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PubMed1983

[Substitution of mucous membrane in the oral cavity by a free small intestine transplant following tumor resection].

A series of eight free microvascular jejunal transfers for reconstruction of the inner lining of the mouth is reported. The technical details are discussed and especially the radical approach for the removal of the tumors are presented. Anatomical variations of the vessels to the jejunal graft are demonstrated. The high success rate and the fast recovery of the patients are supporting the indication of this microvascular procedure.

Adolescent↗
PubMed1989

Primary placement of osseointegrated implants in microvascular mandibular reconstruction.

The goal of mandibular reconstruction is to rehabilitate the patient by restoring occlusal relationships, lower facial contour, oral continence, and a denture-bearing surface. One of the major advantages of the use of vascularized bone over all other methods of mandibular reconstruction is its ability to achieve dental rehabilitation rapidly. The use of osseointegrated dental implants is a valuable adjunct in oral rehabilitation. It provides the most rigid form of stabilization to withstand the forces of mastication. In situations in which soft tissue reconstruction or the height of the alveolar ridge is not sufficient for a tissue-borne denture, implants offer the most suitable alternative. Mandibular reconstruction with free tissue transfer techniques is ideally suited for the placement of implants. These can be inserted at the time of mandibular reconstruction. Four months after surgery, when the integration process has occurred, the implants are unroofed, loaded, and ready for prosthetic placement. We will present several representative patients who underwent mandibular reconstruction with microvascular free bone transfer who have been successfully rehabilitated by osseointegrated implants. The process of osseointegration, different types of dental implants, and issues regarding radiation and implants are discussed. This is the first report of dental rehabilitation by primary placement of dental implants in patients undergoing microvascular mandibular reconstruction.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed1987

[Reconstruction following anterior sulco-mandibulectomy. The advantages and disadvantages of different procedures. Apropos of 85 cases].

A retrospective study was conducted on 85 case-reports of patients with epithelioma of anterior and anterolateral region of floor of mouth operated upon in the Stomatology and Maxillofacial Surgery Clinic of Salpêtrière hospital, Paris. An update review of recent advances in surgery for reconstruction of floor of mouth is completed by results of study of the case-reports showing evolution of ideas related to functional results and to vital prognosis (as function of tumoral stage).

Adult↗
PubMedDate not supplied

Mandibular reconstruction: bone graft techniques.

Results of treatment in a series of 60 patients undergoing mandibular reconstruction by a variety of methods are reported. Delayed reconstruction was performed, using a titanium mesh tray with cancellous bone fragments and block bone grafts removed from the iliac crest, rib, and mandible in 34 patients, with an overall success rate of 91%. Immediate reconstruction was performed with a wire mesh prosthesis containing particulate bone and composite flaps in 26 patients, with an overall success rate of 46%. Oral contamination of the graft at the time of surgery appeared to be the factor limiting the success of immediate mandibular reconstruction. Block grafts of bone were extremely reliable in reconstituting the continuity of the mandible when inserted through an extraoral approach as a delayed repair. Mandibular reconstruction was successfully accomplished even following high-dose radiotherapy.

Bacterial Infections↗
PubMed1994

Endosteal implants following tumor surgery and avulsive trauma.

Endosteal implants are part of the reconstructive armamentarium used by head and neck surgical teams in cases of trauma or tumor ablation when inadequate residual anatomy prevents the fabrication of a traditional prosthesis. Three cases of implant supported prosthesis have been presented. Use of endosteal implants is an additional step toward functional reconstruction.

Accidents, Traffic↗
PubMed1976

Reconstruction after mandibulectomy for cancer.

Reconstruction after mandbulectomy for cancer presents a major problem in head and neck surgery. This study reports the experiences with a planned staged method of reconstruction that aims at both cosmetic and functional rehabilitation and that is based on a close cooperation between surgeon and prosthodontist. Stabilization of the remaining mandibular fragments by means of intermaxillary fixation at the time the tumor is resected, delayed bone grafting, and preprosthetic surgery to allow the use of a functional denture are the high points of the method. The results in 58 patients are discussed.

Alveoloplasty↗
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↗
PubMed1988

Use of the Kirschner wire for mandibular reconstruction.

An adaptation of the Kirschner wire, using tie wires for fixation of the Kirschner wire in primary mandibular reconstruction following ablative surgery, is described. Eighteen patients with a Kirschner wire serving as a prosthesis following mandibular resection were followed up. Except for three patients, who had extensive resection of the tongue, all patients were judged as having satisfactory mastication and deglutition. Only two patients required another operation for wire-related complications. The Kirschner wire, when modified as presented, proved a dependable and stable prosthesis for mandibular reconstruction.

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↗
PubMed1997

Factors involved in long- and short-term mandibular plate exposure.

OBJECTIVES: To evaluate and to compare rates and timing of exposure of alloplastic mandibular plates by plate type and tissue reconstruction technique. DESIGN: A retrospective review series of 92 consecutive patients for 4 years (mean follow-up, 30 months). SETTING: National Cancer Institute-designated comprehensive cancer center in a freestanding cancer hospital. PATIENTS: Seventy-nine patients received alloplastic mandibular plates for segmental defects, and 13 patients received compression plates for mandibular osteotomies following ablative cancer surgery, including 21 titanium hollow osseointegrating reconstruction, 41 Storz, 16 Synthes, and 5 AO/ASIF (Arbeitsgemein schott fur Ostcosynthese fragen/Association for the Study of Internal Fixation) plates. Primary flap repair was provided by 71 pedicled soft tissue and 19 osseocutaneous free flaps, with primary closure in the remaining 2. INTERVENTION: Most of the reconstructions of the mandibular defect was with an alloplastic plate with musculocutaneous flap or revascularized bone graft. OUTCOME MEASURES: Clinically apparent intraoral or extraoral plate exposure. RESULTS: Plate exposure occurred in 25 cases. Nine plates were exposed extraorally, at a mean postoperative interval of 40 weeks. The remaining 16 plates were exposed intraorally at a mean postoperative interval of 16 weeks. There was no significant difference in the exposure rates of different plate types or methods of reconstruction. The titanium hollow osseointegrating reconstruction plate had a similar exposure rate compared with the other plates. Size and site of the defect were the only significant predictors of plate exposure Radiotherapy and postoperative complications did not affect the rate of exposure. CONCLUSIONS: Extraoral plate exposure occurs less commonly and later in the postoperative period than intraoral exposure, suggesting different causes. Plate type and type of flap reconstruction do not affect the rate of exposure. This may reflect long follow-up.

Bone Plates↗
PubMed1998

Cytological features of malignant metastatic ameloblastoma: a case report and differential diagnosis.

In this report, the cytological features and differential diagnosis of the metastasis from and subsequent local recurrence of an unusual case of malignant (metastatic) ameloblastoma are described, with histological confirmation. Characteristic cytological findings included fibrovascular central cores surrounded by palisading crowded basaloid or columnar cells or both and rosette-like structures of tumor cells with central fibrillary material. Keratin debris in the background and cystic cavities were prominent components of the metastatic ameloblastoma. The basaloid cells showed scant-to-absent cytoplasm, round-to-oval to tear-shaped nuclei, rare longitudinal nuclear grooves, single or multiple nucleoli, and smooth-to-clefted nuclear contours. No features to predict malignant behavior were identified (abundant mitotic activity, necrosis, nuclear pleomorphism). The cytological features of ameloblastoma appear to be characteristic enough to allow definitive diagnosis. However, since the cytology of this tumor is underreported in the literature, the unwary observer could easily misdiagnose it, especially at metastatic sites.

Ameloblastoma↗
PubMed2004

Comparison of miniplates and reconstruction plates in mandibular reconstruction.

BACKGROUND: The aim of this study is to compare complication rates of miniplates versus reconstruction plates in the fixation of vascularized grafts into segmental mandibular defects. METHODS: Retrospective analysis of 143 consecutive successful microvascular composite flaps performed between 1993 and 2001 was performed. Data were gathered from a computerized database, case notes and pathology reports. Complications were classified as dehiscence, infection, plate or bone removal. RESULTS: In the series, 49% of patients received miniplates, and 51% received plates. No significant differences in complication rates were found between those grafts fixed with miniplates (27%) and those with reconstruction plates (30%). Plate choice was primarily determined by consultant preference. No significant differences were found in patient, defect, treatment, or follow-up characteristics between the plate groups. Twenty-nine percent of patients had at least one late complication at the reconstructed site, and this was higher (39%) in those who had postoperative radiotherapy. CONCLUSIONS: No evidence was found in this study that the increased rigidity offered by reconstruction plates influences the rate of plate or bone removal, infection, or plate exposure. Thus, the decision to use reconstruction or miniplates is not dependent on the rate of plate complications.

Adult↗