Aesthetic and functional reconstruction with the trapezius osseomyocutaneous flap and dental implants in oral cavity cancer patients.

The trapezius osseomyocutaneous flap is the only pedicled flap that is able to transfer vascularized bone for mandibular reconstruction as well as skin for intra-extra oral reconstruction. The trapezius muscle also helps to fill the defect created by the neck dissection and covers the vessels of the neck. This flap has been used in our maxillofacial surgery service during the past 14 years. In spite of having incorporated microvascular flaps in our reconstructive techniques it continues to be one of the flaps we use in selected patients for bone and soft tissue compound defects of the oral cavity. We describe in this article our experience using this flap with dental implants in order to achieve a functional reconstruction. We also discuss when we use this flap for mandibular reconstruction and when a free vascularized flap is used.

[Locoregional treatment of carcinoma epidermoid of the maxillary sinus]. / Tratamiento locorregional del carcinoma epidermoide de seno maxilar.

Squamous-cell carcinoma of the maxillary sinus is an infrequent neoplasm of poor prognosis. Symptoms are evident when the disease is in an advanced stage. Lymph-node metastases are relatively infrequent. The survival rate of patients with this tumor has improved slightly since Obgren reported his experience in 1933, thanks to oncological and surgical advances since then. We report our experience with 28 surgically treated cases of maxillary-sinus squamous-cell carcinoma in the last 10 years, analyzing the reconstructive procedures applied, the disease-free survival rate, and our treatment protocol. A bibliographic review was made to examine all current therapeutic possibilities.

[Oromandibular reconstruction with free peroneal flap and osseointegrated implants]. / Reconstrucción oromandibular con colgajo libre de peroné e implantes osteointegrados.

Free fibula flaps have proved to be one of the most versatile for oromandibular reconstruction due to the available length of bone and the possibility of incorporating a long skin paddle to cover intraoral soft tissues. The use of a osseointegrated dental implants is an important technique for the oral rehabilitation of these patients. Osseointegrated implants provide the most rigid prosthetic stabilization available to withstand masticatory forces. These implants can be placed immediately or in second time procedure. In our case, implantation in the fibula free flap is done after 6-9 months because of the large amount of osteosynthesis material required for the fixation of the flap. Four or six months later, when osseointegration has taken place, the implants are loaded with a dental rehabilitation. We analize 10 cases of mandibular reconstruction with fibula free flap and their aesthetic and functional rehabilitation with osseointegrated implants with a 2 year follow up. Forty-six dental implants were placed developing all of them but one a correct osseointegration. All these patients recovered masticatory function and underwent a considerable improvement in labial competence, salivary continence, speech articulation and facial harmony.