Short and Extra Short Dental Implants in Osseous Microvascular Free Flaps: A Retrospective Case Series

There is limited information regarding implant and prosthetic survival after osseous microvascular free flap (OMFF). This case series aims to describe the placement of short and extra short implants in osseous microvascular free flaps to support prostheses, and present an up to 40-month retrospective follow-up. Short and extra short dental implants were placed in six fibula free flaps (FFF) and in two microvascular deep circumflex iliac artery (DCIA) flaps. In total, 27 short and extra short dental implants have been placed into two different types of free flaps. Kaplan-Meyer (K-M) survival analyses were performed to evaluate the survival and success outcomes of implants and prostheses. Out of the eight patients reconstructed with free flap, five were rehabilitated with prostheses, one patient has a temporary prosthesis, and two patients are in the process of prosthetic rehabilitation. Twenty-seven implants were followed up for up to 40 months, and K-M analyses showed 100% implant survival probability (95% confidence interval: 100%), while the implant success probability was 91.0% (95% confidence interval: 68.6-97.7%). Short and extra short dental implants placed in OMFF presented high survival and success rates in a retrospective case series after up to 40 months.

TRANSCONJUNCTIVAL APPROACH FOR SURGICAL REPAIR OF INFRAORBITAL RIM FRACTURES AND ORBITAL FLOOR FRACTURES

AIMS

The aim of this study is to retrospectively evaluate the use of a transconjunctival surgical approach in maxillofacial surgery on the fractures of the infraorbital rim and the orbital floor by analyzing the operating time, the incidence of perioperative and postoperative complications, as well as the functional and aesthetic outcomes of transconjunctival surgical treatment.

MATERIALS AND METHODS

All the patients on whom we used a transconjunctival approach from December 2017 to December 2021 were included in this retrospective study. The epidemiological causes of fractures of the midface skeleton were analyzed. The length of the operating time of the transconjunctival approach with lateral canthotomy was compared with a control group in which the supraorbital eyebrow approach was performed. In addition, we analyzed the incidence of perioperative and postoperative complications in comparison with publications from other centers.

RESULTS

We used the transconjunctival approach 103 times on 89 patients (in 14 patients the transconjunctival approach was performed bilaterally). In cases where the lateral canthotomy was used to extend the transconjunctival approach, there was no prolongation of the operating time. Perioperative complications included the perforation of the lower eyelid in 2 patients. In the postoperative period we recorded complications in 3 patients. Ectropion of the lower eyelid was present in one patient and entropion of the lower eyelid was observed in two patients. The percentage of perioperative and postoperative complications does not exceed the incidence of complications in transcutaneous approaches on the infraorbital rim.

CONCLUSION

Based on the results of our study, we can consider the transconjunctival approach, either alone or in combination with lateral canthotomy.

Side Effects of mRNA-Based COVID-19 Vaccine: Nationwide Phase IV Study among Healthcare Workers in Slovakia

mRNA-based COVID-19 vaccines such as BNT162b2 have recently been a target of anti-vaccination campaigns due to their novelty in the healthcare industry; nevertheless, these vaccines have exhibited excellent results in terms of efficacy and safety. As a consequence, they acquired the first approvals from drug regulators and were deployed at a large scale among priority groups, including healthcare workers. This phase IV study was designed as a nationwide cross-sectional survey to evaluate the post-vaccination side effects among healthcare workers in Slovakia. The study used a validated self-administered questionnaire that inquired about participants' demographic information, medical anamneses, COVID-19-related anamnesis, and local, systemic, oral, and skin-related side effects following receiving the BNT162b2 vaccine. A total of 522 participants were included in this study, of whom 77% were females, 55.7% were aged between 31 and 54 years, and 41.6% were from Banska Bystrica. Most of the participants (91.6%) reported at least one side effect. Injection site pain (85.2%) was the most common local side effect, while fatigue (54.2%), headache (34.3%), muscle pain (28.4%), and chills (26.4%) were the most common systemic side effects. The reported side effects were of a mild nature (99.6%) that did not require medical attention and a short duration, as most of them (90.4%) were resolved within three days. Females and young adults were more likely to report post-vaccination side effects; such a finding is also consistent with what was previously reported by other phase IV studies worldwide. The role of chronic illnesses and medical treatments in post-vaccination side effect incidence and intensity requires further robust investigation among large population groups.

Oral Complications of ICU Patients with COVID-19: Case-Series and Review of Two Hundred Ten Cases

BACKGROUND

The critically ill patients suffering from coronavirus disease (COVID-19) and admitted to the intensive care units (ICUs) are susceptible to a wide array of complications that can be life-threatening or impose them to long-term complications. The COVID-19 oral mucocutaneous complications require multidisciplinary management and research for their pathophysiological course and epidemiological significance; therefore, the objective of this study was to evaluate the prevalence and characteristics of the critically ill COVID-19 patients with oral complications.

METHODS

We described the clinical and microbiological characteristics of the critically ill COVID-19 patients in our ICU department (Banska Bystrica, Slovakia). In addition, we reviewed the current body of evidence in Ovid MEDLINE^®, Embase, Cochrane Library, and Google Scholar for the oral mucocutaneous complications of ICU patients with COVID-19.

RESULTS

Three out of nine critically ill patients (33.3%) in our ICU department presented with oral complications including haemorrhagic ulcers and necrotic ulcers affecting the lips and tongue. The microbiological assessment revealed the presence of opportunistic pathogens, confirming the possibility of co-infection. On reviewing the current literature, two hundred ten critically ill patients were reported to have oral complications due to their stay in the ICU setting. Perioral pressure ulcers were the most common complication, followed by oral candidiasis, herpetic and haemorrhagic ulcers, and acute onset macroglossia. The prolonged prone positioning and mechanical ventilation devices were the primary risk factors for those oral complications, in addition to the immunosuppressive drugs.

CONCLUSIONS

The multidisciplinary approach is strongly advocated for monitoring and management of COVID-19 patients, thus implying that dermatology and oral healthcare specialists and nurses should be integrated within the ICU teams.

FUNCTIONAL RECONSTRUCTION OF SOFT TISSUE OROFACIAL DEFECTS WITH MICROVASCULAR GRACILIS MUSCLE FLAP

INTRODUCTION

Free flap reconstructive surgery of middle size and large oral and facial defects enables aesthetic and functional rehabilitation. Microvascular flap reconstructive surgery, with flap survival success rate more than 90-98%, is a gold standard in head and neck extensive reconstructions. Currently, head and neck reconstructive surgery is focused not only on defect occlusion and adequate aesthetical result, but the same emphasize is aimed at functional result. Functional result post tongue and lip resection means defect occlusion with the possibility of movement restoration. Free gracilis muscle flap appears to be a choice for functional tongue and lip reconstruction.

MATERIAL AND METHODS

We present 1-year experience with 5 microvascular flap functional reconstructions of middle size and large defects of tongue and lip with free gracilis muscle flap. Four patients post tongue resection and one post subtotal lower lip and cheek resection underwent immediate functional microvascular gracilis muscle flap reconstruction.

RESULTS

All five patients were successfully reconstructed with functional free gracilis muscle flap, with no flap loss. We found gracilis muscle flap harvest is not technically demanding, provides adequate tissue volume for middle size orofacial defects reconstruction, with possibility for skin island harvest, and simple primary closure of donor site with very low morbidity. Patients after tongue reconstruction with free gracilis flap were swallowing spoon ood 1 week post operation. Patient after total lip resection and immediate reconstruction with free gracilis flap presented with oral competence before the discharge. The functional result in the group of patients with free gracilis flap reconstruction for orofacial defect will have to be further evaluated again after 2 years post operation considering the ability to swallow and articulate during the speech for the tongue reconstructions and the oral competence and facial mimic for the lip reconstruction.

CONCLUSION

Microvascular gracilis muscle flap reconstruction compared to radial forearm flap reconstruction enables functional reconstruction of soft tissue defect. Functional reconstruction of soft tissue defects of tongue or lip with microvascular gracilis muscle flap appears to have advantage of adequate volume, very low donor side morbidity and expectancy of movement renewal compared to other microvascular flap reconstructive options such as anterolateral thigh flap, superficial circumflex iliac artery perforator flap, lateral arm free flap or deep inferior epigastric perforator free flap.