RESUMEN
Total glossectomy defects resulting from postoncologic resection are commonly reconstructed with locoregional or free flaps. However, effectively managing complications that may arise after reconstruction can be a significant challenge. We present a unique case series describing prosthetic management of flap-related complications following glossectomy in patients treated for locally advanced tongue cancer. Three patients underwent total glossectomy, neck dissection, reconstruction using free flap, and tracheostomy. Two patients developed an intraoral fistula located in the anterior region of the floor of the mouth. The third patient developed a flap failure requiring a second procedure using a pectoralis major myocutaneous flap for correction of the orocutaneous fistula that ultimately did not heal. Mandibular obturator prostheses lined with a soft liner were fabricated for all the patients, which helped reduce salivary incontinence and improve swallowing and speech. This case series highlights that a collaborative interdisciplinary team approach is crucial for optimizing postoperative function and outcomes when managing complications from reconstructive procedures.
RESUMEN
STATEMENT OF PROBLEM: Several mandibular defect classifications after oncological resection have been proposed with no universal acceptance among surgeons and prosthodontists. Established criteria for describing these mandibulectomy defects are lacking. PURPOSE: The purpose of this systematic review was to analyze the classification systems of mandibular defects available in the scientific literature, provide a critical appraisal, and identify the criteria necessary for a universal description of mandibular discontinuity defects. MATERIAL AND METHODS: An electronic search of the English language literature between 1971 and 2020 was performed on 2 electronic databases (PubMed and Cochrane Library). The search was conducted using MeSH terms and free text words: Mandible neoplasm AND Mandibular reconstruction OR Mandible resection OR Mandible defect AND classification, followed by the application of inclusion and exclusion criteria. Studies describing the classification of osteoradionecrosis of the mandible, mandibular fracture, impacted mandibular third molar, and mandibular endodontic or periodontal treatment were not included. The full texts of selected articles were reviewed in depth to provide a critical appraisal. The various descriptive factors of each classification system were tabulated to identify criteria suitable for the universal description of mandibular discontinuity defects. RESULTS: The electronic search yielded a total of 239 titles and abstracts. Of these, 52 titles relevant to the review were identified by the 2 reviewers independently. Those studies that did not match the predetermined inclusion criteria and duplicates were excluded. By reviewing the 21 selected studies and applying exclusion criteria, 12 studies were selected for full-text reading. A manual search in the references of the selected publications was performed, which yielded 1 additional article that satisfied the inclusion criteria. Thus, a total of 13 full-text articles were included in the final review. After further qualitative analysis and tabulation of relevant information from selected classification systems, the 8 descriptive criteria and a pyramidal hierarchical chart were proposed that included the extent of bony defect, soft tissue defect, dental status, mandibular function, neurological status, condyle status, type of reconstruction, and combined resection. CONCLUSIONS: The spectrum of patients with mandibulectomy defects following resection varies greatly. The question of the most ideal classification system remains unresolved. Eight different criteria for the description of mandibular discontinuity defects and the pyramidal hierarchical chart proposed will allow surgeons and prosthodontists to better communicate and conceptualize an individualized surgical and prosthetic treatment plan.
RESUMEN
AIM: This study was conducted to compare and evaluate the effect of three abutment-implant connections on stress distribution around three different implants under similar material properties and loading condition using finite element analysis (FEA). MATERIALS AND METHODS: Three different types of implant-abutment connections were selected. The features of these connections are Sample A: Tri-channel internal connection (Nobel Biocare); Sample B: Internal conical-hex Morse Taper (ADIN); and Sample C: Internal octa-Morse taper method (Osstem). The following softwares - ANSYS Version: 14.5 for FEA; Meshing software: Hypermesh 11; and CATIA: to produce computerized models of implants and for mandibular modeling were used. The implants were scanned with a high-quality scanner. All the above data were used to produce computerized models by CATIA software. Within the implant system, finite element method modeling was performed by implementing bonded conditions on the abutment-implant interfaces implementing four different load conditions. The computerized model was transferred to ANSYS software. A statistical analysis was done to compare the groups. RESULTS: The samples were evaluated using three-dimensional FEA analysis. It was found that stress at 100 N, 100 N with 15° tilt, 300 N, and 300 N with 15° tilt was found to be highest in Sample A followed by Sample C and Sample B, and the difference was statistically insignificant. CONCLUSION: Within the limitations of the present study, the tri-channel internal connection showed maximum stresses and least by the internal conical-hex Morse Taper and internal octa-morse taper connection.