Clinical evaluation of nasolabial flap & buccal fat pad graft for surgical treatment of oral submucous fibrosis – a randomized clinical trial on 50 patients in Indian population

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We conclude that tooth extractions in patients receiving bisphosphonates can be performed in a safe and predictable way when performed according to established guidelines. Not tooth extractions themselves but rather prevailing infectious conditions may be a key risk factor for the development of MRONJ. http://dx.doi.org/10.1016/j.ijom.2015.08.730 Reconstruction of maxillary and mandibular defects with free fibular flaps: clinical experience review S. Pai ∗ , W. Hsu, T. Lin, F. Lee, C. Lo Department of Oral and Maxillofacial Surgery, St. Martin De Porres Hospital, Chia Yi City, Taiwan Background: Reconstruction of maxillary and mandibular defects represents a challenge to the head and neck reconstructive surgeon. Interruption of the bony continuity produces both a cosmetic and functional deformity. In most of the cases, the fibular flap is our choice flap for vascularized bone transfer to the head and neck. The bone is of exceptional quality, allowing for multiple segmental osteotomies for contouring. The donor site morbidity is minimal. Objective: The purpose of this article is to evaluate the outcomes using a free fibular flap for the reconstruction of the osseous defects in oral and maxillofacial region. Methods: In the OMS department of St. Martin De Porres Hospital, from March 2002 to December 2014, we performed 400 free flaps in head and neck region. We reviewed 89 cases of the microvascular reconstruction techniques and outcomes in free fibular flaps applied to the osseous defects of maxilla and mandible. Findings: There were two flap failure and four partial flap necrosis, giving a success rate of 97.8%. Among 89 patients, the mean age was 57 years old. Most of them were male. (n = 88, 98.9%) All the patients received oncological resection with immediate (n = 85, 95.5%) or secondary (n = 4, 4.5%) reconstruction. Among 85 cases with immediate reconstruction, 81 were those presented with squamous cell carcinoma invading to maxilla (n = 5) and mandible (n = 76). 1 was Langerhans cell histiocytosis. 1 was verrucous carcinoma. 2 were ameloblastoma. Among cases with secondary reconstruction, 2 were osteoradionecrosis. 2 were exposure of reconstruction plate. Conclusions: Free fibular flaps provide the favorable results for the reconstruction of osseous defects in oral and maxillofacial region and give excellent aesthetic and functional outcomes.

Fig. 1. (a) Preoperative photograph of the patient. (b) Preoperative X-ray. (c and d) Preoperative rapid model. (e) Implant template. (f) Completely resected tumor. (g) Postoperative panoramic radiograph. (h and i) Preoperative photograph vs. postoperative photograph.

mandibular malformation, the individualized systematic treatment plans play a vital role. Objectives: In this report, we will present a case of reconstructing the mandibular segmental defect after the resection of a rarely giant ameloblastoma. Methods: The surgery was ‘mandibular tumor and segmental mandible resection and left fibula free flap repair’. The maxilla model and reconstructed mandibular model were successfully prepared with the help of preoperative application of computer aided design and manufacturing (CAD/CAM) technology (Fig. 1c and d), with which the titanium plate was bent into proper shape in advance, and the fibula was shaped during the surgery. Besides, the implant template with four locating rods before the surgery could be worn on maxillary teeth and work in two ways: one was for ensuring the bone graft fixed in the accurate site to acquire proper interarch distance, and the other was for guaranteeing the accuracy of the implant’s site and direction (Fig. 1e). Findings and conclusions: In the case, not only the restoration of bony continuities and facial appearance, but also restoring of the missing teeth and the rehabilitation of the masticatory function were taken into consideration. http://dx.doi.org/10.1016/j.ijom.2015.08.732

http://dx.doi.org/10.1016/j.ijom.2015.08.731

Clinical evaluation of nasolabial flap & buccal fat pad graft for surgical treatment of oral submucous fibrosis – a randomized clinical trial on 50 patients in Indian population

Individualized treatment for the mandibular segmental defect: a case report

P. Pardeshi ∗ , M. Padhye, G. Mandlik, P. Mehta, K. Vij, G. Madiwale, S. Dahiya

J. Pan ∗ , J. Ma, Z. Zhang, X. Huang, S. Chen Beijing Stomatological Hospital, Capital Medical University, Beijing, China Background: Ameloblastomas are slowly growing, locally invasive tumors with high recurrence rate and more common in the mandible, if not treated they can grow to enormous size. Radical resection is the only predictable form of treatment for ameloblastomas. However, the reconstruction of extensive bone defects in the maxillofacial area is still challenging. To meet the demands of functional reconstruction, minimizing the negative influence of

D.Y. Patil University, School Of Dentistry, Navi Mumbai, India Background: Oral submucous fibrosis (OSF) a debilitating, pre-cancerous condition, caused primarily by chewing arecanut mixtures is showing increase prevalence in India. Objectives: To study the efficacy of nasolabial flap (NLF) & buccal fat pad graft (BFPG) for surgical management of OSF. Method: 50 histopathlogically proven cases over a period of 10 years of OSF having inter-incisal distance of less than 20 mm were surgically treated. The procedure involved (1) bilateral release of fibrotic bands (2) measurement of intra-operative inter-incisal distance (greater than 35 mm achieved in all patients after release

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Oral Presentation

of bands) (3) covering the defects with NLF [25] & BFPG [25]. All patients had post-operative physiotherapy, and were followed up regularly for one year. Results were assessed by uptake of BFPG & NF, comparing the preoperative & post-operative interincisal distance, masticatory efficiency, patient’s compliance & post-operative complications. Findings: NF & BFP showed good epithelization and less wound contracture. BFPG was found to be effective in moderate cases (>15 mm). In severe cases (<15 mm), NLF was found to be more effective as it provided better coverage to the defect. Two cases reported of recurrence in BFPG group. Conclusion: The difference in inter-incisal distance was not statistically significant. Uptake of BFPG & NLF was satisfactorily. However, in severe cases NLF provided bulk sufficient to cover the defect. The selection of surgical modality depends on grade of OSF. Post-operative physiotherapy plays a vital role in preventing recurrence. http://dx.doi.org/10.1016/j.ijom.2015.08.733 Immunomodulatory properties and in vivo osteogenesis of mesenchymal stem cells from cryopreserved human dental follicle tissues B.W. Park ∗ , H.J. Lee, Y.H. Kang, S.J. Jang, G.J. Rho Gyeongsang National University, Jinju, Republic of Korea We previously reported that dental follicle tissues from extracted wisdom teeth were successfully cryopreserved for use as a stem cell resource. The goals of the present study are to investigate the immunomodulatory properties of stem cells from fresh and cryopreserved dental follicles (fDFCs and cDFCs respectively) and analyze in vivo osteogenesis after transplantation of DFCs in experimental animals. Third passaged fDFCs and cDFCs revealed similar expression levels of major histocompatibility complex class I and II (MHCI & MHCII): high levels of MHCI but almost negative expressions of MHCII were observed. Both DFCs were in vivo transplanted with demineralized bone matrix scaffold into the mandibular defects of miniature pigs and subcutaneous tissues of mice. Radiological and histological evaluations of the in vivo osteogenesis in DFCs-transplantation sites revealed significantly enhanced new bone formation activities compared with those in scaffold-only implanted control sites. Interestingly, newly generated bones were overgrown compared to the original size of the mandibular defects at 8 weeks post-DFC transplantation. Immunohistochemical analysis of CD3, CD4, and CD8 in the ectopic bone formation sites of mice demonstrated significantly decreased CD4 expression in DFCs-implanted tissues compared with those in control sites. These findings indicate that DFCs possess immunomodulatory properties mediated via inhibition of an adaptive immune response by CD4 and MHCII, which highlights the usefulness of DFCs in tissue engineering fields. Particularly, long-term preserved dental follicles could serve as an excellent autologous or allogenic stem cell resource for bone tissue regeneration as well as a valuable therapeutic agent for immune diseases. http://dx.doi.org/10.1016/j.ijom.2015.08.734

Neoplastic disease of the head and neck misdiagnosed as temporomandibular dysfunction A. Patel 1,∗ , T. Iseli 2 , A. Nastri 2 , D. Wiesenfeld 2 1 Oral & Maxillofacial Unit, Royal Hobart Hospital, Hobart, Tasmania, Australia 2 Head and Neck Oncology Tumour Stream, The Royal Melbourne Hospital, Victoria, Australia

Background: It has been well documented in the past that patients can be misdiagnosed with temporomandibular dysfunction (TMD) when they in fact have a neoplastic cause for their facial pain.1 Objectives: Any patients that present with symptoms suggestive of TMD, should be assessed with a thorough history, examination, and appropriate special tests including radiology.2 The clinician should always be alert to the possibility of an alternative cause to the symptoms, especially if there are no obvious signs of parafunctional habits or TMJ derangement. Findings: We present three cases who were managed within a 12 month period at The Head and Neck Oncology Tumour Stream at The Royal Melbourne Hospital. All were diagnosed and treated for TMD prior to referral to the Royal Melbourne Hospital. Delayed diagnosis, severely impacting patient outcome has been highlighted in all three cases, where orofacial pain or TMD has been incorrectly diagnosed. Conclusions: The paper discusses and highlights the dangers of not appropriately investigating patients with incongruent symptomatology. We will provide an algorithm to aid the diagnoses of patients with this complex presentation to reduce the risk of misdiagnosis or delay the diagnosis of neoplastic disease which can have devastating outcomes for the patient.

References Huntley, T. A., & Wiesenfeld, D. (1994). Delayed diagnosis of the cause of facial pain in patients with neoplastic disease: a report of eight cases. J Oral Maxillofac Surg, 52(1), 81–85. Sidebottom, A. J. (2009). Current thinking in temporomandibular joint management. Br J Oral Maxillofac Surg, 47, 91–94.

http://dx.doi.org/10.1016/j.ijom.2015.08.735 Does RANK-L expression predict behavior of giant cell tumors? Z. Peacock 1,∗ , J. Schwab 2 , W. Faquin 2 , F. Hornicek 2 , D. Ebb 2 , L. Kaban 1 1

Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA, USA 2 Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA Background: Giant cell tumors (GCTs) affect both the maxillofacial (MF) and axial/appendicular (AA) skeletons. No reliable biomarkers exist to determine clinical behavior. Recently, GCTs have been shown to express Ligand for Receptor Activator of Nuclear Factor KappaB (RANK-L) and positive staining has been used as a basis for molecular treatment.1 Objective: To determine if RANK-L expression can predict clinical behavior of GCTs. Methodology: This was a retrospective study of patients with GCTs of the MF and AA skeleton treated at Massachusetts General Hospital from 1993 to 2008. Lesions were classified