Practical Steps toward Prosthodontic Rehabilitation of Free Fibula Flaps: Sequential Techniques of Two Cases.

The free fibula flap has become a relatively common reconstruction modality for composite defects of the maxillo-mandibular skeleton. After establishment of vascular and osseous integration, the next functional goal would include prosthetic rehabilitation. There are specific biological and bio-mechanical parameters required to optimize the success of prosthodontic rehabilitation. These requirements translate to a specific set of surgical modifications to the composite free flap. These case illustrations will outline the sequence of events from a well-established free fibula flap to implant supported hybrid denture. This case review will emphasize anatomical variation of the fibular bone, soft tissue profile, and spatial orientation in light of prosthodontic goals.

Jaw and Dental Abnormalities.

Deviations from anthropometric norms related to facial skeletal development are a relatively normal occurrence in the dental management of the vast majority of patients. A consideration for correction is usually warranted only when there is associated morbidity, functional impairment, or psychosocial detriment. The vast majority of jaw and dental abnormalities are developmental and present themselves within a continuum of clinically conspicuous to overtly obvious. This article highlights a variety of developmental abnormalities that present with structural disharmony of the maxillomandibular complex and secondarily associated dental structures.

Maxillary segmental osteoperiosteal flap with simultaneous placement of dental implants: case report of a novel technique.

Dental restorative space from the opposing dentition requires adequate distance for restorative material for an acceptable restoration. Typically, long-standing edentulous alveolar ridges will have vertical and or horizontal defects that require alveolar ridge augmentation for ideal dental implant restorations. Along with these defects, one will see the opposing dentition supra erupt which can obliterate the restorative space. Multiple surgical techniques have been described to address these dilemmas. The use of osteoperiosteal flaps has been described to address vertical height deficiencies. The purpose of this paper is to document and introduce a maxillary segmental osteoperiosteal flap intrusion to increase the restorative space with simultaneous dental implant placement. As with most dilemmas in treatment planning dental implants, multiple acceptable treatment options are available to the practitioner. This technique is another of many that can be added to the available options. When appropriately planned in select cases, this technique will result with ideal dental implant restorations without compromising the esthetic and functional harmony of the native dentition.

Pleomorphic adenoma of the accessory parotid gland: case report and reappraisal of intraoral extracapsular dissection for management.

Pleomorphic adenoma is the most common tumor of the major and minor salivary glands. Rarely is it found evolving from an ectopic location of major salivary glandular tissue in the mid cheek. A healthy 56-year-old woman presented to our institution with a 20-year duration of a slowly growing right cheek soft tissue mass that was causing facial asymmetry. No significant functional or neurosensory dysfunction was appreciated. Radiologic examination showed a heterogeneous, hyperintense, well-delineated mass within the region of the right buccal fat pad. Fine-needle aspiration biopsy showed benign salivary gland elements consistent with pleomorphic adenoma. The decision was made to perform intraoral extracapsular dissection for removal. Discussion of the clinical assessment and magnetic resonance imaging evaluation with an emphasis on intraoral extracapsular dissection for definitive surgical therapy of longstanding benign salivary gland tumors is emphasized.