Application of supraclavicular island flap in oral and maxillofacial reconstruction.

Several surgical modalities are available for maxillofacial reconstruction as locoregional or microvascular free flaps. PURPOSE: (a) Evaluate the reliability of the supraclavicular flap in cervico-orofacial region; (b) investigate the role of computed tomography angiography (CTA) in predicting the post-operative viability of the flap; (c) assess the speech, feeding, and esthetics after reconstruction using this flap. METHODS: Eleven patients included in this study underwent either conventional or delayed harvesting of the supraclavicular flap (SCF). All the patients had diagnostic computed tomography angiography (CTA) of the supraclavicular flap before the surgery. RESULTS: The mean harvesting time of the flap was 45.45 ± 4.16 min. The average length of the flap was 22.64 ± 1.12 cm, whereas the mean width of the flap was 6.14 ± 1.14 cm. The flap survived in 9 patients, while two patients had complete flap loss. After the surgery, three patients complained of speech difficulties. Two patients had swallowing problems. After the surgery, three patients complained of speech difficulties. Two patients had swallowing problems. Only two patients complained of weakness in the donor site. None of the patients reported that the weakness or pain at the donor site affected their daily activities or quality of life. CONCLUSION: The pedicled SCF represents a safe and feasible option that can be used to reconstruct a wide array of maxillofacial oncologic defects. However, a study with a larger sample size is recommended to achieve more reliable clinical results for the modified delayed technique modification in terms of their effect on the survival of the supraclavicular flap.

A novel design for prosthetic ear guiding device: A technical note.

This article describes a newly designed Prosthetic Auricular Guide (PAG) that allows for accurate planning and positioning of both the auricular implants and the prosthetic auricle. The design aims to provide a cost-effective guiding device for more esthetic ear prostheses which is the patient's main concern. Along with determining the best clinically accepted position of the ear, the device can be used while taking CBCT which allows for the integration of the clinically approved position with the remaining bone for accurate planning of implant positions. Furthermore, the device can be fixed during surgery for accurate transmission of the planned position. The device is also adjustable making it suitable for all patterns of auricular defects, different ages, and even for patients with asymmetric faces.

A custom auricular implant healing abutment: A dental technique.

Skin overgrowth is a complication that hinders bone-anchored prosthetic ear rehabilitation. In order to accurately transfer the healing skin for prosthetic reconstruction, this article introduces a custom-made autopolymerizing acrylic resin auricular cap (button) through indirect pick up of the metal housing. The caps are secured during the healing stage to shape the skin, preventing surgical edema, swelling, and skin overgrowth in patients suffering from keloid reactions from covering the implant abutments. Since skin height and form are changeable, the caps can be relined directly or indirectly if greater skin compression is required. Moreover, these custom-made caps can be utilized during prosthetic silicone ear fabrication to retain the metal housing.

Early osteotomy with delayed implant placement: a step further for immediate loading.

The commonly used implantation technique involves a 2-stage surgical protocol for load-free and submerged healing to ensure predictable osseointegration. This article presents a new approach that benefits from previous bone and soft tissue protocols. It combines new surgical and insertion techniques to perform immediate loading with delayed implant placement, avoiding the problems of discomfort, inconvenience, and anxiety associated with healing periods. It maintains a similar success rate to the present common technique. After osteotomy, bone healing passes through 3 stages (i.e., inflammation, fibrous tissue, and maturation). In the new approach, implant insertion is performed 2 weeks after drilling (i.e., during the fibrous phase). The insertion timing is so selected because collagen formation and revascularization represent an acceptable implant bed configuration. Flap surgery offers the optimal osteotomy approach, but esthetic outcomes are definitely compromised. Accordingly, adopting the punch technique alleviates several postoperative problems, such as pain, tenderness, and swelling. Moreover, the punch technique avoids the sutures needed to adjust the gingiva around the abutment. It provides both cosmetic and functional properties.

Fabrication of polymer root form scaffolds to be utilized for alveolar bone regeneration.

Engineering dental tissues and organs is primarily motivated by a clinical need to restore these lost or diseased structures, in contrast to the use of harvested tissue. The present work focused on designing and characterizing scaffolds suitable for cultivation and implantation into the fresh extraction sockets of teeth, for the purpose of alveolar bone regeneration at a rate and quality higher than that of normal tissue healing for subsequent treatment with dental implants. Three-dimensional hollow root form scaffolds were prepared from poly-L-lactic acid/polyglycolic acid composites (50/50, 65/35, and 75/25 ratios), using the solvent casting compression molding particulate leaching technique. Two different salt particle sizes were used, 150-180 and 180-300 microm, to effect porogenesis. The scaffolds were characterized in vitro and in vivo. The highest percent porosity recorded was 75% with interconnectivity shown by scanning electron microscopy. The scaffolds demonstrated viscoelastic behavior and average strain in response to both static and dynamic forces that were suitable for them under bite-force magnitude anteriorly. The degradation of the root scaffolds depended on composite type, and on salt particle size. Tissue reaction favored samples made with large salt particle size.