Impact of Dynamic Tongue Reconstruction on Sequential Changes of Swallowing Function in Patients Undergoing Total or Near-Total Glossectomy.

PURPOSE: This study aimed to compare the effects of motor-innervated free flap on sequential changes of swallowing function in patients undergoing total or near-total glossectomy with laryngeal preservation. MATERIALS AND METHODS: The medical charts of 21 patients who underwent tongue reconstruction after total or near-total glossectomy between April 2015 and December 2020 were retrospectively reviewed. Patients were divided into groups by reconstruction type: conventional, reconstruction using an anterolateral thigh free flap (n = 11), and dynamic, reconstruction using an anterolateral thigh with innervated vastus lateralis flap (n = 10). Demographics, surgical details, and survival outcomes were investigated. A videofluoroscopic penetration-aspiration scale and functional outcome swallowing scale were analyzed according to postoperative time courses, classified as within 6 months, 6 to 12 months, and after 12 months postoperative. A time-to-event analysis was performed for gastrostomy tube status. RESULTS: The dynamic group showed improved swallowing outcomes at 6 to 12 months postoperative (dynamic vs conventional group, penetration-aspiration scale: 3 ± 1.51 vs 6 ± 1.63, P = 0.024; functional outcome swallowing scale: 1.89 ± 1.36 vs 4 ± 1.41, P = 0.009). In the multivariate analysis, the dynamic group showed a decreased probability of decompensated swallowing function at 6 to 12 months postoperative (odds ratio, 0.062; 95% confidence interval, 0.004-1.084; P = 0.057). A time-to-event analysis revealed no significant difference in gastrostomy tube status between the dynamic and the conventional group. CONCLUSIONS: Considering higher mortality in patients subjected to total or near-total glossectomy, dynamic reconstruction with motor-innervated free flap is worth to perform in terms of enhancing the swallowing function within 1-year postoperative period, thereby improving the quality of life.

Dual Application of Patient-Specific Occlusion-Based Positioning Guide and Fibular Cutting Guide for Accurate Reconstruction of Segmental Mandibular Defect.

In this study, the authors introduced a dual application of patient-specific occlusion-based positioning guide and fibular cutting guide to obtain ideal occlusal relationship and mandibular contour in patients undergoing mandibular reconstruction. A retrospective review was performed in 21 patients who underwent mandibular reconstruction with a fibular osteocutaneous free flap. Using computed tomography and intraoral scanning data, fibular cutting guide and occlusion-based positioning guide were simulated in a modeling software and 3-dimensionally printed. Both guides were applied in 9 patients, defined as dual guide group, while the fibular cutting guide was solely used in the remaining patients, defined as single guide group. Functional outcomes including occlusion status, trismus, presence of osseointegrated implant were assessed at 1-year postoperative period. To evaluate the accuracy of the reconstruction, the discrepancy between the planned simulation and actual surgical result was quantified by measuring mandibular deviation angle and volume conformity. Regarding the functional outcomes, all patients in dual guide group showed satisfactory occlusion and intact oral capacity at postoperative 1-year assessment, while 3 patients in single guide group had prolonged malocclusion. The dual guide group showed significantly decreased deviation angle in coronal (right side, 2.93°±1.98° vs. 7.02°±2.81°, P =0.003) and axial plane (right side, 3.20°±2.04° vs. 7.63°±3.40°, P =0.006). The mean volume conformity between the simulation and actual fibular object was significantly higher in the dual guide group (75.27%±6.12% vs. 59.06%±8.57%, P =0.001). In conclusion, the use of occlusion-based positioning guide combined with the fibular cutting guide can enhance the accuracy of mandible reconstruction and functional outcomes.

Clinical Application of Three-Dimensional Printing of Polycaprolactone/Beta-Tricalcium Phosphate Implants for Cranial Reconstruction.

ABSTRACT: Polycaprolactone (PCL) implants are a biodegradable polymeric material with appropriate mechanical strength and durability for use in cranioplasty. They can be manufactured as patient- customized implants using a three-dimensional (3D) printer. Herein, the authors aimed to share our experience in cranioplasty of patients with deformed and asymmetric skulls using PCL/beta- tricalcium phosphate (ß-TCP) implants.Seven patients underwent cranioplasty using patient-specific PCL/ß-TCP implants. Cranial computed tomography images were converted to a 3D model and mirrored to design a patient-specific implant. Based on the 3D simulation, an implant was 3D printed using PCL/ß-TCP. A 6-month follow-up was conducted with periodic visits and computed tomography scans. Symmetry after surgery and complications were evaluated.Postoperatively, the soft tissue volumes increased to 15.8 ± 17.2 cm 3 and 14.9 ± 15.7 cm 3 at 2 weeks and 6 months of follow-up, respectively. The volume change from 2 weeks to 6 months was -4.4 ± 2.5%. Six patients achieved complete symmetry after cranioplasty, whereas 1 patient noticed partial symmetry. The symmetry remained unchanged at 6 months of follow-up. Upon palpation to assess smoothness, 6 patients exhibited a smooth edge interface, whereas 1 patient had a slightly irregular edge.Based on these findings, 3D-printed PCL/ß-TCP implants are an excellent material for cranioplasty, and a favorable cosmetic outcome can be achieved. Specifically, these novel PCL/ß-TCP implants have good biocompatibility and mechanical strength without any postoperative foreign body reaction.

Klebsiella Aerogenes Infection on the Costochondral Graft of the Nose.

ABSTRACT: Klebsiella aerogenes is a nosocomial and pathogenic bacterium that causes opportunistic infections including most types of infections. After rhinoplasty, the inserted costochondral graft could be a good material for bacterial growth due to less vascularization and difficult-to-reach antibiotics. The unusual bacterial infection should be considered for preventing poor aesthetic results including graft or implant loss when the surgical site infection is uncontrolled despite proper treatment and administration in aesthetic rhinoplasty surgery. The use of appropriate antibiotics for drug sensitivity may be necessary with bacterial culture tests. In this case, an unusual K. aerogenes infection on the costochondral graft of the nose and related treatment course was reported.

Dynamic Hemitongue Defect Reconstruction With Functional Gracilis Muscle Free Transfer.

BACKGROUND: Because the tongue consists of 26 intrinsic and extrinsic muscles, even hemiglossectomy, which preserves some of the tongue and its muscles, leads to functional morbidity in speech and swallowing. Subsequent reconstruction using a conventional fasciocutaneous flap results in limited functional recovery. This study compared the functional recovery of patients who underwent hemiglossectomy based on the fasciocutaneous free flap with or without dynamic gracilis muscle flap reconstruction. METHODS: Twenty-three patients were included in the study. Reconstruction was achieved using radial forearm and gracilis conjoined flaps (n = 7), gracilis flaps (n = 7), and radial forearm flaps (RFFFs) (n = 9) between 2014 and 2019. Functional outcome data were collected via videofluoroscopic swallowing, speech analysis, and a tongue movement scale. RESULTS: In the conjoined flap group, the lingual range of motion in terms of elevation and defect-side lateralization was superior to that of the RFFF group. Furthermore, the conjoined flap was associated with superior protrusion, elevation, and lateralization (on both sides) than the gracilis-only flap. Patients who underwent conjoined-flap reconstruction had better articulation, intelligence, and dysphagia outcomes than patients who underwent reconstruction with RFFFs or gracilis-only flaps. CONCLUSIONS: Although this was a preliminary study, the findings suggest that using a conjoined free flap with an RFFF and a functional gracilis muscle flap for dynamic hemitongue reconstructions could improve postoperative tongue function.

Counterclockwise Rotational Orthognathic Surgery for the Obstructive Sleep Apnea in Class II Dentofacial Deformity: Polysomnography and 3D Computed Tomographic Analysis.

ABSTRACT: Traditionally, maxillomandibular advancement is an orthognathic surgical procedure that has been used to manage obstructive sleep apnea in patients not able or willing to maintain adherence to continuous positive airway pressure therapy or for patient who are not able to adhere to treatment. However, maxillomandibular advancement often leads to unsatisfactory cosmetic results.This prospective study investigated functional and esthetic outcomes using polysomnography and 3-dimensional computed tomography, after counterclockwise rotational orthognathic surgery. We enrolled 17 patients with obstructive sleep apnea, who underwent orthognathic surgery at single institution between March 2013 and December 2018.After 12 months, the patients' mean self-rated score for facial appearance, using a 10-step visual analog scale, was 7.36. The preoperative apnea-hypopnea index and respiratory disturbance index were 34.70 and 37.45, respectively; postoperative indices were 11.60 and to 12.69, respectively (P = 0.003, 0.003). The mean posterior pharyngeal airway space increased from 5357.88 mm3 preoperatively to 8481.94 mm3 after 6 postoperative months.Counterclockwise rotational orthognathic surgery for the correction of obstructive sleep apnea turned out to be the ideal solution not only in the correction of the sleep apnea, but also in the facial esthetics.

Analysis of Speech and Functional Outcomes in Tongue Reconstruction after Hemiglossectomy.

BACKGROUND: Reconstruction in tongue cancer to restore the shape and function of the tongue without airway obstruction in the narrow oral cavity is challenging for reconstructive surgeons. Herein, the authors retrospectively analyzed flaps to reveal the factors that affect the functional outcome of tongue reconstruction. METHODS: Herein, we retrospectively reviewed 30 patients (men, 16; women, 14; mean age, 50.3 years) who underwent the hemi-tongue reconstruction followed by speech therapy between 2009 and 2017. Data about postoperative chemotherapy and radiotherapy were collected. The dimensions (width and length) of the flaps were measured. Speech outcomes were assessed under the conditions of varying distances of the tongue tip from lower incisors when it was protruded, retracted, and elevated. Lateralization was evaluated based on the count of teeth reached by the tip of the tongue from the midline. RESULTS: Preoperative chemotherapy and radiotherapy significantly influenced tongue retraction, tongue articulation, and intelligibility (p = 0.006, 0.002, 0.048, respectively). Postoperative chemotherapy did not statistically significantly influence any outcome measure. Contralateralization of the tongue was significantly decreased in the postoperative radiotherapy group (p = 0.029). The length of the flap showed highly negative correlation with articulation and intelligibility (p = 0.009, p< 0.001, respectively). The width of the flap was not correlated with the outcomes. CONCLUSION: We proved that unlike chemotherapy, postoperative radiotherapy influences the functional outcome of tongue reconstruction. The dimensions, particularly the length of the flap, were also important for restoring the reconstructed tongue function.

Comparison Between Intermaxillary Fixation With Screws and an Arch Bar for Mandibular Fracture.

PURPOSE: Intermaxillary fixation (IMF) using the arch bar has been the standard technique for a long time in the management of mandibular fracture. But because of several complications, intermaxillary fixation with screws has been introduced and adopted to use. This investigation compared the outcomes and complications between the traditional IMF and modified intermaxillary fixation with screws techniques in terms of the malocclusion, surgical time, root injury, and screw or arch bar failure. METHODS: This retrospective review included 66 patients who underwent reconstruction of mandibular fractures that uses traditional arch bar or IMF screws as IMF. Preoperative and postoperative facial bone computed tomography, panoramic x-ray were used to evaluate the patients. The complaints and complications were recorded in electric medical record based on patients' consultation during follow-up. RESULTS: The total complication rate was no higher using anchoring screw as an IMF than using arch bar fixation as an IMF. Mean surgical time was significantly shorter in the anchoring screw group than arch bar fixation (111 versus 157 min; P < .05). After compensation of the number of fracture sites, there was a significant difference in operation time (linear regression model, P = .009). CONCLUSION: This investigation revealed that the IMF using IMF screw systems could be a good alternative for the management of mandibular fracture. It could minimize the whole operation time with the similar complication ratio.

Three-Dimensional Analysis of Airway Change After LeFort III Midface Advancement With Distraction.

INTRODUCTION: LeFort III midface advancement using the distraction technique became the standard method for the correction of various craniofacial syndromes accompanied by the midface retrusion. Midface hypoplasia is known to be related to the imbalance in facial aesthetics, malocclusion, and the airway problem. This study aimed to evaluate the change in airway volume after performing a LeFort III midface advancement with the distraction techniques. PATIENTS AND METHODS: Between April 2008 and February 2013, 7 patients aged 5 to 7 years underwent standard LeFort III osteotomy, followed by distraction with a rigid external distractor with or without internal distractor. The degree of advancement of the midface and the airway volume were evaluated with 3-dimensional computed tomography scans and the 3-dimensional software. RESULTS: The average latent period was 3.57 days. The average manual distraction distance was 17.55 mm for 3.82 weeks. The consolidation period ranged from 3 to 7 months. Changes between the preoperative and postoperative airway volumes were remarkable. The average preoperative postpharyngeal airway volume was 5649.33 mm compared with an average postoperative airway volume of 7403.44 mm. Therefore, the average postpharyngeal airway space increased by a remarkable 32.78%. CONCLUSIONS: This investigation revealed that the LeFort III midface advancement using distraction could increase postpharyngeal airway space by approximately 33% when the midface is advanced by approximately 18 mm. This method could be used as a future reference for LeFort III midface advancement with distraction.

Three-dimensional Photogrammetric Analysis of Facial Soft-to-Hard Tissue Ratios After Bimaxillary Surgery in Facial Asymmetry Patients With and Without Sturge-Weber Syndrome.

Sturge-Weber syndrome (SWS) is a rare neurocutaneous syndrome characterized by facial port-wine stains. Most patients with facial asymmetry due to SWS have soft and/or hard tissue hypertrophy and require both soft tissue correction and bone surgery. In our experience, because SWS patients are more likely than non-SWS patients to be dissatisfied after bone surgery because of limited soft tissue change, we compared soft tissue changes after bimaxillary surgery between facial asymmetry patients with and without SWS.All patients-5 with SWS and 5 without SWS-underwent bimaxillary surgery by a single surgeon. Soft-to-hard ratios were determined using the preoperative and postoperative vertical lengths from the intersection point between the external orbital contour laterally and the oblique orbital line (LO) to the occlusion line (OL) and the LO to the mandible angle (AG) on cephalography and the distances between the lateral canthus (LC) and oral commissure (OC) and between the LC and soft tissue gonion (Go') on 3-dimensional scanned images.The average change in the [LC-OC] to [LO-OL] ratio was 23.03% ± 10.09% in SWS patients and 88.05% ± 10.44% in non-SWS patients (P = 0.008). The average change in the [LC-Go'] to [LO-AG] ratio was 35.54% ± 15.47% in SWS patients and 78.90% ± 47.56% in non-SWS patients (P = 0.032).Soft-to-hard tissue ratios after orthognathic surgery are significantly smaller in SWS patients than in non-SWS patients. This information is important for preoperative patient counseling, managing patient expectations, enhancing results, and planning the second-stage soft tissue surgery.

Large-Scale Study of Long-Term Vertical Skeletal Stability in a Surgery-First Orthognathic Approach Without Presurgical Orthodontic Treatment: Part II.

The surgery-first approach (SFA) is a new paradigm in orthognathic surgery. In our experience over the last 10 years, SFA, particularly for the correction of the class III dentofacial deformity and facial asymmetry, has demonstrated high success rates without any major complications. However, many craniofacial surgeons remain concerned about the skeletal stability of SFA. In the present study, the authors aimed to compare the traditional and SFA with regard to the long-term outcomes of vertical skeletal stability using large-scale data. The authors enrolled patients with skeletal class III dentofacial deformities who had undergone and completed orthognathic surgery between December 2007 and December 2015. The inclusion criteria were based on the presurgical simulation of the dental model, and the authors predicted the potential of the SFA based on this preoperative simulation model. Patients with cleft-related syndromes, and those who had undergone orthognathic surgeries for facial asymmetry or class II deformity were excluded. A total of 104 and 51 class III patients were enrolled in the surgery-first and traditional orthodontics-first groups, respectively. Satisfactory results were achieved in all 155 patients with dentofacial deformity. The initial preoperative measurements of cephalometric analysis, particularly vertical skeletal stability, were similar and well maintained after the procedure in both groups. In conclusion, the SFA without any presurgical orthodontic treatment for correcting dentofacial deformities can achieve similar long-term vertical stability results to the orthodontic treatment-first approach.

One-Piece Mandibuloplasty Compared to Conventional Mandibuloplasty With Narrowing Genioplasty.

BACKGROUND: Recently, the mandibular body and chin shape are known to be important issue as well as the mandibular angle. The authors have performed the one-piece mandibuloplasty from the mandibular angle to the most anterior part of chin to achieve the change of the whole mandibular shape as a one-piece. METHODS: All of 14 patients who complaint prominent mandibular angle and chin were randomly allocated into 2 groups. Group I (n = 7) was treated with conventional mandibuloplasty with narrowing genioplasty and Group II (n = 7) was treated with one-piece mandibuloplasty. Pre- and postoperative clinical photography, cephalometry, computed tomography scan, 3-dimensional photography were taken and occurrence of secondary angle, patient's satisfaction, and operative time were evaluated. RESULTS: The mean volume reduction per side was 41.8 cc on one-piece mandibuloplasty and 36.5 cc on conventional mandibuloplasty with narrowing genioplasty. Furthermore, average lower facial decreased from 64.3 to 61.0 after 6 months postoperatively and was maintained until 3 years on average after the operation. In one-piece mandibuloplasty group shows a little higher satisfaction about mandible body, and it was estimated that the presence of secondary angle makes dissatisfaction. The authors' treatment approach resulted in a shorter total surgery time than conventional technique (70.57 versus 105.14 min, P = 0.002). CONCLUSIONS: One-piece mandibuloplasty based on 3-dimensional printing model turned out to be very successful for the natural shaping of the lower jaw in the patients with the prominent mandible in terms of the technical efficiency and the aesthetic point of view.

Comparison of Facial Proportions Between Beauty Pageant Contestants and Ordinary Young Women of Korean Ethnicity: A Three-Dimensional Photogrammetric Analysis.

BACKGROUND: Although the harmony of facial proportions is traditionally perceived as an important element of facial attractiveness, there have been few objective studies that have investigated this esthetic balance using three-dimensional photogrammetric analysis. OBJECTIVES: To better understand why some women appear more beautiful, we investigated differences in facial proportions between beauty pageant contestants and ordinary young women of Korean ethnicity using three-dimensional (3D) photogrammetric analyses. METHODS: A total of 43 prize-winning beauty pageant contestants (group I) and 48 ordinary young women (group II) of Korean ethnicity were photographed using 3D photography. Numerous soft tissue landmarks were identified, and 3D photogrammetric analyses were performed to evaluate 13 absolute lengths, 5 angles, 3 volumetric proportions, and 12 length proportions between soft tissue landmarks. RESULTS: Group I had a greater absolute length of the middle face, nose height, and eye height and width; a smaller absolute length of the lower face, intercanthal width, and nasal width; a larger nasolabial angle; a greater proportion of the upper and middle facial volume, nasal height, and eye height and width; and a lower proportion of the lower facial volume, lower face height, intercanthal width, nasal width, and mouth width. All these differences were statistically significant. CONCLUSIONS: These results indicate that there are significant differences between the faces of beauty pageant contestants and ordinary young women, and help elucidate which factors contribute to facial beauty. The group I mean values could be used as reference values for attractive facial profiles. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Large-Scale Study of Long-Term Anteroposterior Stability in a Surgery-First Orthognathic Approach Without Presurgical Orthodontic Treatment.

Presurgical orthodontic treatment has long been known as a prerequisite in the traditional orthognathic approach. However, achieving ideal decompensation is very difficult even in the presurgical orthodontic period. For minimization of this problem, the surgery-first orthognathic concept has been introduced. The authors hypothesized that this treatment modality will be feasible for skeletal class III dentofacial deformity patients. In this study, the authors tried to compare the traditional and surgery-first approaches regarding long-term outcomes in terms of stability, based on large-scale data. The patients included in this study had skeletal class III dentofacial deformities, and all underwent, and completed, orthognathic surgery between December 2007 and December 2015. The inclusion criteria were based on presurgical simulation on the dental model, and the authors predicted the potential of the surgery-first approach by this preoperative simulation model. Patients with cleft-related syndromes, those who underwent orthognathic surgeries due to facial asymmetry or class II deformity were excluded from the study. In total, 104 class III patients were enrolled in the surgery-first group and 51 class III patients in the traditional orthodontic-first group. Satisfactory results were achieved in all 155 patients with dentofacial deformity in this study. Overall, the analysis revealed that anteroposterior skeletal long-term stability in the surgery-first approach was not different, statistically or otherwise, from that in the orthodontic-first approach. Anteroposterior skeletal stability was maintained well in the surgery-first approach. In conclusion, surgery-first approach without presurgical orthodontic treatment can achieve similar results of long-term anteroposterior stability in correcting dentofacial deformities as the orthodontic treatment-first approach.

Medial Femoral Condyle Free Flap for Premaxillary Reconstruction in Median Facial Dysplasia.

OBJECTIVE: Median facial dysplasia is a distinct development anomaly of the craniofacial region that is characterized by deficient mid facial structures. Medial femoral condyle free flap could be used as a bony flap, and the unique characteristics of this flap provide the surgeons with the periosteal component as well. In this work, the authors present our experience with a patient of median facial dysplasia with unilateral cleft lip, cleft palate, and premaxillary deficiency. METHODS: The patient was diagnosed with median facial dysplasia accompanied by unilateral cleft lip, cleft palate, and premaxillary. She had presented with severe midface hypoplasia with missing premaxillary bone. Premaxillary reconstruction was performed with the use of medial femoral condyle free flap. RESULTS: Medial femoral condyle free flap was successfully used for premaxillary reconstruction. The flap fitted well to the alveolar bony gap. Since the flap is a periosteal bone flap, the gingival mucosa was reconstructed very well. The lip harmony was considerably restored compared with the preoperative status. CONCLUSIONS: Although several other options are available, the medial femoral condyle free flap is particularly suited for the reconstruction of median facial dysplasia.

Change in Posterior Pharyngeal Space After Counterclockwise Rotational Orthognathic Surgery for Class II Dentofacial Deformity Diagnosed With Obstructive Sleep Apnea Based on Cephalometric Analysis.

Although maxillomandibular advancement (MMA) is an orthognathic surgical procedure used to manage obstructive sleep apnea (OSA) in individuals who are noncompliant with continuous positive airway pressure therapy, simple MMA encounters problems in terms of aesthetic outcomes in Asian populations with preexisting dentoalveolar protrusion. Our current prospective investigation describes changes in posterior pharyngeal space and aesthetic outcomes after counterclockwise rotational orthognathic surgery, which is known to be quite difficult in terms of the maintenance of the skeletal stability in skeletal class II patients with OSA. This prospective study investigated the surgical outcome of patients who suffered from OSA following counterclockwise rotational orthognathic surgery. The patients were skeletal class II patients who underwent orthognathic surgery between March 2013 and December 2014. Cephalometric posterior airway analysis and a questionnaire for facial perception were used to assess pharyngeal airway and patient perception of facial appearance. A total of 14 patients were included. Satisfactory results were achieved without complications in all OSA patients. The airway parameters for anteroposterior length significantly increased. Thirteen patients answered a questionnaire on their facial appearance, and the visual analog scale averaged 7.31 points, indicating a favorable facial appearance. Counterclockwise rotational orthognathic surgery without maxilla advancement for the correction of OSA can effectively increase the posterior pharyngeal space, with favorable aesthetic results. With thoughtful application, this novel approach may be an alternative to standard approaches for the correction of OSA using orthognathic surgery.

Premaxillary Repositioning in the Severe Form of Bilateral Cleft Lip and Palate.

Severe forms of bilateral cleft lip and palate remain a challenging issue. Although nasoalveolar molding dramatically improves overall treatment success, the position of the premaxilla often remains dislocated. The authors attempted to relocate the malpositioned premaxilla into the correct position to obtain the correct three-dimensional (3D) maxillary arch structure and growth. Eight patients with severe bilateral cleft lip and palate were treated with premaxillary osteotomy for premaxilla repositioning. The position of the premaxilla was measured directly using cephalometry. Two raters including orthodontists evaluated the 3D (anteroposterior, transverse, and sagittal) outcomes. Regarding the long-term effects of premaxillary repositioning on midfacial growth, 3D computed tomography scan data were used, including the measurement of the SNA, SNB, and ANB angles according to the time period (T0: preoperative; T1: immediate postoperative; T2: long-term postoperative). All bilateral cleft lips and palates were satisfactorily repaired without any complications, including any premaxillary vascular compromise, nonunion, and occlusal instability. The average visual analog scale scores (0-5) of the anteroposterior, vertical, and transverse dimensions were 3.9, 3.7, and 3.2, respectively. Regarding the effect of premaxillary repositioning on midfacial hypoplasia, the change in the ANB between T1 and T2 was not significant, implying that premaxillary repositioning did not affect the long-term harmony between the maxilla and mandible (ANB of T2-T1: P = 0.1016) based on interim growth data at the time of follow-up and study completion. Premaxillary repositioning effectively corrected the malpositioned premaxilla and repaired the accompanying wide alveolar cleft, achieving successful restoration of maxillary arch coordination. In addition, premaxillary osteotomy after 8 years of age does not seem to cause significant maxillary retrusion.

Swallowing analysis in hemi-tongue reconstruction using motor-innervated free flaps: A cine-magnetic resonance imaging study.

BACKGROUND: This study aimed to explore the outcomes of motor-innervated free flaps in hemi-tongue reconstruction by assessing the tongue mobility through midsagittal images from cine-magnetic resonance imaging. METHODS: In this retrospective study, 47 patients who underwent tongue reconstruction following hemi-glossectomy and 10 control subjects without any surgical history were included. Patients were classified into two groups: the motor and no-motor innervation group. Various spatial parameters related to tongue mobility that were acquired from midsagittal sections were compared during consecutive swallowing phases. RESULTS: Overall, the motor group showed improved functional swallowing scale compared with the no-motor group. In case of tongue base resection, the motor group showed improved mobility of the tongue base during pharyngeal phase, whereas the no-motor group showed increased laryngeal elevation for compensatory movement. CONCLUSION: The tongue reconstruction with motor-innervated free flaps may facilitate swallowing capacity in patients with a hemi-tongue defect combined with tongue base resection.

The impact of dynamic tongue reconstruction using functional muscle transfer: A retrospective review of 94 cases with functional outcome analysis for various glossectomy defects.

The aim of this study was to evaluate the functional outcomes of dynamic tongue reconstruction in various types of glossectomy defects. A retrospective review of patients who underwent tongue reconstruction following cancer resection was performed. Patients were divided into two groups by the type of procedure: dynamic reconstruction using motor-innervated free flaps and conventional reconstruction with fasciocutaneous free flaps. Demographics, including patient and tumor characteristics, and surgical factors, including the type of glossectomy and flap, were investigated. Functional outcomes were compared through quantitative assessment of tongue movement, speech capacity, videofluoroscopic barium swallow, and percutaneous endoscopic gastrostomy (PEG) tube dependency. 94 patients were enrolled in this study. The conventional reconstruction was performed in 52 patients and dynamic reconstruction was performed in 42 patients. Overall, the dynamic group showed improved swallowing capacity (videofluoroscopic swallowing scale, mean ± standard deviation, dynamic group, 3.24 ± 0.79, versus conventional group, 2.88 ± 1.08; p = 0.07). No significant differences in tongue motion and speech outcomes were noted between the groups. In multivariate logistic analysis controlling of various confounders, the dynamic reconstruction was significantly related to improved swallowing outcomes (adjusted odds ratio, 0.148; 95% confidence interval 0.03-0.725; p = 0.018). Dynamic reconstruction was not significantly related to the rate of PEG tube dependency. Within the limitations of the study, it seems that the dynamic tongue reconstruction using motor innervated free flaps can improve swallowing outcome by reproducing the original sling action of tongue musculature and preserving the tongue volume.

Complications arising from clinical application of composite polycaprolactone/bioactive glass ceramic implants for craniofacial reconstruction: A prospective study.

This study aimed to demonstrate the in vitro performance of a novel polymer-ceramic composite incorporating polycaprolactone (PCL) and bioactive glass (BGS-7), and investigate its clinical outcomes in craniofacial reconstruction. After preparation of the material, the biochemical properties of the composite PCL/BGS-7 implant were tested to evaluate apatite formation in simulated body fluid (SBF). Changes in the implant surface after soaking in the SBF were determined using field-emission scanning electron microscopy. For clinical application of the implant, patients with craniofacial defects were prospectively enrolled to receive three-dimensional (3D)-printed PCL/BGS-7 implants. Clinical outcomes were investigated by reviewing postoperative complications, including wound problems, allergic responses, hematoma, seroma, implant displacement, and bone union. The accuracy of reconstruction was assessed by measuring the surface error between the reconstructed and mirrored models. Upon exposure of the PCL/BGS-7 implant to SBF, apatite particles were actively developed on the surface of the PCL/BGS-7 sample, showing favorable bone-binding capacity. Regarding the clinical application, seven patients with craniofacial defects were included. The clinical outcome was favorable in terms of complications, except in one patient, who presented with delayed wound healing due to previous irradiation. The patients showed improvements in symmetry, with a significant change in mean ± SD surface error between preoperative (5 ± 3 mm) and postoperative (1.5 ± 0.65 mm) status (p = 0.018). Wthin the limitations of the study it seems that the PCL/BGS-7 implants might be a relevant option for repairing craniofacial bone defects, owing to its favorable bone-binding property and clinical safety, with few complications.