Reverse facial artery-submental artery deepithelialised submental island flap to reconstruct maxillary defects following cancer ablation.

OBJECTIVE: The present study assessed the reliability of the reverse facial artery-submental artery deepithelialised submental island technique to reconstruct maxillary defects. METHODS: The study included 13 patients (9 men and 4 women; 43-62 years) with maxillary defects resulting from cancer ablation. Ten patients presented with maxillary gingival squamous cell carcinoma and the remaining 3 cases were hard palate squamous cell carcinomas. The maxilla was resected and the remaining defects were classified as Class 2a. Reverse facial artery-submental artery deepithelialised submental island flaps measuring 8-10 cm in length and 4-5 cm in width were used to reconstruct the defects. RESULTS: Twelve of the 13 flaps survived. No donor-site problems or palsy of the marginal mandibular branch of the facial nerve occurred. The follow-up period ranged from 8 to 24 months, 1 patient died as a result of local tumour recurrence and 2 patients developed cervical recurrence. CONCLUSION: The reverse facial artery-submental artery deepithelialised submental island flap is safe, quick and simple to use or elevate. The flap is a reliable technique for reconstructing maxillary defects following cancer ablation.

Management considerations in reconstruction of postablative defects of the mandible: vertical distraction of a scapular bone flap and removable lip support: a case report.

OBJECTIVE: To describe vertical distraction osteogenesis of a scapular flap and removable lip support for oral rehabilitation after surgical creation of an ablative defect of the mandible. CASE REPORT: A 70-year-old man who was diagnosed with squamous cell carcinoma of the left lower gingiva underwent segmental mandibulectomy for tumor ablation and reconstruction with a scapular bone flap. To augment bone height of this flap, vertical distraction osteogenesis was performed. After denture fabrication, a removable lip support was placed between the implant-supported denture and the lower lip. RESULTS: The bone height of the scapular bone flap increased by 9 mm. Implants with adequate length could be placed in the distracted bone. The lip support was effective. Two years after masticatory loading, the implants remained stable. CONCLUSION: Vertical distraction osteogenesis of the scapular bone flap was suitable to facilitate postoperative functional and esthetic restoration after tumor resection. A removable lip support was also useful as a supplementary tool for oral rehabilitation.

Rehabilitation of an irradiated mandible after mandibular resection using implant/tooth-supported fixed prosthesis: a clinical report.

Patients undergoing mandibular resection often have facial asymmetry and cosmetic disfigurement, which include a retruded, deviated mandible, motor and sensory deficiencies, and abnormal intermaxillary relationship and occlusion. An implant-supported fixed prosthesis can be an optimal treatment modality. However, there is a problem in creating a repeatable, stable plane of occlusion and maxillomandibular relationship. This report describes the treatment sequence and considerations to rehabilitate a patient undergoing mandibular resection and radiotherapy with an implant-supported fixed prosthesis.

Successful free osteocutaneous scapular flap transfer for mandibular reconstruction in a 93-year-old patient.

With the extension of the average life span and the development of surgical technique, anesthesia, and pre- and postoperative management, operations for elderly patients have become more widely accepted. In the field of plastic surgery, free-flap transfers using microvascular techniques have become a common surgical procedure in reconstruction of the head and neck region after surgical removal of a cancer. There have been several reports of free-flap transfer in patients older than 90 years, but the authors know of no reports of free osteocutaneous flap transfer for mandibular reconstruction, which is a very invasive free-flap surgery, for such patients. The mandible plays a significant role in various kinds of dynamic functions, such as mastication, deglutition, and articulation. Disorder of these functions causes a deterioration in the patient's quality of life. The authors have performed a mandibular reconstruction using an osteocutaneous scapular free flap after resection of a gingival cancer invading the mandibular bone in a 93-year-old Japanese woman. In our case, an osteocutaneous scapular free flap, which permits the patient rapid rehabilitation of the lower leg, is thought to be a good choice because it allows the patient to get out of bed as quickly as possible in the postoperative period to minimize additional complications.

Reconstruction of intraoral defects after cancer surgery using cervical pedicle flaps.

PURPOSE: This article reports the results of using cervical myocutaneous flaps for reconstruction of small- and medium-sized oral defects. PATIENTS AND METHODS: One hundred thirty-one cervical pedicle flaps were used for reconstruction of the defects after resection of oral cancer. Primary sites of the lesions were the tongue, buccal mucosa, floor of the mouth, and lower gingiva. RESULTS: Infrahyoid myocutaneous flaps were used in 53 cases, sternocleidomastoid flaps in 47 cases, and platysma flaps in 31 cases. Among the 131 patients, there was complete necrosis of the skin paddle in 5 cases and partial necrosis in 7 cases. The success rate was 92.5%, 89.4%, and 90.3%, respectively for the 3 types of flaps. CONCLUSIONS: It was concluded that cervical pedicle flaps have clinical value in selected patients needing reconstruction of small- and medium-sized defects after intraoral cancer surgery.

Excision and repair of the peripheral ossifying fibroma: a report of 3 cases.

BACKGROUND: The peripheral ossifying fibroma (POF), one of the most common gingival lesions, has a recurrence rate of nearly 20%. To minimize the reappearance of this lesion, it must be completely excised. In the maxillary anterior region, total excision of a POF can result in an unsightly gingival defect. METHODS: Three cases are presented in which a POF was excised from the gingiva facial to a maxillary central incisor. One of these lesions had previously undergone 2 cycles of conservative excision and recurrence. In all cases, the lesions were excised down to bone. Each of the resulting gingival defects was repaired by a distinct plastic surgery procedure, including a laterally positioned flap, a subepithelial connective tissue graft, and a coronally positioned flap. RESULTS: The defects resulting from the biopsies were satisfactorily repaired. The patients were followed over postsurgical intervals of 10 to 30 months. None of the lesions recurred. CONCLUSIONS: It is customary to manage POF by aggressive excisional biopsy. Several different surgical approaches may potentially be used to repair the resultant gingival defect and minimize patient esthetic concerns.

Microvascular free tissue transfer in oral and maxillofacial reconstruction.

Forty-two patients with head and neck cancer were submitted to microvascular reconstructive procedures. We divided patients in three groups; a first group of 30 patients, in whom the oral floor (8 patients), the part of tongue (14 patients), the lower gingiva (6 patients) and the oropharynx (2 patients) were reconstructed using various sizes of forearm flaps; a second group of 7 patients who underwent buccal mucosa reconstructions with the forearm flaps; and a third group of 5 patients who received rectus abdominis flaps for total tongue reconstruction. Three illustrative cases, one from each group, are presented in detail. Good results were obtained in 39 patients (94%), with both functional and morphological rehabilitation. There were three flap losses due to thrombosis of the microvascular anastomoses. There was no surgical mortality. The average operating time was about 10 hours in total. We concluded that there is a place for these complex procedures in the treatment of selected cases of head and neck tumors.

The 'fixed' removable partial denture: report of case.

Careful monitoring of tissue that had been the site of three previous surgical procedures was necessary, but the patient needed a functional, esthetically acceptable prosthesis. The Andrews bridge was selected because it combines the stabilizing qualities of a fixed prosthesis with the accessibility to the tissues of a removable prosthesis. The recurring nature of the verrucous carcinoma along with extensive tissue loss were additional factors in selecting this appliance. The final results satisfied all the criteria. The patient has been seen at regular follow-up visits for 2 years since the last surgical procedure and there has been no clinical change in the previously involved tissue. The patient has tolerated the prosthesis well and is satisfied with her appearance.