Comprehensive treatment approach for condylar hyperplasia and mandibular crowding with custom lingual braces and 2-jaw surgery.

We report on the successful treatment of a 32-year-old woman with condylar hyperplasia and severe mandibular crowding. In addition, her maxilla was canted to the right, her mandibular midline and chin point deviated to the left, and her maxillary canines were missing. The treatment plan included (1) aligning and leveling the teeth in both arches, (2) correcting overbite and overjet, (3) performing LeFort I osteotomy and bilateral split osteotomies, and (4) correcting the malocclusion postsurgically. The orthodontic treatment was performed with custom lingual braces and clear brackets, and virtual surgical planning techniques were used to plan the orthognathic surgery. The condylar hyperplasia and the mandibular crowding were corrected. At the end of treatment, the patient's face appeared symmetrical. The results suggest that esthetic and functional results can be achieved with the cooperation of 2 specialties and the use of state-of-the-art technology.

Full-thickness skin graft from the neck for coverage of the radial forearm free flap donor site.

PURPOSE: This study describes the use of a full-thickness skin graft (FTSG) from the neck to cover the radial forearm free flap (RFFF) donor site in patients undergoing neck dissection and microvascular reconstruction for ablative head and neck oncologic surgery. The authors propose that an FTSG from the neck provides sufficient tissue quantity and quality, fewer surgical sites, and decreased surgical time and cost compared with other FTSG harvest sites and split-thickness skin grafts (STSGs). MATERIALS AND METHODS: This was a retrospective study of 50 patients from 2007 to 2012 who underwent ablative surgery for oral and head and neck cancer with concomitant cervical lymphadenectomy and RFFF reconstruction with repair of the donor site using an FTSG harvested along the neck dissection incision. Patients who underwent donor site repair using other techniques, such as ulnar transposition flaps, were excluded. Medical records and perioperative photographs were reviewed. RESULTS: Primary closure of the neck without dehiscence was achieved in all cases. There were no recipient site infections. Minor skin graft loss occurred in a minority of patients and was managed with local wound care until healing by secondary intention. No patients required surgical revision of the forearm. CONCLUSIONS: An FTSG from the neck provides adequate coverage for most RFFF harvests and offers favorable functional and esthetic outcomes. The primary advantage is avoiding a third surgical site. Complications were comparable to those using FTSGs from other harvest sites. Importantly, cross-contamination from the head and neck with the forearm was shown not to be an issue.