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1.
Support Care Cancer ; 29(1): 11-15, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32856215

RESUMEN

During the current pandemic scenario, maxillofacial rehabilitation specialists involved with supportive care in cancer must transform its practice to cope with COVID-19 and improve protocols that could quickly return the oral function of complex cancer patients who cannot wait for surgical complex rehabilitation. This includes the role of the maxillofacial prosthodontist for the rehabilitation of surgically treated patients with maxillary cancers by the means of filling obturator prostheses that are considered an optimal scientific-based strategy to reduce hospital stay with excellent pain control, oral function (speech, swallowing, mastication, and facial esthetics), psychologic and quality of life outcomes for the patients following intraoral cancer resection. Therefore, the aim of this commentary was to bring new lights to the strategic use of obturator prostheses for the rehabilitation of oral cancer patients during the COVID-19 pandemic as well as to present a protocol for managing such cases.


Asunto(s)
/epidemiología , Vías Clínicas/organización & administración , Accesibilidad a los Servicios de Salud/organización & administración , Prótesis Maxilofacial , Neoplasias de la Boca/rehabilitación , Obturadores Palatinos , Atención Ambulatoria/métodos , Atención Ambulatoria/organización & administración , Vías Clínicas/normas , Diseño de Prótesis Dental/normas , Estética , Humanos , Reconstrucción Mandibular/instrumentación , Reconstrucción Mandibular/métodos , Reconstrucción Mandibular/normas , Prótesis Maxilofacial/estadística & datos numéricos , Neoplasias de la Boca/cirugía , Ortodoncia/métodos , Ortodoncia/organización & administración , Ortodoncia/normas , Obturadores Palatinos/estadística & datos numéricos , Pandemias , Patología Bucal/organización & administración , Patología Bucal/normas , Calidad de Vida , Flujo de Trabajo
2.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(11): 1410-1416, 2020 Nov 15.
Artículo en Chino | MEDLINE | ID: mdl-33191699

RESUMEN

Objective: To investigate the influence of the design and application of novel surgical template on the accuracy of reconstructed mandibula and implant position in occlusion-guided functional mandibular reconstruction, so as to provide guidance for clinical treatment. Methods: Between January 2017 and May 2019, 11 patients with segmental mandible defects were treated, including 8 males and 3 females with an average age of 31.8 years (range, 19-45 years). There were 6 cases of ameloblastoma, 3 cases of keratocystic tumor, and 2 cases of ossifying fibroma. According to Urken classification of mandible defects, there were 1 case of CRB, 4 cases of RB, 2 cases of RBS, and 4 cases of SB. According to the occlusion relationship, a novel surgical template with the reconstruction titanium plate screws and implants drill-guided information was designed and manufactured. With the help of the novel surgical template, the "one and a half" fibula reconstruction mode was used for jaw functional reconstruction, and the implant supported denture was finally completed. The postoperative CT at 1 week were collected to analyze the morphology of the preoperative virtual design jaw and postoperative jaw. The coincidence of fibular reconstructed mandible (fibular upper barrel, fibular reconstructed ramus and condyle, and whole mandible) and implant in mandible were calculated. When the coincidence was less than 80%, it was considered that the deviation was obvious. Oral panoramic X-ray film and cone beam CT were examined at 6 months after operation to evaluate the osseointegration before implant repair. Results: None of the 11 flaps had postoperative vascular crisis. One flap occurred necrosis at 1 month after reconstruction combined with 3 implants failed, and had been removed at 6 months after reconstructed surgery; the others had no flap necrosis. One week postoperatively, the coincidence of the fibular upper barrel was 87.55%±3.08%, the whole mandible was 82.68%±5.94%, and the implant in mandible was 88.00%, with significant differences ( t=8.131, P=0.000; t=2.118, P=0.046; Z=4.070, P=0.000) when compared to 80%, respectively. The fibular reconstructed ramus and condyle was 77.82%±3.54%, with no significant difference ( t=-2.042, P=0.068) when compared to 80%. Six months postoperatively, oral panoramic X-ray film and cone beam CT showed that all 22 implants achieved osseointegration and the palatal mucosa transplantation was performed, then finally completed the denture rehabilitation at 6-9 months after operation. All patients were satisfied with their postoperative appearance. Conclusion: The novel surgical template can guarantee the accuracy of functional mandible reconstruction guided by occlusal guidance, and ultimately achieve the beautiful contour of jaw and occlusal function reconstruction, and improve the patient's life quality.


Asunto(s)
Ameloblastoma , Colgajos Tisulares Libres , Neoplasias Mandibulares , Reconstrucción Mandibular , Procedimientos Quirúrgicos Reconstructivos , Adulto , Ameloblastoma/cirugía , Trasplante Óseo , Femenino , Peroné/cirugía , Humanos , Masculino , Mandíbula/cirugía , Neoplasias Mandibulares/cirugía , Persona de Mediana Edad , Colgajos Quirúrgicos , Adulto Joven
3.
Artículo en Inglés | MEDLINE | ID: mdl-33151192

RESUMEN

Oral cancer treatment involving the maxilla and/or mandible often results in esthetic and functional deficits that can diminish the patient's quality of life. As a result, expeditious reconstruction of the defect and dental rehabilitation is desirable. Dental rehabilitation shortly after reconstruction with an osteocutaneous free flap and resection prosthesis is a persistent challenge for patients with oncologic defects where immediate dental rehabilitation is not a possibility. Additionally, conventional prosthesis fabrication techniques are impractical or impossible due to postoperative anatomical changes and limitations in clinical armamentarium. To address these limitations, a technique and a novel implant-supported prosthetic workflow for the oncologic patient were developed to provide interim dental rehabilitation for such clinical situations. This article describes the prosthesis fabrication technique, reports short-term outcomes, and evaluates patient-reported quality-of-life outcomes using the FACE-Q Head and Neck Cancer Module.


Asunto(s)
Implantes Dentales , Colgajos Tisulares Libres , Reconstrucción Mandibular , Implantación Dental Endoósea , Prótesis Dental de Soporte Implantado , Peroné/cirugía , Humanos , Calidad de Vida
4.
J Oral Maxillofac Surg ; 78(11): 2099.e1-2099.e9, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33131550

RESUMEN

PURPOSE: The use of nonvascular bone grafts for immediate mandibular reconstruction has remained a controversial topic. The purpose of the present study was to investigate the variables that might influence graft survival examining the outcomes from 30 years of experience. MATERIALS AND METHODS: We designed a retrospective cohort study to analyze the data from patients at a tertiary university medical center who had undergone segmental mandibular resection with immediate reconstruction with a nonvascularized free bone graft with or without adjuncts from 1989 to 2019. The predictor variables recorded included general demographic data, pathologic diagnosis, resection length, reconstruction modality, bone graft type, and inferior alveolar nerve procedures. The primary outcome variable was graft success, defined as bony union demonstrated on panoramic radiographs and mandibular stability demonstrated on clinical examination at 4 months postoperatively. Descriptive, bivariate, and linear regression models were computed. RESULTS: The sample included 47 subjects with a mean age of 43 ± 16 years; 51.1% were men. Of the 47 patients, 25 had a tissue diagnosis of benign tumor, most of which were ameloblastoma (n = 16) or ossifying fibroma (n = 6), and 22 had a tissue diagnosis of osteomyelitis or medication-related osteonecrosis of the jaw (MRONJ). The average resection size for all the patients was 6.9 ± 2.5 cm and was 6.1 ± 1.5 cm for those with a benign tumor and 7.8 ± 3.1 cm for those with osteomyelitis or MRONJ. The mean defect size of grafts that failed was 10.7 ± 3.5 cm and 6.5 ± 2.0 cm for those that succeeded (P ≤ .001). A linear regression model revealed that graft length correlated significantly with graft outcome (ß-coefficient, -0.548; 95% confidence interval, 0.905 to 1.542; P ≤ .001). CONCLUSIONS: The results of our study have shown that nonvascular bone grafts can be used to immediately reconstruct mandibular defects greater than 6 cm from benign pathologic lesions; however, larger grafts are more likely to fail.


Asunto(s)
Neoplasias Mandibulares , Reconstrucción Mandibular , Adulto , Trasplante Óseo , Femenino , Humanos , Masculino , Mandíbula/diagnóstico por imagen , Mandíbula/cirugía , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento
5.
Medicine (Baltimore) ; 99(43): e22779, 2020 Oct 23.
Artículo en Inglés | MEDLINE | ID: mdl-33120789

RESUMEN

This study aimed to measure temporomandibular joint (TMJ) with 3-dimensional (3D) reconstruction technique in Chinese northeast population, and to clarify the region for fixation and to provide morphological basis for the application of TMJ prosthesis in Chinese setting.Computed tomography (CT) scan and 3D reconstruction were performed with 132 individuals. Structural markers and measurements were further performed with a 3D model of the total TMJ, including the width, thickness and angle of zygomatic arch, the width and height of articular fossa, as well as the area, width, thickness and angle of mandible in the fixation region of the TMJ prosthesis. All the measured indicators values were compared between bilateral sides and gender groups.There was no statistical difference in the measured indicators between the left side and the right side (P > .05). However, certain parameters, including S, L5, L7, P4, and P5, were significantly different among males and females (P < .05).In this study, 3D CT image was used to obtain the measurement data of TMJ, which provided data support for the clinical application of TMJ prosthesis in Chinese population.


Asunto(s)
Imagenología Tridimensional/métodos , Mandíbula/diagnóstico por imagen , Articulación Temporomandibular/diagnóstico por imagen , Adulto , Anciano , Femenino , Humanos , Prótesis Articulares , Masculino , Mandíbula/cirugía , Reconstrucción Mandibular/métodos , Persona de Mediana Edad , Factores Sexuales , Articulación Temporomandibular/cirugía , Adulto Joven
6.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(5): 938-942, 2020 Oct 18.
Artículo en Chino | MEDLINE | ID: mdl-33047733

RESUMEN

OBJECTIVE: To investigate the position change of the fibular bone after maxillary reconstruction by free fibular flap and to analyze the factors affecting the position change. METHODS: Patients who underwent maxillary reconstruction by free fibular flap in the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from November 2012 to November 2016 were enrolled in this study. CT scans 1 week and 1 year postoperatively were collected and stored in DICOM format. The ProPlan CMF software was used to reconstruct the CT scans and separate the maxilla and each segment of the fibular flap. The Geomagic Control software was used to measure the long axis direction vector of each fibular segment. And the position change direction was recorded. The patients were divided into groups according to the use of the fibula or titanium plate to reconstruct the zygomaticmaxillary buttress. RESULTS: A total of 32 patients were enrolled. Among them, 21 were in the titanium plate group and 11 in the fibula bone group. The angle between the long axis of the fibular segment and the X axis in the X-Y plane was 95.65°±53.49° and 95.53°±52.77°, 1 week and 1 year postoperatively, and there was no statistical difference (P>0.05). The angle between the long axis of the fibular segment and the X axis in the X-Z plane was 96.88°±69.76° and 95.33°±67.42°, respectively, with statistical difference (P=0.0497). The angular changes of the long axis of the fibular segment in the titanium plate group and the fibular bone group were 3.23°±3.93° and 1.94°±1.78°, respectively, and the angular changes in the X-Z plane were 6.02°±9.89° and 3.27°±2.31°, respectively. There was no significant difference between the groups (P>0.05). The long axis changes of the fibular segment in the X-Y plane for reconstruction of the anterior alveolar, posterior alveolar, and buttress were 3.13°±3.78°, 2.56°±3.17°, and 5.51°±4.39°, respectively. There was a statistical difference (P = 0.023) between the posterior and buttress. In the X-Z plane, theses were 4.94°±4.75°, 5.26°±10.25°, 6.69°±6.52°, respectively. There was no statistical difference among the three groups (P>0.05). The main positional deviation directions of the titanium plate group and the fibular bone group were interior and superior sides, and there was no statistical difference between the two groups (P>0.05). CONCLUSION: One year postoperatively, the position of the free fibular flap was changed compared with 1 week postoperatively. The position of the free fibular flap was mainly changed to the interior and superior sides.


Asunto(s)
Colgajos Tisulares Libres , Reconstrucción Mandibular , Trasplante Óseo , Peroné/diagnóstico por imagen , Humanos , Maxilar/diagnóstico por imagen , Maxilar/cirugía
7.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5519-5522, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-33019229

RESUMEN

Because implicit medical knowledge and experience are used to perform medical treatment, such decisions must be clarified when systematizing surgical procedures. We propose an algorithm that extracts low-dimensional features that are important for determining the number of fibular segments in mandibular reconstruction using the enumeration of Lasso solutions (eLasso). To perform the multi-class classification, we extend the eLasso using an importance evaluation criterion that quantifies the contribution of the extracted features. Experiment results show that the extracted 7-dimensional feature set has the same estimation performance as the set using all 49-dimensional features.


Asunto(s)
Reconstrucción Mandibular , Algoritmos , Peroné/cirugía
8.
J Craniomaxillofac Surg ; 48(10): 994-1003, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32893092

RESUMEN

The aim of this paper is to identify risk factors associated with the development of osteosynthesis plates' related complications in fibula free flap reconstructions. This is a case series study of consecutive fibula free flaps. Clinical and radiological variables were recorded. Patient outcomes were evaluated with special attention to osteosynthesis plates' related complications; these included plate exposure, plate fracture, loosening of screws, non-union, bone resorption, oro-cutaneous fistulas, and bone exposure. We have done a descriptive analysis, univariate analysis, and multivariate logistic regression model to explore possible risk factors for osteosynthesis plates' related complications. Data analysis was performed using R software (version 3.5.0). 111 fibula free flaps were studied. 29 patients (26.1%) developed osteosynthesis plates' related complications. The mean time to osteosynthesis plates' related complications was 22 months; range (1-120); the median and mode were 12 months. Patients with preoperative radiotherapy (34% vs 14%, p = 0.021), and secondary reconstruction (31% vs 15%, p = 0.053) had a higher incidence of osteosynthesis plates' related complications. In the univariate analysis, "preoperative radiotherapy" (OR 3.07, 95%CI = 1.139-8.242, p = 0.025) and "extraoral soft-tissue defect" (OR 2.907, 95%CI = 1.032-8.088, p = 0.042) were risk factors for osteosynthesis plates' related complications. We have observed an interaction effect: patients with mandibular Brown's classes III + IV and "secondary reconstruction" have a higher risk for osteosynthesis plates' related complications; more than 47.30 times compared to Brown's class I and "primary reconstruction" (p = 0.026). Different factors may contribute to the development of osteosynthesis plates' related complications. Our study adds important information about these. Patients with higher risk of developing complications should be informed that a second intervention to remove the plates might be necessary.


Asunto(s)
Colgajos Tisulares Libres , Neoplasias Mandibulares , Reconstrucción Mandibular , Placas Óseas/efectos adversos , Trasplante Óseo , Peroné , Fijación Interna de Fracturas/efectos adversos , Humanos , Mandíbula , Estudios Retrospectivos
10.
J Craniomaxillofac Surg ; 48(9): 859-867, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32792109

RESUMEN

BACKGROUND: Bone volume changes following vascularized bone flaps and possible confounding factors over time are described in the literature with some controversy. The purpose of this study was to evaluate the bone volume behavior of two frequently used free flaps. MATERIALS AND METHODS: Computed tomography (CT) scans were examined with regard to bone volume using the software program ITK-SNAP for all patients who required mandibular reconstruction with a free fibula flap (FFF, conventionally vs assisted by computer-aided design/computer-aided manufacturing (CAD/CAM)) or iliac crest flap (DCIA) following mandibular resection because of benign or malign processes, between August 2010 and August 2015. Clinical data, complication rates, and CT scans were analyzed retrospectively. Additionally, complication rates (microvascular revision, flap loss, postoperative fistula or dehiscence, and postoperative bone exposure) were compared within early (≤30 days), late (31st-100th day), and overall (≤100th day) postoperative time intervals. RESULTS: 113 cases, comprizing 89 FFF and 24 DCIA cases, were included. FFF showed superior bone volume behavior over the DCIA flap. Multivariable regression models assessed the relationships between the following and bone volume behavior: interval between operation and CT scan (p < 0.683), age (p = 0.004), gender (p = 0.006), BMI (p = 0.400), adjuvant radiation therapy (p = 0.334), reconstruction with DCIA flap (p < 0.0001), number of segments (p = 0.02), and incidence of dental implant insertion (p = 0.45). CONCLUSIONS: The bone volume of FFFs remains stable. DCIA flaps show a higher bone volume reduction, but the postoperative course might be associated with fewer complications. Time interval between operation and CT scan, age, gender, reconstruction with DCIA flap, and number of fibula segments contributed significantly to bone volume behavior.


Asunto(s)
Colgajos Tisulares Libres/cirugía , Reconstrucción Mandibular , Procedimientos Quirúrgicos Reconstructivos , Trasplante Óseo , Peroné/cirugía , Humanos , Mandíbula/cirugía , Estudios Retrospectivos
11.
Artículo en Chino | MEDLINE | ID: mdl-32791639

RESUMEN

Objective:To investigate the application of free fibular flap based on digital technology in mandibular defects. Method:Eight cases of mandibular defects underwent virtual surgery and guide plate design before operation. The mandibular osteotomy guide plate, fibula plastic guide plate and mandibular reconstruction model were prepared by rapid prototyping technology. The individualized reconstruction titanium plates were prefabricated on the mandibular reconstruction model. Based on the guide plates and the individualized reconstruction titanium plates, the mandibular defects were repaired accurately. At the same time, CT angiography was used to observe the variation of peroneal artery. For patients with soft tissue defects, the superficial position of the point going out muscle of perforator vessels was located, and the skin flaps were designed to repair the soft tissue defect. Result:The free fibular flaps survived in all patients. The guide plates were successfully implanted, the position of the individualized reconstruction titanium plates were accurate, and the occlussions were well recovered. Preoperative CT angiography was carried out without complication in all patients, the desired anatomy was adequately demonstrated in all patients. The superficial position of the point going out muscle of perforator vessels during operation were basically in accordance with those detected by CT angiography. Conclusion:The free fibular flaps based on digital technology can successfully repair mandibular defects with good aesthetic and functional results.


Asunto(s)
Colgajos Tisulares Libres , Reconstrucción Mandibular , Procedimientos Quirúrgicos Reconstructivos , Placas Óseas , Peroné/cirugía , Humanos , Mandíbula/cirugía
13.
J Craniomaxillofac Surg ; 48(8): 719-723, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32713801

RESUMEN

Reconstruction of mandibular discontinuity defects remains a challenge for maxillofacial surgeons. Despite vascularized free flaps representing the current gold standard for managing such defects, the search continues for other less morbid yet predictable interventions. This study aimed at reviving the idea of alloplastic mandibular endoprosthesis as a treatment modality for reconstruction of segmental mandibular defects following eradication of benign tumors. To reconstruct their segmental mandibular defects, this case series compiled seven patients who received patient-specific titanium implant (PSI) with osseointegrated components and were designed to receive a restoration for dental rehabilitation. The recruited patient population was followed-up for a period of 3-5 years. Three of the seven PSIs failed due to extensive intraoral mucosal dehiscence or persistent extraoral fistulae. Patients with the 4 surviving PSIs enjoyed good results in terms of occlusion, masticatory function, mouth opening as well as pleasing facial esthetics. The described technique represents a viable less morbid alternative to the standard bone grafting techniques for mandibular reconstruction in carefully selected patients. Further studies are needed to modify the PSI design and surface treatment for better outcomes.


Asunto(s)
Implantes Dentales , Neoplasias Mandibulares , Reconstrucción Mandibular , Trasplante Óseo , Estética Dental , Humanos , Mandíbula
14.
J Craniofac Surg ; 31(5): 1424-1429, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32502110

RESUMEN

Translating bone regeneration induced by recombinant human bone morphogenetic proteins from animal models to human patients has proven inexplicably inconsistent. This prompted us to test in 5 pediatric patients, an alternative osteoinductive morphogen, recombinant human transforming growth factor ß3 (hTGF-ß3), to reconstruct mandibular defects of such a size to preclude reconstruction with autologous bone. An osteoinductive implant of human demineralized bone matrix (DBM) loaded with 125 µg hTGF-ß3 per gram of DBM was implanted into one defect, and 250 µg hTGF-ß3 per gram of DBM in another. Thereafter in 3 patients limited amounts of particulate cortico-cancellous bone graft harvested from the posterior iliac crest were combined with 250 µg hTGF-ß3 per gram of DBM. Patients were followed up for 3 to 6 years. Three patients achieved clinically significant osteoinduction, 1 patient with hTGF-ß3 only, and 2 by combining hTGF-ß3 with a small supplement of autologous bone. One patient with hTGF-ß3 only and followed up for 5 years retains a viable reconstruction but has had sub-optimal bone regeneration. One patient had osteoinductive failure due to sepsis although the plate reconstruction remains viable. Recombinant human TGF-ß3 initiates osteoinduction in humans and potentiates autologous bone graft activity allowing the reconstruction of large mandibular defects in pediatric patients.


Asunto(s)
Reconstrucción Mandibular , Factor de Crecimiento Transformador beta3/uso terapéutico , Adolescente , Regeneración Ósea/efectos de los fármacos , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Proteínas Recombinantes/uso terapéutico , Factores de Tiempo
15.
Oral Maxillofac Surg ; 24(3): 359-362, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32500381

RESUMEN

BACKGROUND: Checkrein deformity is an uncommon disease with a well-described etiology. It is characterized by a dynamic deformity of the hallux or great toe. We report two cases of checkrein deformity due a fibular graft harvesting in two patients with a mandibular bone defect secondary to an oral cancer treatment. CASE REPORT: We report two young patients with mandibular cancers that had been treated several years before our visit and were currently free of disease. The patients had a mandibular bone defect due to the maxillofacial treatment, solved with a free fibular graft. The current complaint was a great toe deformity that caused pain and made them walk with difficulties. Diagnosis was a checkrein deformity, and after a surgical release of the flexor hallucis longus tendon, both cases returned to normal activities with no walking limitations. CONCLUSION: Our cases highlight that an accurate patient examination is warranted following these reconstructions as many of them can be misdiagnosed, and a relatively simple surgery can improve the patients' limitations.


Asunto(s)
Hallux , Reconstrucción Mandibular , Neoplasias de la Boca , Humanos , Dolor , Tendones
16.
Plast Reconstr Surg ; 146(4): 872-879, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32590512

RESUMEN

BACKGROUND: Virtual surgical planning has contributed to technical advancements in free fibula flap mandible reconstruction. The authors present the largest comparative study on the latest modification of this technology: the use of patient-specific, preoperatively customized reconstruction plates for fixation. METHODS: A retrospective chart review was performed on all patients undergoing mandibular reconstruction with virtually planned free fibula flaps at a single institution between 2008 and 2018. Patient demographics, perioperative characteristics, and postoperative outcomes were reviewed. Reconstructions using traditional fixation methods were compared to those using prefabricated, patient-specific reconstruction plates. RESULTS: A total of 126 patients (mean age, 48.5 ± 20.3 years; 61.1 percent male) underwent mandibular reconstruction with a free fibula flap. Mean follow-up time was 23.5 months. A customized plate was used in 43.7 percent of cases. Reconstructions with patient-specific plates had significantly shorter total operative times compared with noncustomized fixation methods (643.0 minutes versus 741.7 minutes; p = 0.001). Hardware complications occurred in 11.1 percent of patients, with a trend toward a lower rate in the customized plate group (5.5 percent versus 15.5 percent; p = 0.091). Multivariate regression showed that the use of customized plates was a significant independent predictor of fewer overall complications (p = 0.03), shorter operative time (p = 0.014), and shorter length of stay (p = 0.001). CONCLUSIONS: Compared to traditional fixation methods, patient-specific plates are associated with fewer complications, shorter operative times, and reduced length of stay. The use of customized reconstruction plates increases efficiency and represents the latest technological innovation in mandibular reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Asunto(s)
Placas Óseas , Peroné/trasplante , Colgajos Tisulares Libres , Reconstrucción Mandibular/métodos , Cirugía Asistida por Computador/métodos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Planificación de Atención al Paciente , Estudios Retrospectivos , Interfaz Usuario-Computador
18.
Int J Oral Maxillofac Surg ; 49(11): 1408-1415, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32404244

RESUMEN

The aim of this study was to present a treatment protocol for the individual repair of post-traumatic maxillofacial bone defects with vascularized flaps assisted by digital techniques. This study reviewed 20 patients with post-traumatic maxillofacial bone defects who underwent reconstruction with composite vascularized bone flaps assisted by digital techniques between April 2009 and July 2019. Preoperative computed tomography (CT) data were imported into ProPlan CMF software to complete virtual fracture reduction and reconstruction. Surgical navigation, three-dimensionally (3D) printed surgical plates, and prefabricated titanium mesh/plates were used to guide the actual surgery. All patients underwent open reduction and internal fixation and reconstruction surgery in one stage. CT data obtained at 1 week postoperative were imported into Geomagic Control software to evaluate the accuracy of the virtual surgical plan. The mean follow-up interval was 24 months (range 6-96 months). Donor and recipient site morbidity and second-stage procedures to rehabilitate the dentition and cosmetic organs were recorded. The flap success rate was 100%. Nine patients had deep circumflex iliac artery flaps and eleven patients had fibula flaps. The accuracy of computer-assisted surgery was 4.4±0.8mm. There were no postoperative complications. This study is novel in presenting a treatment protocol for individual computer-assisted reconstruction for post-traumatic maxillofacial bone defects with vascularized flaps.


Asunto(s)
Reconstrucción Mandibular , Procedimientos Quirúrgicos Reconstructivos , Cirugía Asistida por Computador , Trasplante Óseo , Peroné/diagnóstico por imagen , Peroné/cirugía , Humanos , Colgajos Quirúrgicos , Tomografía Computarizada por Rayos X
19.
J Craniofac Surg ; 31(5): e483-e485, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32371716

RESUMEN

Functional reconstruction of the jaw defect due to tumor resection poses a challenging problem in maxillofacial surgery. Large bone defects in the mandible due to ablation for tumors may generate a series of problems, as far as function and esthetics of the patient is concerned. The use of free bone flaps for mandibular reconstruction has the obvious advantage of being a well vascularized tissue that can withstand the hostile environment of the oral cavity. Fibular bone presents favorable conditions for implant-supported prosthetic rehabilitation, due to its diameter and the good quality of its cortical bone. The outcome of current study supports the use of simultaneous placement of endosseous implants in free fibula flap for reconstruction of mandibular resection defects with better clinical, aesthetic, and functional outcomes.


Asunto(s)
Implantación Dental Endoósea , Peroné/cirugía , Colgajos Tisulares Libres/cirugía , Mandíbula/cirugía , Reconstrucción Mandibular , Femenino , Humanos , Masculino
20.
Plast Reconstr Surg ; 146(3): 637-648, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32459736

RESUMEN

BACKGROUND: Maxillofacial reconstruction with vascularized bone restores facial contour and provides structural support and a foundation for dental rehabilitation. Routine implant placement in such cases, however, remains uncommon. This study aims to determine dental implant survival in patients undergoing vascularized maxillary or mandibular reconstruction through a systematic review of the literature. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the literature was queried for implant placement in reconstructed jaws using Medical Subject Headings terms on PubMed, Embase, and Cochrane platforms. Weighted implant survivals were calculated for the entire cohort and subcohorts stratified by radiotherapy. Meta-analyses were performed to estimate effect of radiation on implant osseointegration. RESULTS: Of 3965 publications identified, 42 were reviewed, including 1084 patients with 3636 dental implants. Weighted implant survival was 92.2 percent at a median follow-up of 36 months. Survival was 97.0 percent in 269 implants placed immediately in 60 patients versus 89.9 percent in 1897 delayed implants placed in 597 patients, with follow-up of 14 and 40 months, respectively. Dental implants without radiotherapy exposure had better survival than those exposed to radiation (95.3 versus 84.6 percent; p < 0.01) at a median follow-up of 36 months. Meta-analyses showed that radiation significantly increased the risk of implant failure (risk ratio, 4.74; p < 0.01) and suggested that implants placed before radiotherapy trended toward better survival (88.9 percent versus 83.4 percent, p = 0.07; risk ratio, 0.52; p = 0.14). CONCLUSIONS: Overall implant survival was 92.2 percent; however, radiotherapy adversely impacted outcomes. Implants placed before radiotherapy may demonstrate superior survival than implants placed after.


Asunto(s)
Trasplante Óseo/métodos , Implantación Dental Endoósea , Reconstrucción Mandibular/métodos , Oseointegración/fisiología , Colgajos Quirúrgicos/irrigación sanguínea , Humanos , Procedimientos Quirúrgicos Reconstructivos
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