Simultaneous maxillomandibular distraction in unilateral mandibular hypoplasia.

In craniomaxillofacial surgery we often deal with hypoplastic mandibles and mandibular asymmetries, the correction of which is critical to obtaining acceptable aesthetic results. In all of them we find common skeletal problems once growth has finished, such as an inclined occlusal plane and facial asymmetry with a stable dental occlusion. Simultaneous maxillomandibular distraction, which involves a Le Fort I osteotomy and a mandibular osteotomy with intermaxillary fixation during the period of active distraction, is an excellent technique to solve these problems. Virtual surgical planning, stereolithographic models, and surgical guides are supportive tools for obtaining excellent results. In this paper we present our experience with five cases of hypoplastic mandibles and mandibular asymmetries of different aetiologies. In all patients we achieved a considerable improvement in their physical appearance in the distance between the lateral canthus and oral commissure, the height of the mandibular ramus, the inclination of the occlusal plane, and the medial position of the chin. The benefits of virtual surgical planning in terms of choosing the optimal vector and the amount of distraction make it a promising technological tool to achieve excellent outcomes.

Bilateral auricular reconstruction with osseointegrated implant-retained prostheses. Optimization of aesthetic outcomes using virtual planning.

Auricular reconstruction in microtia patients is challenging, particularly in bilateral cases. The use of osseointegrated implants is a safe and effective way to retain the auricular prostheses. With the help of virtual planning we can produce more predictable results with better aesthetic outcomes. We present a case of an 8-year-old bilateral microtia patient who underwent auricular reconstruction with implant-retained prostheses, using virtual planning. Using stereolithographic models and surgical guides was also very helpful to achieve excellent results.

Is submental flap safe for the oncological reconstruction of the oral cavity?

AIM: The reconstruction of oral defects after oncological surgery is not an easy task for head and neck surgeons. The main aim of this work is to evaluate the functionality, viability and safety of submental flap for oral reconstruction. MATERIALS AND METHOD: We analyzed the records of patients diagnosed with oral and oropharyngeal SCC and reconstructed with the use of submental flap in Virgen de las Nieves University Hospital of Granada (Spain) from 2014 and 2015. Nine patients were found. Specific features such as age, sites of occurrence, sex distribution, T stage at diagnosis, nodal involvement, functionality of reconstruction and local and regional failure were determined. RESULTS: The male/female ratio was 8:1. The average age of the patients was 59.6 years (range: 42-75). Tumor locations were base of the tongue (n2), lateral edge of the tongue (n4), floor of the mouth (n2) and buccal mucosa (n1). Six tumors were classified as a T2 tumor and 3 as T3. No major complications were evidenced during the immediate postoperative period. Moreover, all patients showed excellent tissue coverage with acceptable aesthetic and functional outcomes. However, 1 patient showed partial epithelial loss of the skin paleta. Finally, the recurrence rate of disease was 44,4%. Four of 9 patients experienced a local (1/9) or cervical relapse (3/9). DISCUSSION: Submental flap might offer great aesthetic and functional results in oral reconstruction. However, the recurrence rate of disease was too high in our sample. From our point of view, submental flap should be carefully indicated in oncological reconstruction, especially in case of suspicion of lymph node involvement at level Ib.

Colgajo libre osteocutáneo escapular en el tratamiento diferido de herida por arma de fuego / Scapular osteocutaneous free flap in the deferred treatment of firearm wounds

Las heridas por arma de fuego de velocidad alta o intermedia, provocanimportantes pérdidas de tejido óseo y blando. El tratamiento diferido de estoscasos (tratamiento reconstructivo) requiere el aporte de tejido sano de regionesdistantes mediante técnicas microquirúrgicas en la mayoría de las ocasiones. Exponemosla utilidad del colgajo osteocutáneo escapular(COE) para la reconstrucciónde defectos óseos mandibulares laterales con amplio defecto cutáneomucoso. Citamosdetalles técnicos de la realización del colgajo ilustrados con la presentación deun caso clínico de un varón de 19 años con herida por arma de fuego en tercio inferiorde la región lateral izquierda. Pérdida ósea del cuerpo mandibular y cutánea dela mejilla y región yugal ipsilateral.El tratamiento inicial consistió en traqueotomía, desbridamiento de tejidos desvitalizados,ferulización dentaria, bloqueo intermaxilar, colocación de placa de reconstrucciónmandibular y colgajo de avance cervico-facial para cierre del defecto cutáneo.La necrosis del colgajo de avance cervicofacial produjo comunicación orofacial.La retracción cicatricial limitó la apertura oral a 0,8 cm. De forma diferida se procedióa colgajo osteomiocutáneo escapular-paraescapular del brazo izquierdo parareconstrución mandibular y de partes blandas intra y extraorales. Resultados satisfactoriosestética y funcionalmente. Complicaciones producidas: fístula salival, desinsercióndel brazo largo del tríceps, y dehiscencia de herida de zona donante escapularque necesitó intervención para cierre mediante colgajo local(AU)

Firearm wounds caused by high-velocity projectiles causeenormous losses of bone and soft tissue. The deferred treatment ofthese cases (delayed reconstruction) in most cases requires thetransfer of free tissue from other areas of the body. The use ofscapular and parascapular free flaps with scapular bone for thereconstruction of large lateral mandibular defects with extensivesoft-tissue avulsion is reported. The technical details of a free flapare offered with illustrations in the case report of a 19-year-old malewho was shot at close range in the lower third of the left lateralface. Avulsion of the left mandibular body and soft tissue occurredin the region from the cheek to the oral commissure. The initialtreatment was tracheostomy, cleaning of necrotic and devitalizedtissues, wiring of a mandible-to-maxilla arch bar and intermaxillaryfixation, rigid fixation with a reconstructive mandibular plate, anda regional cervical flap to close the skin wound. The cervical flapwas lost and a postoperative oral-cervical fistula appeared. Scarcontraction limited the mouth opening to 0.8 cm. In deferredtreatment, a scapular and parascapular free flap with scapular bonefrom the left shoulder was used to reconstruct the mandibular andintraoral-facial soft-tissue defects. The aesthetic and functionalresults were optimal. Some complications occurred: postoperativesalivary fistula, deinsertion of the long head of the brachial triceps,and scapular wound dehiscence, which will be closed surgically witha local flap(AU)