Eye patch sandwich technique for stabilizing the intraoral skin graft to the cheek.

It is very important to secure skin graft in the defect of oral cavity. The tie-over bolster technique is the most common method for securing intraoral skin grafts. However, gauze is the best material as a bolster that can easily accumulate saliva and debris and cause odor and discomfort to the patient. We describe an alternative technique to stabilize intraoral skin graft between 2 aluminous eye patches and to readily keep the oral hygiene during the securing period.

Intraoral vertical ramus osteotomy for correction of mandibular prognathism: long-term stability.

Various techniques and modifications have been introduced in the treatment of mandibular prognathism. However, there are still few reports concerning long-term stability, especially using the intraoral vertical ramus osteotomy (IVRO) method. The purpose of this study was to investigate the long-term stability for correction of mandibular prognathism using IVRO. Twenty-five mandibular prognathism patients were treated by bilateral IVRO, and were evaluated cephalometrically by reference to the menton. A set of 3 standardized lateral cephalograms were obtained from each subject preoperatively (T1), immediately postoperatively (T2), and after 2 years postoperatively (T3). Relapse was defined as forward movement of menton after the 2-year follow-up. The mean setback of the menton was 12.8 mm in horizontal direction and 0.9 mm downward in vertical direction. The average follow-up was 33.9 months. The mean relapse was 1.3 mm (10.2% = 1.3 of 12.8) in forward direction and 0.6 mm in upward direction. There was no significant movement in the vertical direction. However, significant relapse was shown in the horizontal direction, even though the amount was small. The long-term stability of our present study suggested that IVRO is useful for correction of mandibular prognathism.

Importance of patient's cooperation in surgical treatment for oral submucous fibrosis.

PURPOSE: The aim of this study was to investigate the results of surgical treatment for oral submucous fibrosis (OSF) in patients who did or did not cooperate with the rehabilitation regimen. PATIENTS AND METHODS: There were 54 patients who had surgical treatment of trismus caused by OSF. Split-thickness skin grafts were used to repair surgical defects after surgery on the fibrous bands. According to postoperative collaboration in the rehabilitation regimen, patients were defined as non-cooperative patients (group I) and cooperative patients (group II). Group I (n = 28) and group II (n = 26) were analyzed separately for changes in preoperative, intraoperative, and postoperative interincisal distances (ID) for at least 6 months after surgery. RESULTS: The mean preoperative ID was 18.9 mm (range, 8 to 25 mm) in group I and 18 mm (range, 7 to 25 mm) in group II. The intraoperative ID increased to an average of 39 mm in group I and 38.5 mm in group II. The mean final follow-up ID was 22 mm in group I and 36.1 mm in group II. When evaluating the changes of ID, only a statistically significant difference was found at final visit between groups. CONCLUSIONS: In our study, we found the patient's cooperation is the primary requirement for success in the treatment of OSF.

The use of artificial dermis for surgical defects in the treatment of oral premalignant lesions.

BACKGROUND: This study investigated the application of an artificial dermis as a substitute for split-thickness skin graft in an oral mucosal defect after excision of a premalignant lesion. METHODS: We examined a total of 125 sites repaired with artificial dermis in 84 patients. Forty-one of 84 patients had two different defects and 43 had a single defect. Of 84 patients, there were 52 oral leukoplakia and 32 oral submucous fibrosis. RESULTS: Most patients chewed betel nuts (97.6%). Most of the premalignant lesions were located in the buccal mucosa (94%). The overall success rate was 100% without any or partial graft loss. The minor wound oozing occurred in three grafts (2.4%). No patient had an immunologic reaction or experienced with significant pain. CONCLUSIONS: Therefore, an artificial dermis may be an alterative to a split-thickness skin graft for patients with oral mucosal defects after removal of premalignant lesions.

Effective eradication of oral verrucous carcinoma with continuous intraarterial infusion chemotherapy.

BACKGROUND: We evaluated the effectiveness of intraarterial methotrexate infusion as a primary therapy for oral verrucous carcinoma (VC). METHODS: Fifteen male patients (mean age, 55 years) were included. By using an implantable port-catheter system and a portable pump, methotrexate was continuously infused to the external carotid artery for a mean period of 7.5 days (50 mg/day), followed by weekly bolus of methotrexate (25 mg) via intraarterial route for a mean period of 10 weeks. RESULTS: The tumor regressed dramatically and disappeared completely after treatment within a mean period of 2.5 months. All patients obtained complete remission and recovered without disfigurement. All patients were alive without disease recurrence at a median follow-up of 43 months. The side effects were tolerable. CONCLUSIONS: The results of our treatment modality for oral VC appear to compete favorably with the results of surgical series and even more with those of radiotherapy series.

Artificial dermis graft on the mandible lacking periosteum after excision of an ossifying fibroma: a case report.

Collagen-based grafts have often been used as artificial tissue substitutes for the repair of tissue and organ defects. It is common surgical knowledge that autogenous or artificial skin grafts take well on the intact periosteum of bone. However, many experienced surgeons indicate that autogenous or artificial skin grafts subsist poorly on the bone surface without periosteum. Therefore, primary closure is usually recommended in the wound healing of exposed bone. Vestibuloplasty might be needed to create enough depth of vestibule in the future. In this case report, we describe a peripheral ossifying fibroma surgically excised leaving a bony defect, which was covered by a piece of artificial dermis. Satisfactory result of the repaired surgical defect showed no need of vestibuloplasty after 6 years of follow-up.

The use of miniplate osteosynthesis for skeletal anchorage.

BACKGROUND: The purpose of this study was to explore the use of miniplates as skeletal anchorages for orthodontic treatment and to investigate the stability of miniplates and the causes of failure. METHODS: Forty-four miniplates were applied in the maxilla or mandible as skeletal anchorages in orthodontic treatment. Two weeks later, a force of 100 to 200 g was applied by an elastometric chain or nickel-titanium coil spring to move the teeth. To compare nominal variables related to miniplate failure, the chi-square or Fisher's exact test was used. RESULTS: The average insertion time of a miniplate was approximately 25 to 30 minutes. One miniplate loosened before orthodontic force loading. The other miniplate was removed after orthodontic force loading. The overall success rate was 95.5 percent. The authors found no significant differences in the risk factors for failure of miniplates. CONCLUSIONS: Miniplates are easy to insert for skeletal anchorage, simplify treatment mechanics, and shorten the orthodontic treatment period.

Skeletal changes after modified intraoral vertical ramus osteotomy for correction of mandibular prognathism.

BACKGROUND: Orthognathic surgery is widely used to correct congenital and acquired dentofacial discrepancies. Various surgical procedures have been advocated for correction of mandibular prognathism. In this study, a modified intraoral vertical ramus osteotomy has been developed for surgical correction of mandibular prognathism. The aim of this study is to identify contributing factors to skeletal change by analysing cephalometric changes after modified intraoral vertical ramus osteotomy. METHODS: Forty-one patients, treated for absolute mandibular prognathism by bilateral modified intraoral vertical ramus osteotomy, were evaluated cephalometrically with reference to the menton point. A set of four standardised lateral cephalograms were obtained from each subject preoperatively (T1) and immediately postoperatively (T2), prior to removal of maxillomandibular fixation (T3), and at 1-year postoperatively (T4). The mean setback of the menton was 12.4 mm in the horizontal direction. Relapse was defined as forward movement of the menton during the 1-year follow-up. RESULTS: The highly significant backward movements in a horizontal direction were observed during the maxillomandibular fixation period (T3-T2). Moreover, highly significant forward movement was observed following the maxillomandibular fixation period (T4-T3). After 1-year follow-up (T4-T2), the mean changes of the menton were 0.1 mm backward in the horizontal direction. CONCLUSIONS: In this series, the mean skeletal change compared with the amount of setback was less than 1% (0.1/12.4 mm) in backward movement. The results suggest that the modified intraoral vertical ramus osteotomy technique is useful and the more stable approach for correction of severe mandibular prognathism.

The use of microimplants in orthodontic anchorage.

PURPOSE: Various types of temporary implants have been introduced to serve as orthodontic anchorage. The hypothesis of this study is that microimplants of 1.2 mm diameter can be used as orthodontic anchors, and that their success is related to their length. The aim of this study is to determine the incidence of anchor retention after orthodontic force application for moving teeth, and to determine the relationship of microimplant length to retention rate. METHODS: Fifty-nine microimplants (diameter: 1.2 mm) were placed in 29 patients as orthodontic anchorages. After 2 weeks of microimplant placement, a force of 100 to 200 g was loaded with an elastometric chain or NiTi coil spring. Risk factors were characterized as to why a microimplant may fail, and Fisher's exact test was used for statistical analysis. RESULTS: Nine microimplants were removed and the overall success rate was 84.7%. Exploring the causes for failure, we found significant differences between the length of microimplants and success rate; 6 mm was 72.2% and 8 mm was 90.2%. CONCLUSIONS: The results suggest that microimplants are suited as an alternative orthodontic anchorage. We recommend that 8-mm microimplants are preferable to 6-mm.

Donor site morbidity after harvesting of proximal tibia bone.

BACKGROUND: Bone-grafting procedures are common in head and neck surgery. Donor site morbidity is an important factor in deciding the site for harvest of cancellous bone. The tibia has been recommended as a harvest site. Use of the proximal tibia as a donor site is associated with few complications. Our present study used proximal tibia bone grafts to reconstruct maxillofacial defects and augment bone volume for implantation. METHODS: A retrospective study was undertaken to analyze 40 proximal tibia bone grafts in maxillofacial reconstruction. Minimal follow-up was 6 months. RESULTS: There were no major complications during the follow-up period. Early minor complications (15%) included temporary sensory loss and ecchymosis. Late minor complication (2.5%) was gait disturbance for 2 months. Long-term minor complication (2.5%) was an unsightly scar. CONCLUSION: The procedure for proximal tibia bone graft is easy, has less operative risk, and results in a lower postoperative morbidity rate. Based on our findings, we believe the proximal tibia offers a reliable site for harvest of sufficient quantities of good-quality cancellous bone.

Comparison of deltopectoralis flap and free radial forearm flap in reconstruction after oral cancer ablation.

Defects in the head and neck resulting from ablation of oral cancer frequently lead to disabling functional and cosmetic deformities. Rehabilitation of patients with oral cancer can be an emotionally and technically challenging endeavor. Selection of the donor tissue is clearly dependent upon the defect that is to be reconstructed. The donor tissue should be of sufficient bulk and pliability to facilitate reestablishing contour and function. Regional flap and free flap have been the mainstays of reconstruction for surgical defects after ablation of oral cancer. The records of 77 patients in whom 49 deltopectoral (DP) flaps and 28 free radial forearm flaps (FRFF) were used were analyzed. The success rate of the DP flap was 89.8% and of the FRFF was 96.4%. The minor complication rate at the transplant site (fistula, dehiscence, hematoma) for the DP flaps was 22.4% and for the FRFFs was 14.3%. Overall complication rate at the transplant site for DP flaps was 32.7% and for the FRFFs was 17.9%. The incidence of partial loss of the donor-site skin graft was 4.1% for the DP flaps and 10.7% for the FRFFs. Overall complication rate at the donor site for DP flaps was 10.2% and for the FRFFs was 39.3%. DP flaps had better aesthetic and functional results at the donor site, than FRFFs. However, the DP flap is a staged procedure and results in prolonged hospitalization. In contrast to FRFF, performing a DP flap avoids the difficult technique of microanastomosis, and therefore reduces the donor-site complication rate and the operation time. Therefore, free flaps can not be routinely substituted for regional flaps, but they represent better reconstructive alternatives for specific and selected patients.

Complications of free radial forearm flap transfers for head and neck reconstruction.

Free tissue transfer using microvascular anastomosis has been established as an accepted maxillofacial reconstructive procedure. The free radial forearm flap (FRFF) has become a workhorse flap as a means of reconstructing surgical defects in the head and neck region. Since 1992, we have carried out 38 FRFF transfers in 37 patients for reconstruction after head and neck cancer ablative surgery. We present our clinical experience with head and neck reconstruction using the FRFF and the morbidity of the donor sites. Of the 38 FRFFs, 35 FRFFs were performed successfully. The survival rate of FRFF was 92%. Donor site complications included partial loss of skin graft in 4 donor sites (11%), abnormal sensations in 10 (26%), poor appearance in 3 (8%), and reduced grip strength in 4 (11%). Therefore, we believe that, because of the reliability, functional characteristics, and low donor site morbidity, the FRFF is a useful and versatile flap for reconstruction of head and neck defects.

Clinical evaluation of a new bilayer artificial dermis for repair of oral mucosal defects: report of two cases.

Free mucosal grafts or split-thickness skin grafts have been used in patients undergoing repair procedures for oral mucosal defects. Conventional methods require the creation of second surgical wounds for use as donor sites. We applied two bilayers of artificial dermis to repair a buccal mucosal defect in one case and vestibular extension in another case. After removal of the sutures, no infection, pain, or hemorrhage developed in these patients. The results of granulation and epithelialization were good. Satisfactory appearance and function were achieved in both cases. Therefore, bilayer artificial dermis may be recommended for the repair of oral mucosal defects.

Interdisciplinary management of dental implant patient: a case report.

Maxillary molars can over-erupt when their antagonists are lost and there are no replacements. When the opposing molars severely extrude into the edentulous space, it is difficult to replace the missing teeth with either fixed or removable prostheses. We present the following case report, providing a solution for this type of problem. A two-stage posterior subapical osteotomy was used to reestablish the intermaxillary space. Following orthodontic treatment and implant placement, the patient regained occlusal harmony and normal masticatory function.