Osteoradionecrosis of tympanic bone: reconstruction of outer ear canal with pedicled skin flap, combined with hyperbaric oxygen therapy, in five patients.

OBJECTIVE: To evaluate the results of one-stage surgical repair of the meatal skin defect in patients with long-lasting osteoradionecrosis of the outer ear canal, using a postauricular, inferiorly pedicled skin flap. All patients were also treated with hyperbaric oxygen both pre- and post-operatively. METHODS: A prospective study evaluating the results of a one-stage surgical procedure to repair the meatal skin defect in five patients with osteoradionecrosis of the outer ear canal. All patients were treated with hyperbaric oxygen both pre- and post-operatively. RESULTS: In four of the five patients, intact canal skin was achieved after surgery and hyperbaric oxygen therapy. One patient needed a second operation to cover a small remaining area of bare bone. In one patient, wound healing was unsatisfactory and an area of bare bone remained. CONCLUSION: In cases of osteoradionecrosis of the outer ear canal, the skin defect can be repaired with an inferiorly pedicled skin flap. Although not yet scientifically proven, the peri-operative application of hyperbaric oxygen may be of additional value to improve wound healing in areas of compromised tissue.

Rehabilitation after mandibular reconstruction with fibula free-flap: clinical outcome and quality of life assessment.

Tumors (benign or malignant), osteoradionecrosis or osteomyelitis sometimes lead to large segmental resections of the mandible. Osteo(cutaneous) fibula free-flaps (OFFF) are used to reconstruct these defects. New anatomical relationships as well as possible irradiation of local tissues make dental rehabilitation complicated. The aim of this study was to determine the rate of dental rehabilitation with an implant-retained lower denture or fixed appliances, after segmental resection and reconstruction of the mandible with an OFFF. Data were obtained from 70 patients, who underwent segmental mandibular resection followed by reconstruction with an OFFF, from 1995 to 2005. Dental rehabilitation was defined as a patient, who after segmental mandibular resection and reconstruction with an OFFF, received an implant-retained lower denture or fixed appliances. Clinical and functional assessments, as well as quality of life and denture satisfaction were evaluated. Twenty-four of 70 patients received dental implants; 18 received complete dental rehabilitation. Only a small percentage of patients with segmental mandibular reconstructions with an OFFF received complete dental rehabilitation, mainly because of poor survival after treatment for malignant tumors of the oral cavity. The beneficial effects of dental rehabilitation with an implant-retained denture or fixed appliances, mainly favored cosmetic aspects, rather than oral function.

Oral squamous cell carcinoma in children; review of an unusual entity.

Most commonly, squamous cell carcinoma (SCC) of the oral cavity presents during the fifth and sixth decades of life. Less than 4% of these cancers occur in patients younger than 40 years of age. Only a small sample of this subgroup exists of pediatric patients (< or =20 years), making oral SCC in children an extremely rare entity. An 11-year-old boy is presented who developed a SCC of the gingiva. The relevant literature of oral SCC in pediatric patients will be reviewed as well.

[Restoration of oral functions following a (partial) mandibulectomy due to an oral carcinoma]. / Herstel van orale functies na een (partiële) mandibularesectie vanwege een mondholtecarcinoom.

For patients diagnosed with malignant oral lesions invading the mandible, a partial or complete mandibulectomy is unavoidable. In predicting the invasion of the lesion, preoperative imaging techniques are used, such as an orthopantomogram, computed tomography, and magnetic resonance imaging. A mandibular discontinuity can be restored using a stainless steel or titanium reconstruction plate, or using autogenous non-vascularized or vascularized bone grafts. In achieving the goal of complete rehabilitation endosseous permucosal implants can be inserted in order to support a prosthesis. There is a tendency of a higher implant loss frequency among bone-grafted patients who have had implants after irradiation when compared with non-irradiated patients. After a (partial) mandibulectomy, oromandibular reconstruction by non-vascularized or vascularized bone grafts and endosseous implants provides a unique opportunity to restore some oral functions.