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PubMed2002

[The FAMI screw for temporary intermaxillary fixation. Report of experiences for extending indications].

The aim of this study was to demonstrate the suitability of the FAMI screw (fixation and adaptation in mandibular injuries) for maxillomandibular fixation in the maxillofacial area in orthognathic and trauma surgery. This FAMI screw was used in 28 patients for maxillomandibular fixation with wiring or elastics. The screw is inserted into the labial or buccal surfaces of the alveolar process without predrilling. Adequate intermaxillary fixation with balanced occlusion was created intraoperatively in all patients. In comparison with conventional splinting methods, this technique was far less time-consuming. The use of the FAMI screw has the advantage of being quick and simple, particularly if only a brief period of maxillomandibular immobilization is planned. Furthermore, the risk to the surgeon of sustaining a puncture injury from wire ligatures is distinctly reduced. Screws can be removed without local anesthesia. The above-mentioned method is minimally traumatic, effective, timesaving, and hence inexpensive. It can be used for maxillomandibular immobilization in dentate as well as in edentulous patients.

Bone Screws↗
PubMed1982

Titanium tray mandibular reconstruction.

Mandibular reconstructions still present a difficult and challenging problem. Failures experienced in using rib or iliac bone grafts stimulated clinical and research activities in evaluating the following new techniques: composite myocutaneous bone flaps, bone transplants with microvascular anastomoses, and freeze-dried homografts. This article describes the usefulness of the titanium tray with or without cancellous iliac bone grafts for mandibular reconstruction. The series presented herein includes 12 patients who underwent mandibular reconstruction after trauma or ablative cancer surgery, No immediate or delayed extrusion of the titanium tray was observed with follow-up as long as eight years after surgery. Advantages and disadvantages of this technique will be discussed.

Bone Transplantation↗
PubMed1984

The cheek-neck rotation flap for closure of temporozygomatic-cheek wounds.

The head and neck surgeon is often consulted for evaluation and treatment of traumatic or neoplastic lesions of the lateral aspect of the face. Large malignant cutaneous lesions may require excision with wide margins, often parotidectomy, and possibly neck dissection. Traumatic lesions may involve notable soft-tissue loss, and parotid, facial nerve, or mandibular injury. Management of such planned or unplanned wounds challenges the surgeon due to the magnitude of the soft-tissue defect, cosmetic and functional considerations, and the need for soft-tissue protection and nourishment of repaired structures. Primary reconstruction with a large cheek-neck rotation flap provides the advantages of reliability, simplicity, excellent exposure, vital-structure protection, superior aesthetic results, and eliminates the need for a second operative site to harvest skin grafts or distant flaps. Four illustrative cases are reported, with a discussion to address parotid metastases from carcinoma of the lateral aspect of the face and initial treatment of shotgun injuries to the face.

Adolescent↗
PubMed1986

Dacron mesh tray and cancellous bone in reconstruction of mandibular defects.

We used a Dacron-urethane mesh tray filled with cancellous bone for mandibular reconstruction in 17 patients. Five patients with traumatic defects and two with benign tumors developed solid, functional mandibles. Among ten patients with squamous cell carcinoma, eight had successful reconstruction; one required a second procedure. Mandibles of two of three patients with osteoradionecrosis were successfully reconstructed, but only one of three primary reconstructions was initially successful. The Dacron-urethane mesh tray has the advantage of being stiff but malleable. It easily fits the defect, is radiolucent, and may be used either before or after radiotherapy. We recommend delayed reconstruction, adequate soft-tissue coverage, good immobilization of the mandible, no intraoral contamination, especially with osteoradionecrosis, and hyperbaric oxygen in patients who have been irradiated or have osteoradionecrosis.

Adult↗
PubMed1991

Oromandibular reconstruction using microvascular composite free flaps. Report of 71 cases and a new classification scheme for bony, soft-tissue, and neurologic defects.

We describe 71 cases of oromandibular reconstruction using microvascular composite free flaps. There was an overall flap success rate of 94%, while 97% of the patients in this series had their mandibles reconstructed with free vascularized bone flaps. Fifteen patients were rehabilitated with implant-borne dental prostheses. Primary repair of discontinuity defects of the inferior-alveolar nerve using a variety of nerve grafts was performed in 16 patients. A new classification scheme for composite defects of the oral cavity involving bone, soft tissue, and neurologic defects is proposed and applied in the description of each of the patients in this series.

Adult↗
PubMed1993

Long-term stability of two different mandibular bridging systems.

To evaluate the benefits of narrow-beam roentgenography and spiral tomography for examination and monitoring of screw and plate fixation to bone we studied 22 rigid plate bridgings of mandibular defects. The plate reconstructions were of long duration or considered permanent. In 13 patients, AO-THORP (AO: Arbeitsgemeinschaft für Osteosynthesefragen; THORP: Titanplasma-beschichteten Hohl- und Vollkern-Rekonstruktionsplatten-Systems) reconstructions were used and in nine classic AO stainless steel plate bridgings. With the AO-THORP system, good bone apposition to the screws was evident in 96% (73/76 screws) of the cases. Fixation using the classic AO screws, however, was inadequate in 30% (20/66 screws) of the cases. Plate loosening was noted in 56% (5/9 plates). Examination using narrow-beam roentgenography and spiral tomography provided detailed information about bone resorption around the screws and provided a reliable tool for deciding on a follow-up regimen. When complications occur, they can be detected and treated early, reducing patient morbidity. In our opinion, classic AO plate bridging should always be considered temporary.

Bone Plates↗
PubMed2006

Single osteotomized iliac crest free flap in anterior mandible reconstruction.

While the iliac crest flap provides a natural contour for the lateral segment of the mandible, for the anterior segment en bloc, the use of the iliac graft, even harvested in a V shape, fails to yield a three-dimensional natural-shaped reconstruction. In this report, we present our experience with reconstruction of the anterior segment of the mandible using a single osteotomized free iliac crest flap in 5 patients. The study comprised 4 male patients and 1 female patient, their ages ranging between 34-82 years. In all patients, composite iliac osteomusculocutaneous flaps were harvested based on the deep circumflex iliac artery in the standard manner, and the bony segment of the flap was divided into two segments, performing a single osteotomy. The fixation of bone segments was performed in new positions, sliding the segments in different planes to provide the original shape of the resected mandible segment, and in a manner appropriate to the defect. The overall flap success rate was 100%. In no cases were wound infections or hematomas observed. X-rays showed bone healing without resorption. In conclusion, the use of a single osteotomy for an iliac crest flap in the reconstruction of the anterior segment of the mandible is a simple and safe procedure, and provides a natural and acceptable jaw appearance. The risk of devascularization is quite low when compared with the multiple osteotomy procedure, and it does not need to be fixed with complex devices such as reconstruction plates or external fixators.

Adult↗
PubMed1985

The serratus anterior/rib composite flap in mandibular reconstruction.

A flap comprising the serratus anterior muscle and the underlying rib, based on the serratus branches of the thoracodorsal artery has been developed. In addition to the rib the potential exists to include a cartilaginous growth centre, a functional muscle and/or overlying skin. A latissimus dorsi musculocutaneous unit can be included on a common pedicle. This paper describes its use as both a free and a pedicled composite unit in mandibular reconstruction. The surgical anatomy of the flap is reviewed and cases are shown to illustrate its use in the treatment of congenital, malignant and post-traumatic conditions where reconstruction of the lower jaw is required.

Adolescent↗
PubMed1994

Use of complete dentures to stabilize a segmentally resected mandible: a clinical report.

Although edentulous patients with a midline segmental resection of the mandible can rarely be treated prosthodontically, this patient's dental condition was managed with some success. This success may be related to preservation of the floor of the mouth with graft. By maximum extension of the denture borders and an interlocking occlusion, a mutual stabilization of the residual segments and the denture was achieved in the static condition, which improved swallowing, control of drooling, and self-esteem. Because of the independent muscle function of each side of the mandible, mastication could not be restored adequately.

Chin↗
PubMed1984

Results of bone grafting after rigid fixation.

Results of bone grafting in ten cases of primary mandibular reconstruction using rib grafts and 62 cases of secondary mandibular reconstruction using iliac bone grafts or rib transplants are reported. Two (20%) of the primary transplants were lost and one of the secondary transplants was totally lost and another was partially lost (3.2%) because of infection. All other transplants healed without infection. Pseudarthrosis was observed in 30% of the cases after primary reconstruction and in 15% of the cases after secondary reconstruction.

Bone Plates↗
PubMed1990

Reconstruction of mandibular discontinuity with autogenous iliac bone graft: report of 34 consecutive patients.

This article reviews 34 consecutive reconstructions of mandibular discontinuity defects done between 1972 and 1988. All reconstructions were performed secondarily with use of free iliac crest bone grafting. The technique is described, three cases are presented in detail, and results for the entire series are tabulated. These results show a 100% graft incorporation rate along with low overall morbidity.

Adolescent↗
PubMed1994

Peripheral osteoma of the mandible: a study of 10 new cases and analysis of the literature.

Ten new cases of peripheral osteoma of the mandible are described. These lesions are uncommon and only 15 other cases have been reported in the English language literature over the past 30 years. There is evidence to suggest that the peripheral osteoma of the mandible is a traumatically induced reactive lesion and that muscle traction plays a role in its initiation. In view of this possibility, the term "parosteal osseous hyperplasia" may be more appropriate for those lesions in which a positive history of trauma preceded the onset.

Adolescent↗
PubMed2005

Fixation of a talar osteochondral fracture with cyanoacrylate glue.

Cyanoacrylate glue was invented by Ardis in 1949 and was first used in surgery in 1959 by Coover. By further modifications, a nonhistotoxic form, butyl-2-cyanoacrylate, which had strong tissue binding properties even in nondry environments, was developed. Its use in the fixation of fractures and osteotomies is still under investigation and has had promising results in treatment of craniofacial and mandibular injuries. We fixed a talar osteochondral fracture with cyanoacrylate. After 3 months, magnetic resonance imaging showed an anatomically reduced and intact chondral surface. The clinical result was excellent. We believe cyanoacrylate glue may form an alternative means of fixation for osteochondral and, possibly, for chondral fractures.

Accidental Falls↗
PubMed1996

Mandibular reconstruction with full thickness calvarial bone and temporal muscle flap.

Eleven patients underwent mandibular reconstruction with pedicled temporal muscle flaps combined with vascularised or free full thickness calvarial bone grafts. Six were primary and five secondary reconstructions. The indications were squamous cell carcinoma (n = 6), radio-osteonecrosis (n = 4), and gunshot wound (n = 1). Five patients also had endosseus implants, either simultaneously or delayed. The only major complications were necrosis of the whole calvarial bone (n = 1) and permanent facial nerve palsy (n = 1). The advantages of using full thickness calvarial bone are that it is thick enough to take an endosseous implant, morbidity is low, there is virtually no postoperative pain, the scar is invisible, and there is only one donor area for both hard and soft tissue. Transplantation of full thickness calvarial bone and temporal muscle is a viable alternative to an osseomyocutaneous microvascularised free flap for reconstruction of the mandible when the neck has been previously operated on or irradiated, and anastomosis may be critical.

Adult↗