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O.327 Microvascular free flaps in head and neck reconstruction. Report of 71 cases
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Journal of Cranio-Maxillofacial Surgery 34(2006) Suppl. S1
but did not seem to have an impact on overall excellent patient satisfaction. O.325 Interpositional bone grafts for the augmentation of the severely resorbed posterior mandible L. Piersanti1 , P. Felice2 , G. Corinaldesi2 , C. Marchetti2 . 1 School of Maxillo-facial Surgery, University of Ferrara, Italy; 2 Department of Oral and Maxillofacial Surgery, University of Bologna, Italy Objectives: The aim of this study was to evaluate the use of interpositional iliac bone grafts to augment the height of severely resorbed posterior mandible prior to implant placement. Experimental method: Ten patients affected byman dibular posterior atrophy underwent an interpositional bone graft augmentation. After elevation of a mucoperiosteal flap posterior to the mental foramina, an horizontal osteotomy 3–4 mm above the mandibular canal and two oblique cuts were made in the third coronal of the bone. The osteotomized segment was raised in a coronal direction sparing the lingual periosteum. The bone graft interposed between the raised fragment and the basal bone was fixed with titanium miniplates and miniscrews. After 3–4 months, 39 implants were inserted (XiVE, Friadent, Mannheim, Germany). Abutment connection was performed 3 months after implant insertion and a fixed prosthesis was provided. Implant survival rate, marginal peri-implant bone resorption and bone graft resorption were evaluated. Results: None of the 39 implants inserted failed at 18 months follow-up. The mean marginal bone resorption measured with periapical X-rays was 0.7 mm (range 0.4–1.3 mm). Tomography Dental Scan measurements at the time of bone augmentation and after 3–4 months showed a mean alveolar bone height increase of 6.5 mm (range 5.7–7.2 mm) and a mean volumetric bone resorption of 0.73 mm (range 0.69–0.79 mm). Conclusions: This study suggests that interpositional bone grafts may represent a reliable procedure for the reconstruction of the atrophic posterior mandible with a high survival rate and a low bone resorption rate. O.326 Pre-implant reconstruction of the posterior mandible: Possibility and limits G. Spinelli, A. Abati, D. Giannini, M. Raffaini. Chirurgia Maxillo-Facciale, Universit`a degli Studi di Firenze, Italy Introduction: The posterior reconstruction of the mandible is often reserved for a selected number of patients because there are many difficulties factors and because patients can usually find good satisfaction with interforaminal implants and removable overdentures. Materials and Method: Twenty patients operated for preprosthetic posterior mandible reconstruction were selected for this study. Twelve patients were treated with mandibular block bone grafts, 6 with multiple calvarial block grafts, 2 with fibular free flap. Patients was between 35 and 65 years (50 years average). For the treatment of Cawood and Howell class III and IV atrophy and for monolateral of localized class V, we used bone grafts harvested form mandibular ramus. For bilateral class V atrophy, we used calvarial bone grafts and for total edentulous patients with class V or VI, we used fibular free flaps. Implants were positioned from 4 to 6 mounths after bone grafts. Result: No complications were observed during the surgical procedures and during the healing period. Check-ups showed a minimal degree of bone resorption and an excellent osteointegrative process.
Abstracts, EACFMS XVIII Congress Conclusion: The authors report case series succesfully treated with inlay, onlay, veneer or combined surgical technique before implant placement using mandibular ramus or calvarial bone block grafts, solving many clinical situation (single tooth restoration, localized, ridge augmentation, full-arch restoration) showing the great versatility of these harvesting sites. Alveolar ridge augmentation using autogenous block graft is a reliable and predictable possibility of restoring the adequate bone volume for implant insertion and to restablish a correct maxillomandibular relationship in both sagittal and vertical dimension enchancing a better prosthetic results.
Thursday, 14 September 2006, 11.00−13.20
Hall 3
Microsurgery III O.327 Microvascular free flaps in head and neck reconstruction. Report of 71 cases R. Floriano, B. Peral, R. Alvarez, A. Verrier. Servicio de Cirug´ıa Oral y Maxilofacial, Hospital R´ıo Hortega, Valladolid, Spain Introduction and objetives: Microvascular free-tissue transfer to the head and neck has become an accepted method of reconstruction owing to increased success rates and superior aesthetic and functional results. The objetive was to review our experience with 71 microvascular free flaps performed between 2000 and 2005. Material and Methods: A total of 70 patients underwent 71 microvascular free-flaps for various disorders; the majority of patients in this series (64 cases) underwent surgery for squamous cell cancer. There were 20 vascularized bone-containing free flaps for mandibular and midface reconstruction. In 48 cases the antebrachial flap was used, 2 rectus abdominis free flaps and 2 anterolateral thigh free flap. In one case, 2 simultaneous free flaps were transferred to achieve an optimal bone and soft tissue reconstruction. Results: Of the 71 microvascular free-flaps that were performed, 60 were highly successful; in 8 cases it was necessary to retire by complete necrosis; in 3 cases it appeared a partial necrosis with favorable evolution after local treatment. A 20% of the fibula flaps failed whereas we obtained a rate of success of 92.7% in radial flaps. Conclusions: The success of the use of vascularized free flaps in restoring defects of the oral cavity is clearly demonstrated in this serie. There was an acceptable incidence of complications for radial flap. O.328 Reconstructive options in partial maxillectomy: Temporalis muscle flap plus bone grafts vs free flaps G. Bellocchio, A. Baj, S. Spotti, A.B. Giann`ı. Istituto Ortopedico Galeazzi, Department of Maxillo-facial Surgery, University of Milan, Italy Introduction and Objectives: To evaluate and discuss the reconstructive options for patients with partial maxillectomy defects. Eight consecutive operations had been done by us and this paper reports and audits our experience. Our patients had partial maxillectomy defects resulting from oncologic surgical resections. Treatment of maxillary tumours usually requires a combination of surgical extirpation, followed by radiation therapy, and the resultant defects were reconstructed using temporalis muscle flap plus bone grafts or free flaps.
Journal of Cranio-Maxillofacial Surgery 34(2006) Suppl. S1
but did not seem to have an impact on overall excellent patient satisfaction. O.325 Interpositional bone grafts for the augmentation of the severely resorbed posterior mandible L. Piersanti1 , P. Felice2 , G. Corinaldesi2 , C. Marchetti2 . 1 School of Maxillo-facial Surgery, University of Ferrara, Italy; 2 Department of Oral and Maxillofacial Surgery, University of Bologna, Italy Objectives: The aim of this study was to evaluate the use of interpositional iliac bone grafts to augment the height of severely resorbed posterior mandible prior to implant placement. Experimental method: Ten patients affected byman dibular posterior atrophy underwent an interpositional bone graft augmentation. After elevation of a mucoperiosteal flap posterior to the mental foramina, an horizontal osteotomy 3–4 mm above the mandibular canal and two oblique cuts were made in the third coronal of the bone. The osteotomized segment was raised in a coronal direction sparing the lingual periosteum. The bone graft interposed between the raised fragment and the basal bone was fixed with titanium miniplates and miniscrews. After 3–4 months, 39 implants were inserted (XiVE, Friadent, Mannheim, Germany). Abutment connection was performed 3 months after implant insertion and a fixed prosthesis was provided. Implant survival rate, marginal peri-implant bone resorption and bone graft resorption were evaluated. Results: None of the 39 implants inserted failed at 18 months follow-up. The mean marginal bone resorption measured with periapical X-rays was 0.7 mm (range 0.4–1.3 mm). Tomography Dental Scan measurements at the time of bone augmentation and after 3–4 months showed a mean alveolar bone height increase of 6.5 mm (range 5.7–7.2 mm) and a mean volumetric bone resorption of 0.73 mm (range 0.69–0.79 mm). Conclusions: This study suggests that interpositional bone grafts may represent a reliable procedure for the reconstruction of the atrophic posterior mandible with a high survival rate and a low bone resorption rate. O.326 Pre-implant reconstruction of the posterior mandible: Possibility and limits G. Spinelli, A. Abati, D. Giannini, M. Raffaini. Chirurgia Maxillo-Facciale, Universit`a degli Studi di Firenze, Italy Introduction: The posterior reconstruction of the mandible is often reserved for a selected number of patients because there are many difficulties factors and because patients can usually find good satisfaction with interforaminal implants and removable overdentures. Materials and Method: Twenty patients operated for preprosthetic posterior mandible reconstruction were selected for this study. Twelve patients were treated with mandibular block bone grafts, 6 with multiple calvarial block grafts, 2 with fibular free flap. Patients was between 35 and 65 years (50 years average). For the treatment of Cawood and Howell class III and IV atrophy and for monolateral of localized class V, we used bone grafts harvested form mandibular ramus. For bilateral class V atrophy, we used calvarial bone grafts and for total edentulous patients with class V or VI, we used fibular free flaps. Implants were positioned from 4 to 6 mounths after bone grafts. Result: No complications were observed during the surgical procedures and during the healing period. Check-ups showed a minimal degree of bone resorption and an excellent osteointegrative process.
Abstracts, EACFMS XVIII Congress Conclusion: The authors report case series succesfully treated with inlay, onlay, veneer or combined surgical technique before implant placement using mandibular ramus or calvarial bone block grafts, solving many clinical situation (single tooth restoration, localized, ridge augmentation, full-arch restoration) showing the great versatility of these harvesting sites. Alveolar ridge augmentation using autogenous block graft is a reliable and predictable possibility of restoring the adequate bone volume for implant insertion and to restablish a correct maxillomandibular relationship in both sagittal and vertical dimension enchancing a better prosthetic results.
Thursday, 14 September 2006, 11.00−13.20
Hall 3
Microsurgery III O.327 Microvascular free flaps in head and neck reconstruction. Report of 71 cases R. Floriano, B. Peral, R. Alvarez, A. Verrier. Servicio de Cirug´ıa Oral y Maxilofacial, Hospital R´ıo Hortega, Valladolid, Spain Introduction and objetives: Microvascular free-tissue transfer to the head and neck has become an accepted method of reconstruction owing to increased success rates and superior aesthetic and functional results. The objetive was to review our experience with 71 microvascular free flaps performed between 2000 and 2005. Material and Methods: A total of 70 patients underwent 71 microvascular free-flaps for various disorders; the majority of patients in this series (64 cases) underwent surgery for squamous cell cancer. There were 20 vascularized bone-containing free flaps for mandibular and midface reconstruction. In 48 cases the antebrachial flap was used, 2 rectus abdominis free flaps and 2 anterolateral thigh free flap. In one case, 2 simultaneous free flaps were transferred to achieve an optimal bone and soft tissue reconstruction. Results: Of the 71 microvascular free-flaps that were performed, 60 were highly successful; in 8 cases it was necessary to retire by complete necrosis; in 3 cases it appeared a partial necrosis with favorable evolution after local treatment. A 20% of the fibula flaps failed whereas we obtained a rate of success of 92.7% in radial flaps. Conclusions: The success of the use of vascularized free flaps in restoring defects of the oral cavity is clearly demonstrated in this serie. There was an acceptable incidence of complications for radial flap. O.328 Reconstructive options in partial maxillectomy: Temporalis muscle flap plus bone grafts vs free flaps G. Bellocchio, A. Baj, S. Spotti, A.B. Giann`ı. Istituto Ortopedico Galeazzi, Department of Maxillo-facial Surgery, University of Milan, Italy Introduction and Objectives: To evaluate and discuss the reconstructive options for patients with partial maxillectomy defects. Eight consecutive operations had been done by us and this paper reports and audits our experience. Our patients had partial maxillectomy defects resulting from oncologic surgical resections. Treatment of maxillary tumours usually requires a combination of surgical extirpation, followed by radiation therapy, and the resultant defects were reconstructed using temporalis muscle flap plus bone grafts or free flaps.