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Wang Y, Ma D, Li Y, Zhang C, Yang Y, Wu W. Combined Use of Endoscopic Techniques and Virtual Surgical Planning for Intraoral Approach for Hemi-mandibular Resection and Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5644. [PMID: 38440367 PMCID: PMC10911526 DOI: 10.1097/gox.0000000000005644] [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: 10/11/2023] [Accepted: 01/11/2024] [Indexed: 03/06/2024]
Abstract
Background The study aimed to describe our experience in using endoscopic procedures to aid hemi-mandibular reconstruction with bone flaps through transoral approach. Methods Five patients with huge benign mandibular tumors underwent transoral mandibulectomy and hemi-mandibular reconstruction, using endoscopy. Facial symmetry, occlusion, bone healing, and mandibular similarity were all evaluated postoperatively. The paired-samples t test was used to compare quantitative data, and a P value less than 0.05 was considered a significant difference. Results All five patients who received transoral mandibular surgery recovered in terms of TMJ functionality, facial symmetry, and aesthetic results. Endoscopy monitored and ensured that bone flaps were correctly connected and fixed. The accuracy of endoscopy-guided mandibular reconstruction was confirmed by quantitative examination for four cases, which revealed no statistically significant variations between postoperative CT analysis and preoperative virtual surgical planning data. Conclusions Endoscopy-assisted virtual surgery may resolve concerns with transoral hemi-mandibular reconstruction and broaden indications for mini-invasive mandibular reconstruction. However, only patients with benign mandibular tumors were included in our study, so surgeons should be very cautious if applying this technique to malignant lesions or bony tumors invading soft tissues.
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Affiliation(s)
- Yujiao Wang
- From the State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Dan Ma
- From the State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yun Li
- From the State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Chunyi Zhang
- From the State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yaowu Yang
- From the State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Wei Wu
- From the State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
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Simultaneous Condylar Reconstruction by Free Ramus Osteotomy Graft After Complete Condylectomy for Osteochondroma. J Craniofac Surg 2021; 32:e477-e479. [PMID: 33481470 DOI: 10.1097/scs.0000000000007464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Mandibular condyle osteochondromas cause morphologic and functional disturbances. Multiple options exist for reconstructing the condylar segment following complete condylectomy. In this series, we describe 3 cases of mandibular condyle osteochondroma treated with complete condylectomy, orthognathic surgery, and a novel free ramus osteotomy graft. This is the first report to reconstruct the temporomandibular joint using a free ramus graft. Through this single-staged approach we were able to avoid recurrence, preserve function, and restore facial balance without a separate donor site or an alloplastic implant.
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Le Donne M, Jouan R, Bourlet J, Louvrier A, Ducret M, Sigaux N. Inferior alveolar nerve allogenic repair following mandibulectomy: A systematic review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:233-238. [PMID: 33933668 DOI: 10.1016/j.jormas.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/08/2021] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Processed nerve allografts (PNA) are an alternative to nerve autografts to reconstruct the inferior alveolar nerve (IAN) when it is damaged. The purpose of this study was to report the results of IAN reconstruction using PNA in the context of aggressive benign mandibular pathology. MATERIAL AND METHOD A systematic literature review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement through the MEDLINE (Pubmed) and SCOPUS (Elsevier) databases. Studies concerning reconstructive surgeries of IAN by PNA, performed at the same time as the surgical resection of the benign pathologies of the mandible were included. The following data were analyzed: gender and patient age, cause of mandibular resection, graft dimensions, sensory recovery at least 6 months after surgery according to the MRC scale, and adverse events related to the intervention. RESULTS The initial search yielded 290 studies and 5 were included in the final review. A total of 33 patients underwent 36 IAN reconstructions; 14 patients were female (42.4%) and mean age was 30 years old. The mean length of graft used was 64.0 ± 9.1 mm. The most common pathology that led to nerve resection was ameloblastoma (52%). Among the reconstructions for which follow-up data were available, functional sensory recovery occurred in 92.9% of cases. CONCLUSION PNA are a reliable, safe, and effective alternative to nerve autografts for the rehabilitation of the IAN with 92.9% of functional recovery according to the reported literature, avoiding any comorbidity associated with the use of a donor site.
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Affiliation(s)
- Mélanie Le Donne
- Private Practitioner, 3 Rue du Dr François Broussais 17100 Saintes, France, Faculté d'Odontologie, Université de Lyon, Université Claude Bernard Lyon 1, 11 rue Guillaume Paradin, 69008 Lyon, France.
| | - Robin Jouan
- Clinical Doctor, Chirurgie Maxillo-faciale, Hôpital Nord-Ouest, Plateau d'Ouilly 69400 Gleizé Villefranche sur Saône, France
| | - Jérôme Bourlet
- Clinical Doctor, Hospices Civils de Lyon, Chirurgie Maxillo-faciale et Stomatologie, Hôpital de la Croix Rousse, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
| | - Aurélien Louvrier
- Clinical Doctor, Service de chirurgie Maxillo-faciale et Stomatologie, Centre Hospitalier Régional Universitaire Jean Minjoz, 3 boulevard Alexandre Fleming, 25000 Besançon, France
| | - Maxime Ducret
- Associate Professor, Hospices Civils de Lyon, PAM Odontologie, Lyon, France, Faculté d'Odontologie, Université de Lyon, Université Claude Bernard Lyon 1, 11 rue Guillaume Paradin 69008 Lyon, France; Faculty of Dentistry, McGill University, 2001 Avenue McGill College #500 Montreal QC H3A 1G1, Canada
| | - Nicolas Sigaux
- Clinical Doctor, Hospices Civils de Lyon, Chirurgie Maxillo-faciale et Plastique de la face, Hôpital Lyon Sud, 165 chemin du Grand Revoyet, 69310 Pierre-Bénite, France,; UFR de Médecine Lyon Sud, Université Claude Bernard Lyon 1, Université de Lyon, 165 Chemin du petit Revoyet, 69221 Oullins, France
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Rahpeyma A, Khajehahmadi S. Parapharyngeal Hemangiopericytoma: the Role for Mandibular Proximal Segment Replantation-Review of Literature. Indian J Surg Oncol 2019; 10:708-712. [PMID: 31857770 DOI: 10.1007/s13193-019-00975-w] [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: 05/06/2019] [Accepted: 08/07/2019] [Indexed: 12/01/2022] Open
Abstract
Pharyngeal hemangiopericytoma is a rare tumor .Surgical access to space has been selected based on the location of the tumor in this space, size, and type of pathology. Hemangiopericytoma requires extracapsular dissection. Hemorrhagic nature and tight attachment to adjacent tissues are the other reasons for choosing the surgical approach with the best access. The patient was a 55-year-old female with left-sided facial swelling and dumbbell-shaped lesion involving buccal and lateral pharyngeal space. Brisk hemorrhage happened during biopsy. Submandibular incision, osteotomy of mandibular angle, and temporary proximal segment removal were done. Extracapsular dissection of the lesion performed under direct vision. Proximal segment was returned to the original location and internally fixed with miniplate. Postoperative course was without complication. Mandibular proximal segment replantation technique should be used to treat parapharyngeal tumors with a hemorrhagic tendency.
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Affiliation(s)
- Amin Rahpeyma
- 1Oral & Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,2Department of Oral and Maxillofacial Surgery, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeedeh Khajehahmadi
- 3Dental Research Center, Mashhad University of Medical Sciences, Vakilabad Blvd, Mashhad, Iran.,4Department of Oral and Maxillofacial Pathology,School of Dentistry, Mashhad University of Medical Sciences, Vakilabad Blvd, Mashhad, Iran
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Abstract
To preserve the continuity of the mandible after resection or traumatic bone loss, the defect is usually reconstructed with a bone graft fixed by a reconstruction plate. The fate of these plates is the objective of this study. Twenty-three patients (4 females and 19 males) required a reconstructive procedure to restore the discontinuity defect in the mandible by a mandibular reconstruction plate. Postoperative follow-up was performed to assess the outcomes of these plates. The mean age of the patients was 28.22 years. The most common cause of the discontinuity defect was bullet injury. The mean follow-up period was 3.65 years. The most common postoperative complication was the surgical site infection. The reconstruction plate of the mandible is associated with long-term success and body acceptance in the hands of an experienced surgeon.
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Condyle Head Reimplantation Combined With Vascularized Free Flap for Mandibular Reconstruction. J Craniofac Surg 2018; 28:1559-1562. [PMID: 28708658 DOI: 10.1097/scs.0000000000003930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Due to the anatomic and functional complexity, reconstruction of the condylar process after mandibular tumor extirpation remains a surgical challenge. The aim of this study was to present the results and experience of condyle head reimplantation combined with vascularized free flap for mandibular reconstruction in our institution. In the current study, the authors evaluated the clinical features of condyle head reimplantation combined with vascularized free flap for mandibular reconstruction in 5 patients with benign mandibular intraosseous lesions from December 2013 to March 2015 in our institution. All patients showed nearly normal mouth opening, with minimal mandibular deviation and joint symptoms. The radiograph data showed that 4 patients had no obvious bone resorption of condyles while only 1 patient had prominent condyle resorption. All the condyles were cut above the condylar neck, with the biggest remaining condyle height being 2.8 cm and the smallest one being 1.1 cm. Moreover, the original vertical height of mandibular ramus was decreased by 2 to 3 mm during the surgery. In conclusion, this study revealed that combining the condyle reimplantation with vascularized free flap constitutes a reliable method in condylar reconstruction and a slight reduction of the vertical height of condyles may help to diminish unfavorable outcomes.
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