Prelaminated Nose Reconstruction: Comparison of Forehead and Radial Donor Site and Review of the Literature.

INTRODUCTION: Total nose reconstruction is demanding as it is a 3-dimensional structure that needs lining, support and external coverage. Usually, several stages are needed to achieve a satisfactory result. The authors present 2 cases of prelaminated radial forearm and 2 prelaminated forehead nose reconstructions and compare both methods. According to our review of the literature, this is the first report of prelaminated forehead for total nose reconstruction. MATERIALS AND METHODS: The last 5 years the authors have treated 4 patients with prelaminated flaps for total nose reconstruction. The age ranged from 50 to 75 years. There were 3 male patients and one female. Three patients underwent total nose amputation due to squamous cell carcinoma and one due to melanoma. RESULTS: Two patients were treated with prelaminated radial forearm reconstruction and 2 with prelaminated forehead reconstruction. Both patients that were treated with prelaminated radial forearm reconstruction had the collapse of the nasal pyramid and had salvage procedures with replacement of the cartilaginous framework with iliac bone graft framework. CONCLUSIONS: Prelaminated nose reconstruction with either the radial forearm or forehead flap needs several stages. There is the possibility of infection-collapse of the cartilage framework, therefore, the authors recommend reconstruction of the nasal skeleton with an iliac bone graft. The flaps are stiff and difficult to handle. The authors don't think that prelaminated nose reconstruction with the radial forearm flap has advantage compared with the classic several stages nose reconstruction with radial forearm flap. Possibly, prelaminated forehead reconstruction can be applied for aged patients who cannot undergo microsurgical reconstruction.

Osteonecrosis of the jaw and bisphosphonate use in breast cancer patients.

It is renowned that breast cancer patients suffer from a number of cancer-related skeletal events, while drugs recently added to the practitioners' quiver, such as aromatase inhibitors, intensify the need to preserve bone mass in this group of patients. Bisphosphonates are potent inhibitors of both normal and pathologic bone resorption. Besides their apoptotic and antiproliferative activity on osteoclasts, bisphosphonates can also exert various effects on macrophages, keratinocytes and fibroblasts. Bisphosphonate-related osteonecrosis of the jaw is a complication that emerged after broad clinical use of bisphosphonates, and which has not yet been adequately described in a clinical trial setting. The purpose of this review is to critically reflect the incidence, etiopathogenesis, prevention and treatment of osteonecrosis of the jaw. Succinct suggestions are provided to ensure clinicians prevent and detect the complications early.

Ultrastructural changes of the palatal mucosa following application of 4-nitroquinoline-l-oxide (4NQO) in rats subjected to major salivary gland excision.

OBJECTIVE: It has been suggested that saliva exerts a protective role against the carcinogenic effect of various substances in the oral cavity. The objective of this study was to examine the ultrastructural changes of the palatal mucosa caused by the application of 4-nitroquinoline-l-oxide (4NQO) in the presence or absence of saliva. STUDY DESIGN: Wistar-Furth rats subjected and not subjected to total bilateral excision of the major salivary glands were either painted with an aqueous solution of 4NQO or with propylene glycol only (controls). Two animals of each group were humanely killed periodically. The areas of the palatal lesions were immediately sliced and processed for TEM examination. RESULTS: Ultrastructurally, the progressive changes to squamous cell carcinoma were observed in the animals painted with 4NQO. In the desalivated animals group, the ultrastructural alterations appeared earlier than in the group with salivary glands. CONCLUSIONS: Saliva appeared to delay but not hinder tumor induction by 4NQO.