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Okoturo E. Review of the Literature on the Current State of Periosteum-Mediated Craniofacial Bone Regeneration. Craniomaxillofac Trauma Reconstr 2024; 17:253-262. [PMID: 39329075 PMCID: PMC11423379 DOI: 10.1177/19433875231214068] [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: 09/28/2024] Open
Abstract
Study Design This is an article review on the current state of periosteum-mediated bone regeneration (PMBR). It is a known mandibular reconstruction option in children, and though poorly understood and unpredictable, the concerns of developmental changes to donor and recipient tissues shared by other treatment options are nonexistent. The definitive role of periosteum during bone regeneration remains largely unknown. Objective The objective is to review the literature on the clinical and molecular mechanism evidence of this event. Methods Our search methodology was modeled after the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Search strategies were categorized into search 1 for clinical evidence of mandibular regeneration and search 2 for gene expression review for craniofacial regeneration. The quality assessment of each publication was undertaken, and inclusion criteria comprise mandibular continuity defect for search 1 and use of gene expression assay propriety kit for search 2. Results 33 studies were selected for search 1 while four studies with non-human subjects were selected for search 2. Monitoring of PMBR onset was advised at 2 weeks post-operative, and the gene expression results showed an upregulation of genes responsible for angiogenesis, cytokine activities, and immune-inflammatory response in week 1 and skeletal development and signaling pathways in week 2. Conclusions The results suggest that young periosteum has a higher probability of PMBR than adult periosteum, and skeletal morphogenesis regulated by skeletal developmental genes and pathways may characterize the gene expression patterns of PMBR.
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Affiliation(s)
- Eyituoyo Okoturo
- Lead Research - Molecular Oncology Program, Medical Research Centre, Lagos State University College of Medicine (LASUCOM), Lagos, Nigeria
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Atmodiwirjo P, Bangun K, Rachadian Ramadan M, Tania V, Djohan M, Ralena NA, Amanda NF. Does Free Fibular Flap Reconstruction Affect the Quality of Life in Pediatric Patients With Various Extend of Mandible Defects? J Craniofac Surg 2024; 35:1411-1416. [PMID: 38838364 DOI: 10.1097/scs.0000000000010347] [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: 01/04/2024] [Accepted: 05/03/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND The long-term outcomes in pediatric patients with various extents of mandible defects have not been well-documented. METHODS A retrospective case series in which this study looked at pediatric patients under the age of 13 who had mandibular reconstruction with free fibular flap and had not received another operation in the previous 6 months. The eating, swallowing, speech function, and quality of life are evaluated with EORTC QLQ-H&N35 after the mandible growth spurt has occurred. RESULTS A total of 7 patients were included in this study with operation ages ranging from 6 years 1 month to 12 years 2 months. The etiology of malignant tumors was found in 2 patients and benign tumors in 5 patients. The mandibular defect distribution consists of 1 class Ic, 1 class II, 2 class IIc, 2 class III, and 1 class IVc. All patients reported no swallowing or speech difficulties. However, transient eating trouble was seen in 1 patient due to the extensive defect size that causes tooth loss. Only 1 patient received dental rehabilitation. The patients displayed an overall good quality of life with an average score of 2.857. CONCLUSIONS Free fibular flap for mandibular reconstruction in children who have not reached their mandibular growth peak have a satisfying outcome, both in their function and quality of life.
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Affiliation(s)
- Parintosa Atmodiwirjo
- Department of Surgery, Division of Plastic, Reconstructive and Aesthetic Surgery
- Reconstructive Microsurgery and Oncoplasty Section, Department of Surgery, Division of Plastic, Reconstructive and Aesthetic Surgery, Dr. Cipto Mangunkusumo National Hospital, Faculty of Medicine Universitas Indonesia
| | - Kristaninta Bangun
- Department of Surgery, Division of Plastic, Reconstructive and Aesthetic Surgery
- Department of Surgery, Division of Plastic, Reconstructive and Aesthetic Surgery, Cleft and Craniofacial Centre, Dr. Cipto Mangunkusumo National Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Mohamad Rachadian Ramadan
- Department of Surgery, Division of Plastic, Reconstructive and Aesthetic Surgery
- Reconstructive Microsurgery and Oncoplasty Section, Department of Surgery, Division of Plastic, Reconstructive and Aesthetic Surgery, Dr. Cipto Mangunkusumo National Hospital, Faculty of Medicine Universitas Indonesia
| | - Vika Tania
- Department of Surgery, Division of Plastic, Reconstructive and Aesthetic Surgery
- Department of Surgery, Division of Plastic, Reconstructive and Aesthetic Surgery, Cleft and Craniofacial Centre, Dr. Cipto Mangunkusumo National Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Michael Djohan
- Department of Surgery, Division of Plastic, Reconstructive and Aesthetic Surgery
| | | | - Nadira Fildza Amanda
- Department of Surgery, Division of Plastic, Reconstructive and Aesthetic Surgery
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Huang RS, Benour A, Wong Riff KWY. Survival and infection rates of microvascular free flaps in pediatric mandibular reconstruction: A systematic review and meta-analysis. Microsurgery 2024; 44:e31200. [PMID: 38828556 DOI: 10.1002/micr.31200] [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: 02/10/2024] [Revised: 04/08/2024] [Accepted: 05/16/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Vascularized free tissue transfer has been established as an effective method in the reconstruction of mandibular defects. However, a limited understanding of its efficacy in pediatric patients persists due to its infrequent presentation. The aim of this study is to systematically consolidate the survival and infection rates of free flaps in pediatric mandibular reconstruction. METHODS A systematic literature search was conducted on Ovid Medline, Embase, and Cochrane Library for studies published up to January 2024. We included peer-reviewed studies reporting on survival and infection outcomes associated with free flap mandibular reconstruction in pediatric patients (<18 years). We performed a random-effects meta-analysis with the inverse-variance weighted approach to estimate survival and infection rates. Heterogeneity was assessed by I2, and publication bias was examined using Egger's test. RESULTS A total of 26 studies, reporting on 463 free flaps and 439 pediatric patients with a mean age of 10.7 years, were included in our study. Most free flaps originated from the fibula (n = 392/463, 84.7%) and benign tumors were the most common cause for mandibular reconstruction (n = 179/463, 38.7%). The pooled estimate for survival of flaps was 96% (95% CI: 93-97, I2 = 0%), and recipient-site infections were estimated to occur in 9% (95% CI: 6-13, I2 = 0%) of cases. The most common reported complications within the study timeframe were early malocclusion (n = 28/123, 21.4%) and bite abnormalities (18/131, 13.7%). CONCLUSION Free tissue transfer for mandibular reconstruction in pediatric patients is effective and safe. Further research is required to explore functionality following mandibular reconstruction in diverse pediatric populations.
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Affiliation(s)
- Ryan S Huang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ali Benour
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Leinster, Ireland
| | - Karen W Y Wong Riff
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
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Okoturo E. Genetic determinants of periosteum-mediated craniofacial bone regeneration: a systematic review. Arch Craniofac Surg 2023; 24:251-259. [PMID: 37584066 PMCID: PMC10766501 DOI: 10.7181/acfs.2023.00381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 07/21/2023] [Accepted: 08/01/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Periosteum-mediated bone regeneration (PMBR) is a recognized method for mandibular reconstruction. Despite its unpredictable nature and the limited degree to which it is understood, it does not share the concerns of developmental changes to donor and recipient tissues that other treatment options do. The definitive role of the periosteum in bone regeneration in any mammal remains largely unexplored. The purpose of this study was to identify the genetic determinants of PMBR in mammals through a systematic review. METHODS Our search methodology was designed in accordance with the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. We conducted a quality assessment of each publication, and evaluated the differences in gene expression between days 7 and 15. RESULTS A total of four studies satisfied the inclusion criteria. The subjects and tissues examined in these studies were Wistar rat calvaria in two studies, mini-pigs in one study, and calves and mice in one study. Three out of the four studies achieved the necessary quality score of ≥ 3. Gene expression analysis showed increased activity of genes responsible for angiogenesis, cytokine activities, and immune-inflammatory responses on day 7. Additionally, genes related to skeletal development and signaling pathways were upregulated on day 15. Conclusions: The results suggest that skeletal morphogenesis is regulated by genes associated with skeletal development, and the gene expression patterns of PMBR may be characterized by specific pathways.
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Affiliation(s)
- Eyituoyo Okoturo
- Division of Head & Neck Cancer Oral, Department of Maxillofacial Surgery, Lagos State University Teaching Hospital (LASUTH), Lagos, Nigeria
- Molecular Oncology Program, Medical Research Centre, Lagos State University College of Medicine (LASUCOM), Lagos, Nigeria
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Wu YC, Tai HC. Pediatric Mandibular Reconstruction With Free Serratus Anterior-Rib Composite Flap: A Case Report. Ann Plast Surg 2023; 90:S75-S80. [PMID: 37075297 DOI: 10.1097/sap.0000000000003424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
ABSTRACT Reconstruction of children's mandibles after mandibular resection for benign or malignant tumors is challenging. Microvascular flap reconstruction is a common treatment option for restoring mandibular continuity after the resection of oral cavity neoplasms.We presented 2 cases of childhood mandibular reconstruction after tumor wide excision and segmental mandibulectomy, one for malignant cancer and one for benign ossifying fibroma, with serratus-rib composite free flap. All 2 patients had a favorable facial profile, functional outcome, and dental occlusion at the last follow-up. The development of children's mandible and donor site needs to be considered compared with adult's mandibular reconstruction. Given its reliability and utility, this flap can be an alternative for pediatric mandibular reconstruction compared with the free fibular flap and other candidates.
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Affiliation(s)
- Yao-Cheng Wu
- From the Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan
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Altam A, Alredae S, Alsaaidi A, Ahmed F, Aljbri W, Nasr B, Alyhari Q, Al-Nagga A. Microsurgical reconstruction of the enormous traumatic oromandibular defect by osteocutaneous fibula-free flap in a 9-year-old child: a case report. Pan Afr Med J 2022; 43:13. [PMID: 36451728 PMCID: PMC9674532 DOI: 10.11604/pamj.2022.43.13.36738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/01/2022] [Indexed: 07/28/2023] Open
Abstract
Enormous oromandibular defects in children remain a reconstructive challenge due to the region's unique features and the scarcity of a perfectly matched recipient site. The osteocutaneous fibula-free flap (OCFFF) is an excellent option for these defects. Most reports on oromandibular reconstruction in children are limited to surgical techniques instead of long-term follow-up, especially in resource-limited settings. We reported a 9-year-old child who presented with a massive oromandibular defect caused by a high-energy gunshot. Firstly, the patient was treated with debridement, lower defect edges approximation, and tracheostomy. After one week, the procedure of OCFFF was performed, and two months later, the lower lip was reconstructed using a tongue flap. The aesthetic outcome was excellent at two years, and the patient could speak and eat without impaired oral function. In conclusion, microsurgical reconstruction using OCFFF for massive oromandibular defects in our child patient was safe with satisfactory facial aesthetics and oral function.
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Affiliation(s)
- Abdulfattah Altam
- Department of General Surgery, School of Medicine, Sana´a University, Sana´a, Yemen
| | - Saleh Alredae
- Department of Maxillofacial and Dental Surgery, School of Medicine, Sana´a University, Sana´a, Yemen
| | - Ahmed Alsaaidi
- Department of General Surgery, School of Medicine, Sana´a University, Sana´a, Yemen
| | - Faisal Ahmed
- Department of Urology, School of Medicine, Ibb University of Medical Sciences, Ibb, Yemen
| | - Waleed Aljbri
- Department of Urology, School of Medicine, Sana´a University, Sana´a, Yemen
| | - Burkan Nasr
- Department of General Surgery, School of Medicine, Sana´a University, Sana´a, Yemen
| | - Qasem Alyhari
- Department of General Surgery, School of Medicine, Ibb University of Medical Sciences, Ibb, Yemen
| | - Abdullah Al-Nagga
- Department of anesthesiology, Al-Thora Modern Hospital, Faculty of Medicine, Sana´a University of Medical Sciences, Sana´a, Yemen
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Zimmerer RM, Sander AK, Schönfeld A, Lethaus B, Gellrich NC, Neuhaus MT. Congenital Mandibular Hypoplasia: Patient-Specific Total Joint Replacement as a Line Extension in the Treatment of Complex Craniofacial Anomalies. J Maxillofac Oral Surg 2022; 22:410-418. [PMID: 37122781 PMCID: PMC10130262 DOI: 10.1007/s12663-022-01780-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/14/2022] [Indexed: 10/14/2022] Open
Abstract
Abstract
Introduction
Congenital mandibular hypoplasia (CMH) remains challenging because of the underlying combined hard and soft tissue deficiency. Treatment options include craniofacial distraction, orthognathic surgery, and autologous grafts, although the latter produces inadequate results after distraction and autologous grafting. Unsatisfactory long-term stability may cause relapse, necessitating reoperation.
Material and Methods
We investigated the feasibility of using alloplastic total joint replacement (TJR) in growing and young adult CMH patients. The primary outcome was long-term reconstruction stability, without implant failure. Secondary outcomes were TMJ function and pain, and jaw movements achieved during surgery.
Results
Three patients (age: 9–22 years) were treated by the same surgeon at one institution during 2018–2021. Anamnesis and clinical parameters were obtained from patient records. Preoperative 3D-scans were superimposed with postoperative 3D-scans and preoperative plans, including TJR-implant STL files, to measure jaw movement. All patients underwent prior reconstructive surgery. Mandibular movement of 16.4–20.1 mm in the sagittal direction was achieved. Post-TJR follow-up ranged from 24 to 42 months. No long-term complications occurred. At the latest follow-up, the maximal interincisal opening was between 21 and 40 mm, and all implants were functioning, without failure.
Conclusion
In selected CMH cases, alloplastic TJR can deliver satisfactory medium-term results with predictable and stable outcomes, even in growing patients.
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