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Flaps optimisation selection in reconstruction of head and neck soft tissue defects
174 Four-dimensional computed tomography evaluation of condylar movement in patients underwent mandibular reconstruction
Conclusion: Although Abbe flap is not the most common method to repair cleft lip and palate, but it can solve the problem of aesthetic and function of poor primary repair.
M. Akashi ∗ , T. Sekitani, Y. Ohtsuki, Y. Kakei, T. Hasegawa, N. Negi, K. Hashikawa, Y. Shibuya, S. Takahashi, T. Komori
http://dx.doi.org/10.1016/j.ijom.2017.02.595
Kobe University Hospital, Kobe, Japan
Flaps optimisation selection in reconstruction of head and neck soft tissue defects
Background: We previously reported good visualisation of jaw movements using four-dimensional computed tomography (4DCT) to evaluate postoperative outcomes in patients who underwent mandibular reconstruction. Through the experience of that study, we found that 4DCT could excellently visualise condylar movement. Objectives: The purpose of the current study was to show that axial 4DCT was adequate for evaluating the condylar movements. Methods: Seven healthy volunteers (median age, 30 years; range, 27–38 years) and seven patients (median age 65 years, range 52–80 years) who underwent mandibulectomy (segmental in five, hemi in one, marginal in one) and free flap reconstruction (using the fibula in six and the radial forearm in one) were enrolled. Study subjects were instructed to masticate a cookie during the 4DCT scan. The axial volume rendering images showing the bilateral condyle were manually selected for evaluation. The institutional ethics review board approved of this study (No. 1445). Findings and Conclusion: 4DCT motion images could directly visualise bilateral condylar movement. The crosswise difference in the distances of condylar protrusion was significantly greater in patients than in healthy volunteers. We found that axial 4DCT images could excellently visualise a condylar protrusive path. Measurement of condylar protrusion on axial 4DCT images for patients who underwent mandibulectomy and free flap reconstruction has the potential to indicate the postoperative change in functional movement of condyles following mandibular reconstruction. http://dx.doi.org/10.1016/j.ijom.2017.02.594
M.T. Aladimi ∗ , L.J. Li, P. Han, C.J. Li, H.H. Helal West China Hospital of Stomatology, Sichuan University, China Background: Free tissue transfers have become a necessary means in the reconstruction of tumour defects, with many factors affecting the selection of the flap. Objectives: In this study, the authors attempt to evaluate the functional and aesthetic outcomes on both the donor and recipient sites, and to determine the effects of technical factors including the flap thickness and vessels’ diameters measured by ultrasonography, the size of the defect and postoperative volume reduction of the flaps were measured by magnetic resonance imaging (MRI). Methods: Patients operated for elective soft tissue reconstructive surgery Between March 2013 and March 2016 using 55 anterolateral thigh flaps (ALTF), 30 radial forearm flaps (RFF) and 18 latissimus dorsi flaps (LDF), color Doppler ultrasonography was performed to measure the thickness of the flap at the site of the perforator. All preoperative colour Doppler ultrasound examinations of the diameters of donor and recipient sites’ blood vessels were carried out. Results: 97.1% of flaps had complete survival and 2.9% with complete failure (two ALTF and one LDF). ALTF, RFF and LDF difference percentage between MRI1 (3–6 weeks) and MRI2 (6–18 months) of flaps’ volume was 27.6%, 17.9% and 36.1% respectively. Conclusion: Proper selection of the flap is important for the optimisation of the aesthetic and functional outcomes. Ultrasound, MRI, the surgeon’s experience and defect’s extension and nature play a key role in the selection of the flap.
Can Abbe flap solve the problem http://dx.doi.org/10.1016/j.ijom.2017.02.596 M. Al Daghriri King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia Background: Cleft lip repair sometimes may create challenges if the primary repair landed in the inexperienced surgeon, creating a more complicated issue of solving such challenge making the right decision to go around. Correcting such problem is another challenge. Abbe flap is considered to be a solution sometimes to overcome such problem. This flap was first described by Robert Abbe in 1898 although, first description done by Sabtt about sixty years earlier. Restoring aesthetic and functions of the upper lip is the goal of Abbe Flap. Objectives: My aim is to describe the surgical techniques we have adapted at the Cleft Lip and Palate Center, King Fahd Armed Forces Hospital (KFAFH), Jeddah as well as some clinical cases performed. Methods: Use of Abbe flap surgical procedure performed in patients at KFAFH. Findings: The use of Abbe flap can solve the problem of poor primary repair of cleft lip and palate patients.
Delayed maxillofacial reconstruction — thinking inside and outside of the box M. Alterman ∗ , A. Shuster, A. Amir, V. Reiser Department of Oral and Maxillofacial Surgery, Hadassah Medical Center, Jerusalem, Israel The reconstruction of mandibular and midfacial defects has been well discussed in the literature over the last decade. The classic maxillofacial surgical armamentarium has been expanded with numerous technological solutions, minimal invasive approaches and microvascular surgical tools. In the environment of smart operating rooms, and with the use of computerised virtual surgery planning software, threedimensional printers and surgical navigation systems, the ability to preserve patients’ original morphology, function and aesthetics has raised both physician and patient expectations to an all-time high. However, when coming to plan a delayed maxillofacial reconstruction, the original morphology, function and aesthetics are
Conclusion: Although Abbe flap is not the most common method to repair cleft lip and palate, but it can solve the problem of aesthetic and function of poor primary repair.
M. Akashi ∗ , T. Sekitani, Y. Ohtsuki, Y. Kakei, T. Hasegawa, N. Negi, K. Hashikawa, Y. Shibuya, S. Takahashi, T. Komori
http://dx.doi.org/10.1016/j.ijom.2017.02.595
Kobe University Hospital, Kobe, Japan
Flaps optimisation selection in reconstruction of head and neck soft tissue defects
Background: We previously reported good visualisation of jaw movements using four-dimensional computed tomography (4DCT) to evaluate postoperative outcomes in patients who underwent mandibular reconstruction. Through the experience of that study, we found that 4DCT could excellently visualise condylar movement. Objectives: The purpose of the current study was to show that axial 4DCT was adequate for evaluating the condylar movements. Methods: Seven healthy volunteers (median age, 30 years; range, 27–38 years) and seven patients (median age 65 years, range 52–80 years) who underwent mandibulectomy (segmental in five, hemi in one, marginal in one) and free flap reconstruction (using the fibula in six and the radial forearm in one) were enrolled. Study subjects were instructed to masticate a cookie during the 4DCT scan. The axial volume rendering images showing the bilateral condyle were manually selected for evaluation. The institutional ethics review board approved of this study (No. 1445). Findings and Conclusion: 4DCT motion images could directly visualise bilateral condylar movement. The crosswise difference in the distances of condylar protrusion was significantly greater in patients than in healthy volunteers. We found that axial 4DCT images could excellently visualise a condylar protrusive path. Measurement of condylar protrusion on axial 4DCT images for patients who underwent mandibulectomy and free flap reconstruction has the potential to indicate the postoperative change in functional movement of condyles following mandibular reconstruction. http://dx.doi.org/10.1016/j.ijom.2017.02.594
M.T. Aladimi ∗ , L.J. Li, P. Han, C.J. Li, H.H. Helal West China Hospital of Stomatology, Sichuan University, China Background: Free tissue transfers have become a necessary means in the reconstruction of tumour defects, with many factors affecting the selection of the flap. Objectives: In this study, the authors attempt to evaluate the functional and aesthetic outcomes on both the donor and recipient sites, and to determine the effects of technical factors including the flap thickness and vessels’ diameters measured by ultrasonography, the size of the defect and postoperative volume reduction of the flaps were measured by magnetic resonance imaging (MRI). Methods: Patients operated for elective soft tissue reconstructive surgery Between March 2013 and March 2016 using 55 anterolateral thigh flaps (ALTF), 30 radial forearm flaps (RFF) and 18 latissimus dorsi flaps (LDF), color Doppler ultrasonography was performed to measure the thickness of the flap at the site of the perforator. All preoperative colour Doppler ultrasound examinations of the diameters of donor and recipient sites’ blood vessels were carried out. Results: 97.1% of flaps had complete survival and 2.9% with complete failure (two ALTF and one LDF). ALTF, RFF and LDF difference percentage between MRI1 (3–6 weeks) and MRI2 (6–18 months) of flaps’ volume was 27.6%, 17.9% and 36.1% respectively. Conclusion: Proper selection of the flap is important for the optimisation of the aesthetic and functional outcomes. Ultrasound, MRI, the surgeon’s experience and defect’s extension and nature play a key role in the selection of the flap.
Can Abbe flap solve the problem http://dx.doi.org/10.1016/j.ijom.2017.02.596 M. Al Daghriri King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia Background: Cleft lip repair sometimes may create challenges if the primary repair landed in the inexperienced surgeon, creating a more complicated issue of solving such challenge making the right decision to go around. Correcting such problem is another challenge. Abbe flap is considered to be a solution sometimes to overcome such problem. This flap was first described by Robert Abbe in 1898 although, first description done by Sabtt about sixty years earlier. Restoring aesthetic and functions of the upper lip is the goal of Abbe Flap. Objectives: My aim is to describe the surgical techniques we have adapted at the Cleft Lip and Palate Center, King Fahd Armed Forces Hospital (KFAFH), Jeddah as well as some clinical cases performed. Methods: Use of Abbe flap surgical procedure performed in patients at KFAFH. Findings: The use of Abbe flap can solve the problem of poor primary repair of cleft lip and palate patients.
Delayed maxillofacial reconstruction — thinking inside and outside of the box M. Alterman ∗ , A. Shuster, A. Amir, V. Reiser Department of Oral and Maxillofacial Surgery, Hadassah Medical Center, Jerusalem, Israel The reconstruction of mandibular and midfacial defects has been well discussed in the literature over the last decade. The classic maxillofacial surgical armamentarium has been expanded with numerous technological solutions, minimal invasive approaches and microvascular surgical tools. In the environment of smart operating rooms, and with the use of computerised virtual surgery planning software, threedimensional printers and surgical navigation systems, the ability to preserve patients’ original morphology, function and aesthetics has raised both physician and patient expectations to an all-time high. However, when coming to plan a delayed maxillofacial reconstruction, the original morphology, function and aesthetics are