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Ettinger KS, Arce K, Bunnell AM, Nedrud SM. Mandibular Reconstruction: When to Graft, When to Flap, and When to Say No. Atlas Oral Maxillofac Surg Clin North Am 2023; 31:91-104. [PMID: 37500204 DOI: 10.1016/j.cxom.2023.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Affiliation(s)
- Kyle S Ettinger
- Section of Head & Neck Oncologic and Reconstructive Surgery, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine and Science, Rochester, MN, USA.
| | - Kevin Arce
- Section of Head & Neck Oncologic and Reconstructive Surgery, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine and Science, Rochester, MN, USA
| | - Anthony M Bunnell
- Department of Oral & Maxillofacial Surgery, Division of Head and Neck Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Stacey M Nedrud
- Department of Oral & Maxillofacial Surgery, Division of Head and Neck Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
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Lynn JV, Lalchandani KB, Daniel M, Urlaub KM, Ettinger RE, Nelson NS, Donneys A, Buchman SR. Adipose-Derived Stem Cells Enhance Graft Incorporation and Mineralization in a Murine Model of Irradiated Mandibular Nonvascularized Bone Grafting. Ann Plast Surg 2023; 91:154-158. [PMID: 37450875 DOI: 10.1097/sap.0000000000003598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND Nonvascularized bone grafting represents a practical method of mandibular reconstruction. However, the destructive effects of radiotherapy on native bone preclude the use of nonvascularized bone grafts in head and neck cancer patients. Adipose-derived stem cells have been shown to enhance bone healing and regeneration in numerous experimental models. The purpose of this study was to determine the impact of adipose-derived stem cells on nonvascularized bone graft incorporation in a murine model of irradiated mandibular reconstruction. METHODS Thirty isogenic rats were randomly divided into 3 groups: nonvascularized bone graft (control), radiation with nonvascularized bone graft (XRT), and radiation with nonvascularized bone graft and adipose-derived stem cells (ASC). Excluding the control group, all rats received a human-equivalent dose of radiation. All groups underwent mandibular reconstruction of a critical-sized defect with a nonvascularized bone graft from the contralateral hemimandible. After a 60-day recovery period, graft incorporation and bone mineralization were compared between groups. RESULTS Compared with the control group, the XRT group demonstrated significantly decreased graft incorporation (P = 0.011), bone mineral density (P = 0.005), and bone volume fraction (P = 0.001). Compared with the XRT group, the ASC group achieved a significantly increased graft incorporation (P = 0.006), bone mineral density (P = 0.005), and bone volume fraction (P = 0.013). No significant differences were identified between the control and ASC groups. CONCLUSIONS Adipose-derived stem cells enhance nonvascularized bone graft incorporation in the setting of human-equivalent radiation.
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Affiliation(s)
- Jeremy V Lynn
- From the Craniofacial Research Laboratory, University of Michigan, Ann Arbor, MI
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Towards Optimum Mandibular Reconstruction for Dental Occlusal Rehabilitation: From Preoperative Virtual Surgery to Autogenous Particulate Cancellous Bone and Marrow Graft with Custom-Made Titanium Mesh-A Retrospective Study. J Clin Med 2023; 12:jcm12031122. [PMID: 36769770 PMCID: PMC9918119 DOI: 10.3390/jcm12031122] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023] Open
Abstract
The purpose of this retrospective study was to evaluate computer-assisted virtual surgery and the outcomes of mandibular reconstruction using an autogenous particulate cancellous bone and marrow (PCBM) graft combined with a custom-made titanium mesh (TiMesh) using a three-dimensional (3D) printing model. Eighteen consecutive patients were included, and preoperative virtual simulation surgery was performed using digital data. Segmental bone defects showed deviation of the mandible due to displacement of the condyle and segments, unnatural length of the mandibular body, or poorer intermaxillary relationship compared to the marginal bone defect caused by previous operations. These mandibular disharmonies could be simulated, and virtual surgery was performed on a computer with adjustment of displaced mandibular segments, length of the mandibular body, and dental arch with digital bone augmentation. TiMesh was manually pre-bent using a 3D printing model, and PCBM from the iliac crest was grafted with TiMesh. The short-term clinical results were good; reconstruction of the alveolar crest was prosthetically desirable; and minor complications were observed. In conclusion, virtual reconstruction is crucial for treating complex deviated mandibles. Accurate condylar and dental arch positions with an optimum mandibular length are important for prosthetically satisfactory mandibular reconstruction.
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Alghamdi M, Alshehri M, Sindi M. Quality of Life Assessment and Co-Morbidities of Maxillofacial Surgery Department Patients Undergoing Iliac Crest Harvesting Procedures. ANNALS OF DENTAL SPECIALTY 2022. [DOI: 10.51847/9rqm6kkwpj] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Gao N, Fu K, Cai J, Chen H, He W. The role of folded fibular flap in patients' reconstruction of mandibular defects: a retrospective clinical study. Sci Rep 2021; 11:23853. [PMID: 34903811 PMCID: PMC8668899 DOI: 10.1038/s41598-021-03331-7] [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: 02/19/2021] [Accepted: 11/29/2021] [Indexed: 11/09/2022] Open
Abstract
This study has analyzed 41 patients with mandibular ameloblastoma who underwent a partial mandibulectomy and reconstruction by folding the free fibular flap. In the preoperative and postoperative (6 months and 24 months after surgery), the Quality of Life (QOL) of these patients was assessed by using the University of Washington Quality of Life Questionnaire (UW-QOL) and the medical outcome study short form-36 (SF-36) questionnaires. SPSS 20.0 statistical software was used to conduct statistical analysis on the base data of the two groups of patients. Independent sample t test was conducted for sf-36 and UW-QOL scores at two time points in each group. The SF-36 survey showed that body pain (54.54 ± 8.10), general health (55.27 ± 7.54), and health changes (58.29 ± 9.60) decreased significantly at 6 months after surgery, but the mean score at 24 months after surgery all exceeded the preoperational level. At 24 months after the surgery, the vitality (80.41 ± 3.74), social function (81.61 ± 4.07), emotional role (82.39 ± 4.07), psychological health (81.66 ± 4.37) and total score (704.00 ± 31.53) all returned to the preoperative level, which was statistically significant compared with 6 months after surgery. However, there was no significant difference compared with the preoperative level. The UW-QOL survey showed that chewing (56.68 ± 7.23), speech (54.54 ± 7.7) and taste (62.29 ± 10.15) have significantly changed at 6 months after the surgery, and the difference was statistically significant at 24 months after surgery. Saliva generation decreased slightly (80.76 ± 3.35) at 6 months after surgery, but quickly returned to the preoperative level (81.59 ± 4.06). The total score of the patients almost recovered to the preoperative level at 24 months after surgery. The folded the fibular flap can not only repair the defects of soft tissue and bone tissue, but also restore the height of the alveolar ridge to, avoid the imbalance of crown and root ratio after implantation and reduce the occurrence of peri-implant inflammation, so that a true functional reconstruction can be realized.
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Affiliation(s)
- Ning Gao
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Kun Fu
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Jinghua Cai
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Hao Chen
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Wei He
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
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Lin H, Wang X, Huang M, Li Z, Shen Z, Feng J, Chen H, Wu J, Gao J, Wen Z, Huang F, Jiang Z. Research hotspots and trends of bone defects based on Web of Science: a bibliometric analysis. J Orthop Surg Res 2020; 15:463. [PMID: 33032636 PMCID: PMC7545570 DOI: 10.1186/s13018-020-01973-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/23/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Bone defects can be seen everywhere in the clinic, but it is still a challenge for clinicians. Bibliometrics tool CiteSpace is based on the principle of "co-citation analysis theory" to reveal new technologies, hotspots, and trends in the medical field. In this study, CiteSpace was used to perform co-citation analysis on authors, countries (regions) and institutions, journals and cited journals, authors and cited literature, as well as keywords to reveal leaders, cooperative institutions, and research hotspots of bone defects and predict development trends. METHOD Data related to bone defect from 1994 to 2019 were retrieved from the Web of Science core collection; then, we use Excel to construct an exponential function to predict the number of annual publications; conduct a descriptive analysis on the top 10 journals with the largest number of publications; and perform co-citation analysis on authors, countries (regions) and institutions, journals and cited journals, authors and cited reference, and keywords using CiteSpace V5.5 and use the Burst Detection Algorithm to perform analysis on the countries (regions) and institutions and keywords, as well as cluster the keywords using log-likelihood ratio. RESULTS A total of 5193 studies were retrieved, and the number of annual publications of bone defects showed an exponential function Y = 1×10- 70e0.0829x (R2 = 0.9778). The high-yield author was Choi Seong-Ho at Yonsei University in South Korea. The high-yielding countries were the USA and Germany, and the high-yielding institutions were the Sao Paulo University and China and the Chinese Academy of Sciences which were the emerging research countries and institutions. The research results were mainly published in the fields of dentistry, bone, and metabolism. Among them, the Journal of Dental Research and Journal of Bone and Mineral Research were high-quality journals that report bone defect research, but the most cited journal was the Clinical Orthopaedics and Related Research. Hot keywords were regeneration, repair, in vitro, bone regeneration, reconstruction, and graft. The keywords that were strongly cited in 2010-2019 were transportation, osteogenic differentiation, proliferation, and biomaterials. After 2018, proliferation, osteogenic differentiation, stromal cells, transmission, and mechanical properties have become new vocabulary. The drug delivery, vascularization, osteogenic differentiation and biomaterial properties of bone defects were expected to be further studied. CONCLUSION The application of CiteSpace can reveal the leaders, cooperating institutions and research hotspots of bone defects and provide references for new technologies and further research directions.
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Affiliation(s)
- Haixiong Lin
- The First School of Clinical Medicine, Guangzhou University of Chinese Medicine, NO. 12 Jichang Road, Baiyun District, Guangzhou, 510405, People's Republic of China
| | - Xiaotong Wang
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, 510006, People's Republic of China
| | - Minling Huang
- The First School of Clinical Medicine, Guangzhou University of Chinese Medicine, NO. 12 Jichang Road, Baiyun District, Guangzhou, 510405, People's Republic of China
| | - Zige Li
- The First School of Clinical Medicine, Guangzhou University of Chinese Medicine, NO. 12 Jichang Road, Baiyun District, Guangzhou, 510405, People's Republic of China
| | - Zhen Shen
- Kunming Municipal Hospital of Traditional Chinese Medicine, The Third Affiliated Hospital of Yunnan University of Chinese Medicine, Kunming, 650011, People's Republic of China
| | - Junjie Feng
- The First School of Clinical Medicine, Guangzhou University of Chinese Medicine, NO. 12 Jichang Road, Baiyun District, Guangzhou, 510405, People's Republic of China
| | - Huamei Chen
- The First School of Clinical Medicine, Guangzhou University of Chinese Medicine, NO. 12 Jichang Road, Baiyun District, Guangzhou, 510405, People's Republic of China
| | - Jingjing Wu
- The First School of Clinical Medicine, Guangzhou University of Chinese Medicine, NO. 12 Jichang Road, Baiyun District, Guangzhou, 510405, People's Republic of China
| | - Junyan Gao
- The First School of Clinical Medicine, Guangzhou University of Chinese Medicine, NO. 12 Jichang Road, Baiyun District, Guangzhou, 510405, People's Republic of China
| | - Zheng Wen
- Department of Orthopaedics & Traumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, NO. 16 Jichang Road, Baiyun District, Guangzhou, 510405, People's Republic of China
| | - Feng Huang
- The First School of Clinical Medicine, Guangzhou University of Chinese Medicine, NO. 12 Jichang Road, Baiyun District, Guangzhou, 510405, People's Republic of China.
- Department of Orthopaedics & Traumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, NO. 16 Jichang Road, Baiyun District, Guangzhou, 510405, People's Republic of China.
| | - Ziwei Jiang
- Department of Orthopaedics & Traumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, NO. 16 Jichang Road, Baiyun District, Guangzhou, 510405, People's Republic of China.
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Pelled G, Lieber R, Avalos P, Cohn-Yakubovich D, Tawackoli W, Roth J, Knapp E, Schwarz EM, Awad HA, Gazit D, Gazit Z. Teriparatide (recombinant parathyroid hormone 1-34) enhances bone allograft integration in a clinically relevant pig model of segmental mandibulectomy. J Tissue Eng Regen Med 2020; 14:1037-1049. [PMID: 32483878 PMCID: PMC7429307 DOI: 10.1002/term.3075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 02/02/2023]
Abstract
Massive craniofacial bone loss poses a clinical challenge to maxillofacial surgeons. Structural bone allografts are readily available at tissue banks but are rarely used due to a high failure rate. Previous studies showed that intermittent administration of recombinant parathyroid hormone (rPTH) enhanced integration of allografts in a murine model of calvarial bone defect. To evaluate its translational potential, the hypothesis that rPTH would enhance healing of a mandibular allograft in a clinically relevant large animal model of mandibulectomy was tested. Porcine bone allografts were implanted into a 5-cm-long continuous mandible bone defect in six adult Yucatan minipigs, which were randomized to daily intramuscular injections of rPTH (1.75 μg/kg) and placebo (n = 3). Blood tests were performed on Day 56 preoperation, Day 0 and on Day 56 postoperation. Eight weeks after the surgery, bone healing was analyzed using high-resolution X-ray imaging (Faxitron and micro computed tomography [CT]) and three-point bending biomechanical testing. The results showed a significant 2.6-fold rPTH-induced increase in bone formation (p = 0.02). Biomechanically, the yield failure properties of the healed mandibles were significantly higher in the rPTH group (yield load: p < 0.05; energy to yield: p < 0.01), and the post-yield displacement and energy were higher in the placebo group (p < 0.05), suggesting increased mineralized integration of the allograft in the rPTH group. In contrast to similar rPTH therapy studies in dogs, no signs of hypercalcemia, hyperphosphatemia, or inflammation were detected. Taken together, we provide initial evidence that rPTH treatment enhances mandibular allograft healing in a clinically relevant large animal model.
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Affiliation(s)
- Gadi Pelled
- Skeletal Biotech Laboratory, The Hebrew University-Hadassah Faculty of Dental Medicine, Jerusalem, Israel
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Raphael Lieber
- Skeletal Biotech Laboratory, The Hebrew University-Hadassah Faculty of Dental Medicine, Jerusalem, Israel
| | - Pablo Avalos
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Doron Cohn-Yakubovich
- Skeletal Biotech Laboratory, The Hebrew University-Hadassah Faculty of Dental Medicine, Jerusalem, Israel
| | - Wafa Tawackoli
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Joseph Roth
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Emma Knapp
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA
- Center for Musculoskeletal Research, University of Rochester, Rochester, NY, USA
| | - Edward M. Schwarz
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA
- Center for Musculoskeletal Research, University of Rochester, Rochester, NY, USA
| | - Hani A. Awad
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA
- Center for Musculoskeletal Research, University of Rochester, Rochester, NY, USA
| | - Dan Gazit
- Skeletal Biotech Laboratory, The Hebrew University-Hadassah Faculty of Dental Medicine, Jerusalem, Israel
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Zulma Gazit
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Gjerde CG, Shanbhag S, Neppelberg E, Mustafa K, Gjengedal H. Patient experience following iliac crest-derived alveolar bone grafting and implant placement. Int J Implant Dent 2020; 6:4. [PMID: 32020348 PMCID: PMC7000591 DOI: 10.1186/s40729-019-0200-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/11/2019] [Indexed: 12/11/2022] Open
Abstract
Background The objective of this study was to assess patient-reported outcomes such as satisfaction and quality of life after advanced alveolar bone augmentation with anterior iliac crest grafting and implant treatment in orally compromised patients. Methods This cross-sectional retrospective cohort study included 59 patients (29 women and 30 men) with major functional problems, who underwent advanced alveolar augmentation with autologous iliac bone grafts during a 10-year period (2002–2012). The self-administered questionnaire included 36 validated questions related to (1) demographics, (2) perceived general and oral health, (3) donor site and hospitalization, (4) status of implants and/or prosthesis, and (5) oral health-related quality of life (OHRQoL). Results Questionnaires were completed by 44 patients: 24 women and 20 men (response rate, 74.6%). Most patients reported good tolerance of the operative iliac bone harvesting (85%) and implant (90%) procedures. Post-operative pain at the donor site was reported by 38%, lasting 18.1 ± 16.1 days. An average of 4.3 ± 3.5 days of hospitalization and 20.2 ± 18.5 days of sick leave was reported. The overall satisfaction with prosthetic reconstruction was 90.5%. OHRQoL was reported with a mean Oral Health Impact Profile-14 (OHIP-14) score of 8.4. Conclusion Favorable OHRQoL and satisfaction were reported after advanced reconstruction of alveolar ridges with iliac crest-derived grafting and implants in severely compromised patients. However, this treatment requires substantial resources including hospitalization and sick leave.
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Affiliation(s)
- Cecilie G Gjerde
- Department of Oral and Maxillofacial Surgery, Institute of Clinical Dentistry, University of Bergen, Årstadveien 19, 5009, Bergen, Norway. .,Centre for Clinical Dental Research, Institute of Clinical Dentistry, University of Bergen, Bergen, Norway.
| | - Siddharth Shanbhag
- Centre for Clinical Dental Research, Institute of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Evelyn Neppelberg
- Department of Oral and Maxillofacial Surgery, Institute of Clinical Dentistry, University of Bergen, Årstadveien 19, 5009, Bergen, Norway.,Department of Oral and Maxillofacial Surgery, Head and Neck Clinic, Haukeland University Hospital, Bergen, Norway
| | - Kamal Mustafa
- Centre for Clinical Dental Research, Institute of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Harald Gjengedal
- Department of Prosthodontics, Institute of Clinical Dentistry, University of Bergen, Bergen, Norway
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Reconstruction and Implant-Supported Rehabilitation of an Iatrogenically Caused Maxillary Alveolar Defect. IMPLANT DENT 2019; 28:510-513. [PMID: 31135650 DOI: 10.1097/id.0000000000000910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Defects of the oral and maxillofacial region may arise from several reasons such as trauma, infection, cyst, tumor, medication related osteonecrosis of the jaw, and misuse of some irritant agents. For reconstruction, autogenous grafts remain the gold standard among the alternatives. In our case, a 42-year-old woman referred to our clinic for implant-supported fixed bridge rehabilitation of her edentulous and defected left 2nd premolar and 1st molar region. In examinations, devitalizing agent-dependent large defect was observed. Anterior iliac crest (AIC) grafting technique was preferred for reconstruction. Consecutively, 16-week bone healing and 3-month implant osseointegration periods were uneventful. After fabrication of the implant-supported fixed bridge, the patient was followed up for 2.5 years with no signs of bone resorption, gingival inflammation, and pain. AIC grafting and implant-borne fixed bridges seem stable and satisfactory methods for large maxillofacial defects.
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Nonvascularized Bone Graft Reconstruction of the Irradiated Murine Mandible: An Analogue of Clinical Head and Neck Cancer Treatment. J Craniofac Surg 2019; 30:611-617. [PMID: 30531286 DOI: 10.1097/scs.0000000000005032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Nonvascularized bone grafts (NBGs) represent a practical method of mandibular reconstruction that is precluded in head and neck cancer patients by the destructive effects of radiotherapy. Advances in tissue-engineering may restore NBGs as a viable surgical technique, but expeditious translation demands a small-animal model that approximates clinical practice. This study establishes a murine model of irradiated mandibular reconstruction using a segmental iliac crest NBG for the investigation of imperative bone healing strategies. Twenty-seven male isogenic Lewis rats were divided into 2 groups; control bone graft and irradiated bone graft (XBG). Additional Lewis rats served as graft donors. The XBG group was administered a fractionated dose of 35Gy. All rats underwent reconstruction of a segmental, critical-sized defect of the left hemi-mandible with a 5 mm NBG from the iliac crest, secured by a custom radiolucent plate. Following a 60-day recovery period, hemi-mandibles were evaluated for bony union, bone mineralization, and biomechanical strength (P < 0.05). Bony union rates were significantly reduced in the XBG group (42%) compared with controls (80%). Mandibles in the XBG group further demonstrated substantial radiation injury through significant reductions in all metrics of bone mineralization and biomechanical strength. These observations are consistent with the clinical sequelae of radiotherapy that limit NBGs to nonirradiated patients. This investigation provides a clinically relevant, quantitative model in which innovations in tissue engineering may be evaluated in the setting of radiotherapy to ultimately provide the advantages of NBGs to head and neck cancer patients and reconstructive surgeons.
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Warshavsky A, Fliss DM, Frenkel G, Kupershmidt A, Moav N, Rosen R, Sechter M, Shapira U, Abu-Ghanem S, Yehuda M, Zaretski A, Yanko-Arzi R, Reiser V, Horowitz G. Quality of life after mandibulectomy: the impact of the resected subsite. Int J Oral Maxillofac Surg 2019; 48:1273-1278. [PMID: 30871848 DOI: 10.1016/j.ijom.2019.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/07/2019] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Abstract
The purpose of this study was to identify the factors that impact the quality of life (QOL) scores of patients undergoing mandibulectomy. All patients with a diagnosis of an oral cavity neoplasm involving the mandible who underwent a mandibulectomy between January 1, 2000 and December 31, 2015 and completed a University of Washington QOL questionnaire (UW-QOL) were included in the study. Fifty-eight patients fulfilled all inclusion criteria and completed the UW-QOL questionnaire. Forty patients (69%) underwent a segmental mandibulectomy and 18 patients underwent a marginal mandibulectomy. Forty-eight patients (82.7%) had a free flap reconstruction. There was no significant difference in the QOL scores between patients who underwent a marginal or a segmental mandibulectomy. In contrast, patients who underwent symphysial resection reported significantly worse scores in various domains compared to patients with body or ramus segmental mandibulectomy. Patients who underwent a segmental mandibulectomy that included the symphysis had worse outcomes in chewing, recreation, health-related and social QOL domains compared to those whose mandibulectomy did not include the symphysis.
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Affiliation(s)
- A Warshavsky
- Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | - D M Fliss
- Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - G Frenkel
- Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - A Kupershmidt
- Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - N Moav
- Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - R Rosen
- Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - M Sechter
- Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - U Shapira
- Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - S Abu-Ghanem
- Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - M Yehuda
- Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - A Zaretski
- Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - R Yanko-Arzi
- Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - V Reiser
- Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - G Horowitz
- Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
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Urlaub KM, Lynn JV, Carey EG, Nelson NS, Polyatskaya Y, Donneys A, Mazzoli AC, Buchman SR. Histologic Improvements in Irradiated Bone Through Pharmaceutical Intervention in Mandibular Distraction Osteogenesis. J Oral Maxillofac Surg 2018; 76:2660-2668. [DOI: 10.1016/j.joms.2018.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/08/2018] [Accepted: 05/08/2018] [Indexed: 01/22/2023]
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Subjective morbidity following fibular free flap reconstruction in head and neck cancer patients. The Journal of Laryngology & Otology 2018; 132:729-733. [PMID: 30039779 DOI: 10.1017/s0022215118001068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aimed to evaluate the presence of subjective post-operative donor site morbidity after fibula free flap reconstruction in head and neck cancer patients, utilising three validated instruments: the 36-item Short Form Health Survey, the Short Musculoskeletal Function Assessment questionnaire and the Lower Limb Core Scale. METHODS In this retrospective study, all head and neck cancer patients who underwent fibula free flap reconstruction between January 2009 and July 2014 were identified. All questionnaires and their respective subcomponents were scored. RESULTS Twenty-one cases were included. Patients were found to have a higher Short Musculoskeletal Function Assessment bothersome index (22.42 vs 13.77, p = 0.03), a lower Short Form 36 Health Survey Physical Component Summary score (42.44 vs 50, p < 0.01) and a decreased Lower Limb Core Scale score (47.08 vs 90.52, p < 0.01), compared to US population norms. The Short Form 36 Health Survey Mental Component Summary scores and Short Musculoskeletal Function Assessment function index failed to demonstrate significant differences. Gender affected overall disability. CONCLUSION In this study, significant long-term disability was demonstrated after fibular flap reconstruction, as measured by the Lower Limb Core Scale.
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Mandibular reconstruction with vascularised bone flaps: a systematic review over 25 years. Br J Oral Maxillofac Surg 2017; 55:113-126. [DOI: 10.1016/j.bjoms.2016.12.010] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 12/02/2016] [Indexed: 11/19/2022]
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Sierra NE, Diaz-Gallardo P, Knörr J, Mascarenhas V, García-Diez E, Munill-Ferrer M, Bescós-Atín MS, Soldado F. Bone Allograft Segment Covered with a Vascularized Fibular Periosteal Flap: A New Technique for Pediatric Mandibular Reconstruction. Craniomaxillofac Trauma Reconstr 2017; 11:65-70. [PMID: 29387307 DOI: 10.1055/s-0036-1593992] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 08/16/2016] [Indexed: 10/20/2022] Open
Abstract
The free vascularized fibular graft is nowadays the preferred technique for pediatric mandibular reconstruction. Despite the versatility and proven efficacy for restoring the facial appearance and maxillomandibular function, those mandibular reconstructions with free vascularized fibula associate difficulties for a simultaneous restoration of the alveolar height and facial contour, which are derived from the height discrepancy between the fibula and the native mandible. In addition, the donor-site growth and morbidity are of special concern in the pediatric patient. We report a novel technique for pediatric mandibular reconstruction, in an 11-year-old girl, using a combination of a bone allograft segment with a vascularized fibular periosteal flap (VFPF), after resection of an Ewing sarcoma located at the right body of the mandible. The patient has showed optimal cosmetic, functional, and radiological outcomes, which have been maintained for 2.5 years, without detecting donor-site complications. Through this original technique, and based on the powerful osteogenic and vasculogenic properties of the pediatric VFPFs, we could effectively reconstruct a large mandibular defect providing a functional and aesthetic reconstruction, while avoiding the potential morbidity associated with the fibula resection.
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Affiliation(s)
- Nicolas E Sierra
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Vall D'Hebron, Barcelona, Spain
| | - Paula Diaz-Gallardo
- Department of Pediatric Orthopaedic Surgery, Hospital Sant Joan de Deu, Barcelona, Catalunya, Spain
| | - Jorge Knörr
- Department of Pediatric Orthopaedic Surgery, Hospital Sant Joan de Deu, Barcelona, Catalunya, Spain
| | | | - Eloy García-Diez
- Department of Oral and Maxillofacial Surgery, Hospital Sant Joan de Deu, Barcelona, Catalunya, Spain
| | - Montserrat Munill-Ferrer
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Vall D'Hebron, Barcelona, Spain
| | - Maria S Bescós-Atín
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Vall D'Hebron, Barcelona, Spain
| | - Francisco Soldado
- Department of Pediatric Orthopaedic Surgery, Hospital Sant Joan de Deu, Barcelona, Catalunya, Spain
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Kanno T, Karino M, Yoshino A, Koike T, Tatsumi H, Tsunematsu K, Nariai Y, Ide T, Bai Y, Dong QN, Sekine J. Computer-assisted Secondary Reconstruction of Mandibular Continuity Defects Using Non-Vascularized Iliac Crest Bone Graft Following Oral Cancer Resection. J HARD TISSUE BIOL 2017. [DOI: 10.2485/jhtb.26.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Takahiro Kanno
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
| | - Masaaki Karino
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
| | - Aya Yoshino
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
| | - Takashi Koike
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
- Division of Oral and Maxillofacial Surgery, Hamada Medical Center
| | - Hiroto Tatsumi
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
- Division of Oral and Maxillofacial Surgery, Oki Regional Hospital
| | - Koji Tsunematsu
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
- Division of Oral and Maxillofacial Surgery, Masuda Red Cross Hospital
| | - Yoshiki Nariai
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
- Division of Oral and Maxillofacial Surgery, Matsue City Hospital
| | - Taichi Ide
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
| | - Yunpeng Bai
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
| | - Quang Ngoc Dong
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
| | - Joji Sekine
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
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Okoturo E. Non-vascularised iliac crest bone graft for immediate reconstruction of lateral mandibular defect. Oral Maxillofac Surg 2016; 20:425-429. [PMID: 27725996 DOI: 10.1007/s10006-016-0585-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 09/22/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Mandibular defect reconstruction is extremely important to achieving an improved quality of life of patients as this bony defect influences facial harmony and aesthetics. Reconstruction of mandibular defects at our centre comprises use of reconstruction plate, non-vascularised anterior iliac crest graft and vascularised fibula flap. Despite the large mandibular defect recorded in our developing environment, non-vascularised iliac crest graft continues to play a role in its exclusive use for lateral mandibular defects. The aim of this study was to analyse the role, complications and outcomes of the use of non-vascularised iliac crest graft for mandibular reconstruction in a free flap-enabled centre. PATIENTS AND METHOD This was a retrospective case cohort from study institution's records of mandibular reconstruction following mandibular surgery for benign tumours. Eligibility for study inclusion comprised case cohort with head and neck diseases requiring mandibular surgery and reconstruction with either reconstruction plate, non-vascularised iliac crest graft or vascularised fibula flap. RESULTS A total of 18 subjects underwent iliac crest grafting. Of the 18 subjects with iliac crest graft, 7 (39 %) were females while 11 (61 %) were males. Ten of the 18 subjects with iliac crest grafting were diagnosed with ameloblastomas. Six (33.3 %) subjects had class H (Jewer's classification) mandibular defect. The average graft length was 5.4 cm and height was 2.3 cm. Three cases experienced graft site complications of which two grafts were lost. All 18 cases experienced good to acceptable clinical outcomes. Predictors of graft outcome were not statistically significant. CONCLUSION Despite our small sample size, it is suggestible that non-vascularised iliac crest graft be considered for lateral mandibular defect reconstruction, considering the reduced graft failure rate and satisfactory clinical outcomes from this study.
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Affiliation(s)
- Eyituoyo Okoturo
- Maxillofacial Head and Neck Cancer Division, Oral and Maxillofacial Surgery Department, Lagos State University College of Medicine/Teaching Hospital (LASUCOM/LASUTH), Lagos, Nigeria.
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Indications of Free Grafts in Mandibular Reconstruction, after Removing Benign Tumors: Treatment Algorithm. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e845. [PMID: 27622113 PMCID: PMC5010336 DOI: 10.1097/gox.0000000000000832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 06/01/2016] [Indexed: 11/25/2022]
Abstract
Background: Mandibular reconstruction has been the subject of much debate and research in the fields of maxillofacial surgery and head and neck surgery. Materials and Methods: A retrospective observational study was undertaken with 14 patients diagnosed with benign tumorous pathologies and who underwent immediate mandibular resection and reconstruction at the Hospital del Salvador Maxillofacial Surgery Unit and Dr. Rodrigo Fariña’s private clinic between the years 2002 and 2012. We propose a treatment algorithm, which is previous teeth extractions in area that will be removed. Results: Fourteen patients underwent surgery, and a total of 40 dental implants were installed in 6 men and 8 women, the mean age of 33.5 (age range, 14–58 y). Reconstruction with iliac crest bone graft, and rehabilitation following this protocol (average of reconstruction was 8.7 cm), was successful with no complications at all in 12 patients. One patient had a minor complication, and the graft was partially reabsorbed because of communication of the graft with the oral cavity. This complication did not impede rehabilitation with dental implants. Another patient suffered the total loss of the graft due to infection because of dehiscence of oral mucosa and great communication with the mouth. Another iliac crest free graft reconstruction was undertaken 6 months later. Conclusions: The scientific evidence suggests that mandibular reconstruction using free grafts following the removal of benign tumors is a biologically sustainable alternative. The critical factor to improve the prognosis of free grafts reconstruction in benign tumors is to have good quality soft tissue and avoid communication with the oral cavity. For this, it is vital to do dental extractions before removing the tumor.
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Brandão TB, Vechiato Filho AJ, Prado Ribeiro AC, Gebrim EMMS, Bodard AG, da Silva DP, Santos-Silva AR, Ishida LC, Dias RB. Evaluation of use of acrylic resin-based surgical guide in the function and quality of life provided by mandibular prostheses with microvascular free fibula flap: A four-year, randomized, controlled trial. J Prosthet Dent 2016; 116:457-463.e2. [DOI: 10.1016/j.prosdent.2016.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 02/11/2016] [Accepted: 02/16/2016] [Indexed: 11/25/2022]
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Allsopp BJ, Hunter-Smith DJ, Rozen WM. Vascularized versus Nonvascularized Bone Grafts: What Is the Evidence? Clin Orthop Relat Res 2016; 474:1319-27. [PMID: 26932740 PMCID: PMC4814434 DOI: 10.1007/s11999-016-4769-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 02/22/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is a general perception in practice that a vascular supply should be used when large pieces of bone graft are used, particularly those greater than 6 cm in length for long-bone and large-joint reconstructions. However, the scientific source of this recommendation is not clear. QUESTIONS/PURPOSES We wished to perform a systematic review to (1) investigate the origin of evidence for this 6-cm rule, and (2) to identify whether there is strong evidence to support the importance of vascularization for longer grafts and/or the lack of vascularization for shorter grafts. METHODS Two systematic reviews were performed using SCOPUS and Medline, one for each research question. For the first research purpose, a review of studies from 1975 to 1983 matching article title ("bone" and "graft") revealed 725 articles, none of which compared graft length. To address the second purpose, a review of articles before 2014 that matched "bone graft" AND ("vascularised" OR "vascularized") AND ("non-vascularised" OR "non-vascularized") revealed 633 articles, four met prespecified inclusion criteria and were evaluated qualitatively. MINORS ratings ranged from 16 to 18 of 24, and National Health and Medical Research Council [NHMRC] Evidence Hierarchy ratings ranged from III-2 (comparative studies without concurrent controls) to III-3 (comparative studies with concurrent controls). RESULTS No evidence was found that clarified grafts longer than 6 cm should be vascularized. The first reference to the 6-cm rule cites articles that do not provide strong evidence for the rule. Of the four articles found in the second systematic review, none examined osseous union of vascularized and nonvascularized grafts with respect to length. One study (III-3, MINORS 18 of 24) of fibular grafts to various limb defects found that vascularization made no difference to union rate or time to union. Vascularized grafts were more likely to require surgical revision for wound breakdown, nonunion, graft fracture, or mechanical problems (hazard ratio [HR], 5.97, p = 0.008) and grafts smaller than 10 cm had fewer complications requiring revision (HR, 0.88; p = 0.03). Three studies (III-2 to III-3, MINORS 16 to 18 of 24) that examined fibular grafts to the femoral head found that vascularized grafts had superior Harris hip and pain scores. Two of the three articles showed that vascularization was associated with superior radiologic measures of collapse progression. CONCLUSIONS No compelling evidence was found to illuminate the origin of the 6-cm rule for vascularized bone grafts, or that such a rule is based on published research. The evidence we found for grafts to long-bone defects suggested that vascularization might increase the risk of complications that require a surgical revision without increasing union rates or time to union. For large joints, vascularization may result in better functional scores and pain scores, while the evidence that they improve radiologic measures of progression is mixed. There were no studies of long-bone or large-joint reconstructions that examined the role of length with respect to osseous union. We suggest that future studies should present data for graft lengths quantitatively and with individual data points rather than categories of length ranges. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Bradley J. Allsopp
- grid.416060.50000000403901496Department of Surgery, School of Clinical Science at Monash Health, Faculty of Medicine, Monash University, Monash Medical Centre, Clayton, 3168 Victoria Australia
| | - David J. Hunter-Smith
- grid.416060.50000000403901496Department of Surgery, School of Clinical Science at Monash Health, Faculty of Medicine, Monash University, Monash Medical Centre, Clayton, 3168 Victoria Australia ,grid.466993.70000000404362893Department of Surgery, Frankston Hospital, Peninsula Health, 2 Hastings Road, Frankston, Victoria 3199 Australia ,Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health, Frankston, Victoria Australia
| | - Warren M. Rozen
- grid.416060.50000000403901496Department of Surgery, School of Clinical Science at Monash Health, Faculty of Medicine, Monash University, Monash Medical Centre, Clayton, 3168 Victoria Australia ,grid.466993.70000000404362893Department of Surgery, Frankston Hospital, Peninsula Health, 2 Hastings Road, Frankston, Victoria 3199 Australia ,Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health, Frankston, Victoria Australia
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Structured review of papers reporting specific functions in patients with cancer of the head and neck: 2006 - 2013. Br J Oral Maxillofac Surg 2016; 54:e45-51. [PMID: 26923873 DOI: 10.1016/j.bjoms.2016.02.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 02/09/2016] [Indexed: 11/21/2022]
Abstract
Health-related quality of life (HRQoL) focuses on 4 core domains: physical and psychological function, social interaction, disease, and treatment-related symptoms, and is a key outcome in patients with cancer of the head and neck. We reviewed papers published between 2006 and 2013 that used validated questionnaires to report functional outcome in this group. A total of 572 papers were identified and 118 of them concerned function. Specific outcomes included anxiety, chewing, maxillectomy, mucositis, pain, shoulder function, and trismus. The specific functions most often identified were xerostomia, speech or voice, and swallowing or dysphagia. A considerable body of evidence has now accumulated on HRQoL and functional outomes although the precise role of HRQoL during the planning of treatment remains controversial. Over time, the emphasis of the studies included has tended to move away from the reporting of outcomes in general to more hypothesis-driven and group-specific work.
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Abstract
PURPOSE OF REVIEW This review focuses on issues in managing ameloblastomas of the mandible and maxilla. We will refer to current practice in the treatment of ameloblastomas based on the available evidence. RECENT FINDINGS Recent reviews have been trying to establish natural history, growth patterns and malignant potential. This provides the clinicians and the patients with useful prognostic information. Controversies in management of ameloblastomas in relation to the type, age and site exist. This paper aims to categorize these issues. More recently, the authors have adopted the staged treatment approach as an additional step to ensure margin clearance. SUMMARY Current evidence favours radical resection to provide better control rates. This applies to maxillary lesions of all ages, and solid mandibular lesions in adults (>18 years) where growth has ceased and the patient has matured enough to withstand the impact of resection and reconstruction. Conservative management is advocated for unicystic lesions with good control rates. In children and adolescents, a conservative approach is recommended. This approach aids to minimize both psychological and the impact on growth. Furthermore, most of the lesions are unicystic and the recurrent lesions have been shown to be much smaller and can be managed promptly within a good healthcare system.
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Brown JS, Barry C, Ho M, Shaw R. A new classification for mandibular defects after oncological resection. Lancet Oncol 2016; 17:e23-30. [DOI: 10.1016/s1470-2045(15)00310-1] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 08/26/2015] [Accepted: 09/03/2015] [Indexed: 10/22/2022]
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Costal Grafting in Mandibular Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e565. [PMID: 26893990 PMCID: PMC4727717 DOI: 10.1097/gox.0000000000000544] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 09/02/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reconstruction of mandibular bone defect is a common indication in craniomaxillofacial surgery, and free fibular flap is the gold standard for this indication. However, there are alternatives; nonvascular bone grafting is one of them, and we present the costal grafting for mandibular reconstruction, a classic technique that is reliable, efficient, and produced less morbidity than the technique of using composite free flaps. METHOD A 9-year retrospective review of 54 patients treated surgically for mandibular reconstruction was performed. The criterion mainly analyzed was graft survival. The surgical technique was described in detail. RESULTS A total of 54 patients with mandibular bone defect were identified. Five symphysis, 46 corpus, and 20 ramus defects were considered. These patients underwent reconstruction by costal grafting, and the engrafting was successful in 92.6% of cases. Dental rehabilitation with dental implants was realized in 70% of cases. CONCLUSIONS The approach described in this article allowed the authors to obtain good results with costal grafting for mandibular reconstruction and dental rehabilitation. Costal grafting is a good alternative for fibula free flap in specific indications. Reconstruction of mandibular bone defect is a common indication in craniomaxillofacial surgery. Since the 1980s, the gold standard for these defects is the use of free fibular flap.(1) In some cases, this technique is contradicted; the surgeon then has several possibilities for the use of free osteomyocutaneous flaps (iliac crest, scapula, and serrato-costal flaps).(2-8).
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Chae MP, Smoll NR, Hunter-Smith DJ, Rozen WM. Establishing the natural history and growth rate of ameloblastoma with implications for management: systematic review and meta-analysis. PLoS One 2015; 10:e0117241. [PMID: 25706407 PMCID: PMC4338260 DOI: 10.1371/journal.pone.0117241] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 12/22/2014] [Indexed: 12/14/2022] Open
Abstract
Background Ameloblastoma is the second most common odontogenic tumor, known to be slow-growing, persistent, and locally aggressive. Recent data suggests that ameloblastoma is best treated with wide resection and adequate margins. Following primary excision, bony reconstruction is often necessary for a functional and aesthetically satisfactory outcome, making early diagnosis paramount. Despite earlier diagnosis potentially limiting the extent of resection and reconstruction, an understanding of the growth rate and natural history of ameloblastoma has been notably lacking from the literature. Method A systematic review of the literature was conducted by reviewing relevant articles from PubMed and Web of Science databases. Each article’s level of evidence was formally appraised according to the Centre of Evidence Based Medicine (CEBM), with data from each utilized in a meta-analysis of growth rates for ameloblastoma. Results Literature regarding the natural history of ameloblastoma is limited since the tumor is immediately acted upon at its initial detection, unless the patient voluntarily refuses a surgical intervention. From the limited data, it is derived that the highest estimated growth rate is associated with solid, multicystic type and the lowest rate with peripheral ameloblastomas. After meta-analysis, the calculated mean specific grow rate is 87.84% per year. Conclusion The growth rate of ameloblastoma has been demonstrated, offering prognostic and management information, particularly in cases where a delay in management is envisaged.
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Affiliation(s)
- Michael P. Chae
- Department of Plastic and Reconstructive Surgery, Frankston Hospital, Peninsula Health, Frankston, Victoria, Australia
- Department of Surgery, Monash University, Clayton, Victoria, Australia
- Monash University Plastic and Reconstructive Surgery Unit, Peninsula Clinical School, Frankston, Victoria, Australia
- * E-mail:
| | - Nicolas R. Smoll
- Department of Plastic and Reconstructive Surgery, Frankston Hospital, Peninsula Health, Frankston, Victoria, Australia
- Department of Surgery, Monash University, Clayton, Victoria, Australia
- Monash University Plastic and Reconstructive Surgery Unit, Peninsula Clinical School, Frankston, Victoria, Australia
| | - David J. Hunter-Smith
- Department of Plastic and Reconstructive Surgery, Frankston Hospital, Peninsula Health, Frankston, Victoria, Australia
- Department of Surgery, Monash University, Clayton, Victoria, Australia
- Monash University Plastic and Reconstructive Surgery Unit, Peninsula Clinical School, Frankston, Victoria, Australia
| | - Warren Matthew Rozen
- Department of Plastic and Reconstructive Surgery, Frankston Hospital, Peninsula Health, Frankston, Victoria, Australia
- Department of Surgery, Monash University, Clayton, Victoria, Australia
- Monash University Plastic and Reconstructive Surgery Unit, Peninsula Clinical School, Frankston, Victoria, Australia
- Department of Surgery, James Cook University Clinical School, Townsville, Queensland, Australia
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Devireddy SK, Senthil Murugan M, Kishore Kumar RV, Gali R, Kanubaddy SR, Sunayana M. Evaluation of Non-vascular Fibula Graft for Mandibular Reconstruction. J Maxillofac Oral Surg 2014; 14:299-307. [PMID: 26028850 DOI: 10.1007/s12663-014-0657-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 07/01/2014] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Functional and cosmetic defects in maxillofacial region are caused by various ailments like trauma, neoplasm, developmental, infections and iatrogenic causes. Reconstruction of these defects with free flaps remains the gold standard but demerits like need for surgical expertise and equipment, prolonged duration of surgery, compliance of the patient and increased cost are associated with microvascular reconstruction. Hence reconstruction with nonvascular bone grafts can be considered when defect is nonirradiated and <9 cm and with sufficient soft tissue cover available. PURPOSE To retrospectively evaluate clinical, radiological outcome and complications encountered with mandibular reconstruction using non vascular fibula graft. PATIENTS AND METHODS This retrospective study included 7 patients who were treated in the Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Nellore, AP between 2011 and 2013 with histologically proven benign osteolytic lesions of mandible that require a segmental mandibulectomy and primary reconstruction using autogenous non-vascularised fibular graft. The clinical case records of the patients and personal patient assessment forms (Quality of Life Assessment Forms) were analysed. They were recalled every 3rd, 6th and 9th month after surgery for evaluation of clinical, radiological outcome of the graft and complications occurring at recipient and donor sites. RESULTS In all the 7 patients, the lower border continuity was maintained except in one where the graft was dislodged. Tongue movements in all the patients were unrestricted. Jaw movements were affected in cases of ramus defects with slight deviation to operated side and reduced mouth opening. Radiological observations revealed no significant changes in 3 months except for slight reduction in graft height. The radioopaque bridging with continuity of lower border of mandible was noticed in 6th month indicating the take of the graft. This was achieved in every case except in one where the graft was lost due to dislodged reconstruction plate. In 9th month the edges of the graft i.e., graft to native mandible junction showed more resorption (3 mm) especially where there is >2 mm of gap. Whereas increase in height of graft in other areas especially in graft to graft junction was seen. Significant graft resorption was seen in two cases. There were no major complications associated with the donor site. CONCLUSION Avascular fibula graft although a second choice to vascularised fibula, is a favourable option for mandible defects of 6-10 cm under optimum conditions especially in developing countries where financial and/or surgical resources are limited. An attempt for primary reconstruction with this is never futile as it prevents aesthetic deformity even in the event of failure and thus makes secondary reconstruction easy. However in order to confirm the results a prospective study with large scale of patients is necessary.
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Affiliation(s)
- Sathya Kumar Devireddy
- Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Chintareddypalem, Nellore, 524002 A.P. India
| | - M Senthil Murugan
- Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Chintareddypalem, Nellore, 524002 A.P. India ; OMFS, SRM Dental College and Hospital, Ramapuram, Chennai, India
| | - R V Kishore Kumar
- Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Chintareddypalem, Nellore, 524002 A.P. India
| | - Rajasekhar Gali
- Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Chintareddypalem, Nellore, 524002 A.P. India
| | - Sridhar Reddy Kanubaddy
- Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Chintareddypalem, Nellore, 524002 A.P. India
| | - M Sunayana
- Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Chintareddypalem, Nellore, 524002 A.P. India
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Quality of Life Assessment in Patients After Mandibular Resection and Free Fibula Flap Reconstruction. J Oral Maxillofac Surg 2014; 72:1616-26. [DOI: 10.1016/j.joms.2014.02.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 01/31/2014] [Accepted: 02/05/2014] [Indexed: 11/20/2022]
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Miyamoto I, Yamashita Y, Yamamoto N, Nogami S, Yamauchi K, Yoshiga D, Kaneuji T, Takahashi T. Evaluation of mandibular reconstruction with particulate cancellous bone marrow and titanium mesh after mandibular resection due to tumor surgery. IMPLANT DENT 2014; 23:108-15. [PMID: 24637525 DOI: 10.1097/id.0000000000000041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There are numerous treatment modalities for mandibular defects after tumor surgery. Autogenous particulate cancellous bone marrow graft combined with titanium mesh (PCBM-MESH) is an alternative procedure. The purpose of this study was to evaluate PCBM-MESH for mandibular reconstruction. There were a total of 10 cases from 2000 to 2011. Mandibles were successfully reconstructed in 9 cases; however, reconstruction failed in 1 case. Overall, the recovery of facial contours was excellent; conversely, the evaluation of prosthetic treatment varied widely. Thus, we suggest 3 steps for mandibular reconstruction: (1) recover the continuity of bone segments; (2) simulate optimum facial contours and dental occlusion; and (3) perform the occlusion with dental prostheses. PCBM-MESH is a valuable method for mandibular defects-particularly for restoring facial contours and a favorable alveolar ridge.
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Affiliation(s)
- Ikuya Miyamoto
- *Lecturer, Division of Oral Medicine, Kyushu Dental University, Fukuoka, Japan. †Associate Professor, Department of Oral and Maxillofacial Surgery, Miyazaki University, Miyazaki, Japan. ‡Assistant Professor, Department of Oral and Maxillofacial Surgery, Oita University, Oita, Japan. §Assistant Professor, Division of Oral and Maxillofacial Surgery, Kyushu Dental University, Fukuoka, Japan. ‖Lecturer, Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan. ¶Professor and Chairman, Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, Sendai, Japan
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Novel Oncologic, Surgical, and Prosthetic Treatment of High-Grade Surface Osteosarcoma, Osteoblastic Mandible Type. J Oral Maxillofac Surg 2013; 71:e224-31. [DOI: 10.1016/j.joms.2012.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 11/06/2012] [Accepted: 11/06/2012] [Indexed: 11/23/2022]
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Shih TC, Teng NC, Wang PD, Lin CT, Yang JC, Fong SW, Lin HK, Chang WJ. In vivo evaluation of resorbable bone graft substitutes in beagles: histological properties. J Biomed Mater Res A 2013; 101:2405-11. [PMID: 23526767 DOI: 10.1002/jbm.a.34540] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 09/30/2012] [Accepted: 11/19/2012] [Indexed: 11/07/2022]
Abstract
Calcium phosphate cement (CPC) is a promising material for use in minimally invasive surgery for bone defect repairs due to its bone-like apatitic final setting product, biocompatibility, bioactivity, self-setting characteristics, low setting temperature, adequate stiffness, and easy shaping into complicated geometrics. However, even though CPC is stable in vivo, the resorption rate of this bone cement is very slow and its long setting time poses difficulties for clinical use. Calcium sulfate dehydrate (CSD) has been used as a filler material and/or as a replacement for cancellous bone grafts due to its biocompatibility. However, it is resorbed too quickly to be optimal for bone regeneration. This study examines the invivo response of a hydroxyapatite (HA), [apatitic phase (AP)]/calcium sulfate (CSD) composite using different ratios in the mandibular premolar sockets of beagles. The HA (AP)/CSD composite materials were prepared in the ratios of 30/70, 50/50, and 70/30 and then implanted into the mandibular premolar sockets for terms of 5 and 10 weeks. The control socket was left empty. The study shows better new bone morphology and more new bone area in the histological and the histomorphometric study of the HA (AP)/CSD in the 50/50 ratio.
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Affiliation(s)
- Tsai-Chin Shih
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China
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Ghassemi A, Furkert R, Prescher A, Riediger D, Knobe M, O'dey D, Gerressen M. Variants of the supplying vessels of the vascularized iliac bone graft and their relationship to important surgical landmarks. Clin Anat 2013; 26:509-21. [DOI: 10.1002/ca.22199] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 10/03/2012] [Accepted: 10/09/2012] [Indexed: 11/06/2022]
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Bartaire E, Mouawad F, Mallet Y, Milet P, El Bedoui S, Ton Van J, Chevalier D, Lefebvre JL. Morphologic assessment of mandibular reconstruction by free fibula flap and donor-site functional impairment in a series of 23 patients. Eur Ann Otorhinolaryngol Head Neck Dis 2012; 129:230-7. [DOI: 10.1016/j.anorl.2011.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 06/20/2011] [Accepted: 06/30/2011] [Indexed: 10/27/2022]
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Agrawal A, Mehrotra D, Mohammad S, Singh RK, Kumar S, Pal US. Randomized control trial of non-vascularized fibular and iliac crest graft for mandibular reconstruction. J Oral Biol Craniofac Res 2012; 2:90-6. [PMID: 25737842 DOI: 10.1016/j.jobcr.2012.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 05/31/2012] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Mandibular reconstruction of segmental defects caused by trauma or tumor excision is a challenge despite numerous advances in surgical and fixation techniques. Bone grafts from fibula or iliac crest are most frequently used to reconstruct mandible. METHODS A prospective randomized study was performed in 20 patients with benign mandibular pathology, to compare non-vascularized fibular and iliac crest bone graft for graft success, improvement in esthetics and function, and any associated donor site complications. RESULTS No significant difference in graft success, esthetics, function, or donor site complication were found between the two groups. Function improvement was significantly higher in fibula group as compared to iliac crest. An interesting finding of positive association between length of defect and complication was seen irrespective of the graft used, implying that patients with larger defects had higher complication rates. CONCLUSION Non-vascularized fibular bone graft is as better as iliac crest for reconstruction of mandibular defects of optimal length.
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Affiliation(s)
| | - Divya Mehrotra
- Professor, Department of Oral & Maxillofacial Surgery, Faculty of Dental Sciences,India
| | - Shadab Mohammad
- Professor, Department of Oral & Maxillofacial Surgery, Faculty of Dental Sciences,India
| | - R K Singh
- Professor, Department of Oral & Maxillofacial Surgery, Faculty of Dental Sciences,India
| | - Santhosh Kumar
- Associate Professor, Department of Orthopaedic Surgery, India
| | - U S Pal
- Associate Professor, Department of Oral & Maxillofacial Surgery, King George's Medical University, Lucknow, UP, India
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Shih TC, Chang WJ, Yang JC, Feng SW, Lin CT, Teng NC. In vivo evaluation of resorbable bone graft substitutes in mandibular sockets of the beagle. J Biomed Mater Res A 2012; 100:2726-31. [PMID: 22623380 DOI: 10.1002/jbm.a.34206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 03/19/2012] [Accepted: 04/02/2012] [Indexed: 11/11/2022]
Abstract
Hydroxyapatite (Ca(10)(PO(4))(6)(OH)(2)), with its high biocompatibility and good bioaffinity, stimulates osteoconduction and is slowly replaced by the host bone after implantation. However, clinical use of HA as a bone substitute has proved problematic. It is difficult to prevent dispersion of the HA granules and to mold the granules into the desired shape. Calcium sulfate as a bone graft substitute is rapidly resorbed in vivo releasing calcium ions, but fails to provide a long-term, three-dimensional framework to support osteoconduction. The setting properties of calcium sulfate, however, allow it to be applied in a slurry form, making it easier to handle and apply in different situations. This study examines the in vivo response of a (Hydroxyapatite, apatitic phase)/calcium sulfate dehydrate (CSD) composite using different ratios in the mandibular premolar sockets of the beagle. The HA (AP)/CSD composite materials prepared in ratios of 30/70, 50/50, and 70/30 were implanted into the mandibular premolar sockets for 5 and 10 weeks. The control socket was empty. The authors compared the radiographic properties and the changes in height and width of the mandibular premolar sockets in the beagle. The composite graft in the 30/70 ratio had the best ability to form new bones.
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Affiliation(s)
- Tsai-Chin Shih
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China
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Zwetyenga N, Siberchicot F, Emparanza A. Reconstruction of large mandibular and surrounding soft-tissue defects using distraction with bone transport. Int J Oral Maxillofac Surg 2012; 41:1215-22. [PMID: 22551646 DOI: 10.1016/j.ijom.2012.03.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 01/18/2012] [Accepted: 03/20/2012] [Indexed: 12/01/2022]
Abstract
Reconstruction of large bone and soft-tissue defects of the inferior third of the face is possible using various surgical techniques. Patients who require these procedures need to be in good general health, may have sequelae linked to donor sites, and require several interventions to achieve good aesthetic and functional results. The aim of this study was to report outcomes in patients with large mandibular and soft-tissue defects treated using osteogenic distraction with bone transport. Between 2001 and 2008, 14 patients had distraction with bone transport. Most patients were men (92.1%). The mean age was 43.1 years. The average mandibular bone reconstruction was 13.6 cm. The mean duration of distraction was 2.3 months. No infections occurred, and in all cases reconstruction of soft tissues was obtained. Two patients had non-union and underwent reconstruction using an iliac bone graft. Patients with sufficient bone height (57.1%) had dental implants. 44 implants were inserted, two of which were lost. 36 implants were activated. Six patients had satisfactory oral rehabilitation with implant-supported prostheses. Osteogenic distraction with bone transport allows total or partial restoration of oral function, provides an acceptable appearance, and enables patients to resume a reasonable quality of life.
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Affiliation(s)
- N Zwetyenga
- Department of Maxillofacial Surgery, Plastic and Reconstructive Surgery, Hand Surgery, Université de Bourgogne, Dijon, France.
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Anne-Gaëlle B, Samuel S, Julie B, Renaud L, Pierre B. Dental implant placement after mandibular reconstruction by microvascular free fibula flap: current knowledge and remaining questions. Oral Oncol 2011; 47:1099-104. [PMID: 21873106 DOI: 10.1016/j.oraloncology.2011.07.016] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 07/12/2011] [Accepted: 07/20/2011] [Indexed: 11/28/2022]
Abstract
Mandibular reconstruction by microvascular free fibula flap has dramatically improved the quality of life of patients treated by interruptive surgery. A simple prosthesis can be used for dental rehabilitation but in many cases, these prostheses remain nonfunctional. The use of osseointegrated implants restores both function and aesthetics. The technique for implantation in fibula flap is very similar to the technique in native mandible but access to the bone is the most difficult step of the surgery. The success rate for osteointegration ranges from 86% to 99% but the success rate of the prosthesis is much lower. This difference could be explained by the vertical discrepancy between the graft and the remaining mandible, which leads to an unfavourable implant-crown ratio. The quality of soft tissues is also a limiting factor for the prosthesis, and hypertrophy often appears after the placement of the abutments. The type of the prosthesis (fixed or removable) should also be discussed. Occlusal considerations should be highlighted as occlusion remains abnormal in many cases. Three-dimensional imaging might help in the planning of these complex reconstructions. A close collaboration between the maxillo-facial surgeon, the oral surgeon and the prosthodontist is necessary to obtain good results.
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Affiliation(s)
- Bodard Anne-Gaëlle
- Surgery Department, Centre Léon Bérard, 28 rue Laennec, 69373 Lyon cedex 08, France.
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Chang EI, Leon P, Hoffman WY, Schmidt BL. Quality of life for patients requiring surgical resection and reconstruction for mandibular osteoradionecrosis: 10-year experience at the university of California San Francisco. Head Neck 2011; 34:207-12. [DOI: 10.1002/hed.21715] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2010] [Indexed: 11/10/2022] Open
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Wan Q, Zwahlen RA, Cheng G, Li Z, Li Z. Influence of mandibular reconstruction on patients' health-related quality of life. J Oral Maxillofac Surg 2011; 69:1782-91. [PMID: 21272970 DOI: 10.1016/j.joms.2010.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 06/07/2010] [Accepted: 07/01/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate and compare the influence of different types of mandibular reconstruction on health-related quality of life (HR-QoL) of nonrecurrence patients. PATIENTS AND METHODS We recruited 252 patients who underwent mandibular reconstruction between 1994 and 2007 for this cross-sectional study. They were classified into groups based on reconstruction technique: free bone graft (FBG) group, particulate bone cancellous marrow graft (PBCMG) group, reconstruction plate (RP) group, and microvascular free flap group. The University of Washington Head and Neck Quality of Life Questionnaire and 5 supplemental domains regarding the donor sites were used to evaluate and compare HR-QoL among the groups. RESULTS The outcomes of the University of Washington Head and Neck Quality of Life Questionnaire differed significantly among the groups (P < .0001). The results of the additional donor site domains also differed greatly among the groups (P < .0001). Appearance, chewing, activity, appearance-donor site, and function-donor site were the domains that were most frequently chosen by the patients as the most important issues. Most of the patients rated their HR-QoL as somewhat better compared with their experience the month before they underwent reconstruction. The HR-QoL and overall quality of life (QoL) during the past 7 days were rated as very good in the FBG group and PBCMG group and good in the RP group and microvascular free flap group. CONCLUSIONS HR-QoL of patients in the FBG and PBCMG groups did not differ significantly with regard to any of the domains, and these 2 groups consistently had the highest mean scores. Both groups differed significantly from the RP group, which tended to report the lowest mean scores for the domains.
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Affiliation(s)
- Qilong Wan
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China
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Mandibular reconstruction using nonvascularized autogenous bone grafting. Curr Opin Otolaryngol Head Neck Surg 2010; 18:227-31. [PMID: 20508523 DOI: 10.1097/moo.0b013e32833a46ed] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This paper will discuss reconstruction of the mandible with autogenous nonvascularized bone grafting. New developments in this area will be investigated by reviewing the most recent literature on this topic as compared with other techniques currently employed. With the advances of vascularized free flap reconstruction it is important to investigate the indication for nonvascularized techniques. RECENT FINDINGS Replacement of a portion of the mandibular bone is a common procedure for patients undergoing ablative cancer surgery or for infection as well as temporomandibular joint replacement secondary to disease or trauma. The subject of mandibular reconstruction has seen great advances in recent years with the advent of vascularized free tissue transfer. Other newer areas of mandibular replacement include tissue engineering and distraction osteogenesis. Traditional nonvascularized autogenous bone graft replacement can still play a vital role in rehabilitating these patients. SUMMARY Although vascularized free flap reconstruction of mandibular defects has become the more common method of treating the postablative cancer surgery patient, there remain indications for nonvascularized reconstruction of mandibular defects as well as other techniques.
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Vu DD. Poster 21: Quality of Life of Vascular Versus Non-Vascular Bone Graft Reconstruction of Segmental Mandibular Defects. J Oral Maxillofac Surg 2009. [DOI: 10.1016/j.joms.2009.05.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Current Opinion in Otolaryngology & Head and Neck Surgery. Current world literature. Curr Opin Otolaryngol Head Neck Surg 2009; 17:326-31. [PMID: 19602933 DOI: 10.1097/moo.0b013e32832fa68b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yuan H, Chen N, Lü X, Zheng B. Experimental study of natural hydroxyapatite/chitosan composite on reconstructing bone defects. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s1007-4376(09)60009-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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