Treatment of mandibular osteoradionecrosis by cancellous bone grafting.

PURPOSE: This study was undertaken to evaluate a new method in the treatment of mandibular osteoradionecrosis. PATIENTS AND METHODS: Eight patients, seven male and one female, with a mean age of 64 years (range, 43 to 67 years), suffering from osteoradionecrosis of the mandible, two bilaterally and six unilaterally, were treated. Five initially had hyperbaric oxygen (HBO) followed by sequestrectomy, and three had sequestrectomy alone. Because healing failed to occur, all patients were treated by removal of the necrotic bone in the affected part of the mandible and filling the defect with compressed particulated cancellous bone and marrow from the tibia. The patients were observed for an average period of 39 months (range, 20 to 93 months). RESULTS: Primary healing was achieved in two patients with unilateral osteoradionecrosis and HBO treatment. In another patient treated with HBO primary healing occurred on one side while the other healed secondarily. In the remaining five patients, complete secondary healing took place, but it was complicated in three patients by fistulas, two of which were associated with fractures of the mandibular body. The fistulas were excised, and complete healing of the soft tissues occurred, but the fractures resulted in pseudarthrosis. CONCLUSIONS: The technique presented in this study can be useful in the treatment of osteoradionecrosis as an alternative to continuity resection and reconstruction with free osteocutaneous flaps, but, whenever possible, it should be proceeded by HBO treatment.

Lag screw fixation of composite radial forearm grafts in the reconstruction of mandibular discontinuities.

PURPOSE: This report reviews the results of immediate mandibular reconstruction performed with unosteotomized composite osteocutaneous forearm flaps using a lag screw technique for stabilization of the bone graft. PATIENTS AND METHODS: Six patients, reconstructed as described, were followed-up for a mean period of 21 months postoperatively (range, 13 to 36 months). RESULTS: Good initial stability was achieved, and healing was uneventful. At radiographic examination 12 months postoperatively, bony healing without dislocation of the segments was found in all patients. CONCLUSION: The lag screw technique provides good initial stability and allows functional stresses to be transmitted to the graft.

Dental implant survival in the irradiated jaw: a preliminary report.

Seventeen oral cancer patients (47 to 78 years, mean 67) were treated with external radiation in areas that included future implant sites. Implants were placed in the irradiated jaws after a period of 18 to 228 months (mean 88 months). The patients received 103 implants and were followed for 1 to 62 months (mean 21 months) after implant loading. The cumulative survival rate of the implants after 1 year was 97% in the mandible and 92% in the maxilla. While the irradiation dose used did not affect implant survival, this result may possible be influenced by the addition of hyperbaric oxygen treatment for patients receiving more than 50 Gy. Irradiation for treatment of oral cancer does not seem to reduce the survival rate of implants as compared to those placed in the nonirradiated jaw.

Mandibular reconstruction by secondary reimplantation of resected segments: a preliminary report.

This paper presents a new method of reconstructing the mandible after ablative surgery for cancer. This method uses autogenous grafts consisting of the respected part of the mandible, which is hollowed out, defatted in chloroform/methanol, sterilized with ethylene oxide, irradiated with beta-radiation (dose 25 kGy), and stored for 7-10 months. At reimplantation, they were filled with compressed, autogenous, particulate cancellous bone. All grafts took, and four of six host-graft junctions healed.

Preoperative Intermaxillary Fixation has no Influence on Weight Loss Induced by Vertical Banded Gastroplasty.

Surgery is the only therapeutic modality that has shown lasting results in the treatment of morbid obesity. Ability to lose weight by voluntary dieting has been associated with unsatisfactory weight loss after gastroplasty. This report examines the effect of preoperative inter-maxillary fixation (IMF) on weight reduction induced by vertical banded gastroplasty (VBG). Twenty-four patients entered the study and were randomly assigned to either 10 weeks of IMF or 10 weeks on the waiting-list. Patient groups were similar in respect to age, gender and Body Mass Index (BMI). All patients were urged to lose weight preoperatively. Patients in the IMF group lost 18 kg (-12 to -36; median, range) and the waiting list group lost 3 kg (+ 3 to -30) during the 10 weeks prior to surgery. Total weight loss from time of inclusion to 24 months postoperatively was the same in both groups. Our results suggest that weight loss up to 2 years after VBG is not Influenced by short-term preoperative IMF. Although we found no obvious advantage in having patients pre-treated by IMF, our findings indicate that jaw wiring can be used for patients in whom moderate preoperative weight loss is desired without endangering the effect of VBG on body weight development.

Disk-repositioning onlays in the treatment of temporomandibular joint disk displacement: comparison with a flat occlusal splint and with no treatment.

Sixty-three patients with an arthrographic diagnosis of disk displacement with reduction were randomly assigned to three treatment groups: (I) onlays to maintain disk repositioning, (II) flat occlusal splint, or (III) untreated controls. Guidance for construction of the disk-repositioning onlays was established during arthrography to obtain a recaptured disk position relative to the condyle. The onlays were cemented to the teeth and maintained the new intercuspal position anteriorly and inferiorly. The flat occlusal splint was used at night only and was adjusted to maintain a maximal occlusal contact in centric relation and centric occlusion. Clinical examinations were performed before and after 6 months of treatment. The disk-repositioning onlays improved joint function and reduced joint and muscle pain when compared with the flat occlusal splint and with nontreatment. The signs and symptoms in the flat occlusal splint group were no different from those in the control group. It is concluded that disk-repositioning onlays are effective in reducing pain and dysfunction associated with disk displacement with reduction in patients in whom the disk can be maintained in a normal relationship to the condyle with the aid of such onlays. The symptoms, however, returned when the onlays were removed after 6 months; this raises the question of whether a permanent change in the intercuspal position is necessary for long-term success.