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Ge CY, Dong L, Xu ZW, Yang WL, Qian LX, Yang XW, Hao DJ. Avulsion fracture of the anterior superior iliac crest following autograft for anterior lumbar fusion: case report and literature review. Front Surg 2024; 11:1327028. [PMID: 38327545 PMCID: PMC10847530 DOI: 10.3389/fsurg.2024.1327028] [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: 10/24/2023] [Accepted: 01/12/2024] [Indexed: 02/09/2024] Open
Abstract
Avulsion fracture of the anterior superior iliac crest (ASIC) following autogenous bone grafting for anterior lumbar fusion (ALF) is an extremely rare complication. We describe a very rare case of avulsion fracture of the ASIC following autograft for ALF in a revision surgery for treating lumbar tuberculosis. A 68-year-old woman with lumbar tuberculosis underwent posterior debridement and posterior iliac crest bone graft fusion; however, her lumbar tuberculosis recurred 9 months after surgery. She then underwent a lumbar revision surgery, including removal of the posterior instrumentation and debridement, followed by anterior L2 corpectomy, debridement, anterior left iliac crest bone graft fusion, and internal fixation. When walking for the first time on postoperative day 3, she experienced a sharp, sudden-onset pain in the anterior iliac crest harvest area. X-ray revealed an avulsion fracture of the ASIC. Considering her failure to respond to conservative treatment for one week and large displacement of the fracture ends, an open reduction and internal fixation surgery was scheduled. Her pain symptoms were significantly relieved after the operation. Although rare, fracture of the ASIC following autograft for ALF should not be ignored. Fracture of the ASIC is usually treated conservatively. Additional surgical treatment is required only when intractable pain fails to respond to conservative treatment or when there is a large displacement of fracture ends that are not expected to heal spontaneously.
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Affiliation(s)
| | | | | | | | | | | | - Ding-Jun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Wang W, Li X, Mei D, Zhao B. Autogenous solid dentin for horizontal ridge augmentation with simultaneous implantation in a severe bone defect: A 3.5-year follow-up clinical report. J Prosthet Dent 2023:S0022-3913(23)00412-2. [PMID: 37442750 DOI: 10.1016/j.prosdent.2023.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 07/15/2023]
Abstract
Autogenous dental root placement is an available approach for horizontal alveolar ridge augmentation in patients with severe bony defects. However, in previous reports, bone augmentation has been done before the implant placement. This clinical report describes the use of dentin grafting for alveolar ridge augmentation and simultaneous implant placement in the maxillary left central incisor region with a severe horizontal bone defect. Under strict adherence to the recommended indications, dentin grafting and simultaneous implantation could be clinically feasible protocols.
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Affiliation(s)
- Wenxue Wang
- Postgraduate student, Department of Oral Implantology, The Affiliated Hospital of Qingdao University, School of Stomatology of Qingdao University, Qingdao, Shandong, PR China
| | - Xin Li
- Attending, Department of Oral Implantology, The Affiliated Hospital of Qingdao University, School of Stomatology of Qingdao University, Qingdao, Shandong, PR China
| | - Dongmei Mei
- Attending, Department of Oral Implantology, The Affiliated Hospital of Qingdao University, School of Stomatology of Qingdao University, Qingdao, Shandong, PR China
| | - Baodong Zhao
- Professor, Department of Oral Implantology, The Affiliated Hospital of Qingdao University, School of Stomatology of Qingdao University, Qingdao, Shandong, PR China.
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Postoperative Morbidity and Complications in Elderly Patients after Harvesting of Iliac Crest Bone Grafts. MEDICINA-LITHUANIA 2021; 57:medicina57080759. [PMID: 34440965 PMCID: PMC8401410 DOI: 10.3390/medicina57080759] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 07/23/2021] [Accepted: 07/25/2021] [Indexed: 02/01/2023]
Abstract
Background and objectives: In oral and maxillofacial operations, the iliac crest is a commonly used donor site from which to harvest bone for augmentation prior to dental implantation or for reconstruction of jaw defects caused by trauma or pathological lesions. In an aging society, the proportion of elderly patients undergoing iliac crest bone grafting for oral augmentation is growing. Although postoperative morbidity is usually moderate to low, the age and health of the patient should be considered as risk factors for complications and delayed mobilization after the operation. The aim of this retrospective study was to evaluate the postoperative morbidity and complications in elderly patients after the harvesting of iliac crest bone grafts for oral surgery. Material and Methods: Data were collected from a total of 486 patients (aged 7–85) who had a surgical procedure that included the harvesting of iliac crest bone grafts for intraoral transplantation. All patients were operated on between 2005 and 2021 in the Department for Oral and Maxillofacial Surgery of the University Hospital in Aachen, Germany. As parameters for postoperative morbidity and complications, gait disturbances, hypesthesia of cutaneous nerves, incision hernias, iliac crest fractures, delayed wound healing, and unfavorable scar formation at the donor site were all evaluated. Results: The study was performed with 485 patients due to the exclusion of one patient as the only one from whom grafts were taken from both sides. When younger and older patients were compared, neither gait disturbances (p = 0.420), nor hernias (p = 0.239), nor fractures (p = 0.239), nor hypesthesia (p = 0.297), nor wound healing delay (p = 0.294), nor scar problems (p = 0.586) were significantly different. However, the volume of the graft was significantly correlated with the duration of the hospital stay (ρ = 0.30; p < 0.01) but not with gait disturbances (ρ = 0.60; p = 0.597). Additionally, when controlling for age (p = 0.841), sex (p = 0.031), ASA class (p = 0.699), preexisting orthopedic handicaps (p = 0.9828), and the volume of the bone graft (p = 0.770), only male sex was associated with the likelihood of suffering gait disturbances (p = 0.031). Conclusions: In conclusion, harvesting bone grafts from the anterior iliac crest for intraoral augmentation is a safe procedure for both young and elderly patients. Although there is some postoperative morbidity, such as gait disturbances, hypesthesia, scar formation, or delayed wound healing at the donor site, rates for these minor complications are low and mostly of short duration. Major complications, such as fractures or incision hernias, are very rare. However, in our study, the volume of the bone graft was associated with a longer stay in hospital, and this should be considered in the planning of iliac crest bone graft procedures.
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Three-dimensional Printing Technology for Deep Circumflex Iliac Artery Flap: From Recipient to Donor Sites. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3618. [PMID: 34123686 PMCID: PMC8191693 DOI: 10.1097/gox.0000000000003618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/24/2021] [Indexed: 11/27/2022]
Abstract
The deep circumflex iliac artery (DCIA) flap is one of the most commonly used vascularized free flaps for jaw reconstruction; however, its clinical application is limited by donor site complications. We aimed to describe a new technique of using 3-dimensionally (3D) printed patient-specific devices for mandibular reconstruction with DCIA flap and simultaneous dental implants, and for donor site restoration after harvesting the DCIA flap. One patient with mandible ameloblastoma underwent mandibular reconstruction using a DCIA flap with the “jaw-in-a-day” approach. The 3D-printed patient-specific devices included mandibular cutting guides, DCIA harvesting and dental implant guide, surgical plate, and iliac prosthesis. The postoperative 1-month accuracy measurement showed the mean distance deviations of the mandible, transferred bone grafts, dental implants and iliac prosthesis were 1.8 mm, 2.1 mm, 0.9 mm, and 1.2 mm, respectively. Three-dimensionally printed iliac prosthesis satisfactorily restored the contour of the iliac crest after DCIA flap harvesting. No complication of donor site was recorded during the follow-up of 12 months. We successfully used 3D-printed patient-specific implants in both donor and recipient sites for DCIA flap jaw reconstruction. Further studies with a larger sample size and long-term follow-up are needed.
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Lee JH, Yeo ISL. Eleven-year follow-up of reconstruction with autogenous iliac bone graft and implant-supported fixed complete denture for severe maxillary atrophy: A case report. Medicine (Baltimore) 2020; 99:e18950. [PMID: 32118708 PMCID: PMC7478408 DOI: 10.1097/md.0000000000018950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE The iliac bone graft procedure is one of the treatment options for individuals with extremely resorbed alveolar bones. An autogenous block bone graft can allow the use of an implant-supported fixed dental prosthesis, rather than conventional removable dentures, by completely edentulous patients. However, the iliac bone graft technique is an invasive procedure and should be carefully selected based on its long-term clinical results. This case report describes 11-year long-term outcomes for implant-supported complete denture on the grafted iliac bone. PATIENT CONCERNS A 68-year-old Asian man was referred for oral rehabilitation with fixed dental prostheses. The patient had been unsatisfied with his removable dental prostheses in masticatory performance. DIAGNOSIS Radiographical examination revealed severely atrophied maxilla. INTERVENTIONS The atrophied maxilla was reconstructed with an iliac block bone graft, after which an implant-supported fixed complete denture was placed. OUTCOMES During 11 years of follow-up, several prosthetic and mechanical complications were encountered. Nevertheless, no biological complications were observed. Marginal bone levels around the implants were well-maintained on the radiographs after 11 years of prosthetic use. LESSONS Iliac bone graft can be chosen as a predictable treatment option that allows patients with extremely atrophic maxilla to use a fixed dental prosthesis instead of a removable denture.
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Affiliation(s)
- Jae-Hyun Lee
- Department of Prosthodontics, One-Stop Specialty Center, Seoul National University Dental Hospital
| | - In-Sung Luke Yeo
- Department of Prosthodontics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, South Korea
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Venet L, Perriat M, Mangano FG, Fortin T. Horizontal ridge reconstruction of the anterior maxilla using customized allogeneic bone blocks with a minimally invasive technique - a case series. BMC Oral Health 2017; 17:146. [PMID: 29216869 PMCID: PMC5721474 DOI: 10.1186/s12903-017-0423-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 11/12/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Different surgical procedures have been proposed to achieve horizontal ridge reconstruction of the anterior maxilla; all these procedures, however, require bone replacement materials to be adapted to the bone defect at the time of implantation, resulting in complex and time-consuming procedures. The purpose of this study was to describe how to use a 3D printed hardcopy model of the maxilla to prepare customized milled bone blocks, to be adapted on the bone defect areas using a minimally invasive subperiosteal tunneling technique. METHODS Cone beam computed tomography (CBCT) images of the atrophic maxilla of six patients were acquired and modified into 3D reconstruction models. Data were transferred to a 3D printer and solid models were fabricated using autoclavable nylon polyamide. Before the surgery, freeze-dried cortico-cancellous blocks were manually milled and adapted on the 3D printed hardcopy models of the maxillary bone, in order to obtain customized allogeneic bone blocks. RESULTS In total, eleven onlay customized allogeneic bone grafts were prepared and implanted in 6 patients, using a minimally invasive subperiosteal tunneling technique. The scaffolds closely matched the shape of the defects: this reduced the operation time and contributed to good healing. The patients did not demonstrate adverse events such as inflammation, dehiscence or flap re-opening during the recovery period; however, one patient experienced scaffold resorption, which was likely caused by uncontrolled motion of the removable provisional prosthesis. Following a 6 month healing period, CBCT was used to assess graft integration, which was followed by insertion of implants into the augmented areas. Prosthetic restorations were placed 4 months later. CONCLUSIONS These observations suggest that customized bone allografts can be successfully used for horizontal ridge reconstruction of the anterior maxilla: patients demonstrated reduced morbidity and decreased total surgery time. Further studies on a larger sample of patients, with histologic evaluation and longer follow-up are needed to confirm the present observations.
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Affiliation(s)
- Laurent Venet
- Department of oral surgery, Hospices Civils de Lyon, Lyon, France
| | - Michel Perriat
- Department of oral surgery, Hospices Civils de Lyon, Lyon, France
| | | | - Thomas Fortin
- Department of Oral Surgery, Dental School of Lyon, University Claude Bernard, Lyon 1, 6-8 rue Guillaume Paradin, 69007, Lyon, France. .,UJF-Grenoble 1 / CNRS / TIMC-IMAG UMR 5525, F-38041, Grenoble, France.
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Kim HS, Kim JY, Hur H, Nam W. Herniation after deep circumflex iliac artery flap: two cases of rare complication. Maxillofac Plast Reconstr Surg 2016; 38:10. [PMID: 27054130 PMCID: PMC4766219 DOI: 10.1186/s40902-016-0055-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 02/09/2016] [Indexed: 11/20/2022] Open
Abstract
Herniation after harvesting of deep circumflex iliac artery (DCIA) flap is a known but not a common complication. It occurs about 2.8 to 9 % according to the literatures and can proceed to a more severe complication such as bowel obstruction. There are several factors that exacerbate the risk: surgical factors, operator factor, and patient factors. Surgical factors include large anatomical defect and denervation of related muscles. Operator factor stands for unpunctual suture technique. Patient factors represent obesity, diabetes, pulmonary disease, smoking habits, and so on. Thus, herniation might occur regardless of meticulous suture. Herein, we would like to report two cases of herniation after DCIA flap harvesting and repaired by Lichtenstein tension-free hernioplasty with literature review.
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Affiliation(s)
- Hee-Sung Kim
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Yonsei-ro 50, Seodaemun-gu, Seoul, 120-752 Korea
| | - Jae-Young Kim
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Korea
| | - Hyuk Hur
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Woong Nam
- Department of Oral and Maxillofacial Surgery, Oral Cancer Research Institute, Yonsei University College of Dentistry, Yonsei-ro 50, Seodaemun-gu, Seoul, 120-752 Korea
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Posnick JC, Gray JA. Is It Safe to Re-Harvest the Anterior Iliac Crest to Manage Le Fort I Interpositional Defects in Young Adults With a Repaired Cleft? J Oral Maxillofac Surg 2015; 73:S32-9. [DOI: 10.1016/j.joms.2015.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 04/09/2015] [Indexed: 11/26/2022]
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Analysis of postoperative pain at the anterior iliac crest harvest site: a prospective study of the intraoperative local administration of ropivacaine. Asian Spine J 2015; 9:39-46. [PMID: 25705333 PMCID: PMC4330217 DOI: 10.4184/asj.2015.9.1.39] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 05/19/2014] [Accepted: 05/20/2014] [Indexed: 11/17/2022] Open
Abstract
Study Design This was a prospective randomized comparative study. Purpose The aim of this study was to objectify donor site-related pain following anterior iliac crest graft harvesting, in patients who have undergone multilevel anterior cervical discectomy and fusion with plating (ACDFP); and to assess the effect of an intraoperative local single injection of ropivacaine on postoperative pain. Overview of Literature Multilevel ACDFP can be associated with a high non-union rate. Autogenous iliac bone has been used to increase union rates, although a high incidence of donor site-related pain has been reported. Methods Forty consecutive patients who required 3-level or 4-level ACDFP were prospectively assessed for donor site-related pain. Pain levels were assessed daily for five days postoperative using the visual analog scale (VAS). Patients were randomly assigned to group A or B. In group A patients, 7-10 mL of ropivacaine (0.2%) was injected into the iliac crest after iliac crest graft harvesting. Morphine usage via patient controlled analgesia was calculated. At six months postoperative, patient complaints at the harvest site were documented. Results Patients were randomly assigned to group A or B. In group A, ropivacaine was locally administered at the site of the iliac crest graft harvest after fascia closure. In group B, no additional treatments were administered. The average patient age in group A was 56±7.6 years, whereas the average age of patients in group B was 52.6±10.4 years. Group A had an average of 0.6±0.7 previous surgeries per patient, whereas group B had an average of 0.8±1.0 previous surgeries per patient. The average number of levels fused in group A was 3.6±0.7, whereas the average number of levels fused in group B was 3.7±0.9 (all p>0.05). In group A, the mean ropivacaine volume administered was 8.4±1.5 mL. No patient complaints regarding chronic pain, were reported six months postoperatively. No complications were encountered from the harvest site, and all patients underwent successful 3-level and 4-level ACDFP. Statistical analysis showed significant differences for VAS on postoperative day 1 (p=0.004) and day 2 (p=0.005). Conclusions VAS assessment showed overall moderate perioperative morbidity in terms of donor site-related pain, which was reduced by administering ropivacaine.
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