1
|
McBee DB, DiLeo MJ, Keehn CC, Huang AT, Haskins AD, Hernandez DJ. Early and Late Complications of Mandibulectomy Free Flap Reconstruction: Does the Selective Use of Soft Tissue Only Flaps Reduce Complications? Ann Otol Rhinol Laryngol 2024; 133:672-678. [PMID: 38676442 PMCID: PMC11179315 DOI: 10.1177/00034894241250177] [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] [Indexed: 04/28/2024]
Abstract
PURPOSE This study aims to evaluate the factors most associated with early and late complications following microvascular free tissue transfer (MVFTT) after mandibulectomy. METHODS A retrospective review of patients undergoing MVFTT after segmental mandibulectomy from September 2016 to February 2021 was performed across a single academic institution. Surgical variables were collected, including the location of the resultant mandibular defect (anterior vs posterior) and flap type (osseous or non-osseous). The primary outcome variables included postoperative complications (early, <90 days; and late, >90 days) and the patients' functional status (return to oral intake). Descriptive statistics, chi-square test, Fischer's exact test, and 2-sample t tests were used to analyze differences among variables. RESULTS We analyzed a cohort of 114 consecutive patients with mandibular defects, comprising 57 anterior and 57 posterior defects. Bony free flaps with hardware were used to reconstruct 98% of anterior defects compared to 58% of posterior defects (P < .001). All soft tissue only flaps did not utilize any hardware during the reconstruction. Anterior defects demonstrated more late complications requiring additional surgery (30% vs 9%, P = .04). A secondary analysis of posterior mandibular reconstructions compared soft tissue only flaps and bony free flaps with hardware and showed equivalent rates of early (12% vs 13%, P > .99) and late (9% vs 8%, P > .99) complications requiring additional surgery while demonstrating a similar return to full oral competence (55% vs 46%, P = .52) and recovery of a 100% oral diet (67% vs 54%, P = .53). CONCLUSION Osseous free tissue transfer for segmental mandibular defects remains the gold standard in reconstruction. In our patient cohort, anterior mandibular defects are associated with greater late (>90 day) complications requiring additional surgery. Comparable outcomes may be achieved with soft tissue only versus osseous free flap reconstruction of posterior mandibular defects.
Collapse
Affiliation(s)
- Dylan B. McBee
- Bobby R. Alford Department of Otolaryngology—Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Michael J. DiLeo
- Bobby R. Alford Department of Otolaryngology—Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Caroline C. Keehn
- Bobby R. Alford Department of Otolaryngology—Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Andrew T. Huang
- Bobby R. Alford Department of Otolaryngology—Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Angela D. Haskins
- Bobby R. Alford Department of Otolaryngology—Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - David J. Hernandez
- Bobby R. Alford Department of Otolaryngology—Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
2
|
Kamalakar A, Tobin B, Kaimari S, Robinson MH, Toma AI, Cha T, Chihab S, Moriarity I, Gautam S, Bhattaram P, Abramowicz S, Drissi H, García AJ, Wood LB, Goudy SL. Delivery of A Jagged1-PEG-MAL hydrogel with Pediatric Human Bone Cells Regenerates Critically-Sized Craniofacial Bone Defects. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.10.06.561291. [PMID: 37873448 PMCID: PMC10592619 DOI: 10.1101/2023.10.06.561291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Treatments for congenital and acquired craniofacial (CF) bone abnormalities are limited and expensive. Current reconstructive methods include surgical correction of injuries, short-term bone stabilization, and long-term use of bone grafting solutions, including implantation of (i) allografts which are prone to implant failure or infection, (ii) autografts which are limited in supply. Current bone regenerative approaches have consistently relied on BMP2 application with or without addition of stem cells. BMP2 treatment can lead to severe bony overgrowth or uncontrolled inflammation, which can accelerate further bone loss. Bone marrow-derived mesenchymal stem cell-based treatments, which do not have the side effects of BMP2, are not currently FDA approved, and are time and resource intensive. There is a critical need for novel bone regenerative therapies to treat CF bone loss that have minimal side effects, are easily available, and are affordable. In this study we investigated novel bone regenerative therapies downstream of JAGGED1 (JAG1). We previously demonstrated that JAG1 induces murine cranial neural crest (CNC) cells towards osteoblast commitment via a NOTCH non-canonical pathway involving JAK2-STAT5 (1) and that JAG1 delivery with CNC cells elicits bone regeneration in vivo. In this study, we hypothesize that delivery of JAG1 and induction of its downstream NOTCH non-canonical signaling in pediatric human osteoblasts constitute an effective bone regenerative treatment in an in vivo murine bone loss model of a critically-sized cranial defect. Using this CF defect model in vivo, we delivered JAG1 with pediatric human bone-derived osteoblast-like (HBO) cells to demonstrate the osteo-inductive properties of JAG1 in human cells and in vitro we utilized the HBO cells to identify the downstream non-canonical JAG1 signaling intermediates as effective bone regenerative treatments. In vitro, we identified an important mechanism by which JAG1 induces pediatric osteoblast commitment and bone formation involving the phosphorylation of p70 S6K. This discovery enables potential new treatment avenues involving the delivery of tethered JAG1 and the downstream activators of p70 S6K as powerful bone regenerative therapies in pediatric CF bone loss.
Collapse
Affiliation(s)
- Archana Kamalakar
- Department of Pediatric Otolaryngology, Emory University, Atlanta, GA, USA
| | - Brendan Tobin
- Parker H. Petit Institute for Bioengineering and Biosciences, Georgia Institute of Technology, Atlanta, GA, USA
- School of Chemistry and Biomolecular Engineering, Georgia Tech College of Engineering, Atlanta, GA, USA
| | - Sundus Kaimari
- Department of Pediatric Otolaryngology, Emory University, Atlanta, GA, USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - M. Hope Robinson
- Department of Pediatric Otolaryngology, Emory University, Atlanta, GA, USA
| | - Afra I. Toma
- Department of Pediatric Otolaryngology, Emory University, Atlanta, GA, USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Timothy Cha
- Department of Pediatric Otolaryngology, Emory University, Atlanta, GA, USA
| | - Samir Chihab
- Department of Orthopedics, Emory University, Atlanta, GA, USA
| | - Irica Moriarity
- Neuroscience Program in College of Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Surabhi Gautam
- Department of Orthopedics, Emory University, Atlanta, GA, USA
| | - Pallavi Bhattaram
- Department of Orthopedics, Emory University, Atlanta, GA, USA
- The Atlanta Veterans Affairs Medical Center Atlanta, GA, USA
| | - Shelly Abramowicz
- Department of Pediatric Otolaryngology, Emory University, Atlanta, GA, USA
- Department of Surgery, Division of Oral and Maxillofacial Surgery, Emory University, Atlanta, GA, USA
| | - Hicham Drissi
- Department of Cell biology, Emory University, Atlanta, GA, USA
- Department of Orthopedics, Emory University, Atlanta, GA, USA
- The Atlanta Veterans Affairs Medical Center Atlanta, GA, USA
| | - Andrés J. García
- Parker H. Petit Institute for Bioengineering and Biosciences, Georgia Institute of Technology, Atlanta, GA, USA
- George W. Woodruff School of Mechanical Engineering, Georgia Tech College of Engineering, Atlanta, GA, USA
| | - Levi B. Wood
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
- Parker H. Petit Institute for Bioengineering and Biosciences, Georgia Institute of Technology, Atlanta, GA, USA
- George W. Woodruff School of Mechanical Engineering, Georgia Tech College of Engineering, Atlanta, GA, USA
| | - Steven L. Goudy
- Department of Pediatric Otolaryngology, Emory University, Atlanta, GA, USA
- Department of Pediatric Otolaryngology, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| |
Collapse
|
3
|
Denys E, Pincet L, Lambercy K, Broome M, May L. Does Fibula Free Flap Harvesting Affect Donor Site of Patients in Facial Reconstructions: A Gait Analysis Study. J Oral Maxillofac Surg 2024; 82:728-733. [PMID: 38527727 DOI: 10.1016/j.joms.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 03/03/2024] [Accepted: 03/03/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Vascularized fibula free flap (VFFF) remains gold standard for reconstruction of bony defects of the maxilla or mandible. Research and publications in recent years essentially focused on the evolution and improvement of the recipient reconstructed area but very few concerning the donor site morbidity. PURPOSE The aim of this study was to analyze walking ability of patients following VFFF operation and to determine if there are long term walking disabilities. STUDY DESIGN, SETTING, SAMPLE The retrospective cohort study involved healthy controls and patients who had undergone VFFF between 2012 and 2019 at the oral and maxillo-facial department of the University Hospital in Lausanne, Switzerland. Patients with cardiovascular, pulmonary, neuromuscular or musculoskeletal pathologies that could impair walking were excluded from the study. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE Primary predictor is the reconstruction status, VFFF versus healthy patients (controls). MAIN OUTCOME VARIABLES Main outcomes were gait parameters. Objective evaluation of walking abilities was assessed using the Gait Up system (Gait Up SA, EPFL Innov'Park-C, Lausanne, Switzerland), which are wearable motion sensors that provides 3D analytics of the gait. COVARIATES Covariates implied patient characteristics such as age, sex, time after surgery and subjective evaluation of the gait obtained with two orthopedic validated questionnaires. RESULTS This study implied 10 healthy controls and 11 patients who had undergone VFFF. Results showed statistically significant differences in the speed [m/s] (1.3 vs 1.1 for a P value of .001), the stride length [m] (1.4 vs 1.2 for a P value of 0.003), the flat foot phase [%] (55.0 vs 63.3 for a P value of .006) and the pushing phase [%] (34.1 vs 25.1 for a P value of .008). CONCLUSION AND RELEVANCE Reconstruction using vascularized autograft in maxillofacial surgery is substantial and well described. Our attention focusing on donor site morbidity has demonstrated subjective and objective long-term alterations. These results will have to be confirmed with gait analysis in a prospective project including preoperative and postoperative analysis of the gait of the patient acting himself as his own control, with a larger scale of patients.
Collapse
Affiliation(s)
- Eloi Denys
- Resident Doctor, Department of Internal Medecine, Yverdon Regional Hospital, Yverdon, Switzerland
| | - Laurence Pincet
- Attending Physician, Department of oral and maxillofacial surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Karma Lambercy
- Attending Physician, Department of oral and maxillofacial surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Martin Broome
- Professor, ENT Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Laurence May
- Attending Physician, ENT Department, Lausanne University Hospital, Lausanne, Switzerland.
| |
Collapse
|
4
|
Gattani V, Pawar S, Gupta C, Bhola N, Sonpal P, Agrawal P. Bridging Tradition and Modernity: Embracing the Bipaddled Pectoralis Major Myocutaneous Flap for Challenging Oral Cavity Defects in the Free Flap Era. Cureus 2024; 16:e62341. [PMID: 39006683 PMCID: PMC11246768 DOI: 10.7759/cureus.62341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 06/13/2024] [Indexed: 07/16/2024] Open
Abstract
Oral squamous cell carcinoma is a serious global issue, with the prognosis decreasing as the disease severity increases. The implications of this condition are so disastrous that they cause a lot of suffering for the individual. Early diagnosis has proven to improve patients' overall survival and quality of life. Surgery remains the mainstay in treating oral carcinoma. It is aimed at the complete removal of the cancerous lesion along with the management of cervical nodal metastasis. Larger defects call for reconstruction with bulky flaps. In our case, we had a composite defect postresection of the cancerous lesion, which was reconstructed using a bipaddled pectoralis major myocutaneous flap.
Collapse
Affiliation(s)
- Vaishnavi Gattani
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Wardha, IND
| | - Shreya Pawar
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Wardha, IND
| | - Chetan Gupta
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Wardha, IND
| | - Nitin Bhola
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Wardha, IND
| | - Parmarth Sonpal
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Wardha, IND
| | - Palak Agrawal
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Wardha, IND
| |
Collapse
|
5
|
Li S, Mi L, Bai L, Liu Z, Li L, Wu Y, Chen L, Bai N, Sun J, Liu Y. Application of 3D printed titanium mesh and digital guide plate in the repair of mandibular defects using double-layer folded fibula combined with simultaneous implantation. Front Bioeng Biotechnol 2024; 12:1350227. [PMID: 38456007 PMCID: PMC10917970 DOI: 10.3389/fbioe.2024.1350227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/12/2024] [Indexed: 03/09/2024] Open
Abstract
Fibula transplantation plays an irreplaceable role in restoring the function and morphology of the defected mandible. However, the complex load-bearing environment of the mandible makes it urgent to accurately reconstruct the mandible, ensure the position of the condyle after surgery, and restore the patient's occlusal function and contour. The intervention of digital design and three-dimensional (3D) printed titanium mesh provides a more efficient method and idea to solve this problem. Digital design guides the accurate positioning, osteotomy, and simultaneous implant placement during surgery, and 3D printed titanium mesh ensures stable condyle position after surgery, restoring good mandibular function. The double-layer folded fibula maintains the vertical height of the mandible and a good facial contour, and simultaneous implant placement can establish a good occlusal relationship. This study conducted a retrospective analysis of five patients with jaw defects who underwent digital fibula reconstruction over the past 3 years. It was found that the surgical protocol combining digital design, 3D printed intraoperative guides, 3D printed titanium mesh, free fibula flap, immediate implant, and occlusal reconstruction to repair jaw defects had more ideal facial appearance and biological function. It will provide a more reliable surgical protocol for clinical management of large mandibular defects.
Collapse
Affiliation(s)
- Shangbo Li
- The Affiliated Hospital of Qingdao University, Qingdao, China
- School of Stomatology, Qingdao University, Qingdao, China
| | - Lian Mi
- The Affiliated Hospital of Qingdao University, Qingdao, China
- School of Stomatology, Qingdao University, Qingdao, China
| | - Li Bai
- Zibo Infectious Disease Hospital, Qingdao, China
| | - Zijian Liu
- The Affiliated Hospital of Qingdao University, Qingdao, China
- School of Stomatology, Qingdao University, Qingdao, China
| | - Li Li
- The Affiliated Hospital of Qingdao University, Qingdao, China
- School of Stomatology, Qingdao University, Qingdao, China
| | - Yupeng Wu
- The Affiliated Hospital of Qingdao University, Qingdao, China
- School of Stomatology, Qingdao University, Qingdao, China
| | - Liqiang Chen
- The Affiliated Hospital of Qingdao University, Qingdao, China
- School of Stomatology, Qingdao University, Qingdao, China
- Dental Digital Medicine and 3D Printing Engineering Laboratory of Qingdao, Qingdao, China
| | - Na Bai
- The Affiliated Hospital of Qingdao University, Qingdao, China
- School of Stomatology, Qingdao University, Qingdao, China
| | - Jian Sun
- The Affiliated Hospital of Qingdao University, Qingdao, China
- School of Stomatology, Qingdao University, Qingdao, China
- Dental Digital Medicine and 3D Printing Engineering Laboratory of Qingdao, Qingdao, China
| | - Yanshan Liu
- The Affiliated Hospital of Qingdao University, Qingdao, China
- School of Stomatology, Qingdao University, Qingdao, China
- Dental Digital Medicine and 3D Printing Engineering Laboratory of Qingdao, Qingdao, China
| |
Collapse
|
6
|
Anthraper MSJ, Chandramouli A, Srinivasan S, Rangasamy J. Lyophilized platelet rich fibrin and gelatin incorporated bioadhesive bone cement composite for repair of mandibular continuity defects. Int J Biol Macromol 2024; 258:129086. [PMID: 38161027 DOI: 10.1016/j.ijbiomac.2023.129086] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/02/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
Mandibular continuity defects stem from conditions such as malignancies, trauma, cysts, osteomyelitis and osteoradionecrosis, presenting significant challenges. If mandibular reconstruction fails, it can result in facial collapse, causing significant aesthetic and functional concerns for the patient. In the present study we developed a bio-adhesive Bone Cement (BC) enriched with lyophilised PRF and gelatin to enhance bone repair and induce regeneration. The developed BC consisted of a mixture of Tetracalcium Phosphate (TTCP) and O-Phospho-l-serine (OPLS) in addition to lyophilised Platelet Rich Fibrin (PRF) for sustained growth factor release and gelatin (GE) for improved cement resorption. It is primarily designed for in-situ application, conforming to the shape and size of the defect for effective bone repair and regeneration. The study evaluated four groups: (i) BC (control), (ii) BC-GE (control), (iii) BC-PRF, and (iv) BC-GE-PRF. All the four groups were characterised using FTIR, SEM and XRD. The mechanical studies of the prepared beads exhibited a significant increase in the compressive strength of the PRF loaded bone cement composites. In vitro degradation study of the beads over a 60-day period revealed a significantly higher percentage of bone cement resorption in the gelatin-incorporated groups, BC-GE (44 ± 0.5 %), and BC-GE-PRF (45 ± 2 %). The assessment of growth factor release (TGF-β and VEGF) using ELISA revealed a prolonged and sustained release of both growth factors over a 28-day period. In vitro studies were performed on human Dental Follicle Stem Cells (DFSCs) to assess cell attachment, proliferation, mineralisation and osteogenic differentiation. These studies clearly depicted that BC-PRF and BC-GE-PRF showed significantly greater proliferation of DFSCs. Furthermore, BC-PRF and BC-GE-PRF samples exhibited notably elevated expression of Runx2 and OPN (osteogenic markers), as well as a higher intensity of alizarin red stain (mineralisation). Therefore, it was concluded that PRF incorporated bioadhesive bone cement composites greatly enhance the cell attachment, proliferation, mineralisation and osteogenic differentiation of the DFSCs. Thus, the PRF and gelatin incorporated bone cement composites is expected to facilitate effective and faster bone regeneration and healing in a wide range of dental and maxillofacial defects.
Collapse
Affiliation(s)
- Mary Susan J Anthraper
- Polymeric Biomaterials Lab, School of Nanosciences and Molecular Medicine, Amrita Vishwa Vidyapeetham, Kochi 682041, India
| | - Arthi Chandramouli
- Polymeric Biomaterials Lab, School of Nanosciences and Molecular Medicine, Amrita Vishwa Vidyapeetham, Kochi 682041, India
| | - Sowmya Srinivasan
- Department of Periodontics, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi 682041, Kerala, India
| | - Jayakumar Rangasamy
- Polymeric Biomaterials Lab, School of Nanosciences and Molecular Medicine, Amrita Vishwa Vidyapeetham, Kochi 682041, India.
| |
Collapse
|
7
|
Clegg DJ, Deek AJ, Salomon BJ, Blackburn C, Fahmy MD, Heidel RE, Stephenson SM, Herbig KS, Chun JT, Carlson ER, Boukovalas S. Mandible Reconstruction in a Rural Population: Comparison of Radial Forearm and Free Fibula Flap Outcomes. J Craniofac Surg 2024; 35:119-124. [PMID: 37938094 DOI: 10.1097/scs.0000000000009832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/14/2023] [Indexed: 11/09/2023] Open
Abstract
Comparison of microsurgical reconstructive options after mandible resection is limited in the literature. Fibula free flaps (FFFs) can be costly and have timing limitations, but dental restoration can be performed, with varied reported rates of completion. The radial forearm free flap (RFFF) with mandible plating may be an alternative in select populations. The purpose of this study was to determine if the RFFF has similar outcomes to the FFF for mandible reconstruction in a rural population. A retrospective review of patients who underwent mandibulectomy from 2017 to 2021 at a single tertiary-care academic institution was performed. Those with FFF or RFFF reconstruction were included. Mandible defects were classified using the Jewer-Boyd H-C-L system. Sixty-eight patients were included with 53 undergoing FFF and 15 undergoing RFFF. Immediate reconstruction was significantly more common with RFFF than FFF (100% versus 64.2%; P =0.01). Lateral mandible defects were most common among both groups (52.9% FFF versus 73.3% RFFF; P =0.04). Osseous defect length was similar (9.5 cm FFF versus 7.7 cm RFFF; P =0.07), but soft tissue defect size was significantly larger in the RFFF group (28.6 cm 2 versus 15.3 cm 2 ; P =0.01). Complication rates (47.1% FFF versus 46.7% RFFF; P =0.98) and disease-free status at last follow-up (96.2% FFF versus 80.0% RFFF; P =0.06) were similar. Dental restoration occurred in 21.3% of patients undergoing FFF. Patients undergoing RFFF or FFF reconstruction after mandibulectomy had similar surgical and disease outcomes, with a low rate of completed dental restoration after FFF. Our findings suggest RFFF is a reasonable alternative to FFF for mandible reconstruction in select patients.
Collapse
Affiliation(s)
- Devin J Clegg
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville TN
| | - Andrew J Deek
- Department of Plastic & Oral Surgery, Boston Children's Hospital, Boston, MA
| | - Brett J Salomon
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville TN
| | - Caleb Blackburn
- Department of Oral and Maxillofacial Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
| | - Mina D Fahmy
- Department of Oral & Maxillofacial Surgery, New Hampshire Oral and Maxillofacial Surgery, Pembroke, NH
- Department of Oral & Maxillofacial Surgery, Elliot Hospital, Manchester, NH
| | - Robert E Heidel
- Department of Surgery, Division of Biostatistics, University of Tennessee Graduate School of Medicine
| | - Stacy M Stephenson
- Department of Surgery, Division of Plastic & Reconstructive Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
| | - Kathleen S Herbig
- Department of Surgery, Division of Plastic & Reconstructive Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
| | - Joseph T Chun
- Department of Surgery, Division of Plastic & Reconstructive Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
| | - Eric R Carlson
- Department of Oral and Maxillofacial Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
| | - Stefanos Boukovalas
- Department of Surgery, Division of Plastic & Reconstructive Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
| |
Collapse
|
8
|
Bevans S, Hammer D. Tenants of Mandibular Reconstruction in Segmental Defects. Otolaryngol Clin North Am 2023:S0030-6665(23)00066-X. [PMID: 37246030 DOI: 10.1016/j.otc.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The premises of mandibular reconstruction are the restoration of occlusion and mandibular contour for the purpose of preserving the facial identity, oral airway, and effective speech and mastication. Establishing functional occlusion is the primary tenant in all mandibular reconstruction. In cases of segmental defects, particularly in dentate regions of the mandible, there has been a paradigm shift over the past two decades in how surgeons are approaching the restoration of load-bearing mandibular continuity with capacity for dental implantation. Here we discuss considerations for deciding the most effective method of reconstruction in segmental defects.
Collapse
Affiliation(s)
- Scott Bevans
- Department of Otolaryngology, Tripler Army Medical Center, 1 Jarrett White Road, TAMC, HI 96818, USA; Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Daniel Hammer
- Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; Department of Oral Maxillofacial Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA
| |
Collapse
|
9
|
Rao D, Weyh A, Bunnell A, Hernandez M. The Role of Imaging in Mandibular Reconstruction with Microvascular Surgery. Oral Maxillofac Surg Clin North Am 2023:S1042-3699(23)00002-X. [PMID: 37032176 DOI: 10.1016/j.coms.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Imaging plays a critical role in the diagnosis, staging, and management of segmental mandibular defects. Imaging allows mandibular defects to be classified which aids in microvascular free flap reconstruction. This review serves to complement the surgeon's clinical experience with image-based examples of mandibular pathology, defect classification systems, reconstruction options, treatment complications, and Virtual Surgical Planning.
Collapse
Affiliation(s)
- Dinesh Rao
- Department of Radiology, University of Florida, College of Medicine, 655 West 8th Street, Jacksonville, FL 32209, USA.
| | - Ashleigh Weyh
- Department of Oral and Maxillofacial Surgery, University of Florida, College of Medicine, 655 West 8th Street, Jacksonville, FL 32209, USA
| | - Anthony Bunnell
- Department of Oral and Maxillofacial Surgery, University of Florida, College of Medicine, 655 West 8th Street, Jacksonville, FL 32209, USA
| | - Mauricio Hernandez
- Department of Radiology, University of Florida, College of Medicine, 655 West 8th Street, Jacksonville, FL 32209, USA
| |
Collapse
|
10
|
Prosthetically guided mandibular reconstruction using a fibula free flap: three-dimensional Bologna plate, an alternative to the double-barrel technique. Int J Oral Maxillofac Surg 2023; 52:436-441. [PMID: 36038455 DOI: 10.1016/j.ijom.2022.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 08/07/2022] [Accepted: 08/09/2022] [Indexed: 11/21/2022]
Abstract
The fibula free flap represents the gold standard for mandibular reconstruction. However, when harvested as a single barrel, this flap does not allow the native mandibular height to be restored, which is required for implant-supported dental rehabilitation of the patient. The aim of this study was to present a new design for a patient-specific three-dimensionally printed reconstructive plate (3DBO-PSI) that positions the fibula bone at the height of the resected mandibular alveolar bone while restoring the mandibular profile to ensure a correct morphological outcome. Twenty patients were enrolled prospectively between January 2019 and May 2022. All patients underwent a segmental mandibular resection and prosthetically guided reconstruction making use of a fibula free flap supported by the 3DBO-PSI. The mean follow-up period was 20 months. All microvascular and implant-related complications were recorded. Microvascular failure occurred in two patients. No PSI-related complications were recorded during the postoperative follow-up. The proposed reconstructive method was found to be reliable and reproducible. In all treated patients, the bony flap appeared to be adequately positioned to maintain the preoperative intermaxillary relationship, as planned. To date, dental rehabilitation has been completed in seven patients.
Collapse
|
11
|
Harris AL, Kaffenberger TM, Green KJ, Kolich B, Khan N, Solari MG, Sridharan SS, Kubik MW. Functional outcomes of hyoid suspension in anterior oromandibular reconstruction. Am J Otolaryngol 2023; 44:103812. [PMID: 36963234 DOI: 10.1016/j.amjoto.2023.103812] [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: 12/28/2022] [Accepted: 02/19/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Hyoid suspension can be considered in major oromandibular reconstruction. The impact of hyoid suspension on flap viability, swallowing outcomes, airway, and long term radiographic hyoid position is unknown. The objective of this study is to describe outcomes after hyoid suspension in anterior mandibular reconstruction with fibular free flaps. We hypothesized hyoid suspension would not affect flap viability and would benefit functional outcomes. METHODS A retrospective cohort study was conducted in an academic tertiary medical center. The study consisted of 84 adults who underwent anterior mandibular reconstruction from February 2014 to September 2020. The primary outcome studied was the post-suspension flap viability. Secondary outcomes include pre/post-operative hyomental distance on computed-tomography, duration of perioperative tracheostomy, postoperative feeding tube dependence, and post-operative aspiration pneumonia. RESULTS A total of 84, predominantly male (66.5 %), patients with an average age of 58.9 ± 11.5 were included in the study. Of those that met inclusion criteria, 25 (29.4 %) underwent intraoperative hyoid suspension. Univariable analysis showed no significant association between resuspension and post-operative total flap loss (p = 0.864) or partial flap loss (p = 0.318). There was no association between hyoid suspension and any of the studied postoperative functional outcomes or radiographic measures. CONCLUSIONS Hyoid suspension is an option during oromandibular reconstruction and does not impact flap viability. The impact on functional outcomes and long-term hyoid position in this patient subset remains unclear.
Collapse
Affiliation(s)
- Alexandria L Harris
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Thomas M Kaffenberger
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Katerina J Green
- Department of Plastic and Reconstructive Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Brian Kolich
- University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Nayel Khan
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Mario G Solari
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Shaum S Sridharan
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Mark W Kubik
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States.
| |
Collapse
|
12
|
Aquino YSJ. Pathologizing Ugliness: A Conceptual Analysis of the Naturalist and Normativist Claims in "Aesthetic Pathology". THE JOURNAL OF MEDICINE AND PHILOSOPHY 2022; 47:735-748. [PMID: 36562842 PMCID: PMC9784898 DOI: 10.1093/jmp/jhac039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Pathologizing ugliness refers to the use of disease language and medical processes to foster and support the claim that undesirable features are pathological conditions requiring medical or surgical intervention. Primarily situated in cosmetic surgery, the practice appeals to the concept of "aesthetic pathology", which is a medical designation for features that deviate from some designated aesthetic norms. This article offers a two-pronged conceptual analysis of aesthetic pathology. First, I argue that three sets of claims, derived from normativist and naturalistic accounts of disease, inform the framing of ugliness as a disease. These claims concern: (1) aesthetic harms, (2) aesthetic dysfunction, and (3) aesthetic deviation. Second, I introduce the notion of a hybridization loop in medicine, which merges the naturalist and normative understanding of the disease that potentially enables pathologizing practices. In the context of cosmetic surgery, the loop simultaneously promotes the framing of beauty ideals as normal biological attributes and the framing of normal appearance as an aesthetic ideal to legitimize the need for cosmetic interventions. The article thus offers an original discussion of the conceptual problems arising from a specific practice in cosmetic surgery that depicts ugliness as the disease.
Collapse
Affiliation(s)
- Yves Saint James Aquino
- Australian Centre for Health Engagement, Evidence and Values, University of Wollongong, Wollongong, NSW, Australia
| |
Collapse
|
13
|
Xu G, Jia J, Xiong X, Peng L, Bu LL, Wang X. Mandibular Reconstruction With the Contralateral Vascularized Iliac Flap Using Individual Design: Iliac Crest Used to Reconstruct the Ramus and the Anterior Border of the Iliac Wing Used to Reconstruct the Inferior Border: A Case Report. Front Surg 2022; 9:924241. [PMID: 35898581 PMCID: PMC9309430 DOI: 10.3389/fsurg.2022.924241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/16/2022] [Indexed: 11/24/2022] Open
Abstract
Mandible defects resulting from resection of benign or malignant lesions, trauma, or radionecrosis are commonly encountered in the oral and maxillofacial department. Vascularized bone flaps, in general, provide the best functional and aesthetic outcome. The iliac crest provides a large piece of curved cortico-cancellous bone, measuring 6–16 cm in length. It has a natural curvature that complements the curve of the lateral and sometimes anterior mandible and can be placed accordingly to fill defects. In the paper, we report a mandibular reconstruction with a vascularized iliac flap using individual virtual preoperative planning and 3D printing technology. We want to offer a new design idea for mandibular defect reconstruction.
Collapse
Affiliation(s)
- Guangcai Xu
- School of Stomatology, Henan University, Kaifeng, China
- Department of Oral and Maxillofacial Surgery, Henan Provincial People's Hospital; Zhengzhou University People's Hospital; Henan University People's Hospital, Zhengzhou, China
| | - Ju Jia
- Department of Oral Maxillofacial Head Neck Oncology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Xuepeng Xiong
- Department of Oral Maxillofacial Head Neck Oncology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Liwei Peng
- Department of Oral and Maxillofacial Surgery, Henan Provincial People's Hospital; Zhengzhou University People's Hospital; Henan University People's Hospital, Zhengzhou, China
| | - Lin-lin Bu
- Department of Oral Maxillofacial Head Neck Oncology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Xiqian Wang
- Department of Oral and Maxillofacial Surgery, Henan Provincial People's Hospital; Zhengzhou University People's Hospital; Henan University People's Hospital, Zhengzhou, China
- Correspondence: Xiqian Wang
| |
Collapse
|
14
|
Hurley CM, McConn Walsh R, Shine NP, O'Neill JP, Martin F, O'Sullivan JB. Current trends in craniofacial reconstruction. Surgeon 2022; 21:e118-e125. [PMID: 35525818 DOI: 10.1016/j.surge.2022.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 01/23/2022] [Accepted: 04/07/2022] [Indexed: 11/30/2022]
Abstract
Reconstruction of the head and neck continues to pose a variety of difficult functional and aesthetic challenges to the plastic surgeon. While the surgical treatment for midfacial and skull base tumours continues to advance, the three-dimensional reconstruction predicaments continue to increase in complexity. Reconstructive strategies of the head and neck require the restoration of intricate skeletal architecture and large volumes of both internal and external soft tissue envelopes that can withstand adjuvant therapies. Vascularized bone grafts in combination with microsurgical techniques is the current trend of most reconstruction and has replaced local and pedicle flaps as the preferred modality for large defects. This article will focus on concise areas of difficulty in craniofacial reconstruction, including mandibular, midfacial, scalp and base of skull reconstruction. As our goals now move from flap survival to refinement, more complex and innovative reconstructions are executed. The problems with each modality are examined, and the frontiers of head and neck reconstruction are explored. With the potential combination of virtual surgery and tissue engineered biotechnology, we may someday be able to expand our reconstructive capabilities beyond free tissue transfer.
Collapse
Affiliation(s)
- C M Hurley
- Department of Plastic & Reconstructive Surgery, Beaumont Hospital, Dublin, Ireland.
| | - R McConn Walsh
- Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland
| | - N P Shine
- Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland
| | - J P O'Neill
- Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland
| | - F Martin
- Department of Plastic & Reconstructive Surgery, Beaumont Hospital, Dublin, Ireland
| | - J B O'Sullivan
- Department of Plastic & Reconstructive Surgery, Beaumont Hospital, Dublin, Ireland
| |
Collapse
|
15
|
Outcome Analysis of Advanced Oral Cancers Requiring Large Composite Fibular Osteocutaneous Flap Reconstruction: Experience From a Tertiary Care Cancer Hospital. Ann Plast Surg 2022; 88:635-640. [PMID: 35502967 DOI: 10.1097/sap.0000000000003217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Advanced oral cancer entailing extensive resection of large parts of the mucosa, bone, and skin require reconstructions with composite free flaps. Our aim was to analyze the outcomes of those oral squamous cell carcinomas requiring fibular osteocutaneous free flaps with large skin defects. METHODS Perioperative course and histopathological and survival outcomes of 246 consecutive patients warranting composite fibular flaps from January 2010 to June 2015 at Tata Memorial Hospital, Mumbai, India, were retrospectively analyzed. RESULTS Despite majority of T4 disease (88.2%) and stage IV disease (92%) patients, the 5-year overall survival was 52.1% and the 5-year recurrence-free survival was 48.6% with a median follow-up of 42 months with minimal complications. CONCLUSIONS Reconstruction with composite fibular osteocutaneous flaps has comparable outcomes of survival with acceptable complications in mega oral squamous cell carcinomas requiring extensive resection.
Collapse
|
16
|
Truscott A, Zamani R, Akrami M. Comparing the use of conventional and three-dimensional printing (3DP) in mandibular reconstruction. Biomed Eng Online 2022; 21:18. [PMID: 35305669 PMCID: PMC8934485 DOI: 10.1186/s12938-022-00989-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 03/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background There are a number of clinical disorders that require mandibular reconstruction (MR). Novel three-dimensional (3D) printing technology enables reconstructions to be more accurate and beneficial to the patient. However, there is currently no evidence identifying which techniques are better suited for MR, based on the type of clinical disorder the patient has. In this study, we aim to compare 3D techniques with conventional techniques to identify how best to reconstruct the mandible based on the clinical cause that necessitates the reconstructive procedure: cancerous or benign tumours, clinical disorders, infection or disease and trauma or injury. Methods PubMed, Scopus, Embase and Medline were searched to identify relevant papers that outline the clinical differences between 3D and conventional techniques in MR. Data were evaluated to provide a clear outline of suitable techniques for surgery. Results 20 of 2749 papers met inclusion criteria. These papers were grouped based on the clinical causes that required MR into four categories: malignant or benign tumour resection; mandibular trauma/injury and other clinical disorders. Conclusions The majority of researchers favoured 3D techniques in MR. However, due to a lack of standardised reporting in these studies it was not possible to determine which specific techniques were better for which clinical presentations.
Collapse
|
17
|
Krishnaswamy V, Guhan BB, Karthikeyan GR, Mohan AM. Utilization of non-vascularized bone graft with regional flap as an alternative for facial reconstruction. Natl J Maxillofac Surg 2022; 13:143-146. [PMID: 35911802 PMCID: PMC9326202 DOI: 10.4103/njms.njms_133_20] [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: 06/29/2020] [Revised: 08/10/2020] [Accepted: 09/16/2021] [Indexed: 11/04/2022] Open
Abstract
Mandibular resections decision is one of the most important steps in oral cavity malignant or nonmalignant lesions associated with the mandible. The role of mandibular reconstruction is not only for cosmesis, but it is also indicated for functional rehabilitation such as swallowing, phonetics, and for facial symmetrical. Even though the free tissue transfer is considered a gold standard for mandibular reconstruction, the importance of nonvascularized bone grafts (NVBGs) such as fibula, calvarium, rib, sternum, and iliac are still persisting in mandibulectomies condition like patient who have not taken radiotherapy or not willing to undergo radiotherapy or not fit for free tissue transfer and provides a good contour of mandibular replacement. The success rate of NVBG depends upon patient selection, preoperative planning, and meticulous nursing care. Addition to NVBG, regional flaps such as pectoralis major myocutaneous (PMMC) flap will help in soft-tissue replacement of the defect as well as it will help in the situation where primary closure and airtight closure is not possible. This case report will discuss in detail about the management of anterior segmental mandibulectomy due to oncological resection and reconstruction with NVBG with fibula and PMMC.
Collapse
|
18
|
Chatterjee D, Menon A, Sharma J, Rahman Z, N HK. The 3D tongue depressor guide: a low-cost alternative to 3D printing in fibula-based mandibular reconstruction. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-021-01859-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
19
|
Orbital Lateral Cantal Distance Can Predict the Cephalometric Characteristic of Mandible in Iranian Population. J Craniofac Surg 2021; 32:e716-e719. [PMID: 33935146 DOI: 10.1097/scs.0000000000007702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Orbitofacial anthropometrics have become an important tool used in reconstructive surgery. The authors attempt to evaluate the relation between orbital lateral canthal distance and the cephalometric characteristic of mandible in Iranian population.In a cross-sectional study, anthropometric parameters of face in 200 subjects (100 males and 100 females) with mean age of 34.39 ± 18.83 were evaluated by three-dimensional computed tomography imaging.In this study, there was not a significant difference in the age of sex groups (P = 0.183). Also, there was no significant difference in the left and right mandible angle in different sex groups (P = 0.25, P = 0.124, respectively). There were significant differences in the anterior mandible distance, inferior mandible angle distance (P = 0.0001) and lateral cantus distance of sex groups (P = 0.0001). There was a significant correlation between lateral contuse distance and left mandible angle (r = 0.226, P = 0.001), right mandible angle (r = 0.283, P = 0.00), mandible angle (r = -0.266, P = 0.00), anterior mandible angle distance (r = 0.655, P = 0.00), and inferior mandible angle distance (r = 0.582, P = 0.00).Here, we conclude that orbital lateral canthal distance can predict the cephalometric characteristic of mandible in Iranian population.
Collapse
|
20
|
Yamakawa S, Hayashida K. Safety and efficacy of secondary mandibular reconstruction using a free osteo-cutaneous fibula flap after segmental mandibular resection: a retrospective case-control study. BMC Surg 2021; 21:189. [PMID: 33836735 PMCID: PMC8035737 DOI: 10.1186/s12893-021-01194-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 04/05/2021] [Indexed: 12/15/2022] Open
Abstract
Background Free osteocutaneous fibula flap (FFF) is currently considered the best option for segmental mandibular reconstruction; however, there are only a few reports comparing secondary with primary reconstructions using FFF. This study aimed to evaluate the safety and efficacy of secondary mandibular reconstruction using FFF when compared with primary mandibular reconstruction. Methods From October 2018 to February 2020, patients who underwent mandibular reconstruction using FFF after segmental mandibulectomy were retrospectively reviewed. The size and location of the mandibular defect, the segment length and number of osteotomies in the fibula, types of the mandibular plating system, kinds and laterality of the recipient vessels were recorded from the surgical notes. Flap survival, duration of nasogastric tube use, and implant installation after reconstruction were recorded as postoperative evaluation indices. Results Twelve patients underwent mandibular reconstruction using FFF during the study period. There were no significant differences in demographic characteristics other than body mass index between the primary (n = 8) and secondary (n = 4) reconstruction groups. No significant differences were observed in the size and location of defects, the segment length and number of osteotomies in the fibula, and the types of mandibular plating system. There was no significant difference in the kinds of recipient vessels; however, the laterality of recipient vessels was ipsilateral in all cases of primary reconstructions and contralateral in all cases of secondary reconstructions. Three out of eight patients with primary FFF reconstruction developed partial flap necrosis. Four patients in the secondary FFF reconstruction group achieved complete flap survival. The duration of use of the nasogastric tube and implant installation after reconstruction was comparable between the two groups. Conclusion Safe and effective secondary mandibular reconstruction can be performed in this clinical case study using FFF. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-021-01194-3.
Collapse
Affiliation(s)
- Sho Yamakawa
- Division of Plastic and Reconstructive Surgery, Faculty of Medicine Shimane University, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan.
| | - Kenji Hayashida
- Division of Plastic and Reconstructive Surgery, Faculty of Medicine Shimane University, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| |
Collapse
|
21
|
LONG-TERM OUTCOMES OF DIFFERENT RECONSTRUCTION OPTIONS USING AUTOGENOUS BONE GRAFT FOR MANDIBULAR RECONSTRUCTION: A RETROSPECTIVE COMPARATIVE STUDY. INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH 2021. [DOI: 10.36106/ijsr/2638651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background: Several recent studies have attempted to document VBG and NVBG following mandibular reconstruction, mainly the advantages and disadvantages, but very few have specifically evaluated the differences in large parameters including both radiographic and functional aspects for long-term follow-up. However, the object of this study is to compare between two different methods of reconstruction in mandibular defects and to determine the outcomes of different reconstruction options using autogenous vascularized and nonvascularized bone grafts for mandibular reconstruction.
Patients and Methods: a total of 39 patients, 22 (56.4%) females and 17 (43.6%) males, with a mean age of 36.41 years at the time of presentation (age ranged for 48 years). Study was performed in two stages at the Department of Head and Neck Surgery - Oral and Maxillofacial oncology. In the First stage (N=39), bone-density, bone resorption, and bone graft failure were examined radiographically on panorex and CBCT. The second stage included functional evaluation (physical examination and questionnaire) based on pain, infection, speech and recurrence. Both groups were followed-up for at least 1month, 6 months and 1 year.
Results:the results show significant difference in Pain after one month (p=0.032), radiodensity (p=0.05), bone graft resorption (p=0.03) for 1 year follow-up in favor of the VBG group compared to the NVBG group, there was no statistical difference in bone graft failure, infection, speech and recurrence between the two groups.
Conclusion: Vascularized bone graft is the method of choice, especially in extensive malignant defects. On the other hand, novascularized bone graft (81.2% success rate) is a suitable complementary flap for mandible reconstruction mainly in benign and healthy patients. For future studies, large sample size with long-term follow-up more than 1 year will be required to validate our study.
Collapse
|
22
|
San-Marina S, Prummer CM, Voss SG, Hunter DE, Madden BJ, Charlesworth MC, Ekbom DC, Janus JR. Chondrogenic Predifferentiation Inhibits Vascular Endothelial Growth Factor Angiogenic Effect in Pericranium-Derived Spheroids. Tissue Eng Part A 2020; 27:237-245. [PMID: 32640938 DOI: 10.1089/ten.tea.2020.0117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Craniofacial reconstruction of critical bone defects typically requires a bone graft. As graft availability may be restricted by disease or comorbidities, tissue engineering approaches are actively sought. The pericranium could provide new bone graft material. During development and repair, bone transitions through a chondrogenic phase. However, with tissue engineering, pluripotent cells can differentiate directly into bone cells. Does ability to recapitulate bone formation in vitro affect osteogenesis and vascularization of pericranium grafts? To answer this, we obtained tissue from nine patients with preplanned craniotomy surgery and studied three-dimensional osteogenesis and angiogenesis of pericranium-derived spheroids. First, we established growth and differentiation conditions on Matrigel. For each spheroid sample, we investigated (i) continuous osteogenic differentiation (COD) and (ii) osteogenic differentiation preceded by chondrogenesis (CD → OD). The effect of vascular endothelial growth factor (VEGF) was compared to VEGF supplemented with fibroblast growth factor, interleukin (IL)-1, IL-6, platelet-derived growth factor, and tumor necrosis factor-α, a growth factor mix (GFM) with possible synergistic effects. In this limited sample, we observed no age- or sex-related differences in cell expansion. Similarly, no statistically significant differences in osteogenic or angiogenic scores between COD or CD → OD spheroids were noted with regular media. In COD, however, VEGF statistically significantly increased angiogenesis compared to control media (p = 0.007). Also, in COD, both VEGF and VEGF + GFM increased osteogenesis (p = 0.047 and p = 0.038, respectively). By contrast, in CD → OD, neither VEGF nor VEGF + GFM yielded statistically significant angiogenesis or osteogenesis scores compared to control media. To understand these results, we characterized spheroid protein expression by nanoliquid chromatography coupled to tandem mass spectrometry. Nine angiogenic proteins were either uniquely expressed or upregulated in COD compared to CD → OD: (i) endothelial markers JUP, PTGIS, PTGS2, and TYMP, (ii) tissue remodeling factors CHI3L1 and MMP14, and (iii) metabolic pathways modulators ANGPTL4, ITGA5, and WNT5A. ANGPTL4, ITGA5, PTGIS, PTGS2, and WNT5A define a conserved angiogenic network and were >2-fold increased in VEGF compared to VEGF + GFM. Finally, we examined bone formation on printable poly-(propylene-fumarate) (PPF) scaffolds for individualized grafting. Under COD + VEGF conditions, PPF scaffolds loaded with pericranium-derived cells displayed hallmarks of spongiform-like bone formation. Thus, the human pericranium may be a potential repository for bone-generating cells with applications in craniofacial bone repair using tissue printing.
Collapse
Affiliation(s)
- Serban San-Marina
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Stephen G Voss
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Danielle E Hunter
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Benjamin J Madden
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Dale C Ekbom
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeffrey R Janus
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
23
|
Innovative CAD/CAM Guide for Mandibular Reconstruction with Metallic Condylar Head and Free Fibular Flap. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3088. [PMID: 33133942 PMCID: PMC7544273 DOI: 10.1097/gox.0000000000003088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/14/2020] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. In reconstructions of mandibles and condyles, free fibular flaps and metallic condylar heads (CH) are often used after resection. However, in conventional reconstructions, it is difficult to fix the metallic CH on the same preoperative position because the position is determined visually. Therefore, we have made an original computer-aided design and manufacture (CAD/CAM) guide for mandibular condyle reconstruction, combining a metallic CH with a free fibular flap. A 71-year-old woman with gingival carcinoma underwent hemimandibulectomy. We reconstructed the mandible and condyle with a metallic CH and a free fibular flap. We placed a mark on the CAD/CAM guide showing the correct position for fixing the CH to the fibular blocks. We also designed a surface for attaching to the healthy edge of the mandible. The fibular blocks and metallic CH were fixed as 1 unit before separating the flap from the leg and replacing the diseased tissue. Reconstruction was completed by fixing the attachment surface to the healthy side of the mandible. The guide marks solved the difficulty of conventional reconstruction; during surgery, we fixed the metallic CH to the same position as the original bone using these marks. The postoperative deviation of the condyle from the virtual plan was 4.3 mm, whereas the reported deviation of such prostheses was 3.8 mm (range 1.3–6.7); so our guide was acceptably accurate. Furthermore, it appears that the CAD/CAM guide is more useful for reconstruction after hemimandibulectomy including the condyle than after segmental resection without including condyle.
Collapse
|
24
|
Goker F, Baj A, Bolzoni AR, Maiorana C, Giannì AB, Del Fabbro M. Dental implant-based oral rehabilitation in patients reconstructed with free fibula flaps: Clinical study with a follow-up 3 to 6 years. Clin Implant Dent Relat Res 2020; 22:514-522. [PMID: 32578936 DOI: 10.1111/cid.12928] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/20/2020] [Accepted: 05/26/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Oral rehabilitation of patients after maxillofacial reconstructive surgery represents a challenge and stable prosthetic retention can be achieved with the use of dental implants. PURPOSE This retrospective report aimed to evaluate implant-based oral rehabilitation following maxillofacial reconstruction with free fibula flaps. MATERIALS AND METHODS A total of 14 patients who had reconstruction with fibula flaps either by CAD/CAM or conventional surgery were included in this study. A total of 56 implants (40 in flaps, 16 in native bone) were evaluated. Follow-up after reconstructive surgery ranged between 3.25 and 6.3 years. Follow-up after implant surgery ranged between 1.5 and 3.8 years. RESULTS Overall survival rate was 85.7% in free fibula flaps and 85.6% in dental implants. Eight implants were lost in three patients and all of these failures were in dental implants inserted in free flaps. According to the results on patient basis, the implant survival was not influenced by any variable. CONCLUSIONS The maxillofacial reconstruction with free fibula flap and oral rehabilitation with implant-supported prostheses after ablative surgery can be considered as an effective and safe procedure with successful aesthetic and functional outcomes.
Collapse
Affiliation(s)
- Funda Goker
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, Milan, Italy
| | - Alessandro Baj
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, Milan, Italy.,Dental and Maxillo-Facial Surgery Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Alessandro Remigio Bolzoni
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, Milan, Italy.,Dental and Maxillo-Facial Surgery Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Carlo Maiorana
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, Milan, Italy.,Dental and Maxillo-Facial Surgery Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Aldo Bruno Giannì
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, Milan, Italy.,Dental and Maxillo-Facial Surgery Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, Milan, Italy.,IRCCS Orthopedic Institute Galeazzi, Milan, Italy
| |
Collapse
|
25
|
Blanc J, Fuchsmann C, Nistiriuc-Muntean V, Jacquenot P, Philouze P, Ceruse P. Evaluation of virtual surgical planning systems and customized devices in fibula free flap mandibular reconstruction. Eur Arch Otorhinolaryngol 2019; 276:3477-3486. [DOI: 10.1007/s00405-019-05625-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 08/29/2019] [Indexed: 11/30/2022]
|
26
|
Zhang B, Skelly JD, Maalouf JR, Ayers DC, Song J. Multifunctional scaffolds for facile implantation, spontaneous fixation, and accelerated long bone regeneration in rodents. Sci Transl Med 2019; 11:11/502/eaau7411. [DOI: 10.1126/scitranslmed.aau7411] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 01/23/2019] [Accepted: 06/05/2019] [Indexed: 12/16/2022]
Abstract
Graft-guided regenerative repair of critical long bone defects achieving facile surgical delivery, stable graft fixation, and timely restoration of biomechanical integrity without excessive biotherapeutics remains challenging. Here, we engineered hydration-induced swelling/stiffening and thermal-responsive shape-memory properties into scalable, three-dimensional–printed amphiphilic degradable polymer-osteoconductive mineral composites as macroporous, non–load-bearing, resorbable synthetic grafts. The distinct physical properties of the grafts enabled straightforward surgical insertion into critical-size rat femoral segmental defects. Grafts rapidly recovered their precompressed shape, stiffening and swelling upon warm saline rinse to result in 100% stable graft fixation. The osteoconductive macroporous grafts guided bone formation throughout the defect as early as 4 weeks after implantation; new bone remodeling correlated with rates of scaffold composition-dependent degradation. A single dose of 400-ng recombinant human bone morphogenetic protein-2/7 heterodimer delivered via the graft accelerated bone regeneration bridging throughout the entire defect by 4 weeks after delivery. Full restoration of torsional integrity and complete scaffold resorption were achieved by 12 to 16 weeks after surgery. This biomaterial platform enables personalized bone regeneration with improved surgical handling, in vivo efficacy and safety.
Collapse
|
27
|
Bede SYH, Ismael WK, Hashim EA. Reconstruction plate-related complications in mandibular continuity defects. Oral Maxillofac Surg 2019; 23:193-199. [PMID: 31044342 DOI: 10.1007/s10006-019-00762-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 04/23/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the complications associated with the use of reconstruction plates with or without non-vascularized bone graft in reconstruction of mandibular segmental defects caused by trauma and tumor resection and to analyze various factors that are associated with the development of complications. METHODS A retrospective observational study was conducted, and the investigated variables included the age and gender of the patients, etiology of the defect, the site of the defect, the size of the defect, whether bone graft was used or not, type of plate used, and whether the reconstruction was immediate or delayed. The outcome variables were the postoperative complications and the success rate. RESULTS Fifty-one patients were enrolled in this study; the etiology of mandibular defect was trauma in 39 patients (76.5%) and resection of benign or malignant tumors in 12 patients (23.5%). The complication rate was (58.8%) and the success rate was (94.1%); the only factor that significantly increased the incidence of postoperative complications was the size of the defect. CONCLUSION Reconstruction plates demonstrated a high success rate despite the high complication rate. Segmental defects caused by trauma were smaller than those created after tumor resection and the only factor that increased complication rate was the size of the defect; other factors did not affect the complication rate.
Collapse
Affiliation(s)
- Salwan Yousif Hanna Bede
- Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Baghdad, Bab-Almoadham, Baghdad, Iraq.
| | | | - Ehssan Ali Hashim
- Oral and Maxillofacial Surgery Unit, Alyarmook Teaching Hospital, Baghdad, Iraq
| |
Collapse
|
28
|
Kotelnikov GP, Kolsanov AV, Volova LT, Trunin DA, Popov NV, Nikolaenko AN, Stepanov GV. [Technology of manufacturing of personalized reconstructive allogenic bone graft (in Russian only)]. Khirurgiia (Mosk) 2019:65-72. [PMID: 30938359 DOI: 10.17116/hirurgia201903165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To develop the technology of manufacturing of reconstructive allogenic bone graft with individual parameters by using of digital prototyping and modeling. MATERIAL AND METHODS Allogeneic cadaveric bone blocks were used as material. The following methods were used to develop a manufacturing technology for personalized allogenic reconstructive bone implant: harvesting and special preparation of cadaveric material, primary disinfection, viral inactivation, ultrasound management, lyophilization of bone material, CT-examination of patients with various bone defects, digital prototyping and modeling, milling on a machine with numerical program control, X-ray sterilization. RESULTS The technology of manufacturing of reconstructive allogenic bone graft with individual parameters was successfully tested in the treatment of 24 patients with post-traumatic, destructive-dystrophic and degenerative defects of jaws in 2012-2015. Final reconstructive allogenic bone implant has a personalized 3D-geometry in accordance with individual maxillofacial anatomy of particular patient. One of implant surfaces is fully congruent to the jaw bone defect, the others form the width, height and volume of reconstructive bone implant considering personified maxillofacial features. All above-mentioned features of bone implant are important to restore chewing function of dental system. CONCLUSION The problem of bone implant personification may be resolved by using of computed tomography followed by digital analysis of jaw structure, technologies for digital reconstruction of bone defects (digital prototyping and modeling) and digital manufacturing.
Collapse
Affiliation(s)
- G P Kotelnikov
- Samara State Medical University of Ministry of Health of the Russia, Samara, Russia
| | - A V Kolsanov
- Samara State Medical University of Ministry of Health of the Russia, Samara, Russia
| | - L T Volova
- Samara State Medical University of Ministry of Health of the Russia, Samara, Russia
| | - D A Trunin
- Samara State Medical University of Ministry of Health of the Russia, Samara, Russia
| | - N V Popov
- Samara State Medical University of Ministry of Health of the Russia, Samara, Russia
| | - A N Nikolaenko
- Samara State Medical University of Ministry of Health of the Russia, Samara, Russia
| | - G V Stepanov
- Samara State Medical University of Ministry of Health of the Russia, Samara, Russia
| |
Collapse
|
29
|
Alfouzan AF. Review of surgical resection and reconstruction in head and neck cancer. Traditional versus current concepts. Saudi Med J 2019; 39:971-980. [PMID: 30284578 PMCID: PMC6201028 DOI: 10.15537/smj.2018.10.22887] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
This review summarizes the development of head and neck cancer resection and reconstruction. The developments in the treatment of cancer patients are reflected in their surgical outcomes, in addition to functional and aesthetic improvements. New technologies, such as surgical simulation and planning, minimally invasive surgery, and microsurgery have been added to the field to improve surgical resection of the tumor and reconstruction. The field is still growing to optimize the management of head and neck cancer.
Collapse
Affiliation(s)
- Afnan F Alfouzan
- Department of Prosthodontics, College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
| |
Collapse
|
30
|
Osteocutaneous flaps for head and neck reconstruction: A focused evaluation of donor site morbidity and patient reported outcome measures in different reconstruction options. Arch Plast Surg 2018; 45:495-503. [PMID: 30466228 PMCID: PMC6258970 DOI: 10.5999/aps.2017.01592] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 03/15/2018] [Indexed: 11/08/2022] Open
Abstract
With significant improvements in success rates for free flap reconstruction of the head and neck, attention has turned to donor site morbidity associated with osteocutaneous free flaps. In this review, we address the morbidity associated with harvest of the four most commonly used osteocutaneous flaps; the free fibula flap, the scapula flap, the iliac crest flap and the radial forearm flap. A comprehensive literature search was performed to identify articles relevant to donor site morbidity for these flaps. We assessed morbidity in terms of incidence of delayed healing, chronic pain, aesthetic outcomes, site specific complications and patient satisfaction/quality of life. Weighted means were calculated when sufficient studies were available for review. The radial forearm and free fibula flaps are associated with high rates of delayed healing of approximately 20% compared to the scapular (<10%) and iliac flaps (5%). The radial forearm flap has higher rates of chronic pain (16.7%) and dissatisfaction with scar appearance (33%). For the majority of these patients harvest of one of these four osteocutaneous does not limit daily function at long-term follow-up. The scapular osteocutaneous flap is associated with the lowest relative morbidity and should be strongly considered when the recipient defect allows. The radial forearm is associated with higher morbidity in terms of scarring, fractures, chronic pain and wrist function and should not be considered as first choice when other flap options are available.
Collapse
|
31
|
Rodriguez I, Trinh B, Deleyiannis FB. Utility of an Anterior Tibial Perforator for Skin Paddle Viability in Through-and-Through Defects of the Mandible. EPLASTY 2018; 18:e24. [PMID: 30333897 PMCID: PMC6161216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective: The present report describes an alternative technique of using a flow- through, double-paddle, fibular, osteocutaneous free flap based on one perforator from the peroneal system and one perforator from the anterior tibial system for a through-and-through mandibular defect. Methods: The patient was a 65-year-old man who underwent a composite resection of the floor of the mouth, mandible, and chin pad due to recurrent oral cavity squamous cell carcinoma. The fibula was harvested with one posterior-lateral septal perforator from the peroneal system and with a second skin perforator from the anterior tibial system to perfuse a 15 × 14 cm skin island. The anterior tibial perforator was anastomosed to the distal end of the peroneal artery in a flow-through technique, and the area between the peroneal and tibial perforators was de-epithelialized to reconstruct separately the floor of mouth and cutaneous defects. Results: Good inflow and outflow of both skin islands were noted at the end of the procedure, and the patient recovered successfully without any fistulas or donor site morbidity. Conclusions: Perforators from the anterior tibial system should be considered for large, through-and-through mandibular defects when using 2 perforators from the peroneal system is not possible. In addition, we believe the flow-through technique can be useful in patients with vessel-depleted necks and provides a suitable match for vessel size between an anterior tibial perforator and the distal end of the peroneal system.
Collapse
Affiliation(s)
- Ivan E. Rodriguez
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus; Aurora
| | - Becky B. Trinh
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus; Aurora
| | - Frederic W-B Deleyiannis
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus; Aurora,Correspondence:
| |
Collapse
|
32
|
Hadouiri N, Feuvrier D, Pauchot J, Decavel P, Sagawa Y. Donor site morbidity after vascularized fibula free flap: gait analysis during prolonged walk conditions. Int J Oral Maxillofac Surg 2018; 47:309-315. [PMID: 29100670 DOI: 10.1016/j.ijom.2017.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/31/2017] [Accepted: 10/12/2017] [Indexed: 11/18/2022]
Abstract
The aim of this study was to determine the effect of vascularized fibula free flap (VFFF) harvest on gait variables during the six-minute walk test (6MWT). Eleven patients who had undergone VFFF harvest and 11 healthy peers participated in this case-control study. The main evaluation consisted of the collection of gait variables using the GAITRite system during three periods of the 6MWT: beginning (0-1min), middle (2:30-3:30min), and end (5-6min). The 6MWT was significantly shorter in the VFFF group than in the reference group (-31%, P<0.001). Most gait variables differed significantly between the groups for each period (P-value range 0.04-0.0004), including toe in/out on the operated side (P-value range 0.005-0.01). The increase in toe in/out on the operated side suggests a functional modification caused by an imbalance of the agonist-antagonist muscles. On comparison of the different periods, gait velocity decreased between the beginning and middle periods and increased between the middle and end periods in both groups. However, a significantly lower velocity between the beginning and end periods was found only for the VFFF group (P=0.026), suggesting an alteration in physical management. In conclusion, these results suggest that VFFF harvesting could alter gait and joint integrity.
Collapse
Affiliation(s)
- N Hadouiri
- Laboratory of Clinical Functional Exploration of Movement, University Hospital of Besançon, Besançon, France
| | - D Feuvrier
- Orthopaedic, Traumatology, Plastic, Reconstructive and Hand Surgery Unit, University Hospital of Besançon, Besançon, France; Anatomy Laboratory, UFR SMP, University of Franche-Comte, Besançon, France
| | - J Pauchot
- Orthopaedic, Traumatology, Plastic, Reconstructive and Hand Surgery Unit, University Hospital of Besançon, Besançon, France
| | - P Decavel
- Laboratory of Clinical Functional Exploration of Movement, University Hospital of Besançon, Besançon, France; Integrative and Clinical Neurosciences EA481, Bourgogne Franche-Comte University, Besançon, France
| | - Y Sagawa
- Laboratory of Clinical Functional Exploration of Movement, University Hospital of Besançon, Besançon, France; Integrative and Clinical Neurosciences EA481, Bourgogne Franche-Comte University, Besançon, France.
| |
Collapse
|
33
|
Offodile AC, Lin JAJ, Chang KP, Abdelrahman M, Kou HW, Loh CYY, Aycart MA, Kao HK. Anterolateral Thigh Flap Combined with Reconstruction Plate Versus Double Free Flaps for Composite Mandibular Reconstruction: A Propensity Score-Matched Study. Ann Surg Oncol 2018; 25:829-836. [DOI: 10.1245/s10434-017-6309-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Indexed: 08/30/2023]
|
34
|
Kotelnikov GP, Kolsanov AV, Shcherbovskikh AE, Nikolaenko AN, Prikhod'ko SA, Popov NV, Khassan MA. [Reconstruction of posttraumatic and postoperative defects of lower jaw]. Khirurgiia (Mosk) 2017:69-72. [PMID: 28745712 DOI: 10.17116/hirurgia2017769-72] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- G P Kotelnikov
- Samara State Medical University, Health Ministry of the Russian Federation, Samara, Russia
| | - A V Kolsanov
- Samara State Medical University, Health Ministry of the Russian Federation, Samara, Russia
| | - A E Shcherbovskikh
- Samara State Medical University, Health Ministry of the Russian Federation, Samara, Russia
| | - A N Nikolaenko
- Samara State Medical University, Health Ministry of the Russian Federation, Samara, Russia
| | - S A Prikhod'ko
- Samara State Medical University, Health Ministry of the Russian Federation, Samara, Russia
| | - N V Popov
- Samara State Medical University, Health Ministry of the Russian Federation, Samara, Russia
| | - M A Khassan
- Samara State Medical University, Health Ministry of the Russian Federation, Samara, Russia
| |
Collapse
|
35
|
Abbasi AJ, Azari A, Mohebbi SZ, Javani A. Mandibular Rami Implant: A New Approach in Mandibular Reconstruction. J Oral Maxillofac Surg 2017; 75:2550-2558. [PMID: 28672137 DOI: 10.1016/j.joms.2017.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 05/19/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The mandible is an essential esthetic and functional component of the lower third of the face and its reconstruction has always been a challenge, especially after severe post-traumatic injuries. The purpose of the present report was to introduce a new approach of mandibular reconstruction in a patient who had lost the entire mandible except for the rami after being severely injured in a blast. MATERIALS AND METHODS A new approach using a titanium mandibular rami implant technique was applied using computer-aided 3-dimensional virtual planning and rapid prototyping technology. A prosthetic component was supported by the mandibular implant, which achieved occlusion and dedicated function for the patient. RESULTS This method offered precise adaptation of the implant and prosthesis and an easier surgical procedure, providing a shortened operation time, no donor site morbidity, and more predictable outcomes. CONCLUSION This new technique allows reconstruction of large-scale mandibular defects that is not possible by conventional surgical methods.
Collapse
Affiliation(s)
- Amir Jalal Abbasi
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Sina Hospital, and Craniomaxillofacial Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Azari
- Associate Professor, Prosthodontics Department, Dental School, Tehran University of Medical Sciences, Tehran, Iran.
| | - Simin Z Mohebbi
- Associate Professor, Community Oral Health Department, Dental School, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezoo Javani
- Resident, Department of Oral and Maxillofacial Surgery, School of Dentistry, and Craniomaxillofacial Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
36
|
Chang EI, Yu P. Prospective series of reconstruction of complex composite mandibulectomy defects with double island free fibula flap. J Surg Oncol 2017; 116:258-262. [DOI: 10.1002/jso.24647] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 03/18/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Edward I. Chang
- Department of Plastic Surgery; MD Anderson Cancer Center; Houston Texas
| | - Peirong Yu
- Department of Plastic Surgery; MD Anderson Cancer Center; Houston Texas
| |
Collapse
|
37
|
Yao CM, Ziai H, Tsang G, Copeland A, Brown D, Irish JC, Gilbert RW, Goldstein DP, Gullane PJ, de Almeida JR. Surgical site infections following oral cavity cancer resection and reconstruction is a risk factor for plate exposure. J Otolaryngol Head Neck Surg 2017; 46:30. [PMID: 28390434 PMCID: PMC5385089 DOI: 10.1186/s40463-017-0206-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 03/27/2017] [Indexed: 01/01/2023] Open
Abstract
Background Plate-related complications following head and neck cancer ablation and reconstruction remains a challenging problem often requiring further management and reconstructive surgeries. We aim to identify an association between surgical site infections (SSI) and plate exposure. Methods A retrospective study between 1997 and 2014 was performed to study the association between postoperative SSI and plate exposures. Eligible patients included those with a history of oral squamous cell carcinoma who underwent surgical resection, neck dissection, and free tissue reconstruction. Demographic and treatment related information was collected. SSI were classified based on CDC definition and previously published literature. Univariable analysis on demographic factors, smoking history, diabetes, radiation, surgical and hardware related factors; while multivariable analysis on SSI, plate height, segmental mandibulectomy defects and radiation were conducted such as using cox proportional hazard models. Results Three hundred sixty-five patients were identified and included in our study. The mean age of the study group was 59.2 (+/−13.8), with a predominance of male patients (61.9%). 10.7% of our patient cohort had diabetes, and another 63.8% had post-operative radiation therapy. Patients with SSI were more likely to have plate exposure (25 vs. 6.4%, p <0.001). Post-operative SSI, mandibulectomy defects, and plate profile/thickness were associated with plate exposure on univariable analysis (OR = 5.72, p < 0.001; OR = 2.56, p = 0.014; OR = 1.44, p = 0.003 respectively) and multivariable analysis (OR = 5.13, p < 0.001; OR = 1.36, p = 0.017; OR = 2.58, p = 0.02 respectively). Conclusion Surgical site infections are associated with higher rates of plate exposure. Plate exposure may require multiple procedures to manage and occasionally free flap reconstruction.
Collapse
Affiliation(s)
- Christopher M Yao
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, 3-955, Toronto, ON, M5G 2 M9, Canada
| | - Hedyeh Ziai
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, 3-955, Toronto, ON, M5G 2 M9, Canada
| | - Gordon Tsang
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, 3-955, Toronto, ON, M5G 2 M9, Canada
| | - Andrea Copeland
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, 3-955, Toronto, ON, M5G 2 M9, Canada
| | - Dale Brown
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, 3-955, Toronto, ON, M5G 2 M9, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, 3-955, Toronto, ON, M5G 2 M9, Canada
| | - Ralph W Gilbert
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, 3-955, Toronto, ON, M5G 2 M9, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, 3-955, Toronto, ON, M5G 2 M9, Canada
| | - Patrick J Gullane
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, 3-955, Toronto, ON, M5G 2 M9, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, 3-955, Toronto, ON, M5G 2 M9, Canada.
| |
Collapse
|
38
|
Immediate Transoral Allogeneic Bone Grafting for Large Mandibular Defects. Less Morbidity, More Bone. A Paradigm in Benign Tumor Mandibular Reconstruction? J Oral Maxillofac Surg 2017; 75:828-838. [DOI: 10.1016/j.joms.2016.09.049] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/29/2016] [Accepted: 09/29/2016] [Indexed: 11/22/2022]
|
39
|
Short-term outcomes of mandibular reconstruction in oncological patients using a CAD/CAM prosthesis including a condyle supporting a fibular free flap. J Craniomaxillofac Surg 2017; 45:330-337. [DOI: 10.1016/j.jcms.2016.12.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/03/2016] [Accepted: 12/06/2016] [Indexed: 11/21/2022] Open
|
40
|
Kakabadze A, Mardaleishvili K, Loladze G, Karalashvili L, Chutkerashvili G, Chakhunashvili D, Kakabadze Z. Reconstruction of mandibular defects with autogenous bone and decellularized bovine bone grafts with freeze-dried bone marrow stem cell paracrine factors. Oncol Lett 2017; 13:1811-1818. [PMID: 28454328 PMCID: PMC5403483 DOI: 10.3892/ol.2017.5647] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 11/17/2016] [Indexed: 12/14/2022] Open
Abstract
The gold standard following segmental mandibulectomy is vascularized autologous bone graft in the form of the fibula flap. However, in bone reconstruction the use of autogenous bone does not always guarantee a successful outcome. The aim of the present investigation was to develop a novel biologically active bone (BAB) graft, and to use it for the reconstruction of large size defects of the mandible bone following tumor resection. In the first part of the present study, biologically active bone graft was developed by using human freeze-dried bone marrow stem cells (BMSCs) paracrine factors and three-dimensional bone scaffold derived from cancellous bovine bone following decellularization. In the second part of the research, one male and three female patients with primary tumors of the mandible underwent hemimandibulectomy. The mandibular bone defects following tumor resection were reconstructed with autogenous rib grafts in three patients and BAB graft was used in one patient. The graft-host interfaces were covered with decellularized human amnion/chorion membrane graft. All patients were followed-up every five months following the reconstruction of the mandible, with no complications observed. Preliminary clinical investigations demonstrated that a BAB graft containing freeze-dried BMSC paracrine factors may be used for the reconstruction of large mandibular bone defects following tumor resection.
Collapse
Affiliation(s)
- Ann Kakabadze
- Department of Clinical Anatomy, Tbilisi State Medical University, 0177 Tbilisi, Georgia.,Department of Molecular and Translational Medicine, Institute of Medical Research, Ilia State University, 0177 Tbilisi, Georgia
| | - Konstantine Mardaleishvili
- Department of Clinical Anatomy, Tbilisi State Medical University, 0177 Tbilisi, Georgia.,Department of Surgery, Cancer Research Center, 0177 Tbilisi, Georgia
| | - George Loladze
- Department of Surgery, Cancer Research Center, 0177 Tbilisi, Georgia
| | - Lia Karalashvili
- Department of Clinical Anatomy, Tbilisi State Medical University, 0177 Tbilisi, Georgia.,Department of Molecular and Translational Medicine, Institute of Medical Research, Ilia State University, 0177 Tbilisi, Georgia
| | - Gocha Chutkerashvili
- Department of Molecular and Translational Medicine, Institute of Medical Research, Ilia State University, 0177 Tbilisi, Georgia
| | - David Chakhunashvili
- Department of Clinical Anatomy, Tbilisi State Medical University, 0177 Tbilisi, Georgia
| | - Zurab Kakabadze
- Department of Clinical Anatomy, Tbilisi State Medical University, 0177 Tbilisi, Georgia
| |
Collapse
|
41
|
Kumar BP, Venkatesh V, Kumar KAJ, Yadav BY, Mohan SR. Mandibular Reconstruction: Overview. J Maxillofac Oral Surg 2016; 15:425-441. [PMID: 27833334 PMCID: PMC5083680 DOI: 10.1007/s12663-015-0766-5] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 02/28/2015] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Mandibular reconstruction has changed significantly over the years and continues to evolve with the introduction of newer technologies and techniques. PURPOSE This article reviews the history of oromandibular reconstruction, biomechanics of mandible, summarizes the reconstruction options available for mandible with defect classification, goals in reconstruction, the various donor sites, current reconstructive options, dental rehabilitation and persistent associated problems. SUMMARY Oromandibular reconstruction, although a challenge for the head and neck reconstructive surgeon, is now reliable and highly successful with excellent long-term functional and aesthetic outcomes with the use of autogenous bone grafts and current reconstructive options. The ideal reconstruction would provide a solid arch to articulate with the upper jaw, restoring swallowing speech, mastication, and esthetics. Autogenous vascularized bone grafts in combination with microsurgical techniques have revolutionized mandibular reconstruction in oral cancer surgery. Current trends in mandibular reconstruction aim to achieve reestablishment of a viable mandible of proper form and maxillary mandibular relationship while decreasing the need for invasive autogenous graft procurement. However the optimal reconstruction of mandibular defects is still controversial in regards to reconstructive options which include the donor site selection, timing of surgery and method of reconstruction.
Collapse
Affiliation(s)
- Batchu Pavan Kumar
- Oral and Maxillofacial Surgery, Kamineni Institute of Dental Sciences, Sreepuram, Narketpally, Nalgonda, 508254 Andhra Pradesh India
| | - V. Venkatesh
- Oral and Maxillofacial Surgery, Kamineni Institute of Dental Sciences, Sreepuram, Narketpally, Nalgonda, 508254 Andhra Pradesh India
| | - K. A. Jeevan Kumar
- Oral and Maxillofacial Surgery, Kamineni Institute of Dental Sciences, Sreepuram, Narketpally, Nalgonda, 508254 Andhra Pradesh India
| | - B. Yashwanth Yadav
- Oral and Maxillofacial Surgery, Kamineni Institute of Dental Sciences, Sreepuram, Narketpally, Nalgonda, 508254 Andhra Pradesh India
| | - S. Ram Mohan
- Oral and Maxillofacial Surgery, Kamineni Institute of Dental Sciences, Sreepuram, Narketpally, Nalgonda, 508254 Andhra Pradesh India
| |
Collapse
|
42
|
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
| |
Collapse
|
43
|
Wang Y, Zhang H, Fan S, Zhang D, Huang Z, Chen W, Ye J, Li J. Mandibular reconstruction with the vascularized fibula flap: comparison of virtual planning surgery and conventional surgery. Int J Oral Maxillofac Surg 2016; 45:1400-1405. [DOI: 10.1016/j.ijom.2016.06.015] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/22/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022]
|
44
|
Shaikh SM, Faisal S, Khyani IAM, Sikandar B. Resilience Through Squamous Cell Carcinoma and Rhabdomyosarcoma of Oral Cavity: A Unique Case Report. World J Oncol 2016; 7:85-90. [PMID: 28983370 PMCID: PMC5624705 DOI: 10.14740/wjon978w] [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] [Accepted: 08/10/2016] [Indexed: 12/17/2022] Open
Abstract
Rhabdomyosarcoma (RMS) is a soft tissue neoplasm of mesenchymal origin. It is a commonly encountered malignant tumor amongst pediatric patients, yet relatively rare in adults. It usually involves the head and neck region, genitourinary organs and retroperitoneal structures. In adults, the most commonly affected area is the head and neck region. We present here a case of a 30-year-old male patient with a primary squamous cell carcinoma of the tongue (T1, N0, M1), successfully cured with surgery and chemoradiotherapy and later on development of metachronous ipsilateral lesion on the left lower alveolus. Biopsy was consistent with spindle cell RMS. Immunohistochemistry demonstrated positivity for desmin, vimentin and myogenin, thus confirming the mesenchymal origin. With the best of our literature search, this is an exceptional case presenting two malignant lesions with diverse genetic origins, diagnosed at stage 1 and giving a favorable outcome.
Collapse
Affiliation(s)
- Sidra Mumtaz Shaikh
- Dow University of Health Sciences, Former House Officers, Civil Hospital Karachi, Pakistan
| | - Sobia Faisal
- Dow University of Health Sciences, Former House Officers, Civil Hospital Karachi, Pakistan
| | - Iqbal A M Khyani
- Department of ENT, Head and Neck Surgery, Dow University of Health Sciences, Karachi, Pakistan
| | - Bushra Sikandar
- Department of Pathology, Dow University of Health Sciences, Karachi, Pakistan
| |
Collapse
|
45
|
Ciocca L, Tarsitano A, Marchetti C, Scotti R. A CAD–CAM-prototyped temporomandibular condyle connected to a bony plate to support a free fibula flap in patients undergoing mandiblectomy: A pilot study with 5 years of follow up. J Craniomaxillofac Surg 2016; 44:811-9. [DOI: 10.1016/j.jcms.2016.04.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 03/30/2016] [Accepted: 04/19/2016] [Indexed: 11/17/2022] Open
|
46
|
|
47
|
Okoturo E, Ogunbanjo OV, Arotiba GT. Spontaneous Regeneration of the Mandible: An Institutional Audit of Regenerated Bone and Osteocompetent Periosteum. J Oral Maxillofac Surg 2016; 74:1660-7. [PMID: 26970145 DOI: 10.1016/j.joms.2016.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 02/11/2016] [Accepted: 02/11/2016] [Indexed: 12/16/2022]
Abstract
PURPOSE Childhood mandibular lesions are frequently benign; this allows for a conservative surgical approach to their management. Two of the most common approaches for reconstruction of acquired mandibular defects in adolescents are vascularized and nonvascularized osseous flaps or grafts. A third, less commonly used treatment option often used in developing parts of the world that some Western centers are considering as part of their treatment algorithm is spontaneous bone regeneration. This study reports on the authors' experiences with spontaneous bone formation of the resected young mandible. It also attempts to quantify any relation between spontaneous bone regeneration and an aging osteocompetent periosteum. PATIENTS AND METHODS This was a retrospective study based on consecutive data collated from records of the oral and maxillofacial surgery departments from 2 tertiary institutions. Eligible patients were no older than 18 years and had benign mandibular neoplasms. The surgical procedure was mandibulectomy with subperiosteal dissection and intermaxillary fixation. Regenerated bone evaluation was by clinical examination and periodic panoramic radiographs. RESULTS Sixteen consecutive cases with mandibular lesions were seen at the 2 institutions, 8 of which met the inclusion criteria. The average age was 10.75 years. The predominant pathology was unicystic ameloblastoma. All cases exhibited spontaneous bone regeneration, with 2 cases exhibiting "incomplete" bone regeneration. CONCLUSION Immediate reconstruction can be delayed to allow for spontaneous bone regeneration of defects in young patients. In the absence of regeneration, secondary reconstruction can be considered. Although the literature reports more young patients with bone regeneration than adults, increasing age during childhood and adolescence might not necessarily indicate a decrease in periosteal bone-regenerating potential.
Collapse
Affiliation(s)
- Eyituoyo Okoturo
- Senior Lecturer and Chief, Division of Head and Neck Surgical Oncology, Department of Oral and Maxillofacial Surgery, Lagos State University College of Medicine and Teaching Hospital, Ikeja, Lagos, Nigeria.
| | - Olabode V Ogunbanjo
- Senior Lecturer and Consultant, Department of Oral and Maxillofacial Surgery, Lagos State University College of Medicine and Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Godwin T Arotiba
- Professor and Consultant, Department of Oral and Maxillofacial Surgery, College Of Medicine University Of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| |
Collapse
|
48
|
Long-Term Operative Outcomes of Preoperative Computed Tomography–Guided Virtual Surgical Planning for Osteocutaneous Free Flap Mandible Reconstruction. Plast Reconstr Surg 2016; 137:619-623. [DOI: 10.1097/01.prs.0000475796.61855.a7] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
49
|
Mandibular Reconstruction Using the Free Vascularized Fibula Graft: An Overview of Different Modifications. Arch Plast Surg 2016; 43:3-9. [PMID: 26848439 PMCID: PMC4738125 DOI: 10.5999/aps.2016.43.1.3] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 12/22/2015] [Accepted: 12/31/2015] [Indexed: 11/29/2022] Open
Abstract
The reconstruction of the mandible is a complex procedure because various cosmetic as well as functional challenges must be addressed, including mastication and oral competence. Many surgical techniques have been described to address these challenges, including non-vascularized bone grafts, vascularized bone grafts, and approaches related to tissue engineering. This review summarizes different modifications of the free vascularized fibula graft, which, since its introduction by Hidalgo in 1989, has become the first option for mandibular reconstruction. The fibula free flap can undergo various modifications according to the individual requirements of a particular reconstruction. Osteocutaneous flaps can be harvested for reconstruction of composite defects. 'Double-barreling' of the fibula can, for instance, enable enhanced aesthetic and functional results, as well as immediate one-stage osseointegrated dental implantation. Recently described preoperative virtual surgery planning to facilitate neomandible remodeling could guarantee good results. To conclude, the free fibula bone graft can currently be regarded as the "gold standard" for mandibular reconstruction in case of composite (inside and outside) oral cavity defects as well as a way of enabling the performance of one-stage dental implantation.
Collapse
|
50
|
HUANG JEHNSHYUN, CHEN WENHUI, LIU PAOHSIN, HUANG TZETA, HSIAO JENNREN, HO CHEINLIANG. OUTCOME ANALYSIS OF CONDYLAR PROSTHESIS IN LARGE HEAD AND NECK NEOPLASM RECONSTRUCTION. J MECH MED BIOL 2015. [DOI: 10.1142/s0219519415400400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Reconstruction of the condyle after an ablative procedure for mouth neoplasms remains a surgical challenge because these patients with advanced cancer involving the condyle are subjected to massive ablative surgery, and subsequent major reconstruction with free flap and/or reconstruction prosthesis, the prognosis being poor. Therefore, reports of condylar prosthesis in head and neck cancer reconstruction are rare and with mixed results. This report is for the review of the literature and case series study of the condylar prosthesis. As with virtual technique improvement nowadays, an innovation CAD CAM technique is applied for the treatment plan for these patients. We analyze a serial case of advanced oral neoplasms who receives tumor ablation, i.e., mandibulectomy and disarticular resection, and gains symmetrical mandibular architecture after reconstruction with plate and condylar prosthesis. There is still high complication rate (41.7%) noted, namely condylar prosthesis displacement (two cases), impinge on external ear canal (two cases), and erosion of cranial base (one case). The reasons are attributed to massive flap burden, scar contraction, poor dental articulation, and possible technique error during the operation. According to the outcome analysis, virtual technique including with reconstruction plate and condylar prosthesis in conjunction with flap reconstruction are feasible treatment modality for this serial case of advanced oral neoplasms.
Collapse
Affiliation(s)
- JEHN-SHYUN HUANG
- Institute of Oral Medicine National Cheng Kung University Hospital, College of Medicine National Cheng Kung University, Tainan, Taiwan
- Department of Stomatology National Cheng Kung University Hospital, College of Medicine National Cheng Kung University, Tainan, Taiwan
| | - WEN-HUI CHEN
- Department of Dentistry, E-Da Hospital Kaohsiung, Taiwan
| | - PAO-HSIN LIU
- Department of Biomedical Engineering College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - TZE-TA HUANG
- Institute of Oral Medicine National Cheng Kung University Hospital, College of Medicine National Cheng Kung University, Tainan, Taiwan
- Department of Stomatology National Cheng Kung University Hospital, College of Medicine National Cheng Kung University, Tainan, Taiwan
| | - JENN-REN HSIAO
- Department of Otolaryngology National Cheng Kung University Hospital, College of Medicine National Cheng Kung University, Tainan, Taiwan
| | - CHEIN-LIANG HO
- Division of Plastic and Reconstructive Surgery Department of Surgery National Cheng Kung University Hospital, College of Medicine National Cheng Kung University, Tainan, Taiwan
| |
Collapse
|