- Email: [email protected]
Hard tissue—Particulate bone and soft tissue, cervical tissue and flap manipulations
Symposia
Symposium: The Reconstruction of the Cancer Patient (cont’d)
Hard Tissue-Particulate Bone and Soft Tissue, Cervical Tissue and Flap Manipulations Robert E. Marx, DDS, Miami, FL Predictable hard tissue reconstruction is based on osteogenesis derived from osteocompetent cellular transplantation. Its survival, bone formation and long term bone maintenance is dependent on a cellular and vascular host tissue often requiring either myocutaneous flaps of hyperbaric oxygen to obtain. The correct application of bone regeneration biology principles and viable vascular soft tissue can predictably produce bony reconstructions with endosteal and periosteal systems of bone remodeling and maintenance. Bone Cell Biology Two phased bone regeneration Osteogenesis Osteoconduction Osteoinduction Cellular survival and bone cell storage Tissue Preparations Surgical preparation of tissue bed Hyperbaric oxygen Myocutaneous flaps Pectoralis Major Lattisimus Dorsi Trapezius Sternocleidomastoid Walk-up flap Bi-pedicled neck flap
Graft Placements Allogeneic Bone Cribs Split Ribs Bucco-lingual orientation Split Ribs Superior Inferior orientation Hemi-ilium-Hemimandible cribs Allogeneic Mandible cribs Bone Cell compression and delivery Fixation techniques Complications Graft infections Tissue Dehiscence Recurrent Cancer Rehabilitation Functional Improvements Swallowing Chewing Drooling Psychological Improvements Depression Introversion Self Image Cosmesis References Principles and Techniques of Bony Reconstruction in Center Patients. International Advances in Surgical Oncology. Marx, R.E. and Kline, S.N. A.H. Liss & Co., Chapter 6, pp 167-228.1983 Reconstruction and Rehabilitation of Cancer Patients. Major Preprcsthetic Surgery. W.B. Saunders Co., Philadelphia, PA., 1986. Marx, R.E. and Saunders, T.M., Chapter 9, pp. 347-428 Problem Wounds in Oral and Maxillofacial Surgery: The Role of Hyperbaric Oxygen. Marx, R.E. and Johnson, R.P. Problem Wounds the Role of Oxygen. Davis, J.C. and Hunt, T.K., Eds. El Sevir Company, pp. 65-123.1987
CPC ON FACIAL PAIN Presented on Friday, September 22,8:00-lo:30 a.m. Moderator: Welden E. Bell, DDS, Dallas, TX
Chronic Somatic Pain Robert L. Campbell, DDS, Richmond, VA (case not provided)
Post-traumatic Mandibulo-facial
Pain
John M. Gregg, DDS, MS, PhD, Blacksburg, VA 41 year old female sustained injury to inferior alveolar nerve during root canal therapy. Periapical foreign material was observed in the mandibular canal on x-ray. An intractable chronic pain syndrome developed with elements of deafferentation hypersensitivity as well as central autonomic dysesthesia. Treatment consisted of stel-
6
late ganglion block, tricyclic pharmacotherapy, neuroma resection and autologus sural nerve graft. Introduction History Demographics and nature of nerve injury Pain syndrome characteristics Function impairment Previous medical, physiologic and surgical treatments Examination Head and neck exam findings Neurologic assessment-(neurosurgery reflex responses) Laboratory assessment-(radiographs, thermography) Trigeminal and stellate ganglion (nerve block responses) Differential Diagnoses Sympathetic nerve pain
AAOMS
.
1989
Symposium: The Reconstruction of the Cancer Patient (cont’d)
Hard Tissue-Particulate Bone and Soft Tissue, Cervical Tissue and Flap Manipulations Robert E. Marx, DDS, Miami, FL Predictable hard tissue reconstruction is based on osteogenesis derived from osteocompetent cellular transplantation. Its survival, bone formation and long term bone maintenance is dependent on a cellular and vascular host tissue often requiring either myocutaneous flaps of hyperbaric oxygen to obtain. The correct application of bone regeneration biology principles and viable vascular soft tissue can predictably produce bony reconstructions with endosteal and periosteal systems of bone remodeling and maintenance. Bone Cell Biology Two phased bone regeneration Osteogenesis Osteoconduction Osteoinduction Cellular survival and bone cell storage Tissue Preparations Surgical preparation of tissue bed Hyperbaric oxygen Myocutaneous flaps Pectoralis Major Lattisimus Dorsi Trapezius Sternocleidomastoid Walk-up flap Bi-pedicled neck flap
Graft Placements Allogeneic Bone Cribs Split Ribs Bucco-lingual orientation Split Ribs Superior Inferior orientation Hemi-ilium-Hemimandible cribs Allogeneic Mandible cribs Bone Cell compression and delivery Fixation techniques Complications Graft infections Tissue Dehiscence Recurrent Cancer Rehabilitation Functional Improvements Swallowing Chewing Drooling Psychological Improvements Depression Introversion Self Image Cosmesis References Principles and Techniques of Bony Reconstruction in Center Patients. International Advances in Surgical Oncology. Marx, R.E. and Kline, S.N. A.H. Liss & Co., Chapter 6, pp 167-228.1983 Reconstruction and Rehabilitation of Cancer Patients. Major Preprcsthetic Surgery. W.B. Saunders Co., Philadelphia, PA., 1986. Marx, R.E. and Saunders, T.M., Chapter 9, pp. 347-428 Problem Wounds in Oral and Maxillofacial Surgery: The Role of Hyperbaric Oxygen. Marx, R.E. and Johnson, R.P. Problem Wounds the Role of Oxygen. Davis, J.C. and Hunt, T.K., Eds. El Sevir Company, pp. 65-123.1987
CPC ON FACIAL PAIN Presented on Friday, September 22,8:00-lo:30 a.m. Moderator: Welden E. Bell, DDS, Dallas, TX
Chronic Somatic Pain Robert L. Campbell, DDS, Richmond, VA (case not provided)
Post-traumatic Mandibulo-facial
Pain
John M. Gregg, DDS, MS, PhD, Blacksburg, VA 41 year old female sustained injury to inferior alveolar nerve during root canal therapy. Periapical foreign material was observed in the mandibular canal on x-ray. An intractable chronic pain syndrome developed with elements of deafferentation hypersensitivity as well as central autonomic dysesthesia. Treatment consisted of stel-
6
late ganglion block, tricyclic pharmacotherapy, neuroma resection and autologus sural nerve graft. Introduction History Demographics and nature of nerve injury Pain syndrome characteristics Function impairment Previous medical, physiologic and surgical treatments Examination Head and neck exam findings Neurologic assessment-(neurosurgery reflex responses) Laboratory assessment-(radiographs, thermography) Trigeminal and stellate ganglion (nerve block responses) Differential Diagnoses Sympathetic nerve pain
AAOMS
.
1989