 (53.9%) patients. The average age of the resorption group was 55.4 . All of the 5 patients with 4 or 5 implants on their reconstruction did not developed PIBR. 59.1% of patients with 1 segment reconstruction developed PIBR, 54.6% with 2 segments and 33.3% with 3 segments. Discussion: Age and poor oral hygiene appeared to be clearly more related to PIBR. An important number of implant (4 or 5) and a reconstruction with more than 1 segment seemed to decrease PIBR. Further studies are required to confirm these hypotheses.
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Bolzoni AR, Baj A, Sweed AH, Giannì AB, Montrasio EF, Beltramini GA. Role of Axial Split Osteotomy of Free Fibula Flap in Mandibular Reconstruction and Dental Rehabilitation. Plast Reconstr Surg Glob Open 2020; 8:e2546. [PMID: 32095389 PMCID: PMC7015618 DOI: 10.1097/gox.0000000000002546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 10/04/2019] [Indexed: 12/03/2022]
Abstract
The fibula free flap (FFF) is regarded as the gold standard in mandibular reconstruction. Dental rehabilitation is important to improve the health-related quality of life of patients undergoing mandibular reconstruction. FFF provides adequate cortical bone osseous tissue for use in dental implantation. The application of “axial split osteotomy” via a double-barrel fibula graft may enable discrepancies between the native mandible and FFF to be avoided, thereby improving the likelihood of early and successful dental rehabilitation.
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Yao CMKL, Chang EI, Lai SY. Contemporary Approach to Locally Advanced Oral Cavity Squamous Cell Carcinoma. Curr Oncol Rep 2019; 21:99. [PMID: 31701240 DOI: 10.1007/s11912-019-0845-8] [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: 01/17/2023]
Abstract
PURPOSE OF REVIEW Surgical management of locally advanced oral cavity squamous cell carcinomas (OCSCC) has long been recognized as a primary treatment modality. Technological advances have led to significant improvements in our surgical approach, from improvement in the visualization of tumors to more efficient and precise reconstruction. Here, we review the latest technological advances in surgical extirpation and reconstruction of locally advanced OCSCCs. RECENT FINDINGS The focus of technological innovation in surgical extirpation has been on improving visualization, with the use of intraoperative ultrasound for margin delineation, intraoperative navigation, narrow-band imaging, and the use of fluorescence. Though early, these are promising steps to ensuring complete resection of the cancer. Advances in reconstruction have been centered on the incorporation of computer assisted design, manufacturing, and virtual surgical planning, allowing for more complex three-dimensional defects to be expeditiously reconstructed. As these technologies are still under development, their impact on oncologic outcomes are not yet robustly defined; however, as technology continues to advance and become more widely available, new technologies will undoubtedly become integrated into enhancing surgical precision and planning.
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Affiliation(s)
- Christopher M K L Yao
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1445, Houston, TX, 77030, USA.
| | - Edward I Chang
- Department of Plastic Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1258, Houston, TX, 77030, USA.
| | - Stephen Y Lai
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1445, Houston, TX, 77030, USA.
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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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Naujokat H, Açil Y, Harder S, Lipp M, Böhrnsen F, Wiltfang J. Osseointegration of dental implants in ectopic engineered bone in three different scaffold materials. Int J Oral Maxillofac Surg 2019; 49:135-142. [PMID: 31053519 DOI: 10.1016/j.ijom.2019.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/15/2019] [Accepted: 04/09/2019] [Indexed: 11/16/2022]
Abstract
The in vivo regeneration of bone flaps might be an alternative to autogenous bone grafting. The first human case of mandibular reconstruction using the greater omentum as a bioreactor was reported in 2016. However, whether engineered bone will support the osseointegration of dental implants has not yet been investigated. In this study, bone tissue engineering was performed in the greater omentum of nine miniature pigs using bone morphogenetic protein 2, bone marrow aspirate, and three different scaffolds: hydroxyapatite, biphasic calcium phosphate (BCP), and titanium. After 8 weeks, two implants were placed in each scaffold; after another 8 weeks, the bone blocks were harvested for radiographic, histological, and histomorphometric analysis. All implants exhibited sufficient primary stability, and the success rate was 100%. The bone-to-implant contact ratios (BICs) were 38.2%, 68.5%, and 42.9%; the inter-thread bone densities were 29.4%, 64.9%, and 33.5%; and the peri-implant bone-scaffold densities were 56.4%, 87.6%, and 68.6% in the hydroxyapatite, BCP, and titanium groups, respectively. The BIC showed a strong correlation (r = 0.76) with the peri-implant bone-scaffold density. This study shows that de novo engineered bone leads to successful osseointegration and therefore may allow implant-based prosthodontic rehabilitation.
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Affiliation(s)
- H Naujokat
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany.
| | - Y Açil
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - S Harder
- Department of Prosthodontics, Propaedeutics and Dental Materials, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - M Lipp
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - F Böhrnsen
- Department of Oral and Maxillofacial Surgery, University Hospital of Göttingen, Göttingen, Germany
| | - J Wiltfang
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany
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Kang YF, Liang J, He Z, Xie S, Zhang L, Shan XF, Cai ZG. Cortical bone resorption of fibular bone after maxillary reconstruction with a vascularized fibula free flap: a computed tomography imaging study. Int J Oral Maxillofac Surg 2019; 48:1009-1014. [PMID: 30979515 DOI: 10.1016/j.ijom.2019.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 01/06/2019] [Accepted: 03/12/2019] [Indexed: 10/27/2022]
Abstract
This study was performed to evaluate the cortical bone resorption of fibular bone after maxillary reconstruction with a fibula free flap. A total of 35 patients with maxillary defects that were repaired using a fibula flap (62 fibula segments) between January 2011 and January 2016 were enrolled. Computed tomography (CT) images taken 1 week and 1 year postoperative were used to evaluate cortical bone resorption. The 62 fibula segments were measured on four different surfaces in the CT images. At 1 week, the thickness of the cortical bone was 2.57 ± 0.58 mm, 2.72 ± 0.46 mm, 3.84 ± 0.98 mm, and 4.36 ± 0.90 mm for the exterior, interior, superior, and inferior sides, respectively. At approximately 1 year, the cortical bone thickness was significantly reduced to 2.00 ± 0.65 mm (P < 0.01), 2.25 ± 0.60 mm (P < 0.01), 3.37 ± 0.90 mm (P < 0.01), and 2.96 ± 0.84 mm (P < 0.01) for the exterior, interior, superior, and inferior sides, respectively. The cortical bone thickness of fibular bone is significantly reduced 1 year after the restoration of maxillary defects with a fibula free flap, most significantly on the inferior side.
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Affiliation(s)
- Y-F Kang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, and National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - J Liang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, and National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Z He
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, and National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - S Xie
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, and National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - L Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, and National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - X-F Shan
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, and National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China.
| | - Z-G Cai
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, and National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China.
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Anatomical Consideration for the Safe Elevation of the Deep Circumflex Iliac Artery in Flap Surgery. Plast Reconstr Surg 2018; 142:193-201. [PMID: 29649061 DOI: 10.1097/prs.0000000000004514] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Deep circumflex iliac artery osteocutaneous flap transfer has frequently been applied to large defects in the maxillary and mandible regions, but the use rate has decreased gradually because of the complicated anatomy of the deep circumflex iliac artery. This study investigated the comprehensive anatomy of the deep circumflex iliac artery in relation to flap surgery with the aim of providing navigational guidelines for safe deep circumflex iliac artery harvesting. METHODS Sixty-two sides of the hemi-abdominal wall were dissected in fixed Korean cadavers. Several dimensions of the deep circumflex iliac artery and its positional relationships with surgical landmarks were measured, and the patterns of the arterial supply and anastomosis were identified. RESULTS The mean distance between the anterior superior iliac spine and the lateral border of the femoral artery was 57.5 mm. The deep circumflex iliac artery generally originated almost at the same level as the inguinal ligament, and its highest level was 14.8 mm superior to that ligament. Emerging points of the ascending branch were observed both medial and lateral to the anterior superior iliac spine, but no transverse branch pierced the transversus abdominis muscle medial to the anterior superior iliac spine. CONCLUSIONS The incision line for safe deep circumflex iliac artery harvesting was parallel and 2 cm superior to the inguinal ligament and 6 cm from the anterior superior iliac spine. This position of the safe incision line can be easily determined using the thumb. Sex differences in the incidence of the deep circumflex iliac artery originating above or below the inguinal ligament will be another useful guide for easily detecting the deep circumflex iliac artery.
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Di Giuli R, Zago M, Beltramini GA, Pallotta ML, Bolzoni A, Baj A, Giannì AB, Sforza C. Donor-Site Morbidity After Osteocutaneous Free Fibula Transfer: Longitudinal Analysis of Gait Performance. J Oral Maxillofac Surg 2018; 77:648-657. [PMID: 30481496 DOI: 10.1016/j.joms.2018.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 10/20/2018] [Accepted: 10/25/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE The purpose was to evaluate donor-site clinical morbidity and changes in kinematic gait parameters after the harvest of a vascularized free fibula flap for facial reconstruction. MATERIALS AND METHODS We enrolled 14 patients (aged 50 ± 15 years) in a longitudinal study. Every patient underwent a double evaluation in which a presurgical assessment and 6-month postsurgical assessment were performed. Subjective donor-site evaluation was carried out through unstructured clinical questioning about pain, paresthesia, walking ability, and restrictions in activity. Further subjective evaluations were assessed through the Western Ontario and McMaster Universities Osteoarthritis Index and the Point Evaluation System for Lower Extremity Fibulectomy. A clinical evaluation of the donor site assessed muscular deficits, sensibility disturbance, and wound healing. Temporal and spatial kinematic parameters were measured through gait analysis during overground walking at a comfortable speed. RESULTS Postsurgical clinical examinations detected 1 patient affected by a neurologic disorder and 3 patients with donor-site pain, whereas 10 patients (71%) declared no residual alterations in the operated leg. On average, the Western Ontario and McMaster Universities Osteoarthritis Index score was 367 of 2,400, and the Point Evaluation System for Lower Extremity Fibulectomy score was 19 of 24. Presurgical versus postsurgical gait analysis comparison showed no significant differences in gait parameters except for a 6% reduction in the double-support phase. Stance values were higher for the operated limb in both evaluations (+1.3% before surgery, +1.8% after surgery). No alterations were detected in the range of motion of the lower-limb joints. CONCLUSIONS Considering the slight modification of the gait pattern, which is not usually perceived by patients, vascularized free fibula flap harvest was generally associated with successful functional and subjective outcomes of the donor site.
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Affiliation(s)
- Riccardo Di Giuli
- Resident, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy, and Maxillofacial and Dental Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Matteo Zago
- Postdoctoral Student, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy, and Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Giada A Beltramini
- Research Associate, Maxillofacial and Dental Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy, and Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Maria Ludovica Pallotta
- Resident, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy, and Maxillofacial and Dental Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Alessandro Bolzoni
- Research Associate, Maxillofacial and Dental Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy, and Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Alessandro Baj
- Adjunct Professor, Maxillofacial and Dental Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy, and Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Aldo Bruno Giannì
- Professor and Unit Head, Maxillofacial and Dental Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy; and Director, Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Chiarella Sforza
- Professor, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.
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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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Impact of 3D virtual planning on reconstruction of mandibular and maxillary surgical defects in head and neck oncology. Curr Opin Otolaryngol Head Neck Surg 2018; 26:108-114. [PMID: 29470184 DOI: 10.1097/moo.0000000000000437] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review describes the advances in 3D virtual planning for mandibular and maxillary reconstruction surgical defects with full prosthetic rehabilitation. The primary purpose is to provide an overview of various techniques that apply 3D technology safely in primary and secondary reconstructive cases of patients suffering from head and neck cancer. RECENT FINDINGS Methods have been developed to overcome the problem of control over the margin during surgery while the crucial decision with regard to resection margin and planning of osteotomies were predetermined by virtual planning. The unlimited possibilities of designing patient-specific implants can result in creative uniquely applied solutions for single cases but should be applied wisely with knowledge of biomechanical engineering principles. SUMMARY The high surgical accuracy of an executed 3D virtual plan provides tumor margin control during ablative surgery and the possibility of planned combined use of osseus free flaps and dental implants in the reconstruction in one surgical procedure. A thorough understanding of the effects of radiotherapy on the reconstruction, soft tissue management, and prosthetic rehabilitation is imperative in individual cases when deciding to use dental implants in patients who received radiotherapy.
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