Extended Free Forearm Flap for Treatment of Temporomandibular Joint Pseudoankylosis.

Pseudoankylosis of temporomandibular joint (TMJ) is characterized by limited mouth opening and impaired mandibular mobility induced by pathologic factors outside the joint itself, usually leading to compromised speech, swallowing, and breath functions. Multiple surgical approaches or reconstructive procedures have been proposed to resolve the joint pseudoankylosis and restore the mandibular movement for these affected patients. Free forearm flap has been widely used in reconstruction for various congenital or acquired defects or deformities; however, this flap has been rarely employed for TMJ pseudoankylosis in the literature. Here, the authors reported that noma-induced TMJ pseudoankylosis was diagnosed and successfully treated by extended free forearm flap with length over 10 cm in a Chinese female patient.

[One-staged correction of alveolar cleft and lip and nasal deformities secondary to lip cleft].

OBJECTIVE: To investigate individualized one-staged correction of alveolar cleft and lip and nasal deformities secondary to lip cleft. METHODS: The alveolar cleft and lip and nasal deformities secondary to lip cleft were corrected in one stage. RESULTS: From 2004 to 2007, 37 cases were treated. 33 patients were treated successfully with primary healing in bony recipient area. Cancellous bone exposure happened in 3 cases. The wounds healed after debridement and drainage. The cosmetic results were satisfactory. CONCLUSIONS: One-staged correction of alveolar cleft and the lip and nasal deformities secondary to lip cleft can achieve good results.

Application of lateral arm free flap in oral and maxillofacial reconstruction following tumor surgery.

OBJECTIVE: To describe the application of lateral arm free flap (LAFF) in reconstruction of defects in the oral and maxillofacial regions following ablative oncological surgery. SUBJECTS AND METHODS: The study included 16 patients (13 male, 3 female, mean age 56, range 35-69 years). Sixteen LAFF were harvested to reconstruct defects caused by the dissection of malignant tumors of the oral and maxillofacial regions. The tumor was squamous cell carcinoma of the tongue (6 cases), floor of the mouth (4), retromolar area (3), inner cheek (2), and lower gingival (1). Flap sizes ranging from 5 x 7 to 6 x 9 cm were harvested using a sterile tourniquet for bloodless technique. The anastomoses were carried out using a magnifier or microscope. All donor defects were closed primarily. RESULTS: Fourteen flaps healed without venous insufficiency. One flap, in a female patient, survived with mild local microcirculatory obstruction but that of another female patient developed necrosis. There was no significant complication at the donor sites. The advantages of this flap include anatomically reliable vascular supply, accessible donor site, and the aesthetic quality of donor tissue is good. Compared with the radial artery, the posterior radial collateral artery is a nonessential vessel of the arm. The disadvantages are the relatively smaller vessel size for anastomosis and thicker subcutaneous tissue. CONCLUSIONS: For the repair of moderate-sized defects of the maxillofacial area, especially in male patients, the LAFF can be recommended.

[Application of the free vascularized lateral upper arm flap in intraoral reconstruction following ablative tumour surgery].

OBJECTIVE: To evaluate the application of the lateral arm free flap (LAFF) in the reconstruction for intraoral defects. METHODS: Intraoral reconstruction was performed using the LAFF for 10 patients with oral squamous cell carcinoma of the tongue (n = 3), cheek (n = 4), gingiva (n = 1) and oropharynx (n = 2). There were 8 men and 2 women (mean age, 52 years). RESULTS: Nine LAFF healed uneventfully. One flap was lost on the second postoperative day due to venous insufficiency. The donor defect was closed primarily In all patients. There were no significant complications at the donor site. CONCLUSIONS: Because of the thin and pliable nature, the lateral upper arm flap can be recommended as a choice for repair of moderate-sized defects of the oral maxillofacial area.