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Tabet P, Bellavance S, Harris JR, Ansari K, Osswald M, Nayar S, Seikaly H. Prefabricated Fibula Flap vs Bone-Driven and Delayed Implant Installation for Jaw Reconstruction. JAMA Otolaryngol Head Neck Surg 2024:2818465. [PMID: 38696187 PMCID: PMC11066769 DOI: 10.1001/jamaoto.2024.0425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/14/2024] [Indexed: 05/05/2024]
Abstract
Importance Restoration of dental occlusion and oral rehabilitation is the ultimate goal of functional jaw reconstruction. Objective To evaluate the prefabricated fibula flap (PFF) technique in occlusion-driven jaw reconstruction for benign or previously treated malignant disease. Design, Setting, and Participants This cohort study was conducted from January 2000 to December 2019 at the University of Alberta Hospital and Institute of Reconstructive Sciences in Medicine in Edmonton, Alberta, Canada, among patients who underwent PFF or bone-driven and delayed osseointegrated implant installation (BDD). Patients were followed up for a minimum of 1 year after occlusal rehabilitation. Data were analyzed from July 2021 to June 2022. Exposures Patients underwent BDD or PFF, which consists of osseointegrated dental implant installation and skin grafting of the fibular bone 3 to 6 months before jaw tumor resection or defect reconstruction. The implant osseointegration is completed at the time of jaw reconstruction, allowing for full reconstruction, loading, and restoration of the dental occlusion in the immediate postoperative period. Main outcomes and Measure Safety, effectiveness, accuracy, timeliness of occlusal reconstruction, and aesthetic appeal were compared between PFF and BDD. Groups were compared for the following variables: postoperative complications, number of bony segments used, number of procedures needed, total operative time, time to occlusal rehabilitation, and number of implants installed, exposed, lost, and used (ie, exposed implants - lost implants). Aesthetic appeal was assessed using standardized full-face and profile digital photographs taken before and 6 to 12 months after the operation and analyzed by 3 naive raters. Results Among 9 patients receiving PFF (mean [SD] age, 43.3 [13.0] years; 7 men [77.8%]) and 12 patients receiving BDD (mean [SD] age, 41.9 [18.0] years; 8 men [66.7%]), the overall complication rate was similar (4 patients [44.4%] vs 3 patients [25.0%], respectively; relative risk, 1.78 [95% CI, 0.52 to 6.04]). The number of patients with implant loss was similar between PFF and BDD groups (0 patients vs 3 patients [25.0%], respectively; difference, -25.0 percentage points [95% CI, -48.4 to 9.7 percentage points]). PFF had a clinically meaningful faster mean (SD) occlusal rehabilitation compared with BDD (12.1 [1.9] months vs 60.4 [23.1] months; difference, -48.3 months [95% CI, -64.5 to -32.0 months]). The mean (SD) difference in preoperative to postoperative aesthetic score was similar between PFF and BDD groups (-0.8 [1.5] vs -0.2 [0.8]; difference, -0.6 [95% CI, -1.6 to 0.4]). Conclusions and Relevance This study found that PFF compared with BDD was a safe, effective, and aesthetic reconstructive option for patients with benign or previously treated jaw malignant tumors. This technique may provide rapid occlusal reconstruction and oral rehabilitation.
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Affiliation(s)
- Paul Tabet
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Institute for Reconstructive Sciences in Medicine, Misericordia Community Hospital, Edmonton, Alberta, Canada
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Université de Montréal, Montreal, Quebec, Canada
| | - Samuel Bellavance
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Université de Montréal, Montreal, Quebec, Canada
| | - Jeffrey R. Harris
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Institute for Reconstructive Sciences in Medicine, Misericordia Community Hospital, Edmonton, Alberta, Canada
| | - Khalid Ansari
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Institute for Reconstructive Sciences in Medicine, Misericordia Community Hospital, Edmonton, Alberta, Canada
| | - Martin Osswald
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Institute for Reconstructive Sciences in Medicine, Misericordia Community Hospital, Edmonton, Alberta, Canada
| | - Suresh Nayar
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Institute for Reconstructive Sciences in Medicine, Misericordia Community Hospital, Edmonton, Alberta, Canada
| | - Hadi Seikaly
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Institute for Reconstructive Sciences in Medicine, Misericordia Community Hospital, Edmonton, Alberta, Canada
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Neckel N, Neckel PH, Hirt B, Doll C, Hofmann E, Nahles S, Heiland M, Kreutzer K, Koerdt S. A modified pull-through approach with a pedicled bone flap for oral and oropharyngeal cancer resection: a feasibility study. Surg Radiol Anat 2024; 46:341-352. [PMID: 38361154 PMCID: PMC10960749 DOI: 10.1007/s00276-024-03302-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 01/08/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE Compromised swallowing, speaking, and local complications are the major disadvantages of established approaches to the posterior tongue and oropharynx. The mandibular split involves an esthetically unpleasant bipartition of the lower lip and is prone to bony non-union or sequestration. The conventional pull-through technique on the other hand lacks the secure reattachment of the lingually released soft tissues. METHODS The feasibility of a new modified pull-through approach was tested on three anatomical specimens. CAD/CAM cutting guides were used to design a retentive bone flap to properly refixate the genioglossus and geniohyoid muscles after the procedure. The radiographic assessment and treatment planning was performed on 12 cadavers. The entire procedure was tested surgically via dissection in three of those cases. This procedure was then applied in a clinical case. RESULTS Precise repositioning and dynamic compression of bony segments was possible reproducibly and without injury to adjacent structures. In all dissected cases, a median lingual foramen was found and in two cases vessels entering it could be dissected Radiologic anatomical landmarks were sufficient in all 12 cases to perform the clinical planning procedure. Clinically, the osteotomized segment demonstrated good blood supply and plateless repositioning was verified postoperatively via cone beam scan. CONCLUSION The method presented is safe and easy to perform. Individual cutting guides improve the safety and accuracy of the procedure, potentially eliminating the need for osteosynthesis. We provide the anatomical and radiologic basis for clinical evaluation of this pedicled bone flap procedure and present the clinical application of this modified pull-through approach.
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Affiliation(s)
- Norbert Neckel
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Hindenburgdamm 30, 13353, Berlin, Germany.
| | - Peter H Neckel
- Institute of Clinical Anatomy and Cell Analysis, University of Tübingen, Tübingen, Germany
| | - Bernhard Hirt
- Institute of Clinical Anatomy and Cell Analysis, University of Tübingen, Tübingen, Germany
| | - Christian Doll
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Hindenburgdamm 30, 13353, Berlin, Germany
| | - Elena Hofmann
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Hindenburgdamm 30, 13353, Berlin, Germany
| | - Susanne Nahles
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Hindenburgdamm 30, 13353, Berlin, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Hindenburgdamm 30, 13353, Berlin, Germany
| | - Kilian Kreutzer
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Hindenburgdamm 30, 13353, Berlin, Germany
| | - Steffen Koerdt
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Hindenburgdamm 30, 13353, Berlin, Germany
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3
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Doub JB, Kang A, Lee C, Dyalram D, Shih P, Twaddell WS, Lubek JE. Risk Factors for Infection Recurrence After Surgical Resection of Advanced Stage Osteonecrosis of the Mandible. J Oral Maxillofac Surg 2024; 82:332-340. [PMID: 38199239 DOI: 10.1016/j.joms.2024.01.001] [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: 11/03/2023] [Revised: 12/28/2023] [Accepted: 01/01/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Advanced stage osteoradionecrosis (ORN) and medication-related osteonecrosis of the jaw (MRONJ) are challenging disease entities requiring multimodal therapy including surgical resection. However, risk factors associated with infection recurrence are poorly understood. PURPOSE The purpose of this study was to identify risk factors associated with infection recurrence following resection of advanced stage ORN or MRONJ of the mandible. STUDY DESIGN, SETTING, SAMPLE This was a retrospective cohort study including patients who underwent segmental mandibulectomy for management of ORN or MRONJ between 2016 and 2021 at the authors' institution. Subjects who did not have margin viability data were excluded. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE The primary predictor variable was viability of resection margins on histopathologic analysis (viable or nonviable). Secondarily, other risk factors categorized as demographic (age, sex, race), medical (comorbidities), and perioperative (reconstructive modality, antibiotic duration, microbiological growth) were evaluated. MAIN OUTCOME VARIABLE The primary outcome variable was time to infection recurrence defined as time from surgical resection to clinical diagnosis of a fistula tract, abscess, or persistent inflammatory symptoms necessitating surgical intervention. COVARIATES Not applicable. ANALYSES Descriptive and bivariate statistics were used to identify associations between risk factors and time to infection recurrence. A significance level of P ≤ .05 was considered significant. RESULTS The cohort consisted of 57 subjects with a mean age of 63.3 ± 10.0 years (71.9% Male, 75.4% White) treated for ORN (47.4%) or MRONJ (52.6%). A total of 19/57 (33%) subjects developed a recurrence of infection with 1 and 2 year survival of 75.8 and 66.2%, respectively. Nonviable resection margins were associated with earlier time to infection recurrence (P ≤ .001, hazard ratio (HR) = 11.9, 95% confidence interval (CI) = 3.84 to 36.7) as was younger age (P = .005, HR = 0.921, 95% CI = 0.869 to 0.976) and atypical pathogen growth on culture (P = .002, HR = 8.58, 95% CI = 2.24 to 32.8). CONCLUSIONS AND RELEVANCE Histopathologic margin viability was associated with earlier time to infection recurrence following resection of advanced stage ORN or MRONJ of the mandible. Additional studies are needed to identify interventions that may improve outcomes in this demographic.
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Affiliation(s)
- James B Doub
- The Doub Laboratory of Translational Bacterial Research, University of Maryland School of Medicine, Baltimore, MD; Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD.
| | - Allison Kang
- University of Maryland School of Medicine, Baltimore, MD
| | - Cameron Lee
- Department of Oral-Maxillofacial Surgery, University of Maryland, Baltimore, MD
| | - Donita Dyalram
- Department of Oral-Maxillofacial Surgery, University of Maryland Schools of Dentistry and Medicine, Baltimore, MD
| | - Pauline Shih
- Department of Anatomic Pathology, University of Maryland School of Medicine, Baltimore, MD
| | - William S Twaddell
- Department of Anatomic Pathology, University of Maryland School of Medicine, Baltimore, MD
| | - Joshua E Lubek
- Department of Oral-Maxillofacial Surgery, University of Maryland Schools of Dentistry and Medicine, Baltimore, MD
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Papanikolas MJ, Clark JR. Trends in free flap reconstruction of the head and neck: a single surgeon series of 1027 free tissue transfers. ANZ J Surg 2024; 94:140-147. [PMID: 38149718 DOI: 10.1111/ans.18798] [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: 06/29/2023] [Revised: 10/08/2023] [Accepted: 11/12/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Free tissue transfer has fundamentally changed head and neck surgery, enabling reliable reconstruction of large defects with better function and aesthetics. This study assesses two decades of trends in free flap reconstruction, and how disease incidence, survival, surgeon caseload, team approach, and technology have impacted practice. METHODS Retrospective analysis of 1027 head and neck free flaps from 2006 to 2022. Outcomes examined include chronological changes in flap selection, indication, length of stay, incorporation of virtual surgical planning (VSP), annual caseload, survival, and their associations with the single versus multi-team approach. RESULTS There were 764 soft-tissue and 263 osseous reconstructions utilizing 21 different flaps. Anterolateral thigh and radial forearm accounted for 76.7% of soft tissue flaps, with recent increase in superficial circumflex iliac perforator flaps in young patients. Osseous flap proportion remained stable, but fibula flaps increased five-fold with more VSP, dental implants, oral cancer, and multi-team surgery. Outcomes such as complication rates, length of stay and disease specific/overall survival have improved over time despite increasing complexity (P = 0.001, P = 0.001, P < 0.001, and P < 0.001, respectively). However, there was no significant difference in operative time, complication rate, or disease specific/overall survival between single team or multi-team approaches (P = 0.45, P = 0.054, P = 0.57, and P = 0.60, respectively). CONCLUSION Single and multi-team approaches may have similar fundamental outcomes, but as caseload, complexity, and life-expectancy increases, both patients and surgeons benefit from a collaborative multi-team approach that focuses on improving long-term functional outcomes.
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Affiliation(s)
- Michael J Papanikolas
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney Head and Neck Cancer Institute, Sydney, New South Wales, Australia
| | - Jonathan R Clark
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney Head and Neck Cancer Institute, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
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Kang YF, Ge YJ, Lv XM, Ding MK, Shan XF, Cai ZG. One-stage jaw reconstruction and prosthetic rehabilitation with an iliac flap: a case report and literature review. Maxillofac Plast Reconstr Surg 2024; 46:3. [PMID: 38231325 PMCID: PMC10794675 DOI: 10.1186/s40902-024-00413-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/08/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND One-stage jaw reconstruction with fibular flap and prosthetic rehabilitation restores bony and dental continuity simultaneously. It was also called as "jaw-in-a-day (JIAD)" technique. However, bone volume and height of fibular flap may be insufficient for dental implant insertion. The provision of a considerable amount of bone makes an iliac flap the ideal choice in these cases. We present the first case report to document the use of one-stage jaw reconstruction and prosthetic rehabilitation with the iliac flap. CASE PRESENTATION We modified the conventional JIAD workflow to make it suitable for iliac flap. Two cases were presented who both underwent segmental mandibulectomy for ameloblastoma. Virtual surgical planning was performed in all cases. The iliac crest was positioned upward to provide cortical bone for achieving primary stability of dental implants. Similar to the "all-on-4" procedure, the iliac bone was placed 12 to 15 mm below the occlusal plane to create adequate space for the implant-retained prosthesis. Immediate implant-based dental rehabilitation was performed at same stage. The surgery was successful in all cases without any short-term complications. In the first postoperative week, patients were given a liquid diet through a nasal feeding tube. The liquid diet is advised until 1 month after the surgery. Thereafter, a soft diet is recommended. Patients were advised to resume routine mastication and normal diet 3 months after the surgery. Peri-implantitis occurred in one patient, and additional gingival graft was required. Postoperative function and esthetics were satisfactory at the last follow-up visit. CONCLUSIONS One-stage jaw reconstruction and prosthetic rehabilitation with the iliac flap are safe and useful for restoring postoperative function and esthetics. It should be used in more cases with a longer follow-up in further studies.
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Affiliation(s)
- Yi-Fan Kang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, National Medical Products Administration (NMPA) Key Laboratory for Dental Materials, , Beijing, China
| | - Yan-Jun Ge
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, National Medical Products Administration (NMPA) Key Laboratory for Dental Materials, , Beijing, China
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xiao-Ming Lv
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, National Medical Products Administration (NMPA) Key Laboratory for Dental Materials, , Beijing, China
| | - Meng-Kun Ding
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, National Medical Products Administration (NMPA) Key Laboratory for Dental Materials, , Beijing, China
| | - Xiao-Feng Shan
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China.
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, National Medical Products Administration (NMPA) Key Laboratory for Dental Materials, , Beijing, China.
| | - Zhi-Gang Cai
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China.
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, National Medical Products Administration (NMPA) Key Laboratory for Dental Materials, , Beijing, China.
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Chan TG, Nickel C, Solares C, Irizarry R, Pipkorn P, Baddour HM, Gross JH. Stacked fibula flap for unilateral total maxillectomy reconstruction with orbital preservation. Head Neck 2024; 46:218-227. [PMID: 37933883 DOI: 10.1002/hed.27567] [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: 08/04/2023] [Revised: 10/12/2023] [Accepted: 10/23/2023] [Indexed: 11/08/2023] Open
Abstract
Unilateral total maxillectomy is indicated for locally advanced maxillary tumors that require complete removal of the midface bony structure and inferior orbital rim. Reconstruction of this defect is challenging due to aesthetic and functional concerns. A retrospective review of patients at two tertiary-care institutions undergoing unilateral total maxillectomy reconstruction with a stacked fibula flap from 2018 to 2022 was performed. Each patient's clinical course was reviewed, and attention was focused on the demonstration of surgical steps with photos. Twenty patients underwent stacked fibula flap reconstruction for unilateral total maxillectomy orbital preservation defects. Surgical extirpation was performed for malignancy (80%, 16/20) and for osteoradionecrosis or benign tumor in 20% (4/20). The complication rate was 30% (6/20). Most flaps survived (95%, 19/20). We present a modified, reproducible method of fibula flap reconstruction for unilateral total maxillectomy with orbital preservation that only requires two segments and maintains positive aesthetic and functional results.
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Affiliation(s)
- Tyler G Chan
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chris Nickel
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Clementino Solares
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Rachel Irizarry
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Patrik Pipkorn
- Department of Otolaryngology - Head and Neck Surgery, Siteman Cancer Institute, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Harry Michael Baddour
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Jennifer H Gross
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
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Sukato DC, Kerr R, Aghaloo T, Yu JW, Blackwell KE, Jayanetti J. The Implant-borne Articulation Splint in Fibula Free Flap Mandibular Reconstruction: A Technical Note. J Craniofac Surg 2023; 34:2455-2459. [PMID: 37800941 DOI: 10.1097/scs.0000000000009751] [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: 07/06/2023] [Accepted: 07/31/2023] [Indexed: 10/07/2023] Open
Abstract
Computer-aided design and computer-aided manufacturing and digitally simulated surgeries have revolutionized maxillomandibular reconstruction. In particular, this technology has increased the accuracy and facilitated the process of dental implantation in fibula free flaps. Despite the efficacy of virtual planning, there is a minor degree of translational difference between digital and intraoperative measurements, which may affect the precision of implant and fibula orientations. This is especially concerning during the last stage of fibula insetting, where the graft segments have the potential to roll, yaw, or pitch. The objective of this study is to describe an advanced prosthodontic technique that ensures the fibula grafts and implants remain in a restorable position during final insetting. We describe the technique and workflow of the implant-borne articulation splint through a case presentation and demonstrate results at 4 months postoperative and postradiotherapy. Given the degree of investment placed in virtual planning, free flap reconstruction, and endosteal implants, a technique that ensures optimal restorability of each implant is pivotal. Larger studies are still required to fully elucidate the cost-effectiveness and long-term results of the implant-borne articulation splint.
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Affiliation(s)
- Daniel C Sukato
- Department of Head and Neck Surgery, Kaiser Permanente Oakland Medical Center, Oakland
| | - Rhorie Kerr
- Department of Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, David Geffen School of Medicine at UCLA
| | - Tara Aghaloo
- UCLA School of Dentistry, Section of Oral and Maxillofacial Surgery, Los Angeles, CA
| | - Jason W Yu
- University of Colorado Health, Plastic and Reconstructive Surgery, Aurora, CO
| | - Keith E Blackwell
- Department of Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, David Geffen School of Medicine at UCLA
| | - Jay Jayanetti
- Section of Maxillofacial Prosthetics, UCLA School of Dentistry, Los Angeles, CA
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Reconstructive Surgery. J Oral Maxillofac Surg 2023; 81:E263-E299. [PMID: 37833026 DOI: 10.1016/j.joms.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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Gao N, Fu K, Cai J, He W. A retrospective study on application of fibula/iliac flap surgical techniques to mandibular defects. Sci Rep 2023; 13:16505. [PMID: 37783776 PMCID: PMC10545820 DOI: 10.1038/s41598-023-43643-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 09/26/2023] [Indexed: 10/04/2023] Open
Abstract
This study group consists of a total of 61 patients who underwent fibula flap and iliac flap surgeries to repair mandibular defects. Patients' Quality Of life (QOL) at 6 and 24 months after surgery is investigated and compared by the EORTC-QLQ-H&N and OHIP-14. The base data of the two groups of patients are collected and analysed by the SPSS 20.0 statistical software. Independent sample t test was conducted for EORTC-QLQ-H&N and OHIP-14 scores at two time points in each group. The 61 cases of free flap all survived and the difference in the location of the primary tumor between the two groups is statistically significant. The EORTC-QLQ-H&N showed that the score of speech, diet, social contact, and teeth all went up at 6 months after surgery, but went down dramatically at 24 months after surgery. The OHIP-14 showed that there was significant reduction in functional limitation at 24 months after surgery, with statistical significance (p < 0.05) between the groups of iliac flap (19.16 ± 5.33) and fibula flap (33.77 ± 7.71). Therefore, it is suggested that patients suffering from mandibular defects receive surgery utilizing the iliac flap, while those with a larger range of defects or lesions involving the condyle and chin should receive corrective surgery utilizing the fibular flap.
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Affiliation(s)
- Ning Gao
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Kun Fu
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Jinghua Cai
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Wei He
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
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Alzahrani BK, Fatani B, Alshalawi HS, Almutairi RM, AlRfydan HS, Alhindi MM. Survival of Dental Implants Placed in Iliac, Fibula, and Radial Forearm Flaps: A Comprehensive Review. Cureus 2023; 15:e48031. [PMID: 37916255 PMCID: PMC10617750 DOI: 10.7759/cureus.48031] [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] [Accepted: 10/31/2023] [Indexed: 11/03/2023] Open
Abstract
Various donor sites have been extensively documented in the literature for bone free flaps in head and neck reconstruction. These include the radius, scapula, rib, ilium, femur, fibula, and metatarsal bone. Among them, the fibula, ilium, and scapula are the most commonly used and studied for placing endosseous implants and for rehabilitation purposes. Each donor site has its own advantages and disadvantages, which depend on factors such as whether the reconstruction is for the maxilla or mandible, the required volume and length of the bone and soft tissue, and the location, extent, and type of defect that needs to be reconstructed. The aim of this current review is to comprehensively assess the existing literature on the survival of implants in fibula, radial, and iliac flaps.
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Affiliation(s)
| | | | | | - Rana M Almutairi
- Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Hesham S AlRfydan
- Oral and Maxillofacial Surgery, Ministry of Health - Health Qassim Cluster, Qassim, SAU
| | - Maryam M Alhindi
- Oral and Maxillofacial Surgery, King Saud University, Riyadh, SAU
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Frias V, Al Afif A, Markiewicz MR. Immediate Free Fibula Flap After Maxillectomy With Simultaneous Full-arch Dental Implant-Supported Prosthetic Rehabilitation of the Midface and Mandible: The "Super Reconstruction Concept". J Craniofac Surg 2023; 34:2153-2156. [PMID: 37643124 DOI: 10.1097/scs.0000000000009695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/27/2023] [Indexed: 08/31/2023] Open
Abstract
Immediate reconstruction and dental rehabilitation for ablative defects of the head and neck in one surgery is now a commonly used technique among reconstructive surgeons. Often patients are edentulous or partially edentulous in the jaw opposing that with pathology. In this case, only rehabilitating the dental arch affected by pathology would not render the patient with a functional occlusion. We introduce the "super reconstruction" concept which includes not only rehabilitating the dental arch affected by pathology but also the opposing arch, giving the patient a fully functional occlusion at the time of ablative surgery. This concept is described through a case of a patient with a T4aN0M0 squamous cell carcinoma of the maxilla who underwent total maxillectomy, immediate fibula flap reconstruction of the maxilla with, and full arch dental implant placement into the maxilla and opposing mandible with prosthetic rehabilitation.
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Affiliation(s)
- Vladimir Frias
- Department of Oral Oncology, Roswell Park Comprehensive Cancer Center
| | - Ayham Al Afif
- Department of Head & Neck/Plastic & Reconstructive Surgery, Roswell Park Comprehensive Cancer Center
| | - Michael R Markiewicz
- Department of Head & Neck/Plastic & Reconstructive Surgery, Roswell Park Comprehensive Cancer Center
- Department of Oral and Maxillofacial Surgery, Associate Dean for Hospital Affairs, School of Dental Medicine, University at Buffalo
- Department of Neurosurgery, Division of Pediatric Surgery, Department of Surgery, Jacobs School of Medicine and Biomedical Sciences
- Craniofacial Center of Western New York, John Oishei Children's Hospital, Buffalo, NY
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12
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Mañón VA, Oda N, Boudreaux E, Tran H, Young S, Melville JC. Implant Survival in Tissue-Engineered Mandibular Reconstruction-Early Experiences. Craniomaxillofac Trauma Reconstr 2023; 16:234-238. [PMID: 37975026 PMCID: PMC10638974 DOI: 10.1177/19433875221116962] [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: 11/19/2023] Open
Abstract
Study Design This article is to evaluate the early outcomes of dental implants placed in bone generated with tissueengineering techniques, specifically recombinant human bone morphogenic protein-2 (rhBMP-2), allogeneicbone particulate, and bone marrow aspirate concentrate (BMAC) in patients with resection of benignpathology. Objective To evaluate the long-term prognosis of dental implants placed in tissue engineered mandibular reconstruction. Methods We retrospectively evaluated 12 patient records, all of whom underwent segmental mandibular resection of benign pathology and reconstruction with a combination of BMAC, rhBMP-2, and allogeneic bone. Collecteddata points included the patient's age, gender, medical and social histories, implant site and placement date, resection/reconstruction date, final prosthesis, pathology resected, and follow-up dates (average 25 monthsof follow-up). Implant success was defined as clinical osseointegration (immobility), absence of peri-implantradiolucency, and absence of infection. Results Twelve patients met inclusion criteria with a total of 46 implants. The overall implant survival rate was 91.3%. There were 4 implant failures occurring in two patients: 1 failure in Patient 3 and 3 failures in Patient 8. Neitherpatient had any existing medical comorbidities or social history known to increase the risk for implant failure. The average implant placement occurred 11.6 months after mandibular reconstruction. Conclusions Preliminary findings of implant placement in bone generated with tissue engineering techniques have shown to be another predictable alternative for orofacial rehabilitation. Practical Implications: Dental rehabilitationusing dental implants is a predictable treatment option for patients that have required reconstruction of largebony defects status post resection of benign pathology using novel tissue engineering techniques.
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Affiliation(s)
- Victoria A. Mañón
- Bernard and Gloria Pepper Katz, Department of Oral and Maxillofacial Surgery, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Nicholas Oda
- Bernard and Gloria Pepper Katz, Department of Oral and Maxillofacial Surgery, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Emeric Boudreaux
- Bernard and Gloria Pepper Katz, Department of Oral and Maxillofacial Surgery, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Huy Tran
- Private Practice, Torrance, CA, USA
| | - Simon Young
- Bernard and Gloria Pepper Katz, Department of Oral and Maxillofacial Surgery, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - James C. Melville
- Head and Neck Oncologic and Microvascular Reconstructive Surgery, Bernard and Gloria Pepper Katz, Department of Oral and Maxillofacial Surgery, The University of Texas Health Science Center at Houston, Houston, TX, USA
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13
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Chang YM, Tsai CY, Wei FC. Fibula Jaw-during-Admission. J Plast Reconstr Aesthet Surg 2023; 82:247-254. [PMID: 37207438 DOI: 10.1016/j.bjps.2023.01.010] [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: 11/28/2022] [Accepted: 01/29/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Fibula Jaw-in-a-Day (JIAD) is considered the most advanced approach for segmental mandibular defect reconstruction and dental rehabilitation. However, it has limitations and challenges for further pursuit. We propose Fibula Jaw-during-Admission (JDA) as a solution. MATERIALS AND METHODS From 2019 to 2021, six patients received fibula "Jaw-during-Admission." Segmental mandibulectomy, fibula transfer, and immediate dental implantation were performed simultaneously during a single surgery. Intraoral scans were used to fabricate temporary light occlusion contact dental prostheses while on the ward prior to discharge during the first and second week post operation. The prostheses were installed before discharge and changed to permanent ones with normal occlusal contact in the clinic at about six months after X-ray confirmation of bone healing. RESULTS All six surgeries succeeded. Four patients received palatal muco-periosteal graft after debridement of peri-implant overgrown granulation tissue. Follow-up ranged from 12 to 34 months (average 21.2 months) and revealed good function and appearance in all patients. CONCLUSION Fibula JDA is superior to the Fibula JIAD approach for simultaneous mandibular reconstruction with fibula and dental rehabilitation. There is no need for postoperative intermaxillary fixation. The surgery can be performed more reliably with less stress. It provides an additional opportunity for dental rehabilitation if initial dental prosthesis installation during JIAD fails. Postreconstruction intraoral scans provide greater precision and more flexibility in milling dental prosthesis which are mapped to the reconstructed mandible during the postoperative period.
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Affiliation(s)
- Yang-Ming Chang
- Department of Oral and Maxillofacial Surgery, Chang Gung Memorial Hospital, Taiwan
| | - Chi-Ying Tsai
- Department of Oral and Maxillofacial Surgery, Chang Gung Memorial Hospital, Taiwan
| | - Fu-Chan Wei
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University and Medical College, Taiwan.
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14
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Tumuluri V, Leinkram D, Froggatt C, Dunn M, Wykes J, Singh J, Low T(H, Palme CE, Howes D, Clark JR. Outcomes of immediate dental implants in vascularised bone flaps for mandibular reconstruction. ANZ J Surg 2023; 93:1682-1687. [PMID: 37026415 PMCID: PMC10953371 DOI: 10.1111/ans.18427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 01/14/2023] [Accepted: 03/13/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND The aim of this study is to assess the outcomes of immediate implant placement for dental rehabilitation following mandibular reconstruction with vascularised bone flaps in a single Australian tertiary cancer centre. METHODS A retrospective analysis of patients who underwent immediate dental implant or delayed placement in vascularised bone flaps was performed. Primary outcome measures assessed included the number of implants placed, operative time, complication rates, time to radiotherapy initiation, dental rehabilitation rates and time to dental rehabilitation. RESULTS In total, 187 dental implants were placed in 52 patients, of which 34 patients underwent immediate implant placement and 18 had delayed implant placement. There were no significant differences in the postoperative complication rate (32% immediate vs. 33% delayed, P = 0.89) or time to postoperative radiotherapy (median 42 days immediate vs. 47 days delayed, P = 0.24). Dental rehabilitation was achieved in 62% of the immediate cohort versus 78% of the delayed cohort. The time to be fitted with a dental prosthesis was significantly shorter in the immediate cohort (median 150 days immediate vs. 843 days delayed, P = 0.002). CONCLUSIONS The placement of immediate dental implants at the time of primary reconstruction of the mandible is a safe procedure and facilitates timely dental rehabilitation.
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Affiliation(s)
- Vinay Tumuluri
- Faculty of Health and Medical Sciences, School of DentistryUniversity of AdelaideAdelaideAustralia
| | - David Leinkram
- Department of Head and Neck SurgerySydney Head and Neck Cancer Institute, Chris O'Brien LifehouseSydneyNew South WalesAustralia
| | - Catriona Froggatt
- Department of Head and Neck SurgerySydney Head and Neck Cancer Institute, Chris O'Brien LifehouseSydneyNew South WalesAustralia
| | - Masako Dunn
- Department of Head and Neck SurgerySydney Head and Neck Cancer Institute, Chris O'Brien LifehouseSydneyNew South WalesAustralia
| | - James Wykes
- Department of Head and Neck SurgerySydney Head and Neck Cancer Institute, Chris O'Brien LifehouseSydneyNew South WalesAustralia
- Sydney Medical School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Jasvir Singh
- Department of Head and Neck SurgerySydney Head and Neck Cancer Institute, Chris O'Brien LifehouseSydneyNew South WalesAustralia
| | - Tsu‐Hui (Hubert) Low
- Department of Head and Neck SurgerySydney Head and Neck Cancer Institute, Chris O'Brien LifehouseSydneyNew South WalesAustralia
- Sydney Medical School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Royal Prince Alfred Institute of Academic SurgerySydney Local Health DistrictSydneyNew South WalesAustralia
- Department of Otolaryngology – Head & Neck Surgery, Faculty of Medicine and Health SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Carsten E. Palme
- Department of Head and Neck SurgerySydney Head and Neck Cancer Institute, Chris O'Brien LifehouseSydneyNew South WalesAustralia
- Sydney Medical School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Dale Howes
- Department of Head and Neck SurgerySydney Head and Neck Cancer Institute, Chris O'Brien LifehouseSydneyNew South WalesAustralia
- Sydney Dental School, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
| | - Jonathan R. Clark
- Department of Head and Neck SurgerySydney Head and Neck Cancer Institute, Chris O'Brien LifehouseSydneyNew South WalesAustralia
- Sydney Medical School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Royal Prince Alfred Institute of Academic SurgerySydney Local Health DistrictSydneyNew South WalesAustralia
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15
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Tamaki A, Zender CA. Free Flap Donor Sites in Head and Neck Reconstruction. Otolaryngol Clin North Am 2023:S0030-6665(23)00047-6. [PMID: 37173238 DOI: 10.1016/j.otc.2023.04.001] [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] [Indexed: 05/15/2023]
Abstract
Microvascular free tissue transfer, also referred to as free flaps surgery, is a reconstructive technique that has become a foundational component of complex head and neck reconstruction. There have been considerable advancements in the field over the last 30 years including the number and variety of free flaps. Each of these free flaps has unique characteristics that must be considered for the defect when selecting a donor site. Here, the authors focus on the most common free flaps used in head and neck reconstruction.
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Affiliation(s)
- Akina Tamaki
- Department of Otolaryngology- Head and Neck Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, LKS 5045, Cleveland, OH 44106, USA.
| | - Chad A Zender
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati Medical Center, 231 Albert Sabin Way, MSB 6408, Cincinnati, OH 45229, USA
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16
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Quadri P, McMullen C. Oral Cavity Reconstruction. Otolaryngol Clin North Am 2023:S0030-6665(23)00048-8. [PMID: 37164898 DOI: 10.1016/j.otc.2023.04.002] [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: 05/12/2023]
Abstract
This summary provides a concise overview of oral cavity reconstruction to optimize functional outcomes in the modern era. Soft tissue and osseous reconstruction options for a wide range of oral cavity sites including lip, oral tongue, floor of mouth, buccal, hard palate, and composite oromandibular resections are reviewed. The appropriate applications of primary closure, secondary intention, skin grafts, and dermal substitute grafts are included. Anatomic considerations, indications, contraindications, and complications of local, regional, and free flaps in oral cavity reconstruction are discussed. Specific defects and the appropriate options for reconstruction of those defects are delineated.
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Affiliation(s)
- Pablo Quadri
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, CSB - 6 Floor, Tampa, FL 33612, USA
| | - Caitlin McMullen
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, CSB - 6 Floor, Tampa, FL 33612, USA.
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17
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Li J, Li X, Ma K, Sun J, Bai N, Liu Y. Rehabilitation of long-term mandibular defects by whole-process digital fibula flap combining with implants: A case report. J Prosthodont 2023; 32:187-195. [PMID: 36542449 DOI: 10.1111/jopr.13627] [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: 07/06/2022] [Revised: 11/28/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Currently, the gold standard and workhorse in mandibular reconstruction is the free vascularized fibula flap. Particularly for patients who have had mandibulectomy for a long time, it is still difficult to precisely reconstruct the mandibular contour and successfully restore the patient's chewing function and esthetics. For the restoration and rehabilitation of long-term mandibular abnormalities, three-dimensional (3D) virtual surgical planning (VSP) and 3D-printed surgical guides are essential. Digital design and manufacturing were used to improve the accuracy of prostheses and facilitate occlusal reconstruction. Therefore, equipped with the methods of 3D VSP, 3D-printed surgical guides, free vascularized fibular flap, and immediate dental implants, this clinical report provides a feasible solution for mandibular reconstruction.
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Affiliation(s)
- Jian Li
- Department of Oral Prosthodontics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.,School of Stomatology of Qingdao University, Qingdao, Shandong, China
| | - Xue Li
- Department of Oral Prosthodontics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Kai Ma
- Department of Oral Prosthodontics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jian Sun
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.,Dental Digital Medicine and 3D Printing Engineering Laboratory of Qingdao University, Qingdao, Shandong, China
| | - Na Bai
- Department of Oral Prosthodontics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.,Dental Digital Medicine and 3D Printing Engineering Laboratory of Qingdao University, Qingdao, Shandong, China
| | - Yanshan Liu
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.,Dental Digital Medicine and 3D Printing Engineering Laboratory of Qingdao University, Qingdao, Shandong, China
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18
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Maisi S, Dominguez M, Gilong PC, Kiong CT, Hajam S, Badruddin AFA, Siew HF, Gopalan S, Choon KT. In-house Virtual Surgical Planning for Mandibular Reconstruction with Fibula Free Flap: Case series and literature review. ANNALS OF 3D PRINTED MEDICINE 2023. [DOI: 10.1016/j.stlm.2023.100109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
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19
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McIlwain W, Inman J, Namin A, Kazi A, Shumrick C, Ducic Y. Management of Palatal Defects after Free-Flap Reconstruction and Radiotherapy. Semin Plast Surg 2023; 37:39-45. [PMID: 36776801 PMCID: PMC9911226 DOI: 10.1055/s-0042-1759797] [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: 12/24/2022]
Abstract
Palatal fistulas have significant effects on quality of life. Traditional prosthetic rehabilitation and surgical reconstruction of palate defects in radiation-naïve tissues are well described. However, palatal fistulas developing after initial tumor extirpation, free-flap reconstruction, and adjuvant radiation or chemoradiation are associated with challenging secondary tissue effects. In this review, we will discuss the management of palatal fistulas after surgical reconstruction and radiotherapy.
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Affiliation(s)
- Wesley McIlwain
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Jared Inman
- Otolaryngology/Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Arya Namin
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Aasif Kazi
- Otolaryngology/Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Christopher Shumrick
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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20
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Govoni FA, Felici N, Ornelli M, Marcelli VA, Migliano E, Pesucci BA, Pistilli R. Total mandible and bilateral TMJ reconstruction combining a customized jaw implant with a free fibular flap: a case report and literature review. Maxillofac Plast Reconstr Surg 2023; 45:6. [PMID: 36689098 PMCID: PMC9871153 DOI: 10.1186/s40902-023-00374-w] [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: 08/10/2022] [Accepted: 01/10/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The need for whole mandibular bone reconstruction and bilateral joint replacement is fortunately rare, but it is an extremely challenging topic in maxillofacial surgery, due to its functional implications. CAD-CAM techniques development has opened new broad horizons in the surgical planning of complex maxillofacial reconstructions, in terms of accuracy, predictability, and functional cosmetic results. The review of the literature has revealed a small number of scientific reports on total mandibulectomy including the condyles, with only eleven cases from 1980. Most of the works describe reconstructions secondary to dysplastic or inflammatory diseases affecting the lower jaw. The aim of this work, reporting a rare case of massive fibrous dysplasia of the whole mandible, is to share our experience in the management of extended mandibular and bilateral joint reconstruction, using porous titanium patient-specific implants. CASE PRESENTATION The authors present a 20-year-old male patient suffering from massive bone fibrous dysplasia of the mandible. The mandibular body and both the rami and the condylar processes had been involved, causing severe functional impairment, tooth loss, and facial deformation. The young patient, after repeated ineffective conservative surgical treatments, has required a biarticular mandibular replacement. Using virtual surgical planning (VSP) software, the authors, in collaboration with medical engineers, have created a custom-made original titanium porous mandibular implant, suspended from a bilateral artificial temporomandibular joint. The mandibular titanium implant body has been specifically designed to support soft tissues and to fix, in the alveolar region, a free fibular bone graft, for delayed dental implant prosthetic rehabilitation. CONCLUSION The surgical and technical details, as well as the new trends in mandibular reconstructions using porous titanium implants, are reported, and discussed, reviewing literature reports on this topic. Satisfactory functional and cosmetic restorative results have been obtained, and no major complications have occurred. The patient, currently in the 18th month clinical and radiological follow-up, has recently completed the functional restoration program by an implant-supported full-arch dental prosthesis.
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Affiliation(s)
- Flavio Andrea Govoni
- grid.416308.80000 0004 1805 3485Unit of Maxillofacial Surgery, San Camillo-Forlanini Hospital, Rome, Italy
| | - Nicola Felici
- grid.416308.80000 0004 1805 3485Unit of Plastic and Reconstructive Surgery of the Limbs, San Camillo-Forlanini Hospital, Rome, Italy
| | - Matteo Ornelli
- grid.416308.80000 0004 1805 3485Unit of Plastic and Reconstructive Surgery of the Limbs, San Camillo-Forlanini Hospital, Rome, Italy
| | - Vincenzo Antonio Marcelli
- grid.416308.80000 0004 1805 3485Unit of Maxillofacial Surgery, San Camillo-Forlanini Hospital, Rome, Italy
| | - Emilia Migliano
- grid.419467.90000 0004 1757 4473Department of Plastic and Regenerative Surgery, San Gallicano Dermatological Institute IRCCS I.F.O, Rome, Italy
| | - Bruno Andrea Pesucci
- grid.416308.80000 0004 1805 3485Unit of Maxillofacial Surgery, San Camillo-Forlanini Hospital, Rome, Italy
| | - Roberto Pistilli
- grid.416308.80000 0004 1805 3485Unit of Maxillofacial Surgery, San Camillo-Forlanini Hospital, Rome, Italy
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21
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Al-Sabahi ME, Jamali OM, Shindy MI, Moussa BG, Amin AAW, Zedan MH. Aesthetic Reconstruction of Onco-surgical Mandibular Defects Using Free Fibular Flap with and without CAD/CAM Customized Osteotomy Guide: A Randomized Controlled Clinical Trial. BMC Cancer 2022; 22:1252. [PMID: 36460978 PMCID: PMC9717507 DOI: 10.1186/s12885-022-10322-y] [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: 08/28/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Reconstruction of mandibular defects following ablative surgery remains a challenge even for experienced surgeons. Virtual planning and guided surgery, including computer-aided design/computer-aided manufacturing (CAD/CAM), afford optimized ways by which to plan complex surgery. This study aimed to evaluate and compare aesthetic outcome and surgical efficiency of free fibular flap (FFF) with and without CAD/CAM customized osteotomy guide (COG) for reconstruction of onco-surgical mandibular defects. METHODS Twenty-two patients indicated for segmental mandibulectomy were randomly assigned to either CAD/CAM with COG group or that without COG- Model based reconstruction (MB group) at a 1:1 ratio. Aesthetic outcomes were evaluated by means of morphometric assessment and comparison for each differential area (DAr) and angle (DAn) in the affected side to the contralateral side of the mandible using computerized digital imaging analysis (CDIA) based on the post-operative 3D CT-scan. Subjective evaluation was performed using the Visual Analogue Scale (VAS) and Patient's Satisfaction Score (PSS). Surgical efficiency was a secondary outcome and evaluated as total operative time and ischemia time. RESULTS The mean sagittal DAr was significantly lower in the COG group (277.28 ± 127.05 vs. 398.67 ± 139.10 mm2, P = 0.045). Although there was an improvement in the axial DAr (147.61 ± 55.42 vs. 183.68 ± 72.85 mm2), the difference was not statistically significant (P = 0.206). The mean differences (Δ) in both sagittal and coronal DAn were significantly lower in the COG group than in the MB group (6.11 ± 3.46 and 1.77 ± 1.12° vs. 9.53 ± 4.17 and 3.44 ± 2.34°), respectively. There were no statistically significant differences in the axial DAn between the two groups (P = 0.386). The PSS was significantly higher in the COG group, reflecting better aesthetic satisfaction than in the MB group (P = 0.041). The total operation and ischemia time were significantly shorter in favor of the COG group with a mean of (562.91 ± 51.22, 97.55 ± 16.80 min vs. 663.55 ± 53.43, 172.45 ± 21.87 min), respectively. CONCLUSION The CAD/CAM with COG is more reliable and highly valuable in enhancing aesthetic outcomes and surgical efficiency of mandibular reconstruction by FFF compared to that without COG (MB reconstruction). TRIAL REGISTRATION This trial was registered at ClinicalTrials.gov . REGISTRATION NUMBER NCT03757273. Registration date: 28/11/2018.
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Affiliation(s)
- Mohammed Esmail Al-Sabahi
- grid.7776.10000 0004 0639 9286Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt ,grid.444909.4Present Address: Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ibb University, Ibb, Yemen
| | - Omer Mohammed Jamali
- grid.444907.aDepartment of Oral and Maxillofacial Surgery, Faculty of Dentistry, Hodeidah University, Hodeidah, Yemen
| | - Mostafa Ibrahim Shindy
- grid.7776.10000 0004 0639 9286Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Basma Gamal Moussa
- grid.7776.10000 0004 0639 9286Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Ayman Abdel-Wahab Amin
- grid.7776.10000 0004 0639 9286Department of Surgical Oncology, Division of Head and Neck Surgery, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mohamed Hamdallah Zedan
- grid.7776.10000 0004 0639 9286Department of Surgical Oncology, Division of Head and Neck Surgery, National Cancer Institute, Cairo University, Cairo, Egypt
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22
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Muacevic A, Adler JR. Approach for Mandibular Reconstruction Using Vascularized Free Fibula Flap: A Review of the Literature. Cureus 2022; 14:e30161. [PMID: 36397914 PMCID: PMC9647204 DOI: 10.7759/cureus.30161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2022] [Indexed: 01/25/2023] Open
Abstract
Mandible reconstruction is one of the major challenges that face any maxillofacial surgeon worldwide. Different approaches and methods are used for mandible reconstruction, including pedicle flaps, titanium reconstruction plates, and bone grafts. A free fibular flap is used commonly and is considered the gold standard in mandibular reconstruction with a good success rate. Advantages of the free fibula flap include the long pedicle, flexible skin island, good length of dense cortical bone, consistent bone shape, minimal donor site morbidity, superior union rate, anti-collapse effectiveness, segmental blood supply, the potential for two skin paddles, and ease of harvest with a flap survival rate up to 95%. This current review aims to illustrate the approach for mandibular reconstruction using a vascularized free fibula flap.
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23
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Design and implementation of a surgical planning system for robotic assisted mandible reconstruction with fibula free flap. Int J Comput Assist Radiol Surg 2022; 17:2291-2303. [PMID: 36166164 DOI: 10.1007/s11548-022-02748-3] [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: 01/12/2022] [Accepted: 09/05/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Free fibula flap is the gold standard for the treatment of mandibular defects. However, the existing preoperative planning protocol is cumbersome to execute, costly to learn, and poorly collaborative with the robot-assisted cutting of the fibular osteotomy plane. METHODS A surgical planning system for robotic assisted mandibular reconstruction with fibula free flap is proposed in this study. A fibular osteotomy planning algorithm is presented so that the virtual surgical planning of the fibular osteotomy segments can be obtained automatically with selected mandibular anatomical landmarks. The planned osteotomy planes are then converted into the motion path of the robotic arm, and the automatic fibula osteotomy is completed under optical navigation. RESULTS Surgical planning was performed on 35 patients to verify the feasibility of our system's virtual surgical planning module, with an average time of 13 min. Phantom experiments were performed to evaluate the reliability and stability of this system. The average distance and angular deviations of the osteotomy planes are 1.04 ± 0.68 mm and 1.56 ±1.10°, respectively. CONCLUSIONS Our system can achieve not only precise and convenient preoperative planning, but also safe and reliable osteotomy trajectory. The clinical applications of our system for mandibular reconstruction surgery are expected soon.
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Nazarian D, Dikarev A, Mokhirev M, Zakharov G, Fedosov A, Potapov M, Chernenkiy M, Vasilev Y, Kyalov G, Chausheva S, Khachatryan A, Tevosyan A, Arakelyan G. Maxillo-mandibular Defect Reconstruction with Bilateral Free Fibula Flaps with Dental Implant Placement and Immediate Loading: A Case Report of the Three-team Approach. Arch Plast Surg 2022; 49:652-655. [PMID: 36159367 PMCID: PMC9507612 DOI: 10.1055/s-0042-1756350] [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] [Received: 12/16/2021] [Accepted: 02/17/2022] [Indexed: 11/08/2022] Open
Abstract
Patients with advanced malignant tumors, including both jaws, is a challenging task for a head and neck surgeon. Current treatment landscape demonstrates good functional, anatomical, and aesthetic results in patients who could previously receive only palliative care. The extensive tissue defects resulting from oncological resections in the head and neck region require immediate reconstruction due to the exposure of vital structures and their contact with the external environment. A patient was operated using a three-team multidisciplinary approach involving simultaneous work of three specialized teams of maxillofacial and reconstructive microsurgeons, as well as an implantologist and a prosthodontist. This approach allowed simultaneous tumor resection with subsequent reconstruction of the intraoperative defect involving bilateral harvesting of two revascularized free fibular osteomusculocutaneous flaps with dental implantation and simultaneous rehabilitation of dentition with crowns.
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Affiliation(s)
- David Nazarian
- Maxillofacial and Reconstructive Surgery Department, FSBI NMRCO FMBA, Moscow, Russia
| | - Aleksei Dikarev
- Maxillofacial and Reconstructive Surgery Department, FSBI NMRCO FMBA, Moscow, Russia
| | - Mikhail Mokhirev
- Maxillofacial and Reconstructive Surgery Department, FSBI NMRCO FMBA, Moscow, Russia
| | - Georgy Zakharov
- Maxillofacial and Reconstructive Surgery Department, FSBI NMRCO FMBA, Moscow, Russia
| | - Alexander Fedosov
- Maxillofacial and Reconstructive Surgery Department, FSBI NMRCO FMBA, Moscow, Russia
| | - Maksim Potapov
- Maxillofacial and Reconstructive Surgery Department, FSBI NMRCO FMBA, Moscow, Russia
| | - Mikhail Chernenkiy
- Maxillofacial and Reconstructive Surgery Department, NK Clinic, Moscow, Russia
| | - Yuriy Vasilev
- Radiology Department, Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Moscow, Russia
| | - Grigoriy Kyalov
- Maxillofacial and Reconstructive Surgery Department, NK Clinic, Moscow, Russia
| | | | - Arbak Khachatryan
- Maxillofacial and Reconstructive Surgery Department, FSBI NMRCO FMBA, Moscow, Russia
| | - Artur Tevosyan
- Department of clinical medicine, International School "Medicine of the Future", Sechenov University
| | - Gevorg Arakelyan
- Department of clinical medicine, International School "Medicine of the Future", Sechenov University
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A Simplified Approach to Jaw-in-a-Day Using a Preassembled Prosthesis: Lowering the Barrier to Entry. Plast Reconstr Surg Glob Open 2022; 10:e4542. [PMID: 36187282 PMCID: PMC9521744 DOI: 10.1097/gox.0000000000004542] [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: 06/17/2022] [Accepted: 08/03/2022] [Indexed: 11/26/2022]
Abstract
Fibula flap reconstruction with primary dental implant placement has been established as a successful procedure for composite mandibular defects. When using virtual surgical planning, these techniques typically require additional personnel and materials preoperatively and intraoperatively to fabricate occlusal-based guidance and prosthesis. The authors present a technique utilizing a custom-made implant-supported prosthesis completed before surgery that greatly reduces lead time and needed resources. The authors follow the established workflow of segmental mandibulectomy and fibula flap reconstruction using premanufactured cutting guides and placement of dental implants. Cylindrical holes along the implant axes are included in the printed surgical model provided by the guide manufacturer. Acrylic resin and abutments are added to the model to a positioning stent for use during surgery that does not require intraoperative modification before fibula inset. This ensures optimal position for facial esthetics and fixed dental rehabilitation. The presented technique uses printed models already provided by the guide manufacturer, reducing preparation time and requiring fewer personnel and materials intraoperatively. This is an approach to the jaw-in-a-day procedure with a lower barrier to entry that may be used by new craniofacial teams.
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Abstract
SUMMARY Defects involving the midface and maxilla pose unique challenges to reconstructive surgeons. The maxilla serves as the central keystone of the face and interfaces with various other facial subunits to affect form and function. Reconstructive methods range from prosthetics to free tissue transfer, and the indications for different options are reviewed here. Finally, special considerations including management of the orbit, dental rehabilitation, and future directions are discussed.
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27
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Le JM, Gigliotti J, Ying Y, Kase MT, Morlandt AB. Computer-Assisted Microvascular Free Flap Reconstruction and Implant Rehabilitation of the Maxilla-Treatment of a Rare Post-orthognathic Complication. J Maxillofac Oral Surg 2022; 21:82-87. [PMID: 35400916 PMCID: PMC8934816 DOI: 10.1007/s12663-020-01492-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/10/2020] [Indexed: 11/28/2022] Open
Abstract
Orthognathic surgery is generally a safe and predictable procedure. Major postoperative complications are rare and often non-life threatening. An example of a rare complication associated with the LeFort I osteotomy is avascular necrosis of the maxilla (ANM). While cases of ANM have been described in the literature, the majority involves only a portion or segment of the maxillary complex and is commonly treated with conservative measures such as strict oral hygiene, hyperbaric oxygen therapy and local debridement. Occasionally, larger segments of osteonecrosis may require extensive reconstruction such as bone grafting with local soft tissue flaps. Here, we present a patient that underwent a single-stage microvascular free tissue reconstruction with concomitant placement of dental implants and a patient-specific implant (PSI) for post-orthognathic ANM.
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Affiliation(s)
- John M. Le
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama at Birmingham, SDB 419, Rm 406, 1919 7th Ave S, Birmingham, AL 35233 USA
| | - Jordan Gigliotti
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama at Birmingham, SDB 419, Rm 406, 1919 7th Ave S, Birmingham, AL 35233 USA
| | - Yedeh Ying
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama at Birmingham, SDB 419, Rm 406, 1919 7th Ave S, Birmingham, AL 35233 USA
| | - Michael T. Kase
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama at Birmingham, SDB 419, Rm 406, 1919 7th Ave S, Birmingham, AL 35233 USA
| | - Anthony B. Morlandt
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama at Birmingham, SDB 419, Rm 406, 1919 7th Ave S, Birmingham, AL 35233 USA
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Lin CL, Wang YT, Chang CM, Wu CH, Tsai WH. Design Criteria for Patient-specific Mandibular Continuity Defect Reconstructed Implant with Lightweight Structure using Weighted Topology Optimization and Validated with Biomechanical Fatigue Testing. Int J Bioprint 2022; 8:437. [PMID: 35187275 PMCID: PMC8852200 DOI: 10.18063/ijb.v8i1.437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/18/2021] [Indexed: 11/23/2022] Open
Abstract
This study developed design criterion for patient-specific reconstructed implants with appearance consideration and structural optimization of various mandibular continuity defects. The different mandible continuity defects include C (from left to right canines), B (from 1st premolar to 3rd molar), and A (from 3rd molar to ramus) segments defined based on the mandible image. The finite element (FE) analysis and weighted topology optimization methods were combined to design internal support beam structures within different reconstructed implants with corresponding occlusal conditions. Five continuity mandibular defects (single B/C/A+B and combination of B+C and B+C+B segments) were restored using additive manufacturing (AM) reconstructed implant and bone plate to confirm reasonable design criterion through biomechanical fatigue testing. The worst mandible strength was filtered based on the material mechanics and results from segmental bone length, thickness, and height statistics from the established database containing mandible images of 105 patients. The weighted optimization analysis results indicated that the sizes and positions of internal supporting beams within the reconstructed C, B, and A+B implants can be defined parametrically through corresponding segmental bone length, width, and height. The FE analysis found that the weight variation percentage between the parametric designed implants and original core solid implants in the C, B, and A+B was reduced by 54.3%, 63.7%, and 69.7%, respectively. The maximum stress values of the reconstructed implant and the remaining bone were not obviously reduced but the stress values were far lower than the material ultimate strength. The biomechanical fatigue testing indicated that all cases using the AM reconstructed implant could pass the 250,000 dynamic load. However, condyle head, bone plate fracture, and bone screw loosening could be found in cases using bone plates. This study developed a design criterion for patient-specific reconstructed implants for various mandibular continuity defects applicable for AM to further clinical use.
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Affiliation(s)
- Chun-Li Lin
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Yu-Tzu Wang
- Department of Mechanical and Electro-Mechanical Engineering, TamKang University, New Taipei City, Taiwan
| | - Chun-Ming Chang
- National Applied Research Laboratories, Instrument Technology Research Center, Hsinchu, Taiwan
| | - Cheng-Hsien Wu
- Department of Oral and Maxillofacial Surgery, Taipei Veterans General Hospital, School of Dentistry, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Wei-Heng Tsai
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
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29
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Gao N, Fu K, Cai J, Chen H, He W. The role of folded fibular flap in patients' reconstruction of mandibular defects: a retrospective clinical study. Sci Rep 2021; 11:23853. [PMID: 34903811 PMCID: PMC8668899 DOI: 10.1038/s41598-021-03331-7] [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: 02/19/2021] [Accepted: 11/29/2021] [Indexed: 11/09/2022] Open
Abstract
This study has analyzed 41 patients with mandibular ameloblastoma who underwent a partial mandibulectomy and reconstruction by folding the free fibular flap. In the preoperative and postoperative (6 months and 24 months after surgery), the Quality of Life (QOL) of these patients was assessed by using the University of Washington Quality of Life Questionnaire (UW-QOL) and the medical outcome study short form-36 (SF-36) questionnaires. SPSS 20.0 statistical software was used to conduct statistical analysis on the base data of the two groups of patients. Independent sample t test was conducted for sf-36 and UW-QOL scores at two time points in each group. The SF-36 survey showed that body pain (54.54 ± 8.10), general health (55.27 ± 7.54), and health changes (58.29 ± 9.60) decreased significantly at 6 months after surgery, but the mean score at 24 months after surgery all exceeded the preoperational level. At 24 months after the surgery, the vitality (80.41 ± 3.74), social function (81.61 ± 4.07), emotional role (82.39 ± 4.07), psychological health (81.66 ± 4.37) and total score (704.00 ± 31.53) all returned to the preoperative level, which was statistically significant compared with 6 months after surgery. However, there was no significant difference compared with the preoperative level. The UW-QOL survey showed that chewing (56.68 ± 7.23), speech (54.54 ± 7.7) and taste (62.29 ± 10.15) have significantly changed at 6 months after the surgery, and the difference was statistically significant at 24 months after surgery. Saliva generation decreased slightly (80.76 ± 3.35) at 6 months after surgery, but quickly returned to the preoperative level (81.59 ± 4.06). The total score of the patients almost recovered to the preoperative level at 24 months after surgery. The folded the fibular flap can not only repair the defects of soft tissue and bone tissue, but also restore the height of the alveolar ridge to, avoid the imbalance of crown and root ratio after implantation and reduce the occurrence of peri-implant inflammation, so that a true functional reconstruction can be realized.
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Affiliation(s)
- Ning Gao
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Kun Fu
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Jinghua Cai
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Hao Chen
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Wei He
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
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30
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Raghavan P, Vakharia K, Morales RE, Mukherjee S. Surgical Free Flaps and Grafts in Head and Neck Reconstruction: Principles and Postoperative Imaging. Neuroimaging Clin N Am 2021; 32:75-91. [PMID: 34809845 DOI: 10.1016/j.nic.2021.09.002] [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: 11/17/2022]
Abstract
This review article discusses the basic principles behind the use of flaps and grafts for reconstructive surgery in the head and neck, with a special emphasis on the types of commonly used free flaps, their imaging appearance as well as some frequently encountered postoperative complications. Given the ubiquity and complexity of these reconstructive techniques, it is essential that head and neck radiologists be familiar in distinguishing between the expected evolving findings, complications, and tumor recurrence.
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Affiliation(s)
- Prashant Raghavan
- Neuroradiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA.
| | - Kalpesh Vakharia
- Department of Otorhinolaryngology-Head and Neck Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 419 West Redwood Street, Suite 370, Baltimore, MD 21201, USA
| | - Robert E Morales
- Neuroradiology, Diagnostic Neuroradiology Fellowship, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA
| | - Sugoto Mukherjee
- Department of Radiology and Medical Imaging, University of Virginia Health System, PO Box 800170, 1215 Lee Street, Charlottesville, VA 22908-1070, USA
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31
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Wood CB, Ha AY, Puram SV, Jackson RS, Pipkorn P. The two-handed template for planning fibular free flap reconstruction of the head and neck. Head Neck 2021; 44:296-299. [PMID: 34726803 DOI: 10.1002/hed.26901] [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: 08/10/2021] [Accepted: 10/13/2021] [Indexed: 11/06/2022] Open
Abstract
Fibular free flap reconstruction of head and neck defects is complex, and the anatomic relationships among components of the fibular flap pose challenges to reconstructive surgeons. Various techniques have been employed in planning for fibular free flap procedures, but these are often cumbersome and difficult to implement in clinically. We devised a simplistic tool for pre-operative leg selection, wherein the surgeon uses two hands to represent the various components of the fibular flap. The senior author has used this method to aid in leg selection for fibular free flaps. In all cases, utilization of this technique allowed for appropriate leg selection relative to the location of the vascular pedicle and posterior crural septum. The two-handed template for fibular free flap reconstruction is a simple, reproducible, and affordable tool that can aid reconstructive surgeons when they are planning to use a fibular flap.
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Affiliation(s)
- C Burton Wood
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Austin Y Ha
- Department of Plastic Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Ryan S Jackson
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
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32
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Sun Y, Guo Y, Li J, Yang D, Hu K. Three-dimensional finite element analysis of free fibular flap reconstruction of mandible defects. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2021. [DOI: 10.1016/j.adoms.2021.100109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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33
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Ong A, Williams F, Tokarz E, Shokri T, Hammer D, Ducic Y. Jaw in a Day: Immediate Dental Rehabilitation during Fibula Reconstruction of the Mandible. Facial Plast Surg 2021; 37:722-727. [PMID: 34380165 DOI: 10.1055/s-0041-1732478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Reconstructing mandibular defects presents challenges to dental rehabilitation related to altered bone and soft tissue anatomy. Dental implants are the most reliable method to restore the lost dentition. Immediate dental implants have been placed for many years but with unacceptably low rates of dental/prosthetic success. Current virtual technology allows placement of both fibulas and guided implants in restoratively driven positions that also allow immediate dental rehabilitation. Inexpensive three-dimensional printing platforms can create provisional dental prostheses placed at the time of surgery. This article reviews our digital and surgical workflow to create an immediate dental prosthesis to predictably restore the dentition during major jaw reconstruction with fibula free flaps.
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Affiliation(s)
- Adrian Ong
- Otolaryngology and Facial Plastic Surgery Associates, Facial Plastic Surgery, Fort Worth, Texas
| | - Fayette Williams
- Department of Oral and Maxillofacial Surgery, John Peter Smith Health Network, Fort Worth, Texas
| | - Ellen Tokarz
- Department of Otolaryngology Head and Neck Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Tom Shokri
- Department of Otolaryngology, Baylor All Saints Medical Center at Fort Worth, Fort Worth, Texas
| | - Daniel Hammer
- Department of Oral and Maxillofacial Surgery, Naval Medical Center San Diego, San Diego, California
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Facial Plastic Surgery, Fort Worth, Texas
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34
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Lilly GL, Petrisor D, Wax MK. Mandibular rehabilitation: From the Andy Gump deformity to jaw-in-a-day. Laryngoscope Investig Otolaryngol 2021; 6:708-720. [PMID: 34401495 PMCID: PMC8356852 DOI: 10.1002/lio2.595] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/25/2021] [Accepted: 04/17/2021] [Indexed: 12/31/2022] Open
Abstract
The mandible is a critical structure of the lower facial skeleton which plays an important role in several vital functions. Segmental resection of the mandible is at times required in patients with advanced oral cavity malignancies, primary mandibular tumors, and radiation or medication induced osteonecrosis. Mandibulectomy can significantly decrease quality of life, and thus mandibular reconstruction is an important aspect of the operative plan. Mandibular reconstruction is challenging due to the complex three-dimensional anatomy of the mandible, and the precision required to restore dental occlusion in dentate patients. Significant advances have been made over the past decade in the ability to reconstruct and rehabilitate patients after a segmental mandibulectomy. This review will highlight these advances and discuss the timing of dental implantation.
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Affiliation(s)
- Gabriela L. Lilly
- Department of Otolaryngology – Head and Neck SurgeryOregon Health and Science UniversityPortlandOregonUSA
| | - Daniel Petrisor
- Department of Oral and Maxillofacial SurgeryOregon Health and Science UniversityPortlandOregonUSA
| | - Mark K. Wax
- Department of Otolaryngology – Head and Neck SurgeryOregon Health and Science UniversityPortlandOregonUSA
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35
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Impact of Planning Method (Conventional versus Virtual) on Time to Therapy Initiation and Resection Margins: A Retrospective Analysis of 104 Immediate Jaw Reconstructions. Cancers (Basel) 2021; 13:cancers13123013. [PMID: 34208555 PMCID: PMC8235255 DOI: 10.3390/cancers13123013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/11/2021] [Accepted: 06/13/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Computer-aided design and manufacturing of osseous reconstructions are currently widely used in jaw reconstructive surgery, providing an improved surgical outcome and decreased procedural stumbling block. However, data on the influence of planning time on the time-to-surgery initiation and resection margin are missing in the literature. This retrospective, monocentric study compares process times from the first patient contact in hospital, time of in-house or out-of-house biopsy for tumor diagnosis and surgical therapy of tumor resection, and immediate reconstruction of the jaw with free fibula flaps (FFF). Two techniques for reconstruction are used: Virtual surgical planning (VSP) and non-VSP. A total of 104 patients who underwent FFF surgery for immediate jaw reconstruction from 2002 to 2020 are included. The study findings fill the gaps in the literature and obtain clear insights based on the investigated study subjects. Abstract Virtual surgical planning (VSP) and patient-specific implants are currently increasing for immediate jaw reconstruction after ablative oncologic surgery. This technique contributes to more accurate and efficient preoperative planning and shorter operation time. The present retrospective, single-center study analyzes the influence of time delay caused by VSP vs. conventional (non-VSP) reconstruction planning on the soft and hard tissue resection margins for necessary oncologic safety. A total number of 104 cases of immediate jaw reconstruction with free fibula flap are included in the present study. The selected method of reconstruction (conventionally, non-VSP: n = 63; digitally, VSP: n = 41) are analyzed in detail. The study reveals a statistically significant (p = 0.008) prolonged time to therapy initiation with a median of 42 days when the VSP method compared with non-VSP (31.0 days) is used. VSP did not significantly affect bony or soft tissue resection margin status. Apart from this observation, no significant differences concerning local tumor recurrence, lymph node, and distant metastases rates are found according to the reconstruction method, and affect soft or bone tissue resection margins. Thus, we conclude that VSP for immediate jaw reconstruction is safe for oncological purposes.
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36
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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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37
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Sethi RKV, Spector ME, Chinn SB. New Technologies in Bony Reconstruction of Complex Head and Neck Defects. CURRENT SURGERY REPORTS 2021. [DOI: 10.1007/s40137-021-00290-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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38
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Leinkram D, Wykes J, Palme C, Deshpande S, McLaughlin M, Garg P, Wallace C, Howes D, Clark JR. Occlusal-based planning for dental rehabilitation following segmental resection of the mandible and maxilla. ANZ J Surg 2020; 91:451-452. [PMID: 33244862 DOI: 10.1111/ans.16441] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 10/20/2020] [Accepted: 10/26/2020] [Indexed: 11/27/2022]
Abstract
Reconstruction of the maxilla and mandible incorporating a dental prosthesis supported by dental implants is a complex process but has tremendous benefit to patient rehabilitation following ablative procedures. This study presents a protocol that can be used to aid other institutions to provide the highest standard of reconstruction.
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Affiliation(s)
- David Leinkram
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - James Wykes
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Carsten Palme
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Suhas Deshpande
- Department of Oral Restorative Sciences, Westmead Centre for Oral Health, Sydney, New South Wales, Australia
| | - Matthew McLaughlin
- Department of Oral Restorative Sciences, Westmead Centre for Oral Health, Sydney, New South Wales, Australia
| | - Pooja Garg
- Department of Oral Restorative Sciences, Westmead Centre for Oral Health, Sydney, New South Wales, Australia
| | - Christine Wallace
- Department of Oral Restorative Sciences, Westmead Centre for Oral Health, Sydney, New South Wales, Australia.,School of Dentistry, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Dale Howes
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,School of Dentistry, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Jonathan R Clark
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
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39
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The use of medical modeling in microvascular free tissue transfer reconstruction with osseointegrated implantation in complex midface defects. Oral Oncol 2020; 110:104982. [DOI: 10.1016/j.oraloncology.2020.104982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 08/16/2020] [Accepted: 08/23/2020] [Indexed: 11/17/2022]
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40
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Harris BN, Ghazizadeh S, Bayon R, Kejner AE, Cannady SB, Greene BJ, Huang AT, Curry J, Blackwell KE, Ducic Y, Wax MK. Safety of fibula free flap in patients following total knee replacement. Head Neck 2020; 43:585-589. [PMID: 33089587 DOI: 10.1002/hed.26519] [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: 04/29/2020] [Revised: 07/21/2020] [Accepted: 10/12/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Fibula free flap (FFF) is the preferred osteocutaneous flap for reconstruction of large head and neck composite defects. There is a paucity of data whether FFF can be performed safely in patients with knee replacement (total knee arthroplasty [TKA]). METHODS Multi-institutional review of outcomes following FFF in patients who had prior TKA. RESULTS Ten surgeons reported successful FFF in 53 patients with prior TKA. The most common preoperative imaging was a CT angiogram of the bilateral lower extremities. There was no evidence of intraoperative vascular abnormality. Physical therapy began between postoperative day 1 to postoperative day 3. At 1 month postoperatively, 40% of patients were using a cane or walker to ambulate, but by 3 months all had returned to baseline ambulatory status. At >1 year, there were no gait complications. CONCLUSION FFF appears safe in patients with prior knee replacement without an increased risk of complications compared to baseline.
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Affiliation(s)
- Brianna N Harris
- Department of Otolaryngology - Head and Neck Surgery, Scripps Health, San Diego, California, USA
| | - Shabnam Ghazizadeh
- Department of Otolaryngology - Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Rodrigo Bayon
- Department of Otolaryngology - Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Alexandra E Kejner
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Steven B Cannady
- Department of Otolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Benjamin J Greene
- Department of Otolaryngology - Head and Neck Surgery, University of Alabama, Birmingham, Alabama, USA
| | - Andrew T Huang
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Joseph Curry
- Department of Otolaryngology - Head and Neck Surgery, Jefferson University, Philadelphia, Pennsylvania, USA
| | - Keith E Blackwell
- Department of Otolaryngology - Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas, USA
| | - Mark K Wax
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Sciences University, Portland, Oregon, USA
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Wu LJ, Hsieh KH, Lin CL. Integrating Finite Element Death Technique and Bone Remodeling Theory to Predict Screw Loosening Affected by Radiation Treatment after Mandibular Reconstruction Surgery. Diagnostics (Basel) 2020; 10:diagnostics10100844. [PMID: 33086684 PMCID: PMC7589701 DOI: 10.3390/diagnostics10100844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/16/2020] [Accepted: 10/16/2020] [Indexed: 11/27/2022] Open
Abstract
This study developed a numerical simulation to understand bone mechanical behavior and micro-crack propagation around a fixation screw with severe mandibular defects. A mandible finite element (FE) model was constructed in a rabbit with a right unilateral body defect. The reconstruction implant was designed to be fixed using six screws distributed on the distal and mesial sides. The element death technique provided in FE analysis was combined with bone remodeling theory to simulate bone necrosis around the fixation screw in which the strain value reached the overload threshold. A total of 20 iterations were performed to observe the micro-crack propagation pattern for each screw according to the high strain locations occurring in each result from consecutive iterations. A parallel in vivo animal study was performed to validate the FE simulation by placing specific metal 3D printing reconstruction implants in rabbits to compare the differences in bone remodeling caused by radiation treatment after surgery. The results showed that strain values of the surrounding distal bone fixation screws were much larger than those at the mesial side. With the increase in the number of iteration analyses, the micro-crack prorogation trend for the distal fixation screws can be represented by the number and element death locations during the iteration analysis process. The corresponding micro-movement began to increase gradually and induced screw loosening after iteration calculation. The strained bone results showed that relatively high bone loss (damage) existed around the distal fixation screws under radiation treatment. This study concluded that the FE simulation developed in this study can provide a better predictive diagnosis method for understanding fixation screw loosening and advanced implant development before surgery.
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Affiliation(s)
- Le-Jung Wu
- Division of Radiation Therapy, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan;
| | - Kai-Hung Hsieh
- Department of Biomedical Engineering, National Yang-Ming University, Taipei 112, Taiwan;
| | - Chun-Li Lin
- Department of Biomedical Engineering, National Yang-Ming University, Taipei 112, Taiwan;
- Correspondence:
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Qaisi M, Boukheir MA, Shah B, Murphy J. The Predictive Hole Technique: A Technical Note. J Oral Maxillofac Surg 2020; 79:722-727. [PMID: 33010217 DOI: 10.1016/j.joms.2020.08.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/09/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
We describe a novel technique in which predictive holes, normally unique to patient-specific plates, may be utilized with off the shelf stock plates. This allows for the numerous benefits of predictive holes in mandibular reconstruction while negating the added cost of a custom milled plate. Three case examples are presented for technique illustration.
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Affiliation(s)
- Mohammed Qaisi
- Professor of Oral & Maxillofacial Surgery, Midwestern University, Program Director, Division of Oral & Maxillofacial Surgery, Adjunct Attending Physician, Division of Otolaryngology, Cook County Health, Chicago, IL.
| | - Mohamed Ali Boukheir
- Chief Resident, Division of Oral & Maxillofacial Surgery, Cook County Health, Chicago, IL
| | - Biraj Shah
- Assistant Professor of Oral & Maxillofacial Surgery, Midwestern University, Attending Physician, Division of Oral & Maxillofacial Surgery, Cook County Health, Chicago, IL
| | - James Murphy
- Associate Professor of Oral & Maxillofacial Surgery, Midwestern University, Attending Physician, Division of Oral & Maxillofacial Surgery, Adjunct Attending Physician, Division of Otolaryngology, Cook County Health, Chicago, IL
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Harrison P, Patel A, Cheng A, Bell RB. Three-Dimensional Computer-Assisted Surgical Planning, Manufacturing, and Intraoperative Navigation in Oncologic Surgery. Atlas Oral Maxillofac Surg Clin North Am 2020; 28:129-144. [PMID: 32741510 DOI: 10.1016/j.cxom.2020.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Phillip Harrison
- Providence Cancer Institute, Providence Portland Medical Center, 4805 Northeast Glisan Street, Suite 2N35, Portland, OR 97213, USA; The Head and Neck Institute, Head and Neck Surgical Associates, 1849 Northwest Kearney, Suite 300, Portland, OR 97209, USA; Legacy Cancer Institute, Legacy Good Samaritan Medical Center, 1015 Northwest 22nd Avenue, Portland, OR 97210, USA.
| | - Ashish Patel
- Providence Cancer Institute, Providence Portland Medical Center, 4805 Northeast Glisan Street, Suite 2N35, Portland, OR 97213, USA; The Head and Neck Institute, Head and Neck Surgical Associates, 1849 Northwest Kearney, Suite 300, Portland, OR 97209, USA; Legacy Cancer Institute, Legacy Good Samaritan Medical Center, 1015 Northwest 22nd Avenue, Portland, OR 97210, USA. https://twitter.com/patelmddds
| | - Allen Cheng
- Providence Cancer Institute, Providence Portland Medical Center, 4805 Northeast Glisan Street, Suite 2N35, Portland, OR 97213, USA; Legacy Cancer Institute, Legacy Good Samaritan Medical Center, 1015 Northwest 22nd Avenue, Portland, OR 97210, USA. https://twitter.com/allenchengddsmd
| | - R Bryan Bell
- Providence Cancer Institute, Providence Portland Medical Center, 4805 Northeast Glisan Street, Suite 2N35, Portland, OR 97213, USA; Earle A. Chiles Research Institute in the Robert W. Franz Cancer Center, Providence Cancer Institute, 4805 Northeast Glisan Street, Suite 2N35, Portland, OR 97213, USA. https://twitter.com/rbryanbell
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Li CH, Wu CH, Lin CL. Design of a patient-specific mandible reconstruction implant with dental prosthesis for metal 3D printing using integrated weighted topology optimization and finite element analysis. J Mech Behav Biomed Mater 2020; 105:103700. [DOI: 10.1016/j.jmbbm.2020.103700] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/09/2020] [Accepted: 02/13/2020] [Indexed: 11/29/2022]
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Immediate Teeth in Fibulas: Planning and Digital Workflow With Point-of-Care 3D Printing. J Oral Maxillofac Surg 2020; 78:1320-1327. [PMID: 32404269 DOI: 10.1016/j.joms.2020.04.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/05/2020] [Accepted: 04/06/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE Point-of-care 3-dimensional (3D) printing has become more common in recent years because many hospitals have created 3D printing laboratories. Traditional techniques to fabricate an immediate dental prosthesis for fibula and implant reconstructions have involved outsourcing to dental laboratories. This results in delays, making it suitable only for benign disease. In the present report, we have demonstrated a technique for in-house creation of a 3D printed dental prosthesis for placement of implants at free fibula maxillofacial reconstruction. Our digital method has reduced costs and shortened the interval to surgery compared with traditional laboratory techniques. MATERIALS AND METHODS Twelve patients underwent free fibula reconstruction of the mandible or maxilla with immediate implants and immediate teeth. A dental implant-retained restoration was created before surgery for immediate placement at fibula reconstruction. For the first 5 patients, the prosthesis was fabricated by a dental laboratory after virtual surgical planning. For the next 7 patients, the prosthesis was designed by the surgeon and 3D printed via the in-house laboratory. Four of these in-house cases were performed for malignant disease with skin paddles. RESULTS All 12 patients received an immediate implant-retained fixed prosthesis at fibula reconstruction. The time required to generate the in-house 3D printed prostheses was significantly shorter than that required to create the dental laboratory-fabricated prostheses. The costs were also less with the 3D printed prostheses compared with the dental laboratory-fabricated prostheses. CONCLUSIONS The digital workflow we have presented eliminates the delay in creating a dental laboratory-fabricated provisional dental prosthesis for fibula and implant reconstruction. This allows for immediate dental restoration for patients with malignant disease previously considered unsuitable owing to the inherent delay required using an offsite dental laboratory. A decrease in cost to create in-house 3D printed prostheses was noted compared with the prostheses fabricated by a dental laboratory. Case selection is critical to predict the soft tissue needs for composite defects.
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Gileva KS, Adamyan RT, Arutyunov GR, Zolotareva AS. New approaches in jaw defect reconstruction with simultaneous maxillofacial rehabilitation. ACTA ACUST UNITED AC 2020. [DOI: 10.17116/plast.hirurgia202001130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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