Case report. Aggressive ameloblastoma treated with radiotherapy, surgical ablation and reconstruction.

Surgical resection of aggressive solid or multicystic ameloblastoma is a well-documented and accepted treatment modality. Controversies exist, however, with regard to the extent of operative intervention. Unresectable lesions have been treated with radiation or combined radiation and chemotherapy. The authors present a case report of a patient with recurrent ameloblastoma who underwent simultaneous hard- and soft-tissue reconstruction.

Facial rhytidectomy approach for treatment of posterior mandibular fractures.

Surgical access to fractures of the ascending ramus of the mandible is limited when standard techniques are employed. A new method using a facial rhytidectomy technique is described, and seven cases treated by this method are presented. The advantage of this technique includes excellent exposure, predictable and safe dissection, inconspicuous facial scar and minimal postoperative complications.

Open reduction of subcondylar fractures via an anterior parotid approach.

Visualization of subcondylar fractures is limited, and rigid fixation technically difficult, employing standard open surgical techniques--especially when the condyle is displaced out of the glenoid fossa. The majority of condylar neck fractures are treated by closed reduction with maxillomandibular fixation, to obviate the potential for permanent injury to the facial nerve. The technique described employs an anterior parotid, two-layer, sub-SMAS (superficial musculo-aponeurotic system) approach via a rhytidectomy incision that reliably identifies and preserves the neural elements and provides direct access to the pericondylar region. The thirteen patients presented here exhibited satisfactory functional and aesthetic results. Complications included temporary nerve palsies, plate fractures, and a hematoma.

Intraoperative airway management with pan-facial fractures: alternative approaches.

Nasoendotracheal intubation is contraindicated in patients with pan-facial fractures for securing the airway during reconstructive surgery. Oral intubation interferes with intermaxillary fixation during fracture reduction. In these situations, elective tracheostomy is often the airway of choice. However, with the use of rigid internal fixation, postoperative maxillomandibular fixation is unnecessary and traditional tracheostomy may be avoided, unless oral intubation is impossible or long-term airway control is necessary. This article presents Bullard laryngoscopy and submandibular intubation techniques as innovative alternative methods of airway management during surgery. These procedures are indicated in those patients with severe injuries who do not require long-term airway management postoperatively and did not require tracheostomy in the emergency room.

Zygomatico-orbital fractures: historical perspective and current surgical management.

This article presents a general historical review of zygomatico-orbital (ZO) fractures with application of contemporary surgical procedures. Two surgical cases are presented, in which the ZO fractures were approached via a transconjunctival incision with a lateral canthotomy. A two-point rigid internal fixation, combined with a porous high-density polyethylene orbital floor reconstruction, produced uniformly excellent cosmetic and functional results in a total of 42 patients with ZO fractures who were treated over a 2-year period.

Reconstruction of the anterior floor of the mouth using a labial mucosal flap.

"Definitive extirpative surgery alone is no longer an acceptable approach to the management of intra-oral carcinoma. With the resultant functional impairment of the oral cavity, it is incumbent upon the surgeon to accept the responsibility for performing a well-conceived plan of surgical reconstruction." Two cases are presented in this paper, both of which had T2 squamous cell carcinoma lesions of the anterior floor of the mouth. Each case was amendable to wide excision with marginal mandibulectomy and neck dissection. Closure in the first case was accomplished in the conventional manner by suturing the tongue anteriorly to the lip, necessitating a secondary skin graft vestibuloplasty to restore function and esthetics. Had postoperative radiotherapy been required, such a procedure may not have been possible or would have been difficult. Most surgeons agree that the best time to correct any deformity is at the first operation. In the second case, this was accomplished by the use of a simple mucosal pedicle flap supported by a surgical stent. Serious complications may have been avoided if a secondary reconstructive procedure had to be performed after radiotherapy.

Myxoma of the mandible treated by peripheral ostectomy and immediate reconstruction: report of case.

A case of fibromyxoma of the mandible treated by peripheral ostectomy and immediate bone graft is presented. This procedure maintains mandibular continuity and can be accomplished via the intraoral approach. There is minimal chance for recurrence and excellent functional and esthetic results can be predicted.

Timing, results, and complications of mandibular reconstructive surgery: report of 32 cases.

Sufficient information concerning the difficulties encountered in reconstructive surgery is rarely provided in the literature. This study, which was performed on 32 patients, points out a high rate of complication; major and minor complications were encountered in 68.8% of the patients. Benign and traumatic lesions caused the fewest problems. Malignant lesions, particularly those receiving radiotherapy, had the greatest incidence of complications. Successful reconstruction was accomplished in 75% of the cases. The use of a corticocancellous autogenous graft is suggested in selected cases of malignant disease.