Preschool and School Phases of Postmaxillectomy Prosthetic Rehabilitation in a Child: A Clinical Report.

This report describes the postmaxillectomy prosthetic rehabilitation of a child with maxillary chondrosarcoma over an 8-year period. Specifically, it (1) describes the planning and rehabilitation procedures carried out during the period from before the operation to the time when the patient started elementary school and (2) reports the results of evaluations of the patient's oral and psychosocial function conducted during the school phase. The prosthetic treatment plan was separated into two phases (the preschool and school phases) and was started prior to surgery, when an immediate surgical obturator was designed by the surgeons. After the operation, it was considered important to provide the patient and her mother with training regarding how the defect should be cleaned, trismus prevention, and how the prosthesis should be fitted. In addition, esthetic improvements and the ability to speak clearly were also targeted during treatment planning. After surgery, obturators were fabricated in a conventional manner and fitted at the ages of 2, 4, 6, 8, and 10 years. The patient's oral function during the use of the obturators was evaluated objectively. Marked improvements in oral function were seen during both treatment phases. The patient's ability to perform psychosocial functions at school also improved during the use of the obturators.

Reconstruction of a maxillectomy patient with an osteocutaneous flap and implant-retained fixed dental prosthesis: a clinical report.

This clinical report describes a multidisciplinary approach in the implant rehabilitation of a 53-year-old white male diagnosed with chondrosarcoma. Following a maxillectomy and insertion of a surgical obturator, the patient was unable to adapt physically and psychologically to the removable prosthesis. The patient underwent a microvascular free tissue transfer using an osteocutaneous free fibula flap to reconstruct a right/left infrastructure maxillectomy defect, a soft tissue modification of the skin component using an implant retained stent, and placement of maxillary dental implants to retain a fixed prosthesis. Prosthodontic planning and treatment considerations are discussed.

Prosthetic rehabilitation of a maxillofacial defect in a chondrosarcoma patient.

Chondrosarcoma is a malignant tumor in which the tumor cells produce cartilage but not bone. The recommended management is wide local or radical excision, followed by surgical and prosthetic reconstruction. This article explains postsurgical prosthetic rehabilitation of a chondrosarcoma patient by means of intraoral acrylic, and extraoral silicone prosthesis for restoration of normal orofacial function and appearance.

Resection of the ilium in patients with a sarcoma: should the pelvic ring be reconstructed?

AIMS: The aim of the study was to investigate the controversial issue of whether the pelvic ring should be reconstructed following resection of the sarcomas of the ilium. PATIENTS AND METHODS: From our database, we identified 64 patients who underwent excision of a tumour involving the ilium between 1976 and 2015. A total of 35 underwent complete resection, of whom 24 were reconstructed with a non-vascularised fibula graft, and four with extracorporeal irradiation and reimplantation. A total of 29 patients had a partial resection. The mean follow-up was 9.2 years (1.1 to 25.6). Functional outcomes were assessed using the Toronto Extremity Salvation Score (TESS) at final follow-up. In all, 32 patients (50%) had a chondrosarcoma. RESULTS: The mean TESS for all patients was 71.6% (17% to 100%). The mean TESS for those who underwent total resection with reconstruction was 72.0% (17% to 100%) and without reconstruction it was 53.3% (20% to 90%) and for those who underwent partial resection it was 76.3% (31.3% to 100%). The rate of local recurrence was 42.2% and this was more common in those treated by partial resection (p = 0.048). The risk of local recurrence was related to the margin achieved at resection. CONCLUSIONS: Given the high rate of local recurrence following excision of a tumour from the ilium, obtaining wide surgical margins should be a priority even if this requires more aggressive surgery. In young patients, where late recurrence may occur, more radical complete resection should be considered. When total resection of the ilium is considered, reconstruction should also be considered as it confers a higher functional outcome than total resection without reconstruction. Cite this article: Bone Joint J 2017;99-B:538-43.

[The maxillofacial prosthesis: palatal obturators. The principles of treatment and rehabilitation in a case of buccorhinosinusal communication]. / Protesi maxillo-facciale: otturatori palatini. Principi di trattamento e riabilitazione di un caso di comunicazione bucco-rino-sinusale.

Having analysed the causes which lead to the loss of substance from the palatal vault, the different types of communication which then result, their evolution and the consequent functional defects are identified. By describing a complex clinical case, and having taken into consideration both aims and materials, the techniques of prosthetic rehabilitation are illustrated using obturator devices. The results of the various phases are examined.

Three tumor patients with total maxillectomy rehabilitated with implant-supported frameworks and maxillary obturators: a follow-up report.

BACKGROUND: Few reports are available on treatment using implant-supported frameworks with maxillary obturators after total maxillectomy on tumor patients. PURPOSE: To describe, evaluate, and report the clinical and radiographic performance of implant-supported frameworks and maxillary obturators after maxillectomy during the first years of function. MATERIALS AND METHODS: Three patients with cancer in the maxillary region treated by total maxillectomy were rehabilitated. Seventeen dental and two craniofacial implants were installed, and the patients each received implant-supported, screw-retained, three-unit frameworks with a U-shaped bar and obturators retained by four magnetic attachments. Clinical and radiographic data were collected up to 7 years of follow-up. RESULTS: The frequency of complications was low. Two craniofacial implants and one dental implant were loose and removed at abutment connection. No implants were lost after framework connection, and the mean marginal bone loss was small. CONCLUSION: Within the limitations of this report, dental implants are useful for rehabilitation of total maxillectomy patients, and a three-unit, screw-retained, implant-supported framework with maxillary obturator retained by magnetic attachment is a successful treatment concept for this patient group.

Condrosarcoma mixoide de bajo grado en senos paranasales / Low grade myxoid chondrosarcoma of paranasal sinus

El condrosarcoma es un tumor maligno que raramente compromete los senos paranasales. Su crecimiento es lento pero muy agresivo localmente. El tratamiento de elección es la resección amplia en bloque para evitar la recidiva. Se reporta un caso de un condrosarcoma mixoide que compromete las cavidades paranasales en un niño quien fue tratado quirúrgicamente con un seguimiento de 5 años.

The chondrosarcoma is a malignant tumor that rarely involve the paranasal sinus. They have a slow growth but with relentless local progression. The therapy of choice is a wide en bloc resection to avoid recurrences. We report a case of myxoid chondrosarcoma involving the sinonasal cavity in a child treated surgically with a follow up of 5 years.

Prosthetic restoration following removal of chondrosarcoma in the premaxillary region: a case presentation and follow-up for 16 years.

PURPOSE: The present report describes a relatively simple but effective prosthodontic treatment following removal of a moderately well differentiated osteogenic chondrosarcoma in the premaxillary region. MATERIALS AND METHODS: Following removal of a rare tumor, a young man was treated with gold crowns on three molars and a metal-ceramic crown on a first premolar, with attachments in the areas facing the defect for esthetic reasons. A removable partial denture was retained by the attachments and conventional cast retentive circumferential clasps, including a hollow obturator filling the defect. RESULTS: The restoration has served the patient for 16 years, seemingly without discomfort, and it has not required any maintenance. The patient has kept up with his oral hygiene, using conventional methods for the teeth and prosthesis, with periodic flushing with chlorhexidine solution. He has lived a normal family life and finished his university education. CONCLUSION: The problem-free use of the appliance can be at least partly explained by the patient taking oral hygiene measures seriously from the beginning. This report explains how relatively uncomplicated prosthodontic measures can enormously affect quality of life.

[Dedifferentiated chondrosarcoma with maxillary involvement. An anatomo-clinical study, surgical treatment and prosthetic rehabilitation. Apropos of a case]. / Chondrosarcome dédifférencié à localisation maxillaire. Etude anatomo-clinique, traitement chirurgical et réhabilitation prothétique. A propos d'un cas.

A 19 year old girl presented with a dedifferentiated chondrosarcoma of maxilla. The recurring tumor, diagnosed initially from the provoked pain, appeared on the scan image as a heterogeneous mass containing numerous calcifications. Histology showed, within a well differentiated chondrosarcoma, an anaplastic sarcomatous zone of the malignant fibrous histiocytoma (MFH) type. This histologic appearance is consistent with a poorer clinical prognosis. Radical surgery of the 4th tumor recurrence was combined with maxillofacial prosthetic rehabilitation. This appears to be first reported case of a dedifferentiated chondrosarcoma of the MFH type located in the maxilla.

Gait adaptations during walking under visual and cognitive constraints: a study of patients recovering from limb-saving surgery of the lower limb.

The objective of this case series study was reautomatization of gait after limb-saving surgery for tumors at a laboratory of gait analysis. Twelve patients (9 males and 3 females; mean age, 38 years) who underwent limb-saving surgery of the lower limb at least 1 year previously and ten normal subjects (3 males and 7 females; mean age, 37.5 years) were studied. The main outcome measures were walking speed and stride time duration under normal walking conditions as well as the use of different types of constraints. Patients walked with a lower preferred walking speed than the normal subjects. Patients showed a higher coefficient of variation of stride time in normal walking as well as complex walking compared with normal subjects. During walking with constraints, a significant decrease in stride time was found in patients but not in normal subjects. Although restoration of gait after limb-saving surgery is impressive, it is not complete (lower walking speed) and can break down under conditions of visual and cognitive load. Hence, the application of complex tasks reveals that gait reautomatization is not complete in these patients during a period of 2 to 5 years after surgery.

Deterioration of balance control after limb-saving surgery.

OBJECTIVE: Evaluation of the changes in balance control observed in patients after limb-saving surgery for malignant tumors of the lower limb. DESIGN: Case series. RESULTS: In 11 patients who underwent limb-saving surgery and 10 healthy, age-matched controls, displacement of the amplitude of the center of pressure (ACP) and velocity of the center of pressure (VCP) during normal standing and standing on a balance board were registered. Adding such constraints as standing with eyes closed and performing a Stroop task made standing more complex. During normal standing and on the balance board, both groups showed comparable ACP and VCP values. With eyes closed, both patients and controls showed a higher amplitude and velocity in the anterior-posterior direction. In the patient group, the Stroop task affected the ACP (4.5 +/- 0.8 mm) compared with normal standing (2.9 +/- 0.4 mm) and VCP (18.6 +/- 3.0 mm/sec) compared with normal standing (11.9 +/- 1.0 mm/sec). During balance board standing, the authors found a difference in the VCP for both groups whose eyes were closed and who performed under dual-task conditions (controls, 23.2 +/- 3.3 and 14.9 +/- 2.9 mm/sec; patients, 80.1 +/- 12.9 and 23.6 +/- 3.4 mm/sec). CONCLUSIONS: Although the patient group showed impressive upright standing after limb-saving surgery, upright standing become more difficult under higher visual and cognitive loads. This finding indicates that the level of postural automatism is not complete in these patients.

Delayed mandibular reconstruction following removal of a mesenchymal chondrosarcoma. Report of a case.

An unusual case of mesenchymal chondrosarcoma is presented. Initially seen when the patient was 8 years old, the lesion was repeatedly biopsied and curetted with a diagnosis of odontogenic fibroma. In 1971 a diagnosis of osteosarcoma of the chondroblastic type was made. At that time, the patient underwent a partial mandibulectomy with immediate graft. The patient did well until 1981, when a recurrence of the lesion was noted. The microscopic diagnosis at this time was mesenchymal chondrosarcoma. The treatment of this lesion as a staged procedure with initial resection of the mandible and placement of a silicone rubber mandibular prosthesis is discussed. The second stage of the procedure was definitive mandibular reconstruction, with an allogeneic mandible as a crib for autologous particulate cancellous bone from the iliac crest. Although the prognosis of mesenchymal chondrosarcoma is usually grave, this case is unusual because of its long history of multiple procedures performed prior to the definitive treatment of the lesion 14 years after its discovery. Two-year follow-up since the definitive mandibular reconstruction shows adequate range of motion, excellent healing, and no recurrence.

Allografts in orthopedic surgery: a case report and literature review.

Recent advances in orthopedic surgery have reawakened interest in the use of osteochondral allografts. A case is presented of a 32-year-old man who was spared a hemipelvectomy for a huge chondrosarcoma of the pelvis by receiving a massive pelvic allograft. This is apparently the first report of such a procedure being performed in Canada. A history of allografting as well as the fate and immunologic aspects of bone grafts are presented. Bone-banking procedures and the clinical application of allografts in 1986 are discussed.

Rigid reconstruction plates for immediate reconstruction following mandibular resection for malignant tumors.

Thirty-four primary alloplastic reconstructions of segmental mandibular defects caused by surgery for oral malignancy were performed during a 6-year period. Eighty-eight percent of the tumors were classified as stage III or IV. One third of the patients died during follow-up, nine with their primary reconstruction plate in place. During the follow-up, 12 patients required plate removal because of complications; four of them were treated with another plate. Nineteen of 21 patients alive at the end of follow-up were free of disease. Ten had their primary plate in place, and four had had a secondary plate installed because of plate fracture or screw loosening. Three patients had their mandible permanently reconstructed with bone. The functional and esthetic results were considered excellent or fair in a majority of the cases. Because the 5-year survival rate for patients with advanced mandibular malignancies is 15% to 20%, extensive, definitive reconstructive procedures during primary surgery are usually not justified.

Rehabilitation after total femur replacement: a report of 2 cases.

We describe the rehabilitation of 2 patients who underwent total femur replacement after neoplastic involvement of the bone. In the past, patients with cancer of the femur were generally advised to undergo a hip disarticulation or transfemoral amputation. It is now feasible to salvage the limb in selected patients, by excising the entire femur together with any contiguous soft tissue tumor and replacing it with an endoprosthesis. The surgical literature contains a number of reports on total femur replacement, which mention the rehabilitation aspects only briefly, but we found nothing on this relatively uncommon form of surgery in the rehabilitation literature. Physiotherapy techniques such as active assisted exercises, isometric exercises, and hydrotherapy are extremely useful during the early phase of rehabilitation to facilitate a graduated strengthening program. Certain exercises, such as active hip abduction or knee flexion, may not be permitted for several weeks to protect muscles that have been reattached to the prosthesis. Partial weight bearing may be required to allow incorporation of bone allograft around the prosthetic hip joint. Because of these factors patients with total femur replacement may need a longer period of rehabilitation (6-8wk) than patients with total hip or knee replacement. Patients with total femur replacement can, however, achieve full independence with an appropriate rehabilitation program.

Megaprótesis del extremo proximal del fémur para el tratamiento de las lesiones tumorales, osteosíntesis fallida o ruptura del vástago femoral: resultados radiológicos a mediano plazo en 20 casos / Megaprosthesis of proximal femoral end for tumoral conditions, failure of osteosynthesis or rupture of femoral stem. Mid-term radiologic results in 20 cases

Se revisa la evolución radiológica a mediano plazo de 20 pacientes sometidos a colocación de megaprótesis del extremo proximal del fémur entre enero de 1986 y junio de 1991, divididos en dos grupos: el primero, formado por pacientes con lesión tumoral (11 casos) y el segundo integrado por pacientes con osteosíntesis fallida, o bien aflojamiento o ruptura de vástago femoral (nueve casos). En el grupo I hubo una complicación de tipo mecánico. En el grupo II hubo tres complicaciones (33 por ciento), dos de tipo mecánico y una infección. Se comparan nuestros resultados con los de otros autores y se comentan los criterios de nuestro servicio para la indicación de la megaprótesis