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Lubamba GP, Ma Z, Huang G, Men Y, Zhu G, Zhang G, Ma P, Chen S, Gao N, Zhang Z, Li C. Segmental mandibulectomy and microvascular reconstruction with fibula free flap: Comparison between intraoral and extraoral approaches. J Plast Reconstr Aesthet Surg 2024; 97:33-40. [PMID: 39128442 DOI: 10.1016/j.bjps.2024.07.035] [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: 09/05/2023] [Revised: 06/05/2024] [Accepted: 07/22/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Segmental mandibulectomy and reconstruction of resulting defect can be performed via intraoral approach (IOA) or extraoral approach (EOA). Both approaches have advantages, disadvantages, indications, and contraindications to consider during their selection. OBJECTIVE To compare IOA vs EOA of segmental mandibulectomy and microvascular reconstruction with fibula free flap (FFF). METHODS We conducted a retrospective cohort study in which 51 patients who underwent segmental mandibulectomy and microvascular reconstruction with FFF from 2020 to 2024 were included, especially 17 patients by IOA and 34 patients by EOA, representing both groups of this study. Clinical characteristics, surgery parameters, and patients' prognosis were evaluated. Patients' satisfaction and Derriford Appearance Scale (DAS59) were assessed during follow-up. RESULTS Ameloblastoma was the most frequent diagnosis (52.9% managed by IOA vs 70.6% by EOA); FFF was frequently positioned as double barrel (94.1% managed by IOA vs 88.2% by EOA). Compared with EOA group, IOA group had less intraoperative blood loss (mean difference [MD] = -112.2, 95% confidence interval [CI]: -178.9 to -45.5, p = 0.001), higher satisfaction score (MD = 1.3, 95% CI: 0.9 to 1.7, p ˂ 0.001), and lower DAS59 score (MD = -0.5, 95% CI: -0.7 to -0.2, p ˂ 0.001). CONCLUSION Both IOA and EOA were found safe and feasible, presenting similar perioperative features and postoperative outcomes. Patients managed with IOA were more satisfied with aesthetic outcomes than patients managed with EOA. In the absence of simultaneous immediate implant during mandibular FFF reconstruction, after stability of FFF on the defect site, patients should always be referred to an implantologist and/or prosthodontist for teeth restoration to improve functional and aesthetic outcomes.
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Affiliation(s)
- Grace Paka Lubamba
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu 610041, China; Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China; Department of Oral and Maxillofacial Surgery, University Clinics of Kinshasa, Faculty of Dental Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Zhongkai Ma
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu 610041, China; Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Guangzhao Huang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu 610041, China; Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Yi Men
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu 610041, China; Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Guiquan Zhu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu 610041, China; Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Gaowei Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu 610041, China; Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Pingchuan Ma
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu 610041, China; Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Su Chen
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu 610041, China; Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Ning Gao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu 610041, China; Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Zhuoyuan Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu 610041, China; Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
| | - Chunjie Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu 610041, China; Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
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Hakobyan G, Khachatryan L, Khudaverdyan M, Gegham T, Burnazyan S. Diagnostic and Prognostic Value of Indicators of Bone Metabolism Markers in Patients Following Mandibulectomy and Free Fibula Flap Reconstruction with Endosteal Implants. J Maxillofac Oral Surg 2024; 23:719-726. [PMID: 38911414 PMCID: PMC11189845 DOI: 10.1007/s12663-023-01960-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 06/19/2023] [Indexed: 06/25/2024] Open
Abstract
Purpose To evaluate and assess the indicators of bone metabolism markers osteocalcin and β-Cross-Laps in blood serum as a tool for monitoring bone regeneration and determining the time of implantation in patients after mandibulectomy and reconstruction of a free fibular flap with subsequent endosteal implants. Materials and Methods Forty-eight patients in a 6-year period participated in this study, due to resection for tumors. All patients underwent reconstruction with fibula free flap after tumor resection, 4-6 months after osteoectomy, dental implants were installed with further orthopedic rehabilitation. To assess the rate of bone remodeling after transplantation, the content biochemical markers of bone remodeling osteocalcin and β-Cross-Laps serum were determined by enzyme immunoassay. Results All 46 fibular free flaps were healed without complications and were survived. A total 326 implants installed, 8 implants failed to osseointegrate, and 6 implants failed after 5 years of loading (peri-implantitis). Success rate of implants after 5 years was 95,7%. In patients before surgery, the mean of osteocalcin levels was 8.5 ng/ml, two months later, there was a sharp increase in the content of osteocalcin by 15.4 ng/ml, after four months reached 24.7 ng/ml, after six months of 28.6 ng/ml, then the indicator began to decrease and after 12 months it was approaching the norm of 14.7 ng/ml. In patients before surgery, the mean level of β-Cross-Laps was 0.76 ng/ml, after two months bone transplantation the mean level of β-Cross-Laps decreased to - 0.65 ng/ml, after four months the indicator increased and reached of 0.98 ng/ml, after six months the indicator was - 1.56 ng/ml, then these indicators began to decrease and after 12 months, approaching normal values of - 0.87 ng/ml. There is a correlation between different concentrations of osteocalcin or β-Cross- Laps and the success rate of implants. Implants were shown to be unsuccessful low concentrations of osteocalcin and high concentrations of β-Cross-Laps in serum. Conclusion Studies have shown that the long-term survival and success rates of implants placed in the reconstructed areas may guarantee an excellent prognosis of implant-supported prostheses. Bone markers in blood serum osteocalcin and β-Cross-Laps can be used to evaluate the rate of bone remodeling, which allows you to determine the time of implantation.
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Affiliation(s)
- Gagik Hakobyan
- Department of Oral and Maxillofacial Surgery, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia
| | - Levon Khachatryan
- Department of Maxillofacial and Plastic Surgery, Modern Implant Medicine, Armenia Yerevan State Medical University After M. Heratsi, Yerevan, Armenia
| | - Margarita Khudaverdyan
- Department of Therapeutic Dentistry, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia
| | - Tunyan Gegham
- Department of Dental Professional and Continuing Education of Oral and Maxillofacial Surgery, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia
| | - Seda Burnazyan
- Department of Oral and Maxillofacial Surgery, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia
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Corbett J, Rocks M, Wu M, Nemir S, Castro J, Gonzalez G, Azad A, Hacquebord J, Diamond S. Tourniquet Use in Extremity-Based Microsurgery. J Reconstr Microsurg 2024; 40:227-231. [PMID: 37467770 DOI: 10.1055/a-2132-9804] [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: 07/21/2023]
Abstract
BACKGROUND The use of tourniquets and their role in extremity-based microsurgery has not been thoroughly investigated. The purpose of this study was to investigate tourniquet use and its associated outcomes and complications. The authors hypothesize that tourniquets enhance visualization, bloodless approaches to vessel harvest, flap elevation, and anastomosis without added complications. METHODS A retrospective chart review was completed for patients who had undergone extremity-based microsurgery with the use of a tourniquet between January 2018 and February 2022 at two large academic institutions. Demographic characteristics, initial reasons for surgery, complications, and outcomes were recorded. Patients were separated into groups based on tourniquet use during three operative segments: (1) flap elevation, (2) vessel harvest, and (3) microvascular anastomosis. An internal comparison of complication rate was performed between cases for which a tourniquet was used for one operative segment to all cases in which it was not used for the same operative segment. Univariate and multivariate statistical analyses were performed to identify statistically significant results. RESULTS A total of 99 patients (106 surgeries) were included in this study across sites. The mean age was 41.2 years and 67.7% of the patients were male. The most common reason for microsurgical reconstruction was trauma (50.5%). The need for an additional unplanned surgery was the most common surgical complication (16%). A total of 70, 61, and 32% of procedures used a tourniquet for flap elevation, vessel harvest, and for anastomosis, respectively. Statistical analyses identified no difference in complication rates for procedures for which a tourniquet was or was not used for interventions. CONCLUSION Based on these results, the authors state that tourniquets can be utilized for extremity-based microsurgery to enable bloodless dissection without the concern of increased complication rates.
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Affiliation(s)
- John Corbett
- Department of Surgery, George Washington University, Washington, Dist. of Columbia
- Department of Surgery, Texas Tech University Health Science Center El Paso, El Paso, Texas
| | - Madeline Rocks
- Division of Hand Surgery, NYU Langone Health Department of Orthopedic Surgery, New York, New York
| | - Meagan Wu
- Sidney Kimmel Medical College, Thomas Jefferson University Philadelphia, Pennsylvania
| | - Stephanie Nemir
- Department of Surgery, Texas Tech University Health Science Center El Paso, El Paso, Texas
| | - Jose Castro
- Department of Surgery, Texas Tech University Health Science Center El Paso, El Paso, Texas
| | - Gilberto Gonzalez
- Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center El Paso, El Paso, Texas
| | - Ali Azad
- Division of Hand Surgery, NYU Langone Health Department of Orthopedic Surgery, New York, New York
| | - Jacques Hacquebord
- Division of Hand Surgery, NYU Langone Health Department of Orthopedic Surgery, New York, New York
- NYU Langone Health Hansjörg Wyss Department of Plastic Surgery, New York, New York
| | - Shawn Diamond
- Department of Surgery, Texas Tech University Health Science Center El Paso, El Paso, Texas
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Preudhomme R, Veyssière A, Bildstein AC, Chatellier A, Garmi R, Bénateau H. Management after fibula free flap necrosis in maxillofacial reconstruction. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101586. [PMID: 37562713 DOI: 10.1016/j.jormas.2023.101586] [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: 04/15/2023] [Revised: 07/26/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION Few articles discuss the management of a free fibula flap (FFF) necrosis in maxillofacial reconstruction. MATERIAL & METHODS Between 2005 and 2020, 170 FFF were used for maxillofacial reconstruction at the University Hospital of Caen, among which 16 cases suffered total necrosis and flap removal. The authors categorized these 16 cases into three groups based on the proposed salvage treatment and analyzed the post-operative follow-up, including complications, length of hospital stay and delay in radiotherapy. RESULTS In Group A, two patients underwent immediate reconstruction with a new free flap. There were no postoperative complications, and the average hospitalization duration after removal of the first flap was 10 days. In Group B, eleven patients underwent reconstruction with a pedicled musculocutaneous pectoralis major flap. These patients experienced numerous complications, with 73% of them requiring at least one additional surgery, and all of them had an indication for later FFF reconstruction. The average hospitalization duration in this group was 37 days. In Group C, three patients underwent conservative management with debridement and mucosal closure. Two of them experienced complications, and all of them underwent later FFF reconstruction. The average hospitalization duration in this group was 15 days. DISCUSSION Based on our experience and the literature review, the use of an immediate new free flap appears to be the best approach after the removal of a FFF. This generates shorter healing times and shorter hospitalization stays, and this allows better results in terms of function and aesthetics. At least, this is the approach that causes the least delay for radiation therapy if indicated. The other approaches should only be proposed in case of patient's poor general condition or in case of refuse of the patient.
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Affiliation(s)
- Renaud Preudhomme
- Caen University Hospital. Oral and Maxillofacial Surgery Department, Address: Avenue de la Côte de Nacre, 14033 Caen France.
| | - Alexis Veyssière
- Caen University Hospital. Oral and Maxillofacial Surgery Department, Address: Avenue de la Côte de Nacre, 14033 Caen France
| | - Anh-Claire Bildstein
- Caen University Hospital. Oral and Maxillofacial Surgery Department, Address: Avenue de la Côte de Nacre, 14033 Caen France
| | - Anne Chatellier
- Caen University Hospital. Oral and Maxillofacial Surgery Department, Address: Avenue de la Côte de Nacre, 14033 Caen France
| | - Rachid Garmi
- Caen University Hospital. Oral and Maxillofacial Surgery Department, Address: Avenue de la Côte de Nacre, 14033 Caen France
| | - Hervé Bénateau
- Caen University Hospital. Oral and Maxillofacial Surgery Department, Address: Avenue de la Côte de Nacre, 14033 Caen France
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Molteni G, Gazzini L, Sacchetto A, Nocini R, Comini LV, Arietti V, Locatello LG, Mannelli G. Mandibular reconstruction in head and neck cancer: which is the gold standard? Eur Arch Otorhinolaryngol 2023; 280:3953-3965. [PMID: 37269408 DOI: 10.1007/s00405-023-08050-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/30/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION The aim of this study is to perform a systematic review to compare the outcomes of the different surgical options for mandibular reconstruction in head and neck cancer. MATERIAL AND METHODS 93 articles were selected. Four groups were identified: titanium plate without flaps, titanium plate covered by soft tissue flap, bone tissue flaps and double flaps. We compared patients' characteristics, site of mandibulectomy, type of reconstruction and complications. RESULTS 4697 patients were reported. The groups were not homogeneous regarding the type of defect and the treatment history. A significant difference in terms of post-operative complications was found between group 1 and group 2 (p < 0.00001), and between group 2 and group 3 (p < 0.00001). Total complications rate for group 4 was significantly higher when compared to group 3 (p < 0.00001), but no significant difference was found with group 2. CONCLUSION These results suggest that mandibular reconstruction using a microvascular bone flap is the best surgical option in patients without significant comorbidities.
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Affiliation(s)
- Gabriele Molteni
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Head and Neck Department, University Hospital of Verona, Verona, Italy
- Department of Surgery, Dentistry and Pediatrics, University of Verona, Verona, Italy
| | - Luca Gazzini
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Otorhinolaryngology-Head and Neck Surgery Department, San Maurizio Hospital, Bolzano, Italy
| | - Andrea Sacchetto
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria.
- Department of Otolaryngology, Ospedale San Bortolo, AULSS 8 Berica, Vicenza, Italy.
| | - Riccardo Nocini
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Department of Surgery, Dentistry and Pediatrics, University of Verona, Verona, Italy
| | - Lara Valentina Comini
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Otorhinolaryngology Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Valerio Arietti
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Department of Surgery, Dentistry and Pediatrics, University of Verona, Verona, Italy
| | - Luca Giovanni Locatello
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Department of Otorhinolaryngology, Sant'Antonio Abate Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Tolmezzo, Italy
| | - Giuditta Mannelli
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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A Modified Technique for Harvesting Scapular Tip Flap and to Allow 2 Teams to Work at the Same Time. J Craniofac Surg 2023; 34:728-730. [PMID: 35949021 DOI: 10.1097/scs.0000000000008913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/28/2022] [Indexed: 11/26/2022] Open
Abstract
AIM The main aim of the present report is to describe a modified technique of tip scapular flap harvesting to allow 2 surgical teams to work at the same time and to shorten surgical times. MATERIALS AND METHODS The medical records of 25 patients that had undergone maxillary or mandibular reconstruction by using a free scapular tip flap were retrospectively reviewed to identify the possible advantages and disadvantages of this type of flap. RESULTS Thirteen patients analyzed in this series underwent maxillary reconstruction with tip scapular flap, while the other 12 patients underwent mandibular reconstruction. No failures, partial failures, or infections were evidenced in this series. Scapular tip flap allowed for acceptable esthetic and functional outcomes. In all cases, the patient was placed supine. No major complications were observed at the donor site during follow-up. CONCLUSION Scapular tip flap might be extremely useful for head and neck reconstruction. Pedicle length, versatility, and reliability represent the major advantages of this reconstructive recourse. Moreover, the resistance of the scapular vascular system to atherosclerosis could be helpful in patients showing contraindications to free fibula flaps.
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Kim H, Choi N, Kim D, Jeong HS, Son YI, Chung MK, Baek CH. Vascularized osseous flaps for head and neck reconstruction: Comparative analysis focused on complications and salvage options. Auris Nasus Larynx 2023:S0385-8146(23)00022-6. [PMID: 36710169 DOI: 10.1016/j.anl.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 12/12/2022] [Accepted: 01/03/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVES This study aimed to compare the clinical outcomes of fibular (FFF group) and scapular (SFF group) osseous free flaps for reconstructing head and neck defects for primary surgery and salvage options. METHODS We analyzed 156 cases of osseous free flaps in 138 patients from a retrospective review of a single institutional database between January 1996 and January 2020 (FFF, 114 cases in 99 patients; SFF, 42 cases in 39 patients). Clinical profiles such as age, sex, primary tumor site, and defect type were investigated in the two groups. In addition, the incidences and types of perioperative complications, flap compromise, and salvage management were compared between the two groups. RESULTS FFF was used mostly for oromandibular defects, whereas SFF was preferred for maxillary defect reconstruction. The length of hospital stay was longer in the FFF group than in the SFF group. The flap compromise rate was not significantly different between the two groups; however, donor-site complications were not observed in the SFF group as compared to 7.9% in the FFF group. A regional or free (musculo) cutaneous flap was used as a salvage procedure in partial flap compromise. Contralateral SFF was available to replace a completely compromised SFF, whereas it was not feasible in a completely compromised FFF. Cox proportional hazards analysis showed no significant prognostic factors for flap-related complications. CONCLUSION The two osseous free flaps showed differences in defect type, flap donor complications, and options for compromised flap salvage. These findings must be considered carefully in the preoperative planning stage to guarantee early recovery and timely administration of postoperative adjuvant treatment if necessary.
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Affiliation(s)
- HeeJung Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Nayeon Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Donghyeok Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Han-Sin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young-Ik Son
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Man Ki Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Chung-Hwan Baek
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Kumar KPM, Varma S, Vipindas AP, Das Ajay T, Vinod A, Mullath A. Primary Reconstruction in Segmental Resection of Mandible-An Outcome Analysis of Different Reconstructive Techniques. Indian J Otolaryngol Head Neck Surg 2022; 74:6155-6163. [PMID: 36742643 PMCID: PMC9895505 DOI: 10.1007/s12070-021-02843-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/21/2021] [Indexed: 02/07/2023] Open
Abstract
Functional and cosmetic defects in the maxillofacial region may result from trauma, inflammatory disease, benign or malignant tumors. There are several well established reconstructive options for restoring mandibular continuity and function. Traditionally, surgeons have used their past experience to determine the best way to perform the osteotomy, graft harvesting, and graft shaping procedures for mandibular reconstruction. Focus has now shifted to optimize functional and aesthetic outcomes in mandible reconstruction. Refinements in surgical techniques continue to improve patient's quality of life. The purpose of this study was to evaluate the outcome of a range of reconstructive techniques in 20 patients who underwent segmental resection of mandible during the period 2004-2017.
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Affiliation(s)
- K. P. Manoj Kumar
- Department of Oral & Maxillofacial Surgery, KMCT Dental College, Kozhikode, Kerala India
| | - Sujatha Varma
- Department of Oral & Maxillofacial Surgery, KMCT Dental College, Kozhikode, Kerala India
| | - A. P. Vipindas
- Department of Oral & Maxillofacial Surgery, KMCT Dental College, Kozhikode, Kerala India
| | - T. Das Ajay
- Department of Oral & Maxillofacial Surgery, KMCT Dental College, Kozhikode, Kerala India
| | - Aswathi Vinod
- Department of Oral & Maxillofacial Surgery, KMCT Dental College, Kozhikode, Kerala India
| | - Aswin Mullath
- Department of Oral & Maxillofacial Surgery, KMCT Dental College, Kozhikode, Kerala India
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Kuroki T, Takekoshi S, Kitatani K, Kato C, Miyasaka M, Akamatsu T. Protective Effect of Ebselen on Ischemia-reperfusion Injury in Epigastric Skin Flaps in Rats. Acta Histochem Cytochem 2022; 55:149-157. [PMID: 36405551 PMCID: PMC9631984 DOI: 10.1267/ahc.22-00062] [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: 06/14/2022] [Accepted: 08/26/2022] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study was to determine the role of oxidized diacylglycerol (DAG) and the molecular mechanism underlying ischemia-reperfusion (I/R) injury in rat skin flaps. The protective effect of ebselen on the viability of rat skin flaps with I/R injury was investigated. Flaps were designed and raised in the left inguinal region. Then, a microvascular clamp was applied to the vascular pedicle and reperfused after 6 hr. After 7 days of I/R (I/R group), the skin flap survival area ratio was significantly reduced compared to the normal skin. The administration of ebselen significantly improved the ratio compared to the I/R group. The flap survival area ratio of the I/R + ebselen group was significantly improved compared to the I/R + vehicle group. In the I/R + ebselen group, the oxidized DAG content and intensity of phosphorylated PKCα and PKCδ were significantly lower compared to the I/R + vehicle group. Furthermore, the inflammatory response was suppressed in the I/R + ebselen group compared to the I/R + vehicle group. These results indicate that ebselen is useful as a preventive and therapeutic agent for skin flap necrosis caused by I/R, because of reduction and elimination of oxidized DAG.
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Affiliation(s)
- Takahiko Kuroki
- Department of Plastic Surgery, Tokai University School of Medicine
| | - Susumu Takekoshi
- Department of Cell Biology, Division of Host Defense Mechanism, Tokai University School of Medicine
| | - Kanae Kitatani
- Support Center of Medical Research and Education, Tokai University School of Medicine
| | - Chikara Kato
- Department of Cell Biology, Division of Host Defense Mechanism, Tokai University School of Medicine
| | - Muneo Miyasaka
- Department of Plastic Surgery, Tokai University School of Medicine
| | - Tadashi Akamatsu
- Department of Plastic Surgery, Tokai University School of Medicine
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Survival rates of dental implants in patients with head and neck pathologies: 12-year single-operator study. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:28-35. [PMID: 35165065 DOI: 10.1016/j.oooo.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/21/2021] [Accepted: 12/04/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the survival rates of dental implants placed in patients with head and neck pathologies treated with resective surgery with or without free flap reconstruction, radiotherapy alone, and/or chemotherapy. STUDY DESIGN In this study, we retrospectively analyzed the survival of intraoral dental implants placed by the same surgeon over a 12-year period from 2007 to 2019. These implants were followed up clinically and radiographically for a period of 36 months postoperatively and throughout the restorative phase. RESULTS A total of 190 patients with a total of 739 dental implants, comprising both intraoral and zygomatic implants, were included in this study. Overall, the dental implant survival rate was 95%, with a similar rate for dental implants placed in irradiated and nonirradiated bone (90% vs 93%). A lower implant survival rate was noted in implants placed in transplanted bone (79%). In cases of implant failure (n = 17), 35% (n = 6) of protheses survived and remained functional. CONCLUSIONS Our findings support the placement of dental implants in patients with benign and malignant pathologies of the head and neck to improve their quality of life. However, we highlight the need for careful surgical planning and placement by experienced clinicians.
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Bouland C, Albert N, Boutremans E, Rodriguez A, Loeb I, Dequanter D, Javadian R. Risk factors assessment in fibular free flap mandibular reconstruction. ANN CHIR PLAST ESTH 2021; 66:351-356. [PMID: 33810915 DOI: 10.1016/j.anplas.2021.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/17/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The fibular free flap (FFF) is the best choice method for mandibular reconstruction. However, the failure and the complications risk factors (RF) are not yet fully identified. This study aims to analyze these RF in order to improve the success rate. MATERIAL This retrospective study includes all patients who benefited from a FFF mandibular reconstruction between the first of January, 2014 and the thirty-first of December, 2018 in the Department of Stomatology and Maxillofacial Surgery department of the CHU Saint-Pierre Hospital, Brussels, Belgium. RESULTS Thirty patients benefited from this intervention. The overall success rate was 90%. Majority of the patients were men (67%) (mean age: 52 years). The main associated co-morbidities were: alcohol (50%), tobacco consumption (67%) and previous radiotherapy (20%). The mean operative time was 9,5hours. The morbidities rates at the receiving site (RS) and the donor site (DS) were respectively 43% and 30%. Infection and dehiscence of the RS were the main complications. Statistical analysis identified RF for RS infections: atherosclerosis and operative time; RS dehiscence (previous cervical dissection and secondary reconstruction); flap necrosis (ischemia time, rate of infection at the recipient site, history of radiation therapy, alcohol consumption, National Nosocomial Infection Surveillance score (NNISS), and history of cervical dissection); and DS morbidities (NNISS and dehiscence rate at the DS in the early period). CONCLUSION The FFF mandibular reconstruction offers a significant success rate. Nevertheless, this study highlighted several failure and complications RF of the procedure. Previous neck dissection and radiotherapy, operative and the ischemia time, were RF associated with complication at the RS. Furthermore, the NNIS score and the dehiscence rate were also reported as RF for FFF necrosis.
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Affiliation(s)
- C Bouland
- Department of Stomatology-Maxillofacial surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - N Albert
- Department of Stomatology-Maxillofacial surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - E Boutremans
- Department of Stomatology-Maxillofacial surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - A Rodriguez
- Department of Otolaryngology-Head & Neck surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - I Loeb
- Department of Stomatology-Maxillofacial surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - D Dequanter
- Department of Stomatology-Maxillofacial surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium.
| | - R Javadian
- Department of Stomatology-Maxillofacial surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Camarini C, Spagnol G, Pinotti MM, do Canto AM, Maciel FA, de Freitas RR. Mandibular Reconstruction With Block Iliac Crest: An Institutional Experience. Craniomaxillofac Trauma Reconstr 2020; 13:285-289. [PMID: 33456699 PMCID: PMC7797981 DOI: 10.1177/1943387520922763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Mandibular reconstruction is a challenge. Several reconstructive techniques are available, and the individualization of choice for each patient leads to better results and quality of life for the individual. OBJECTIVE The aim of this study is to evaluate the characteristics and complications of cases submitted to mandibular reconstruction with autogenous bone graft block of the iliac crest. METHODS Records of 45 patients undergoing mandibular reconstruction with autogenous bone graft block of the iliac crest were analyzed from January 2000 to December 2014. The data collected included age, gender, etiology and graft size, surgical approach, complications, comorbidities, and habits and addictions. Analysis of variance, chi-square test, and Fisher exact test were used for analysis of the variables with a significance level of P < .05. RESULTS The success rate of the 45 charts analyzed was 75.6%. No statistical differences were found between age and presence of complications, between defect size and presence or absence of complications, and between type of surgical approach and presence or absence of complications. CONCLUSION According to our study, medical history may influence postoperative complications and require attention, though further studies should be performed to further elucidate the relationship between diseases and postoperative complications.
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Affiliation(s)
- Camila Camarini
- Unit of Oral and Maxillofacial Surgery, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Guilherme Spagnol
- Unit of Oral and Maxillofacial Surgery, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Manuela Monteiro Pinotti
- Unit of Oral and Maxillofacial Surgery, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Alan Motta do Canto
- Unit of Oral and Maxillofacial Surgery, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Fernando Alves Maciel
- Unit of Oral and Maxillofacial Surgery, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
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Long-Term Effect of Honeycomb β-Tricalcium Phosphate on Zygomatic Bone Regeneration in Rats. MATERIALS 2020; 13:ma13235374. [PMID: 33256248 PMCID: PMC7731290 DOI: 10.3390/ma13235374] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 12/23/2022]
Abstract
In recent years, artificial bones with high biocompatibility have been developed for hard tissue reconstruction. However, current bone replacement methods are inadequate for large defects, causing infection, exposure, and damage. We have developed a new honeycomb β-tricalcium phosphate (TCP) material, which achieved good bone regeneration after implantation in a rat complete zygomatic bone defect. In this study, we further investigated the ability of honeycomb β- TCP for remodeling after bone regeneration as a long-term result. Bone morphogenic protein (BMP)-2-free honeycomb β-TCP (TCP group) and honeycomb β-TCP with BMP-2 (BMP group) were implanted in the zygomatic bone of rats. Micro-computed tomography was performed to track the zygomatic bone morphology, and specimens were histologically examined for osteogenesis and remodeling. In the TCP group, no bone formation was observed at 1 month, but it was observed at 6 months. Bone formation was observed in the BMP group at 1 month, and β-TCP absorption reproducing the zygomatic bone morphology was observed at 6 months. This honeycomb β-TCP with BMP-2 may provide appropriate remodeling that reproduces good bone formation in the early stage and good morphology in the long term, offering an alternative bone reconstruction material to vascularized bone grafts.
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Attia S, Diefenbach J, Schmermund D, Böttger S, Pons-Kühnemann J, Scheibelhut C, Heiss C, Howaldt HP. Donor-Site Morbidity after Fibula Transplantation in Head and Neck Tumor Patients: A Split-Leg Retrospective Study with Focus on Leg Stability and Quality of Life. Cancers (Basel) 2020; 12:E2217. [PMID: 32784461 PMCID: PMC7465780 DOI: 10.3390/cancers12082217] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 12/21/2022] Open
Abstract
The free fibula flap has been one of the most important microvascular grafts for orofacial reconstruction for more than 30 years. The complication rates at the donor-site reported in literature are considered to be low, but the published data vary greatly in some cases. In particular, restrictions in the stability and balance of the involved leg and their effects on the quality of life have been described very inconsistently to date. Therefore, this study mainly focuses on the stability and balance of the affected leg in a split-leg design. Between December 2014 and January 2018, out of 119 subjects who underwent mainly jaw ablative tumor surgery and reconstruction using a fibula flap, 68 subjects were examined for donor site morbidity. Besides reporting general types of complications, two specific test procedures were used. The Star Excursion Balance Test (SEBT) as a practical test for ankle function and the Foot and Ankle Disability Index (FADI) as a questionnaire in order to assess quality of life, depending on the lower leg function. SEBT revealed an average of 55.3 cm with the operated leg as the supporting leg, which corresponds to 95.5% of 57.9 cm achieved with the healthy leg as the supporting leg. An average FADI score of 89.4% was recorded. SEBT and FADI seem to be suitable methods of examination for subjects post fibular transplantation and pointed out minimal limitations of the involved legs in comparison to the unaffected legs. These limitations were clinically not relevant and they had minor influence on the subjects' quality of life and their daily activities.
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Affiliation(s)
- Sameh Attia
- Department of Cranio Maxillofacial Surgery, Justus-Liebig University Giessen, Klinik Str. 33, 35392 Giessen, Germany; (J.D.); (D.S.); (S.B.); (H.-P.H.)
| | - Jonas Diefenbach
- Department of Cranio Maxillofacial Surgery, Justus-Liebig University Giessen, Klinik Str. 33, 35392 Giessen, Germany; (J.D.); (D.S.); (S.B.); (H.-P.H.)
| | - Daniel Schmermund
- Department of Cranio Maxillofacial Surgery, Justus-Liebig University Giessen, Klinik Str. 33, 35392 Giessen, Germany; (J.D.); (D.S.); (S.B.); (H.-P.H.)
| | - Sebastian Böttger
- Department of Cranio Maxillofacial Surgery, Justus-Liebig University Giessen, Klinik Str. 33, 35392 Giessen, Germany; (J.D.); (D.S.); (S.B.); (H.-P.H.)
| | - Jörn Pons-Kühnemann
- Institute for Medical Informatics, Medical Statistics, Faculty of Medicine, Justus-Liebig University Giessen, Rudolf-Buchheim Str. 6, 35392 Giessen, Germany; (J.P.-K.); (C.S.)
| | - Christine Scheibelhut
- Institute for Medical Informatics, Medical Statistics, Faculty of Medicine, Justus-Liebig University Giessen, Rudolf-Buchheim Str. 6, 35392 Giessen, Germany; (J.P.-K.); (C.S.)
| | - Christian Heiss
- Department of Trauma, Hand and Reconstructive Surgery, Justus-Liebig University Giessen, Rudolf-Buchheim- Str. 7, 35392 Giessen, Germany;
| | - Hans-Peter Howaldt
- Department of Cranio Maxillofacial Surgery, Justus-Liebig University Giessen, Klinik Str. 33, 35392 Giessen, Germany; (J.D.); (D.S.); (S.B.); (H.-P.H.)
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Fang H, Liu F, Sun C, Pang P. Impact of wound closure on fibular donor-site morbidity: a meta-analysis. BMC Surg 2019; 19:81. [PMID: 31277627 PMCID: PMC6612155 DOI: 10.1186/s12893-019-0545-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 06/24/2019] [Indexed: 12/14/2022] Open
Abstract
Background Vascularized free fibular flaps have been the “workhorses” for reconstruction of many kinds of bone defects. Nevertheless, there is no consensus regarding the optimal wound closure method for fibular donor sites. This study aimed to compare prognostic outcomes of primarily closures (PC) and skin grafts (SG) for fibular donor sites. Methods Studies regarding donor-site outcomes of PC versus SG in patients undergoing free fibular flap procedures were included. Two authors individually searched PubMed, Web of Science, EMBASE, Cochrane Library and clinicaltrials.gov up to February 2019, extracted the data and assessed quality of each selected article. Ultimately, The incidences of donor-site morbidities were evaluated. Results Five studies with a total of 119 patients were included in our analysis. No significant differences were found with respect to the rates of donor-site problems between the PC and SG groups. Conclusions Fibular flap patients undergoing PC and SG wound closures may have similar donor-site outcomes. Additional large-scale studies are necessary to draw a solid conclusion. Electronic supplementary material The online version of this article (10.1186/s12893-019-0545-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hui Fang
- Department of Oromaxillofacial-Head and Neck Surgery, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, 117 Nanjing Bei Jie, Heping, Shenyang, Liaoning, 110002, People's Republic of China
| | - Fayu Liu
- Department of Oromaxillofacial-Head and Neck Surgery, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, 117 Nanjing Bei Jie, Heping, Shenyang, Liaoning, 110002, People's Republic of China
| | - Changfu Sun
- Department of Oromaxillofacial-Head and Neck Surgery, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, 117 Nanjing Bei Jie, Heping, Shenyang, Liaoning, 110002, People's Republic of China.
| | - Pai Pang
- Department of Oromaxillofacial-Head and Neck Surgery, Oral Maxillofacial Surgery, School of Stomatology, China Medical University, 117 Nanjing Bei Jie, Heping, Shenyang, Liaoning, 110002, People's Republic of China.
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Seikaly H, Idris S, Chuka R, Jeffery C, Dzioba A, Makki F, Logan H, O'Connell DA, Harris J, Ansari K, Biron V, Cote D, Osswald M, Nayar S, Wolfaardt J. The Alberta Reconstructive Technique: An Occlusion‐Driven and Digitally Based Jaw Reconstruction. Laryngoscope 2019; 129 Suppl 4:S1-S14. [DOI: 10.1002/lary.28064] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 04/23/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Hadi Seikaly
- Division of Otolaryngology–Head and Neck Surgery, Department of SurgeryUniversity of Alberta Edmonton Alberta Canada
- Institute for Reconstructive Sciences in MedicineMisericordia Hospital Edmonton Alberta Canada
| | - Sherif Idris
- Division of Otolaryngology–Head and Neck Surgery, Department of SurgeryUniversity of Alberta Edmonton Alberta Canada
| | - Richelle Chuka
- Institute for Reconstructive Sciences in MedicineMisericordia Hospital Edmonton Alberta Canada
| | - Caroline Jeffery
- Division of Otolaryngology–Head and Neck Surgery, Department of SurgeryUniversity of Alberta Edmonton Alberta Canada
- Institute for Reconstructive Sciences in MedicineMisericordia Hospital Edmonton Alberta Canada
| | - Agnieszka Dzioba
- Division of Otolaryngology–Head and Neck Surgery, Department of SurgeryUniversity of Alberta Edmonton Alberta Canada
| | - Fawaz Makki
- Division of Otolaryngology–Head and Neck Surgery, Department of SurgeryUniversity of Alberta Edmonton Alberta Canada
| | - Heather Logan
- Institute for Reconstructive Sciences in MedicineMisericordia Hospital Edmonton Alberta Canada
| | - Daniel A. O'Connell
- Division of Otolaryngology–Head and Neck Surgery, Department of SurgeryUniversity of Alberta Edmonton Alberta Canada
- Institute for Reconstructive Sciences in MedicineMisericordia Hospital Edmonton Alberta Canada
| | - Jeffrey Harris
- Division of Otolaryngology–Head and Neck Surgery, Department of SurgeryUniversity of Alberta Edmonton Alberta Canada
| | - Kal Ansari
- Division of Otolaryngology–Head and Neck Surgery, Department of SurgeryUniversity of Alberta Edmonton Alberta Canada
| | - Vincent Biron
- Division of Otolaryngology–Head and Neck Surgery, Department of SurgeryUniversity of Alberta Edmonton Alberta Canada
| | - David Cote
- Division of Otolaryngology–Head and Neck Surgery, Department of SurgeryUniversity of Alberta Edmonton Alberta Canada
| | - Martin Osswald
- Division of Otolaryngology–Head and Neck Surgery, Department of SurgeryUniversity of Alberta Edmonton Alberta Canada
- Institute for Reconstructive Sciences in MedicineMisericordia Hospital Edmonton Alberta Canada
| | - Suresh Nayar
- Division of Otolaryngology–Head and Neck Surgery, Department of SurgeryUniversity of Alberta Edmonton Alberta Canada
- Institute for Reconstructive Sciences in MedicineMisericordia Hospital Edmonton Alberta Canada
| | - John Wolfaardt
- Division of Otolaryngology–Head and Neck Surgery, Department of SurgeryUniversity of Alberta Edmonton Alberta Canada
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17
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Mercan U, Sümer M, Uçak Semirgen S, Ballı U, Betil Kabak Y, Şenyurt Ö. Dentin greftinin yeni oluşan kemikteki kemik mineral yoğunluğu üzerindeki etkileri: deneysel bir hayvan çalışması. CUKUROVA MEDICAL JOURNAL 2018. [DOI: 10.17826/cumj.376439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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18
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Khachatryan L, Khachatryan G, Hakobyan G. The Treatment of Lower Jaw Defects Using Vascularized Fibula Graft and Dental Implants. J Craniofac Surg 2018; 29:2214-2217. [DOI: 10.1097/scs.0000000000005015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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19
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Xiao N, Zhang L, Peng X, Mao C, Zhang J, Cai ZG. Non-vascularised fibular bone graft after vascular crisis: compensation for the failure of vascularised fibular free flaps. Br J Oral Maxillofac Surg 2018; 56:667-670. [PMID: 30055855 DOI: 10.1016/j.bjoms.2018.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 06/27/2018] [Indexed: 11/17/2022]
Abstract
After reconstruction of a segmental mandibular defect with a fibular free flap, a vascular crisis can be detected clinically and a "no-flow" phenomenon found during re-exploration. Traditional methods used to solve this include removal of the failed flap and delayed mandibular reconstruction, or restoration of the defect with a functional reconstruction plate or contralateral fibular free flap. Our aim therefore was to investigate under what circumstances it is feasible to use a non-vascularised fibular bone graft (NVFB) as a free bone graft after the failure of a vascularised fibular free flap. From 1 January 2010-31 December 2014, 10 patients who had NVFB after failure of a fibular free flap were included in the study. All patients were treated at the Peking University School and Hospital of Stomatology. NVFB were preserved successfully without infection in all 10 cases, and follow-up imaging showed that it had incorporated well with the residual mandible, the basic function and facial aesthetics of which were maintained. In conclusion we have identified that by precise selection of patients, detailed preoperative planning, and meticulous postoperative care, NVFB can be used as a "rescue" technique after failure of a fibular free flap, and can successfully restore the segmental mandibular defect and facial contour.
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Affiliation(s)
- N Xiao
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - L Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China.
| | - X Peng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - C Mao
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - J Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - Z G Cai
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
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20
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Treatment of a mandibular discontinuity defect by using a fibula free flap and an implant-supported fixed complete denture fabricated with a PEKK framework: A clinical report. J Prosthet Dent 2018; 119:1021-1024. [DOI: 10.1016/j.prosdent.2017.07.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/27/2017] [Accepted: 07/27/2017] [Indexed: 12/31/2022]
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21
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Fahradyan A, Odono L, Hammoudeh JA, Howell LK. Ameloblastic Carcinoma In Situ: Review of Literature and a Case Presentation in a Pediatric Patient. Cleft Palate Craniofac J 2018; 56:94-100. [PMID: 29715060 DOI: 10.1177/1055665618774021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Ameloblastic carcinomas are rare malignant lesions with 3 mandibular pediatric cases reported in the literature. We present a case of ameloblastic carcinoma in situ in a 15-year-old male with a right mandibular cystic lesion on computed tomography. The incisional biopsy revealed plexiform ameloblastoma. Due to the infiltrating and aggressive nature of the tumor, the patient underwent hemimandibulectomy and immediate reconstruction with a vascularized osteocutaneous fibula free flap. The final pathology was read as ameloblastic carcinoma in situ. Given the rarity of this disease in the pediatric population, this case report may be a valuable addition to the current literature.
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Affiliation(s)
- Artur Fahradyan
- 1 Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Lauren Odono
- 2 Division of Oral and Maxillofacial Surgery, Ostrow School of Dentistry of USC, Los Angeles, CA, USA
| | - Jeffrey A Hammoudeh
- 1 Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.,2 Division of Oral and Maxillofacial Surgery, Ostrow School of Dentistry of USC, Los Angeles, CA, USA.,3 Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Lori Kathryn Howell
- 1 Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.,3 Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
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22
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van Gemert JTM, Abbink JH, van Es RJJ, Rosenberg AJWP, Koole R, Van Cann EM. Early and late complications in the reconstructed mandible with free fibula flaps. J Surg Oncol 2018; 117:773-780. [PMID: 29448299 PMCID: PMC5901040 DOI: 10.1002/jso.24976] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 12/13/2017] [Indexed: 11/11/2022]
Abstract
Background and Objectives Evaluation of mandibular reconstructions with free fibula flaps. Identification of factors associated with major recipient site complications, that is, necessitating surgical intervention under general anaesthesia. Methods Seventy‐nine reconstructions were included. The following factors were analyzed: fixation type, number of osteotomies, site of defect (bilateral/unilateral), surgeon, sex, ASA classification, continuous smoking, pathological N‐stage, age, defect size, flap ischemic time, and postoperative radiotherapy. Proportional hazards regression was used to test the effect on the time between reconstruction and intervention. Results Sixty‐nine (87%) of the 79 fibula flaps were successful at the last follow‐up. Forty‐eight major recipient site complications occurred in 41 reconstructions. Nineteen complications required surgical intervention within six weeks and were mostly vascular problems, necessitating immediate intervention. These early complications were associated with defects crossing the midline, with an estimated relative risk of 5.3 (CI 1.1‐20, P = 0.01). Twenty‐nine complications required surgical intervention more than 6 weeks after the reconstruction. These late complications generally occurred after months or years, and were associated with smoking, with an estimated relative risk of 2.8 (CI 1.0‐8.3, P = 0.05). Conclusions Fibula flaps crossing the midline have a higher risk of early major recipient site complications than unilateral reconstructions. Smoking increases the risk of late complications.
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Affiliation(s)
- Johannes T M van Gemert
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan H Abbink
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Robert J J van Es
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Antoine J W P Rosenberg
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ron Koole
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ellen M Van Cann
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
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23
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Santaliz-Ruiz LE, Rivera-Morales MD, Giudiceandrea I, Franceschi F, Domenech-Fagundo E, Pérez-Mitchell C, Avilés D, Pérez-Nieves R. Fibula osteomyocutaneous free flap in mandibular reconstruction: clinical experience in a community-based hospital. EUROPEAN JOURNAL OF PLASTIC SURGERY 2017. [DOI: 10.1007/s00238-017-1377-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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24
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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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25
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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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Burgess M, Leung M, Chellapah A, Clark JR, Batstone MD. Osseointegrated implants into a variety of composite free flaps: A comparative analysis. Head Neck 2016; 39:443-447. [DOI: 10.1002/hed.24609] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 05/13/2016] [Accepted: 08/22/2016] [Indexed: 11/09/2022] Open
Affiliation(s)
- Michael Burgess
- Department of Maxillofacial SurgeryRoyal Brisbane HospitalBrisbane Queensland Australia
| | - Matthew Leung
- University of Sydney Medical SchoolNew South Wales Australia
| | | | - Jonathan R. Clark
- The Sydney Head and Neck Cancer InstituteChris O'Brien LifehouseSydney New South Wales Australia
- Central Clinical SchoolUniversity of SydneySydney New South Wales Australia
- South Western Clinical SchoolUniversity of New South WalesSydney New South Wales Australia
| | - Martin D. Batstone
- Department of Maxillofacial SurgeryRoyal Brisbane HospitalBrisbane Queensland Australia
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Prosthetic Rehabilitation After Fibular Free Flap Surgery of Mandibular Defects in a Patient With Oral Squamous Cell Carcinoma. J Craniofac Surg 2016; 27:e685-e688. [PMID: 27763947 DOI: 10.1097/scs.0000000000002761] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This report is to present the treatment procedure and clinical considerations of prosthodontic management of a patient who had undergone a partial mandibulectomy and fibular free flap surgery. DESIGN A 59-year-old man with a squamous cell carcinoma received a partial mandibular resection. Microsurgical reconstruction with a fibular free flap surgery and implant-supported zirconia-fixed prosthesis produced by computer-aided manufacturing led to successful results for the oral rehabilitation of mandibular defects. CONCLUSIONS The implant-supported zirconia-fixed prosthesis can be recommended for use in patients with mandibulectomy and fibular free flaps. Close cooperation between the surgeon and the prosthodontist is mandatory for the satisfaction of the patient.
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Application of Vacuum-Assisted Closure Therapy and Hyperbaric Oxygen Therapy for an Exposed Titanium Plate After Mandible Reconstruction. J Craniofac Surg 2016; 27:e601-e604. [DOI: 10.1097/scs.0000000000002917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Versatility of Fibula Free Flap in Reconstruction of Facial Defects: A Center Study. J Maxillofac Oral Surg 2016; 16:101-107. [PMID: 28286393 DOI: 10.1007/s12663-016-0930-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 05/21/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To study a series of cases where vascularised fibula flap was used in various combinations of bone with muscle and skin along with its modifications for reconstruction of simple and composite defects of the facial region. PATIENTS AND METHODS The investigators designed a retrospective study composed of patients with any pathology or defect who underwent reconstruction of maxilla or mandible with vascularised fibula free flap from 2009 to 2013. All patients were evaluated for age, gender, location and type of defect, incorporation of adjoining skin paddle and muscle, number of fibula osteotomies, ischaemia time, anticoagulant regimen, length of hospital stay, flap failure rate, dental implant rehabilitation. All patients with a minimum follow-up of 3 months post-operatively, were included in this study. RESULTS The study sample composed of 30 patients with average age of 39.5 years. Immediate reconstruction was done in 86.66 % of patients. 93.1 % were mandibular reconstructions. In 40 % of patients, the fibula was double barrelled. Skin island was included with the fibula in 20 % of patients. 10 % patients underwent dental rehabilitation using implants with 6.66 % requiring distraction osteogenesis of the fibula which was not required with double barrel reconstructions. Hematoma at the recipient site was the commonest post-operative complication, although its frequency was low. A significant donor site morbidity of around 3.33 % was seen. Average stay in hospital was about 7 days. Post-operatively all patients ambulated normally and none used assisted devices. A reconstruction plate was used to achieve the ideal contour of the jaw in most cases. Aesthetic results were usually good, especially in young patients. The overall success rate was 93.33 %. CONCLUSION The fibula has many assets which make it the ideal choice for bony reconstruction of facial skeleton and adjoining soft tissue with predictable results.
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A systematic review of functional outcome and quality of life following reconstruction of maxillofacial defects using vascularized free fibula flaps and dental rehabilitation reveals poor data quality. J Plast Reconstr Aesthet Surg 2016; 69:1024-36. [PMID: 27292287 DOI: 10.1016/j.bjps.2016.05.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 04/04/2016] [Accepted: 05/01/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Reconstruction and oral rehabilitation of segmental maxillofacial defects resulting from ablative surgery is commonly achieved by osteocutaneous vascularized free fibula (VFFF) transplantation combined with implant-supported dental prostheses. We systematically reviewed the literature regarding impact of oral rehabilitation with or without dental implants on functional outcome and quality of life (Qol) following reconstruction of such segmental maxillofacial defects with VFFF. METHODS This systematic review was performed according to the PRISMA guidelines. A literature search was conducted using the databases of Cochrane, MEDLINE and EMBASE. Relevant search terms for maxilla or mandible, reconstruction with VFFF, and oral rehabilitation were used. Two reviewers independently assessed the publications using eligibility and research quality criteria (MINORS). RESULTS In total, 554 unique publications were found. After scrutinization, 2 prospective studies and 8 retrospective case-series without comparison were left for ultimate analysis. Quality ranged from 44% to 88% of the maximum score. Overall survival rate of the VFFF was 99% and the survival rate of dental implants was 95%. Speech intelligibility and overall aesthetic outcome were 'good' to 'excellent'. No statistically significant changes in QoL were found. Methods to measure functional outcome varied strongly, making pooling impossible. CONCLUSIONS Oral rehabilitation with implant-supported dental prostheses after reconstruction of segmental maxillofacial defects with VFFF results in good to excellent speech intelligibility and aesthetics. Results are probably positively biased by the retrospective nature of the studies. In future prospective research, functional outcome measures should be addressed using standardized questionnaires and validated objective tests with adequate follow-up.
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Lodders JN, Parmar S, Stienen NLM, Martin TJ, Karagozoglu KH, Heymans MW, Nandra B, Forouzanfar T. Incidence and types of complications after ablative oral cancer surgery with primary microvascular free flap reconstruction. Med Oral Patol Oral Cir Bucal 2015; 20:e744-50. [PMID: 26116846 PMCID: PMC4670256 DOI: 10.4317/medoral.20657] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 03/06/2015] [Indexed: 11/06/2022] Open
Abstract
Background The aims of the study were 1) to evaluate the incidence and types of postoperative complications after ablative oral cancer surgery with primary free flap reconstruction and 2) identify prognostic variables for postoperative complications. Material and Methods Desired data was retrieved from a computer database at the department of Oral and Maxillofacial Department, Queen Elisabeth hospital Birmingham, United Kingdom, between June 2007 and October 2012. Logistic regression was used to study relationships between preoperative variables and postoperative outcomes. Results The study population consisted 184 patients, comprising 189 composite resections with reconstruction. Complications developed in 40.2% of the patients. Three patients (1.6%) died, 11.1% returned to the operating room, 5.3% developed donor site complications and 6.9% flap complications of which 3.2% total flap failure. In the multivariable analysis systemic complications were associated with anaesthesia time and hospital stay with red cell transfusion. Conclusions A significant proportion of the patients with primary free flap reconstructions after oral cancer surgery develops postoperative complications. Prolonged anaesthesia time and red cell transfusion are possible predictors for systemic complications and hospital stay respectively. Preoperative screening for risk factors is advocated for patient selection and to have realistic information and expectations. Key words:Free flap, complications, oral cancer, risk factors, reconstruction.
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Affiliation(s)
- Johannes N Lodders
- Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for, Dentistry Amsterdam, ACTA, University of Amsterdam and, VU University Amsterdam, De Boelelaan 1118, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands,
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Rehabilitation with dental implants in microvascular iliac graft after solid ameloblastoma resection: a case report. IMPLANT DENT 2015; 22:561-5. [PMID: 24168903 DOI: 10.1097/id.0000000000000007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Ameloblastoma is a true odontogenic tumor that is most frequently found in clinical practice. Osseous resection with clear margins is the recommended treatment followed by bone reconstruction, such as a vascularized graft. The use of osseointegrated dental implants for rehabilitation is advisable, as it allows the recovery of the masticatory function. MATERIALS AND METHODS This case report includes 1 subject, a patient who presented with a large ameloblastoma treated by resection, a microvascular iliac graft, and dental implants. RESULTS After 6 months of regular control, the patient exhibited perfect healing of both the soft tissues and bone graft. At the time of this report, the patient had undergone 36 months of clinical and radiographic follow-up and had not exhibited any sign of osseous loss, implant mobility, or tumor recurrence. CONCLUSIONS The outcome of this case indicates that a microvascular graft and subsequent dental implantation is a good treatment plan that aids in a quick functional rehabilitation in ameloblastoma patients.
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Novel Local Full-Thickness Skin Grafts for Closure of Free Fibular Osteocutaneous Flap Donor Sites. J Oral Maxillofac Surg 2015; 74:200-3. [PMID: 26408102 DOI: 10.1016/j.joms.2015.08.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 08/19/2015] [Accepted: 08/23/2015] [Indexed: 11/23/2022]
Abstract
PURPOSE The fibular flap donor site after skin paddle harvest is usually covered with abdominal full-thickness skin grafts. However, this kind of skin graft creates an inevitable third operative area and additional esthetic damage. The aim of this report was to present a novel approach to manage fibular donor site defects using a full-thickness skin graft from the adjacent area and avoid further esthetic damage in a third area. MATERIALS AND METHODS Seventeen patients underwent mandibular and maxillary defect reconstruction using free fibular osteocutaneous flaps and the fibular donor-site defects were covered with full-thickness skin grafts from the adjacent area. The skin harvesting sites were closed primarily. RESULTS The skin donor sites were closed without dehiscence in all cases. Fifteen full-thickness skin grafts survived completely, whereas 2 grafts were partial failures. There were no complete skin graft losses. All fibular osteocutaneous flaps were viable, and the recipient sites had no complications. CONCLUSIONS This study shows that adjacent full-thickness skin grafts provide a straightforward and reliable technique for closure of the free fibular osteocutaneous flap donor site. The primary advantage of this technique is the avoidance of a third surgical site, an additional surgical scar, and subsequent additional esthetic impairment.
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Liu Y, Han B, Yu T, Li L. A large odontogenic myxoma of the bilateral maxillae: A case report. Oncol Lett 2014; 8:1328-1332. [PMID: 25120718 PMCID: PMC4114706 DOI: 10.3892/ol.2014.2243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 05/23/2014] [Indexed: 02/05/2023] Open
Abstract
Odontogenic myxomas (OMs) are benign mesenchymal locally aggressive neoplasms of the jaw bone. Although OMs predominantly involve the mandible, maxillary tumors are usually more aggressive than mandibular tumors. The present study describes the case of a 37-year-old male with a large odontogenic myxoma of the bilateral maxillae, which caused a defect in the right skull base bone. The tumor was successfully removed through radical resection of the hard tissue and local resection around the envelope of the soft tissue. The tumor exhibited no recurrence. However, the current methods for bilateral maxillary reconstruction to restore the maxillary buttress and achieve an optimal aesthetic appearance are complicated due to the lack of suitable conditions for oral rehabilitation with good dentition.
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Affiliation(s)
- Ying Liu
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Sichuan, P.R. China ; Department of Head and Neck Oncology Surgery, West China Hospital of Stomatology, Sichuan University, Sichuan, P.R. China
| | - Bo Han
- Department of Head and Neck Oncology Surgery, West China Hospital of Stomatology, Sichuan University, Sichuan, P.R. China
| | - Tao Yu
- Department of Head and Neck Oncology, Sichuan Cancer Hospital, Chengdu, Sichuan, P.R. China
| | - Longjiang Li
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Sichuan, P.R. China ; Department of Head and Neck Oncology Surgery, West China Hospital of Stomatology, Sichuan University, Sichuan, P.R. China
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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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Leiggener CS, Krol Z, Gawelin P, Buitrago-Téllez CH, Zeilhofer HF, Hirsch JM. A computer-based comparative quantitative analysis of surgical outcome of mandibular reconstructions with free fibula microvascular flaps. J Plast Surg Hand Surg 2014; 49:95-101. [DOI: 10.3109/2000656x.2014.920711] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Dayangac E, Araz K, Oguz Y, Bacanli D, Caylak B, Uckan S. Radiological and Histological Evaluation of the Effects of Cortical Perforations on Bone Healing in Mandibular Onlay Graft Procedures. Clin Implant Dent Relat Res 2014; 18:82-8. [DOI: 10.1111/cid.12238] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Kenan Araz
- Department of Oral and Maxillofacial Surgery; Faculty of Dentistry; Baskent University; Ankara Turkey
| | - Yener Oguz
- Faculty of Dentistry; Department of Oral and Maxillofacial Surgery; Baskent University; Ankara Turkey
| | - Didem Bacanli
- Experimental Research Center; Faculty of Medicine; Baskent University; Ankara Turkey
| | - Berrin Caylak
- Department of Pathology; Faculty of Medicine; Baskent University; Ankara Turkey
| | - Sina Uckan
- Department of Oral and Maxillofacial Surgery; Faculty of Dentistry; Baskent University; Ankara Turkey
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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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Lim WTW, Teh LY, Yong LT, Tan HK, Peck RHL. Retrospective Analysis of Vascularised Free Fibula Grafts in Oromandibular Reconstruction and Dental Rehabilitation following Resection of Ameloblastoma. PROCEEDINGS OF SINGAPORE HEALTHCARE 2014. [DOI: 10.1177/201010581402300108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: The objective of the study was to review 1) patient demographics, 2) hard tissue defect, 3) surgical information and outcomes, 4) early and late complications and 5) dental rehabilitation. Study Design: A retrospective review was carried out on 44 cases of mandibular ameloblastoma that were treated by resection and mandibular reconstruction using fibula grafts from October 1994 to October 2011 in local institutions. Results: The patients were predominantly Chinese (67.4%) with ages ranging from 11 to 57 years. Defect and surgical data were reviewed and there was only one failure of graft (2.3%). Early complications were observed in 10 patients (23.3%) while late complications were observed in six patients (14%). Dental rehabilitations were in the form of removable dentures (41.9%) and implant supported prostheses (4.7%). Conclusion: The fibula flap has been shown to be a reliable flap with low morbidity and also suitable for future dental rehabilitation.
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Affiliation(s)
| | | | - Loong Tee Yong
- Oral & maxillofacial surgeon in private practice, Singapore
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Kim JH, Kim SG, Lim SC, Oh JS, You JS, Jeong MA. Histomorphometric analysis of bone formation in bony defects around implants in adult dogs: a comparison of grafts of low and high heat-treated autogenous tooth ash. IMPLANT DENT 2013; 22:639-44. [PMID: 24185463 DOI: 10.1097/01.id.0000433933.20759.25] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to compare the bone formation of autogenous tooth ash treated with different temperatures. MATERIALS AND METHODS Heat treatment was rendered by powder after extraction of teeth from dogs. The bony defects were made at iliac and resorbable blast medium surfaced implant placement and bone graft was performed; no bone graft group (control group), low heat-treated tooth ash group (group 1), high heat-treated tooth ash group (group 2). Right side had healing periods of 12 weeks, and the left side had 6 weeks. Histomorphometrical analysis was performed at 12 weeks. RESULTS The control group had poor bone formation and showed large loose connective tissue. Group 1 displayed good healing and bone formation. Group 2 showed higher rate of bone formation than group 1 and the control group. The high heat-treated tooth ash group showed a statistically significant increase in the rate of bone formation in the early stage. CONCLUSION The heat-treated autogenous tooth ash powder showed excellent new bone formation. The temperature of heat treatment is an important factor in new bone formation. The high heat treatment was the optimal treatment method for making tooth ash than the low heat treatment.
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Affiliation(s)
- Jin-Ha Kim
- *Graduate Student, Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University, Gwangju, Korea. †Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University, Gwangju, Korea. ‡Professor, Department of Pathology, School of Medicine, Chosun University, Gwangju, Korea. §Assistant Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University, Gwangju, Korea. ‖Fellow, Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University, Gwangju, Korea. ¶Professor, Department of Dental Hygiene, Kangwon National University, Samcheok, Korea
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García-Díez EM, Cho-Lee GY, Raigosa-García JM, Sieira-Gil R, Pagès CM. Rhytidectomy Approach for Mandibular Reconstruction With Microvascular Free Flaps After Resection of Mandibular Benign Tumors. J Oral Maxillofac Surg 2013; 71:2156-68. [DOI: 10.1016/j.joms.2013.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 05/05/2013] [Accepted: 05/06/2013] [Indexed: 11/25/2022]
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Parbo N, Murra N, Andersen K, Buhl J, Kiil B, Nørholt S. Outcome of partial mandibular reconstruction with fibula grafts and implant-supported prostheses. Int J Oral Maxillofac Surg 2013; 42:1403-8. [DOI: 10.1016/j.ijom.2013.05.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 05/12/2013] [Accepted: 05/16/2013] [Indexed: 10/26/2022]
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Aliano KA, Agulnick M, Cohen B, Gonya G, Low C, Stavrides S, Addona T, Goncalves J, Shin D, Kilgo MS, Davenport TA. Spinal reconstruction for osteomyelitis with free vascularized fibular grafts using intra-abdominal recipient vessels: A series of three cases. Microsurgery 2013; 33:560-6. [DOI: 10.1002/micr.22150] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 05/15/2013] [Accepted: 05/28/2013] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | | | | | | | - John Goncalves
- Division of Cardiothoracic Surgery; Winthrop University Hospital; Mineola NY
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Logan H, Wolfaardt J, Boulanger P, Hodgetts B, Seikaly H. Exploratory benchtop study evaluating the use of surgical design and simulation in fibula free flap mandibular reconstruction. J Otolaryngol Head Neck Surg 2013; 42:42. [PMID: 23800209 PMCID: PMC3729729 DOI: 10.1186/1916-0216-42-42] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 06/11/2013] [Indexed: 11/18/2022] Open
Abstract
Background Surgical design and simulation (SDS) is a useful tool to help surgeons visualize the anatomy of the patient and perform operative maneuvers on the computer before implementation in the operating room. While these technologies have many advantages, further evidence of their potential to improve outcomes is required. The present benchtop study was intended to identify if there is a difference in surgical outcome between free-hand surgery completed without virtual surgical planning (VSP) software and preoperatively planned surgery completed with the use of VSP software. Methods Five surgeons participated in the study. In Session A, participants were asked to do a free-hand reconstruction of a 3d printed mandible with a defect using a 3d printed fibula. Four weeks later, in Session B, the participants were asked to do the same reconstruction, but in this case using a preoperatively digitally designed surgical plan. Digital registration computer software, hard tissue measures and duration of the task were used to compare the outcome of the benchtop reconstructions. Results The study revealed that: (1) superimposed images produced in a computer aided design (CAD) software were effective in comparing pre and post-surgical outcomes, (2) there was a difference, based on hard tissue measures, in surgical outcome between the two scenarios and (3) there was no difference in the time it took to complete the sessions. Conclusion The study revealed that the participants were more consistent in the preoperatively digitally planned surgery than they were in the free hand surgery.
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Affiliation(s)
- Heather Logan
- Institute for Reconstructive Sciences in Medicine, 1W-02, 16940-87 Avenue Misericordia Community Hospital, Edmonton, AB T5R 4H5, Canada.
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Blanco MG, Ostrosky M. Implant prosthetic rehabilitation with a free fibula flap and interpositional bone grafting after a mandibulectomy: A clinical report. J Prosthet Dent 2013; 109:373-7. [PMID: 23763781 DOI: 10.1016/s0022-3913(13)60321-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Askin SB, Aksu AE, Calis M, Tulunoğlu İ, Safak T, Tözüm TF. Report of multidisciplinary treatment of an extensive mandibular ameloblastoma with free iliac crest bone flap, dental implants, and acellular dermal matrix graft. J ORAL IMPLANTOL 2013; 41:107-11. [PMID: 23506101 DOI: 10.1563/aaid-joi-d-13-00003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Liu Y, Chen J, Yan F, Ping F. Mandible reconstruction with transport-disc distraction osteogenesis in children of deciduous dentition. Int J Oral Maxillofac Surg 2012; 41:1223-8. [DOI: 10.1016/j.ijom.2012.04.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Revised: 02/22/2012] [Accepted: 04/26/2012] [Indexed: 11/25/2022]
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Magesh DPU, Kumaravelu C, Maheshwari GU. Efficacy of PRP in the Reconstruction of Mandibular Segmental Defects Using Iliac Bone Grafts. J Maxillofac Oral Surg 2012; 12:160-7. [PMID: 24431834 DOI: 10.1007/s12663-012-0418-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Accepted: 06/12/2012] [Indexed: 11/26/2022] Open
Abstract
This retrospective study was conducted to evaluate the role of platelet-rich plasma (PRP) in the reconstruction of segmental mandibular defects using iliac bone grafts. Thirteen patients underwent reconstruction of post-resection segmental defects of the mandible using titanium reconstruction plates, cortico cancellous iliac bone graft. The patients were randomly separated into two groups. One group of the patients received a PRP graft in addition to the iliac bone graft. Post-operative dimensions of the graft were measured and compared to assess the efficacy of PRP in reconstruction of segmental defects. The post-operative follow-up radiographs confirmed consolidation of the graft in all cases and the segmental defect was obliterated. Thereby mandibular continuity was successfully achieved in all cases. Two patients in the non-PRP group developed an infection and were administered additional antibiotics. The infection was contained and the grafts survived. The use of PRP along with autogenous bone graft may be advantageous since it appeared to enhance the quantity of bone formed. Further long-term follow-up and studies are required to effectively establish the efficacy of PRP and autogenous free bone grafts in the reconstruction of bony defects.
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Affiliation(s)
- D P Uma Magesh
- Chennai Dental Centre, 4/579 Rajiv Gandhi Salai, Kotivakkam, Chennai, 600 041 India
| | - C Kumaravelu
- Chennai Dental Centre, 4/579 Rajiv Gandhi Salai, Kotivakkam, Chennai, 600 041 India
| | - G Uma Maheshwari
- Chennai Dental Centre, 4/579 Rajiv Gandhi Salai, Kotivakkam, Chennai, 600 041 India
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Hou JS, Chen M, Pan CB, Wang M, Wang JG, Zhang B, Tao Q, Wang C, Huang HZ. Application of CAD/CAM-assisted technique with surgical treatment in reconstruction of the mandible. J Craniomaxillofac Surg 2012; 40:e432-7. [PMID: 22484124 DOI: 10.1016/j.jcms.2012.02.022] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 02/19/2012] [Accepted: 02/27/2012] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE The purpose of this clinical study was to explore the optimal method of reconstruct mandible defects individually and immediately. STUDY DESIGN Three-dimensional model simulation technique and vascularized fibular osteomyocutaneous flap were used to repair 15 cases of mandible defects, which were caused by ameloblastoma. A three-dimensional computed tomography (CT) images were converted to a virtual model using CAD software and the 3-dimensional (3D) simulated resin models of skeleton and fibula were used to design the osteotomies, bone segment replacement and titanium mesh shaping preoperatively. RESULTS Fibula flaps were alive and no complication occurred. The patients were satisfied with the results both esthetically and functionally. CONCLUSIONS This preliminarily clinical study and case demonstrated that CAD/CAM-assisted technique with surgical treatment offers an individual anatomical reconstruction of the mandible in ameloblastoma patients. The procedures guarantee intraoperatively an exact placement of the preformed mesh even for precise reconstruction of extensive mandible defects.
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Affiliation(s)
- Jin-Song Hou
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, and Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
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Thimmappa B, Girod SC. Principles of implant-based reconstruction and rehabilitation of craniofacial defects. Craniomaxillofac Trauma Reconstr 2011; 3:33-40. [PMID: 22110816 DOI: 10.1055/s-0030-1249372] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
The final stages of reconstruction following craniofacial trauma or tumor resection often involve the fitting of prostheses. Development of osseointegrated implants for retention of prostheses has improved function and aesthetic outcome. Placement of osseointegrated implants requires coordinated care from multiple specialists and a lifetime commitment of the patient. The workup and surgical treatment algorithms for placement of intraoral compared with extraoral implants are discussed. The quality and quantity of bone available are the most important factors influencing design and placement. The long-term retention of implants is influenced by implant site, local tissue bed preparation, and hygiene. Osseointegrated implants are a part of the complete rehabilitation of patients with craniomaxillofacial defects. Although final fitting and maintenance of prostheses is completed by prosthodontists and patients, successful placement and preservation of implants is affected largely by the plan set forth by the reconstructive surgeon.
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Affiliation(s)
- Brinda Thimmappa
- Division of Plastic and Reconstructive Surgery, Stanford University, Stanford University Medical Center and Lucile Packard Children's Hospital, Palo Alto, California
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