RESUMO
BACKGROUND: The reconstructive options for instability-related anterior glenoid bone loss include iliac crest autograft, allograft, or coracoid transfer. The use of distal clavicle autograft (DCG) has also been described. The purpose of this imaging and cadaveric study was to examine the dimensions, morphology, and bone density of the DCG and compare it with the Latarjet procedure. METHODS: We used 49 computed tomography scans from patients with anterior glenoid bone loss to measure the distal clavicle dimensions and bone density. Four glenoid reconstructions were simulated to compare techniques: DCG inferior surface toward glenoid (DCG inferior), DCG superior, classic Latarjet, and congruent-arc Latarjet. In addition, the morphology of the DCG was assessed on computed tomography and confirmed in 27 cadavers. RESULTS: The mean width of the DCG (11 mm) was significantly greater (P < .001) than that of the classic Latarjet orientation (9 mm) but less (P = .002) than that of the congruent-arc orientation (12 mm). The DCG had a lower bone density than the coracoid (P < .001). The mean articular surface area of the DCG-inferior orientation was 208 mm2, which was greater (P = .013) than that of the DCG-superior orientation (195 mm2) and not significantly different (P = .44) than that of the classic Latarjet orientation (214 mm2). The surface area of the congruent-arc orientation was greater (285 mm2, P < .001) than that of all other graft orientations. The DCG-inferior orientation was able to reconstruct 22% of the glenoid articular surface; DCG-superior orientation, 21%; classic Latarjet orientation, 23%; and congruent-arc orientation, 30%. Three DCG morphologies were identified: square (34%), trapezoidal (53%), and rounded (13%). CONCLUSIONS: The distal clavicle osteoarticular graft was able to reconstruct 22% of the glenoid face. Three morphologies of the distal clavicle were identified, with the square and trapezoidal morphologies most amenable for glenoid reconstruction.
Assuntos
Doenças Ósseas Metabólicas/cirurgia , Transplante Ósseo/métodos , Clavícula/transplante , Instabilidade Articular/cirurgia , Escápula/cirurgia , Adolescente , Adulto , Densidade Óssea , Doenças Ósseas Metabólicas/etiologia , Cadáver , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Articulação do Ombro/cirurgia , Tomografia Computadorizada por Raios X , Transplante Autólogo , Transplante Homólogo , Adulto JovemRESUMO
BACKGROUND: Structural bone graft for reconstruction of glenoid bone stock is often necessary in the setting of revision shoulder arthroplasty. This study introduces a new structural autograft technique using the distal clavicle for treatment of glenoid bone loss in the setting of revision shoulder arthroplasty. METHODS: This is a retrospective, single-surgeon study of patients with significant glenoid bone loss requiring revision shoulder arthroplasty with autologous distal clavicle bone grafting to the glenoid. Twenty patients with failed shoulder arthroplasty who underwent revisions of their glenoid components between 2015 and 2019 were retrospectively identified. Sixteen patients were available with follow-up of greater than 1 year. Patient records and radiographs were reviewed for intraoperative and postoperative complications. Preoperative and postoperative function were evaluated by physical examination and patient-reported outcome surveys. RESULTS: There were no observed intraoperative complications relating to the distal clavicle autograft harvest or placement. There were no iatrogenic nerve injuries or intraoperative instability. One of the 16 patients developed postoperative loosening and subsequent failure of the glenoid baseplate, requiring revision. One additional patient demonstrated increased elevation of the coracoclavicular interval postoperatively, likely related to the distal clavicle autograft harvest. At a mean follow-up of 25 months, 15 of 16 glenoid implants remained well fixed (93.4%), with no evidence of infection, or impingement demonstrated radiographically or clinically. Average patient age was 69 years at the time of surgery. Forward elevation improved from 76° to 123° at final follow-up (P = .0002). The American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score improved from an average of 35.8 to 67.8 at mean follow-up (P = .001). The visual analog scale score improved from an average of 5.9 to 2 at mean follow-up, though not statistically significant (P = .068). There was no significant change in external rotation following surgery (P = .319). CONCLUSION: Osteolysis and bone loss of the glenoid poses a challenging problem in revision shoulder arthroplasty. Distal clavicle autograft augmentation is a viable and reproducible technique to manage structural glenoid defects.
Assuntos
Artroplastia do Ombro , Clavícula/transplante , Cavidade Glenoide/cirurgia , Reoperação/métodos , Articulação do Ombro/fisiopatologia , Idoso , Autoenxertos , Transplante Ósseo/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Falha de Prótese , Radiografia , Amplitude de Movimento Articular , Estudos Retrospectivos , Rotação , Articulação do Ombro/diagnóstico por imagem , Resultado do TratamentoRESUMO
BACKGROUND: This study reports the outcome of resurfacing hemiarthroplasty (RHA) in a cohort of patients with juvenile idiopathic arthritis (JIA) affecting the shoulder joint METHODS: Fourteen uncemented RHA procedures were performed for 11 consecutive patients who required surgery because of JIA. Mean age at surgery was 36.4 years. Mean clinical follow-up was 10.4 years (range, 5.8-13.9 years). A significant humeral head defect (up to 40% surface area) was found in 5 shoulders and filled with autograft from the distal clavicle or femoral head allograft. RESULTS: At latest follow-up, no patient required revision. There was excellent relief from pain. The mean Oxford Shoulder Score and Constant-Murley Score improved significantly. No shoulder had a poor outcome, and 6 had a very good or excellent outcome. Worse outcome was associated with an intraoperative finding of significant humeral head erosion. Two shoulders required early arthroscopic subacromial decompression, but there were no other reoperations. There were no instances of radiographic implant loosening or proximal migration. Painless glenoid erosion was seen in 5 shoulders but was not associated with worse outcome. CONCLUSIONS: The midterm results of RHA for JIA are at least comparable to those for stemmed hemiarthroplasty, with the added benefit of bone conservation.
Assuntos
Artrite Juvenil/cirurgia , Hemiartroplastia , Articulação do Ombro/cirurgia , Adulto , Aloenxertos , Clavícula/transplante , Feminino , Cabeça do Fêmur/transplante , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Avaliação de Resultados da Assistência ao Paciente , Amplitude de Movimento Articular , Estudos Retrospectivos , Articulação do Ombro/diagnóstico por imagem , Adulto JovemRESUMO
BACKGROUND: Treating anterior glenoid bone loss in patients with recurrent shoulder instability is challenging. Coracoid transfer techniques are associated with neurologic complications and neuroanatomic alterations. The purpose of our study was to compare the contact area and pressures of a distal clavicle autograft with a coracoid bone graft for the restoration of anterior glenoid bone loss. We hypothesized that a distal clavicle autograft would be as effective as a coracoid graft. METHODS: In 13 fresh-frozen cadaveric shoulder specimens, we harvested the distal 1.0 cm of each clavicle and the coracoid bone resection required for a Latarjet procedure. A compressive load of 440 N was applied across the glenohumeral joint at 30° and 60° of abduction, as well as 60° of abduction with 90° of external rotation. Pressure-sensitive film was used to determine normal glenohumeral contact area and pressures. In each specimen, we created a vertical, 25% anterior bone defect, reconstructed with distal clavicle (articular surface and undersurface) and coracoid bone grafts, and determined the glenohumeral contact area and pressures. We used analysis of variance for group comparisons and a Tukey post hoc test for individual comparisons (with P <.05 indicating a significant difference). RESULTS: The articular distal clavicle bone graft provided the lowest mean pressure in all testing positions. The coracoid bone graft provided the greatest contact area in all humeral positions, but the difference was not significant. CONCLUSION: An articular distal clavicle bone graft is comparable in glenohumeral contact area and pressures to an optimally placed coracoid bone graft for restoring glenoid bone loss. LEVEL OF EVIDENCE: Basic Science Study; Biomechanics.
Assuntos
Clavícula/transplante , Processo Coracoide/transplante , Cavidade Glenoide/cirurgia , Articulação do Ombro/cirurgia , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Transplante Ósseo , Cadáver , Feminino , Cavidade Glenoide/fisiopatologia , Humanos , Cabeça do Úmero/fisiopatologia , Instabilidade Articular/cirurgia , Masculino , Pessoa de Meia-Idade , Pressão , Rotação , Articulação do Ombro/fisiopatologia , Transplante AutólogoRESUMO
The supraclavicular fasciocutaneous flap is a well-recognized flap in head and neck reconstruction. In this report, we describe for the first time a variation of this flap, the osteocutaneous supraclavicular (SOC) free flap, which was used to reconstruct a composite nasal defect. The defect arose after resection of a recurrent squamous cell carcinoma and involved dorsal nasal skin, cartilage, and the entire nasal bone. A 6 cm × 4 cm size flap including skin, subcutaneous tissue, and a vascularized cortico-periosteal segment of the clavicle was raised based on the transverse cervical artery. The flap survived with no complications. A satisfactory aesthetic outcome was achieved following two revision procedures. We believe that the incorporation of bone to the supraclavicular flap may expand its applications in reconstruction of composite nasal and facial defects.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Clavícula/transplante , Retalhos de Tecido Biológico/transplante , Neoplasias Nasais/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Transplante Ósseo/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Transplante de Pele/métodosRESUMO
BACKGROUND: Limited studies have compared graft-glenoid apposition and glenoid augmentation area between the Latarjet procedure and distal clavicle graft in glenohumeral stabilization. Additionally, preoperative planning is typically performed using computed tomography (CT), and few studies have used 3-dimensional (3D) magnetic resonance imaging (MRI) reformations to assess graft dimensions. PURPOSE: The purpose of this study was 2-fold: (1) to compare bony apposition, glenoid augmentation, and graft width among coracoid and distal clavicle bony augmentation techniques and (2) to determine the viability of 3D MRI to assess bone graft dimensions. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 24 patients with recurrent glenohumeral instability and bone loss were included in this study. 3D CT and 3D MRI reformations were utilized to measure pertinent dimensions for 5 orientations of coracoid and distal clavicle autografts: (1) standard Latarjet procedure (SLJ), (2) congruent arc Latarjet procedure (CLJ), (3) distal clavicle attached by its posterior surface (DCP), (4) distal clavicle attached by its inferior surface (DCI), and (5) distal clavicle attached by its resected end (DCR). Glenoid augmentation was defined as the graft surface area contributing to the glenoid. Bone-on-bone apposition was defined as the graft-glenoid contact area for bone healing potential, and graft width was pertinent for fixation technique. Glenoid bone loss ranged from 0% to 34%. Paired t tests were used to compare graft sizes between patients and compare 3D CT versus 3D MRI measurements. RESULTS: The CLJ had the largest graft surface area (mean, 318.41 ± 74.44 mm2), while the SLJ displayed the most bone-on-bone apposition (mean, 318.41 ± 74.44 mm2). The DCI had the largest graft width (mean, 20.62 ± 3.93 mm). Paired t tests revealed no significant differences between the Latarjet techniques, whereas distal clavicle grafts varied significantly with orientation. All 3D CT and 3D MRI measurements were within 1 mm of each other, and only 2 demonstrated a statistically significant difference (coracoid width: 13.03 vs 13.98 mm, respectively [P = .010]; distal clavicle thickness: 9.69 vs 10.77 mm, respectively [P = .002]). 3D CT and 3D MRI measurements demonstrated a strong positive correlation (r > 0.6 and P < .001 for all dimensions). CONCLUSION: Glenoid augmentation, bony apposition, and graft width varied with coracoid or distal clavicle graft type and orientation. Differences between 3D CT and 3D MRI were small and likely not clinically significant. CLINICAL RELEVANCE: 3D MRI is a viable method for preoperative planning and graft selection in glenoid bone loss.
Assuntos
Instabilidade Articular , Articulação do Ombro , Humanos , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Clavícula/cirurgia , Clavícula/transplante , Autoenxertos , Instabilidade Articular/cirurgia , Tomografia Computadorizada por Raios X , Transplante Ósseo/métodos , Imageamento por Ressonância MagnéticaRESUMO
BACKGROUND: Glenohumeral instability caused by bone loss requires adequate bony restoration for successful surgical stabilization. Coracoid transfer has been the gold standard bone graft; however, it has high complication rates. Alternative autologous free bone grafts, which include the distal clavicle and scapular spine, have been suggested. STUDY DESIGN: Controlled laboratory study. PURPOSE: The purpose of this study was to determine the percentage of glenoid bone loss (GBL) restored via coracoid, distal clavicle, and scapular spine bone grafts using a patient cohort and a cadaveric evaluation. METHODS: Autologous bone graft dimensions from a traditional Latarjet, congruent arc Latarjet, distal clavicle, and scapular spine were measured in a 2-part study using 52 computed tomography (CT) scans and 10 unmatched cadaveric specimens. The amount of GBL restored using each graft was calculated by comparing the graft thickness with the glenoid diameter. RESULTS: Using CT measurements, we found the mean percentage of glenoid restoration for each graft was 49.5% ± 6.7% (traditional Latarjet), 45.1% ± 4.9% (congruent arc Latarjet), 42.2% ± 7.7% (distal clavicle), and 26.2% ± 8.1% (scapular spine). Using cadaveric measurements, we found the mean percentage of glenoid restoration for each graft was 40.2% ± 5.0% (traditional Latarjet), 53.4% ± 4.7% (congruent arc Latarjet), 45.6% ± 8.4% (distal clavicle), and 28.2% ± 7.7% (scapular spine). With 10% GBL, 100% of the coracoid and distal clavicle grafts, as well as 88% of scapular spine grafts, could restore the defect (P < .001). With 20% GBL, 100% of the coracoid and distal clavicle grafts but only 66% of scapular spine grafts could restore the defect (P < .001). With 30% GBL, 100% of coracoid grafts, 98% of distal clavicle grafts, and 28% of scapular spine grafts could restore the defect (P < .001). With 40% GBL, a significant difference was identified (P = .001), as most coracoid grafts still provided adequate restoration (congruent arc Latarjet, 82.7%; traditional Latarjet, 76.9%), but distal clavicle grafts were markedly reduced, with only 51.9% of grafts maintaining sufficient dimensions. CONCLUSIONS: The coracoid and distal clavicle grafts reliably restored up to 30% GBL in nearly all patients. The coracoid was the only graft that could reliably restore up to 40% GBL. CLINICAL RELEVANCE: With "subcritical" GBL (>13.5%), all autologous bone grafts can be used to adequately restore the bony defect. However, with "critical" GBL (≥20%), only the coracoid and distal clavicle can reliably restore the bony defect.
Assuntos
Instabilidade Articular , Articulação do Ombro , Autoenxertos , Transplante Ósseo/métodos , Cadáver , Clavícula/cirurgia , Clavícula/transplante , Processo Coracoide/transplante , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/cirurgia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgiaRESUMO
Two cases with clavicula pro humero reconstruction are described after extensive extraarticular wide resection of osteosarcoma due to the aggressive invasion, pre-operative pathological fracture, and relatively resistant to preoperative chemotherapy. Each patient had proximal humeral osteosarcoma and needed extraarticular resection. One necessitated more than two-third of humeral resection and reconstructed with rotated clavicle reconstruction with use of pasteurized intercalary autogenous bone graft. The other necessitated wide scapular resection, preserving acromio-clavicular joint, could be reconstructed with rotated clavicle. Both had soft tissue reconstruction with pedicled lattissimus dorsi muscle flap for soft tissue defect. The Musculoskeletal Tumor Society score was 73% and 87%, comparable for a previous report with clavicle pro humero reconstruction after conventional resection of proximal humerus or other reconstructive procedures. One had postoperative complication of prominent acromion with skin perforation. Both patients are alive with no evidence of disease, and no local recurrence. Clavicula pro humero reconstruction should be considered in selected patients for whom acromio-clavicular joint could be preserved after extensive resection of humerus or glenoid to obtain wide surgical margin.
Assuntos
Neoplasias Ósseas/cirurgia , Úmero/cirurgia , Procedimentos Ortopédicos/métodos , Osteossarcoma/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Adolescente , Clavícula/cirurgia , Clavícula/transplante , Feminino , Humanos , Úmero/patologia , Masculino , Complicações Pós-OperatóriasRESUMO
BACKGROUND: Bone loss in shoulder instability is a well-recognized cause of failure after stabilization surgery. Many approaches have been described to address glenoid bone loss, including coracoid transfer. This transfer can be technically difficult and has been associated with high complication rates. An ideal alternative to coracoid transfer would be an autologous source of fresh osteochondral graft with enough surface area to replace significant glenoid bone loss. The distal clavicle potentially provides such a graft source that is readily available and low-cost. PURPOSE: To evaluate distal clavicular autograft reconstruction for instability-related glenoid bone loss, specifically comparing the width of the clavicular autograft with the width of an ipsilateral coracoid graft as prepared for a Latarjet procedure. Further, we sought to compare the articular cartilage thickness of the distal clavicle graft with that of the native glenoid. STUDY DESIGN: Controlled laboratory study. METHODS: Twenty-seven fresh-frozen cadaver specimens were dissected, and an open distal clavicle excision was performed. The coracoid process in each specimen was prepared as has been described for a classic Latarjet coracoid transfer. In each specimen, the distal clavicle graft was compared with the coracoid graft for size and potential of glenoid articular radius of restoration. The distal clavicle graft was also compared with the native glenoid for cartilage thickness. RESULTS: In all specimens, the distal clavicle grafts provided a greater radius of glenoid restoration than the coracoid grafts ( P < .0001). On average, the clavicular graft was able to reconstruct 44% of the glenoid diameter, compared with 33% for the coracoid graft ( P < .0001). The articular cartilage of the glenoid was significantly thicker (1.4 mm thicker, P < .0001) than that of the distal clavicular autograft (average ± SD, 3.5 ± 0.6 mm vs 2.1 ± 0.8 mm, respectively). When specimens with osteoarthritis were excluded, this difference decreased to 0.97 mm when compared with the clavicular cartilage ( P = .0026). CONCLUSION: The distal clavicle autograft can restore a significantly greater glenoid bone deficit than the Latarjet procedure and has the additional benefit of restoring articular cartilage to the glenoid. The articular cartilage thickness of the distal clavicle is within 1.4 mm of that of the native glenoid. CLINICAL RELEVANCE: The distal clavicular autograft may be a suitable option for reconstruction of instability-related glenoid bone loss. This graft provides a structural osteochondral autograft with a broader radius of reconstruction than that of a coracoid graft, is locally available, has minimal donor site morbidity, is anatomic, and provides articular cartilage.
Assuntos
Artroplastia/métodos , Clavícula/transplante , Cavidade Glenoide/cirurgia , Instabilidade Articular/cirurgia , Articulação do Ombro/cirurgia , Adulto , Idoso , Artroplastia/efeitos adversos , Cadáver , Processo Coracoide/transplante , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Rotação , Transplante AutólogoRESUMO
The sternocleidomastoid (SCM) myoperiosteal flap offers a relatively simple, single-stage reconstruction of a tracheal defect after conservative resection of an invasive papillary cancer of the thyroid with intraluminal involvement. Vascularised clavicular periosteum provides a viable, pliant, airtight, composite autologous graft with minimal vocal disturbance and a low risk to the parathyroid glands. The operation is not difficult to perform and has an acceptable long-term result even for the occasional operator in the specialised field of tracheal surgery.
Assuntos
Clavícula/transplante , Periósteo/transplante , Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos , Neoplasias da Glândula Tireoide/patologia , Traqueia/cirurgia , Neoplasias da Traqueia/cirurgia , Idoso , Clavícula/cirurgia , Feminino , Humanos , Periósteo/cirurgia , Traqueia/anormalidades , Neoplasias da Traqueia/secundário , TransplantesRESUMO
PURPOSE: Originally introduced for mandibular reconstruction more than 40 years ago, the sternoclavicular graft (SCG) has gained widespread popularity for the reconstruction of the ramus-condyle unit (RCU) owing to its anatomic and histological likeness to the normal mandibular condyle. Conventional longitudinal osteotomy design for its harvest has been fraught with considerable complications at the donor site including fracture clavicle and major neurovascular injury. In an attempt to alleviate these ill effects, a new technique for procuring the sternoclavicular graft is presented. MATERIAL AND METHODS: A split-thickness cortico-cancellous graft was harvested form the sternal end of the clavicle along with the articular disk with the osteotomy cut oriented parallel to the coronal plane, with limited soft tissue dissection. Donor site complications were assessed in terms of incidence of clavicle fracture, neurovascular injury, pleural tear and radiographic healing as seen in the six-month postoperative chest radiograph. RESULTS: 17 patients suffering from unilateral temporomandibular joint ankylosis underwent SCG harvesting for RCU reconstruction following osteoarthrectomy. No adverse events were seen in the intra- and post-operative period in any patient and satisfactory radiographic osseous healing was observed after six months. CONCLUSION: The proposed harvest technique for SCG results in reduced donor site morbidity and favourable healing and greater patient comfort.
Assuntos
Transplante Ósseo/métodos , Clavícula/transplante , Reconstrução Mandibular/métodos , Esterno/transplante , Adolescente , Adulto , Anquilose/cirurgia , Feminino , Humanos , Masculino , Estudos Prospectivos , Disco da Articulação Temporomandibular/cirurgia , Adulto JovemRESUMO
STUDY DESIGN: Cadaveric feasibility study. OBJECTIVE: To assess the anatomic and technical feasibility of rotating a clavicular segment on a sternocleidomastoid muscle (SCM) pedicle into the ventral cervical spine using a cadaveric model and to provide the first clinical case description of performing this procedure. SUMMARY OF BACKGROUND DATA: Reconstruction of the anterior cervical spine in patients with a high risk of pseudoarthrosis may require the use of a vascularized bone graft (VBG). A vascularized clavicular graft rotated on an SCM pedicle would afford all the benefits of a VBG without the added morbidity of free-tissue transfer; however, this technique has not been described. METHODS: A multidisciplinary team hypothesized that it would be anatomically and technically feasible to rotate a pedicled clavicular bone graft from the bottom of C2 to the top of T2 via an anterior approach. Five cadavers underwent bilateral anterior neck dissections for a total of 10 clavicular graft assessments. A case report describes the use of a clavicular VBG in a patient with a 3-level corpectomy defect and a history of failed fusion. RESULTS: Ten clavicles were rotated on an SCM pedicle. The grafts were either harvested as an entire segment or as the superior two-thirds of clavicle, leaving the inferior one-third in situ with pectoralis attachments intact. All grafts reached from the bottom of C2 to the top of T2. When the entire length of exposed clavicle was mobilized, it could cover five to six levels. The case report highlights technical challenges of this procedure in a living patient and provides the clinical context for its potential utility in the reconstruction of the ventral cervical spine. CONCLUSION: This surgical technique is best suited for patients with long-segment cervical defects and an increased risk of pseudarthrosis. Further clinical experience with this technique is required before definitive conclusions can be made. LEVEL OF EVIDENCE: 5.
Assuntos
Transplante Ósseo/métodos , Vértebras Cervicais/cirurgia , Clavícula/transplante , Cervicalgia/cirurgia , Fusão Vertebral/métodos , Idoso , Artrodese/métodos , Cadáver , Vértebras Cervicais/diagnóstico por imagem , Clavícula/diagnóstico por imagem , Estudos de Viabilidade , Feminino , Humanos , Cervicalgia/diagnóstico por imagemRESUMO
This study aimed to compare the joint function and morphology achieved following condylar reconstruction using sternoclavicular grafts (SCG) versus transport distraction osteogenesis (TDO) in temporomandibular joint (TMJ) ankylosis patients. Twenty-two patients with TMJ ankylosis underwent TMJ reconstruction with SCG or TDO (n=11 each). Radiographic and clinical evaluations were performed at 1 week and at 1, 3, and 6 months post-surgery. Clinical criteria examined included the duration of surgery, mean postoperative mouth opening, excursive jaw movements, and pain scores. The radiographic evaluation 6 months postoperatively (computed tomography) included subjective assessment of joint morphology and measurements of the mean condylar height, width achieved, and amount of condylar resorption. The χ2 test and Student t-test were used to compare qualitative and quantitative variables, respectively. Similar mean mouth opening (SCG=31.8mm, TDO=32.1mm at 6 months), excursive movements, and pain scores were observed in the two groups throughout follow-up. Mean condylar resorption was significantly greater in the TDO group (TDO=7.0mm, SCG=2.7mm; P=0.005). The duration of reconstruction surgery was greater in the SCG group (P=0.035). A greater incidence of complications was observed with TDO. In conclusion, based on the protocols used in this study, SCGs are superior to TDO in terms of condylar morphology, stability, and surgical safety.
Assuntos
Anquilose/cirurgia , Transplante Ósseo/métodos , Clavícula/transplante , Reconstrução Mandibular/métodos , Osteogênese por Distração/métodos , Esterno/transplante , Transtornos da Articulação Temporomandibular/cirurgia , Adolescente , Adulto , Anquilose/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Retalhos Cirúrgicos , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Transplante Autólogo , Resultado do TratamentoRESUMO
OBJECTIVE: To report our experience on pedicled partial-thickness clavicular graft (PPCG) for oromandibular reconstruction. STUDY DESIGN: PPCG was used for oromandibular reconstruction after tumor resection in 23 patients with early-stage gingival carcinoma but were eager for postoperative dental implant therapy for restoration of good occlusal function. PPCG was harvested during neck dissection. The sternocleidomastoid (SCM) myocutaneous flap was also harvested in 18 cases. Dental implants were placed in the clavicular graft of 19 cases, and the other 4 declined because of financial concerns. Postoperative viability of the flaps and the dental implants were assessed. RESULTS: All the clavicular grafts survived without necrosis and implant-supported dentures of 19 patients provided satisfactory occlusion and masticatory function. Complications, although low in occurrence, included partial skin pedicle loss, nonunion between the clavicular graft and the remaining inferior border of the mandible, and clavicular bone fracture. CONCLUSIONS: PPCG is a simple but reliable procedure for reconstruction of severe alveolar defects. Correct preoperative evaluation and precise surgical technique contribute to higher success rates and lower complication rates. It is a viable reconstructive option for early-stage gingival carcinoma requiring neck dissection without postoperative radiation therapy.
Assuntos
Clavícula/transplante , Neoplasias Mandibulares/cirurgia , Procedimentos Cirúrgicos Bucais/métodos , Procedimentos de Cirurgia Plástica/métodos , Adulto , Idoso , Implantação Dentária Endóssea/métodos , Implantes Dentários , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical , Tratamento de Ferimentos com Pressão Negativa , Estadiamento de Neoplasias , Retalhos Cirúrgicos , Resultado do TratamentoRESUMO
A brief account is given of the experimental data and the laboratory findings relative to the use of compound bone flaps of clavicle on a pedicle of sternomastoid muscle for restoration of mandibular defects. The clinical data on this method in 18 consecutive patients are presented and discussed.
Assuntos
Clavícula/transplante , Mandíbula/cirurgia , Músculos/transplante , Transplante de Pele , Cirurgia Plástica/métodos , Nervo Acessório/cirurgia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Processo Mastoide , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Transplante AutólogoAssuntos
Artrodese/métodos , Neoplasias Ósseas/cirurgia , Clavícula/irrigação sanguínea , Úmero/patologia , Osteossarcoma/cirurgia , Articulação do Ombro/cirurgia , Adolescente , Artrodese/efeitos adversos , Neoplasias Ósseas/diagnóstico , Transplante Ósseo/métodos , Clavícula/transplante , Seguimentos , Sobrevivência de Enxerto , Humanos , Úmero/cirurgia , Salvamento de Membro/métodos , Masculino , Osteossarcoma/diagnóstico , Medição da Dor , Amplitude de Movimento Articular/fisiologia , Recuperação de Função Fisiológica , Reoperação/métodos , Medição de Risco , Articulação do Ombro/patologia , Resultado do TratamentoRESUMO
A variety of donor-site complications have been reported for anterior cervical discectomy and fusion (ACDF) using autologous iliac bone graft. To minimize such morbidities and to obtain optimal bony fusion at the ACDF surgery, a novel technique was used to harvest cancellous bone from the autologous clavicle instead of the popular iliac crest graft. After a routine cervical discectomy of the affected level, a 1.5-cm linear skin incision was made over the clavicle within 2.5 cm of the sternoclavicular joint on the medial one-third portion. This portion is known as an anatomically safe zone, with no subcutaneous distribution of the supraclavicular nerve. Then, cancellous bone was harvested through a small cortical window developed on the clavicle. Care was taken not to injure the subclavian major vessels and the lung below the clavicle. A box-type titanium cage was packed with the harvested cancellous bone and then inserted into the discectomy-treated space for cervical interbody fusion. From 2009 to 2013, 16 patients with cervical radiculopathy and/or myelopathy underwent single-level ACDF with this method. All but 1 patient experienced significant improvement of clinical symptoms after the surgery and showed radiographic evidence of solid bony fusion and spinal stabilization within 6 months. Further, no peri- and postoperative complications at the clavicular donor site were noted. The mean visual analog scale pain score (range 0 [no pain to 10 [maximum pain]) at 1 year after the surgery was 0.1, and 13 of 14 patients with data at 1-year follow-up were highly satisfied with their donor-site cosmetic outcome. The clavicle is a safe, reliable, and technically easy source of autologous bone graft that yields optimal fusion rates and patient satisfaction with ACDF surgery.