- Email: [email protected]
Healing of incisions in the tongue: A comparison of results with milliwatt carbon dioxide laser tissue welding versus suture repair
CURRENT LITERATURE on the size of the skin defect, extent of the maxillary buttress resection, size of the palatal defect, and loss of orbital support. Type I defects may be repaired with local, regional and distant flaps; skin grafts; and tissue expansion. Types II and III defects have been treated with skin grafts, osseointegrated implants, and various types of maxillofacial prostheses. Autogenous grafts and regional flaps are also useful. Type IV defects may require repair by both regional and distant flaps, or by microvascular free tissue transfer or composite grafts. Type V defects involve the orbital floor and require orbital support along with obturation of the nasal and orbital cavities and separation of the areas from the oral cavity.--R.H. HAUG Reprint requests to Dr Wells: Division of Plastic Surgery, Kentucky Clinic, Suite K454, 740 South Limestone, Lexington, KY 405360284.
Musculomucosal Nasolabial Island Flaps for Floor of Mouth Reconstruction. Uglesic V, Virag M. Br J Plastic Surg 48:8, 1995 The nasolabial flap has been used for palatal and floor of mouth reconstruction for many years. During this time it has undergone numerous modifications in technique. This article presents another modification of the nasolabial flap used for reconstruction of defects created by resection of T1 and T2 cancers of the floor of the mouth. The flap is outlined on the buccal mucosa vertically extending from the maxillary to the mandibular buccal vestibule. The incision starts 1 cm posterior to the labial commisure and ends posteriorly anterior to Stenson's duct. The intraoral incisions are made down to the buccinator muscle. The extraoral incision is made in the nasolabial fold without excising any skin and is carried through skin, subcutaneous tissue, risorus, levator anguli otis, and zygomaticus major until the facial artery is identified. No attempt is made to identify the facial vein, but venous congestion has not been a problem. The facial artery is then ligated distally in the flap and dissection is performed intraorally and extraorally to create an island of tissue consisting of buccal mucosa and buccinator muscle with the facial artery coursing through it. The flap is then rotated 180° and inset into the defect. The donor site is closed primarily in a layered fashion. Defects up to 5 cm in diameter can be reconstructed with bilateral flaps. After 14 flaps in eight patients, the only complication was wound dehiscence in one patient. There were no signs of vascular congestion and only one flap that showed signs of ischemia in a patient who also had a neck dissection performed concomitantly. The flap circulation, however, returned to normal after a few hours. The authors also found no evidence of facial nerve impairment. Some drawbacks to this procedure are that it can only be performed in edentulous patients or patients who are having a marginal mandibulectomy and that it still leaves a visible scar. The flaps do not create cheek distortion, speech problems or ectropion and there is no risk of formation of inclusion cysts.--S. DORSCH Reprint requests to: Dr Uglesic: Klinika za kirurgiju lica, celijusti i usta, KBC Salata 6, 41000 Zagreb, Croatia.
Healing of Incisions in the Tongue: A Comparison of Results With Milliwatt Carbon Dioxide Laser Tissue Welding Versus Suture Repair. Greene CH, Debias DA, Henderson MJ, et al. Ann Otol Rhinol Laryngol 103:964, 1994
731 The healing of carbon dioxide laser weld closures produced by two commercial instruments of differing design were compared. Healing after laser welding was also compared with healing after conventional suture closure on experimental rabbits. Healing was evaluated histologically and by measurement of tensile strength over time. No histologic differences were found between closures produced by different lasers; however, in all cases suture closure resulted in slower healing times consistent with a foreign body reaction prolonging the healing process. Tensile strength measurements were performed at intervals over the first 21 days after the operation. Laser repair was found to be equivalent to or stronger than suture repair at every interval measured. The clinical use of the carbon dioxide laser for tissue welding of oral injuries should be investigated further because it appears to be a good alternative to suture repair.--G.H. Sr,Ert~Er~ Reprint requests to Dr Greene: Departments of Physiology and Pharmacology, Philadelphia College of Osteopathic Medicine, 4150 City Ave, Philadelphia, PA 19131.
Bone Substitute With Osteoinduetive Biomaterials: Current and Future Clinical Applications. Hotz G, Herr G. Int J Oral Maxillofac Surg 23:413, 1994 In craniomaxillofacial surgery, there are several indications for the use of osteoinductive biomaterials. Recent research has shown that it is possible to combine osteoinductive proteins (bone morphogenetic protein, BMP) with suitable carrier materials (such as calcium phosphate ceramics, collagen or inactive collagenous bone matrix, and other organic and inorganic carriers) to obtain new composite osteoinductive biomaterials. The carrier material functions as a slow-delivery system for BMP. Without a carrier, the proteins tend to diffuse too rapidly, before induction can occur. This study investigated nine different calcium phosphate ceramics and inactive rat bone matrix, for their use as a BMP carrier material. The materials were implanted into abdominal wall muscle pouches of immunodeficient adult rats. Results of the study showed that all tested calcium phosphate ceramics are suitable for use as delivery systems for BMP. Commercially available, recombinant human BMP is being awaited in the marketplace.--R.E. ALEXANDER Reprint requests to Dr Hotz: Department of Maxillofacial and Plastic Surgery, University Hospital of Heidelberg, Im Neuenheimer Field 400, 69120 Heidelberg Germany.
Titanium Deposition in Regional Lymph Nodes After Insertion of Titanium Screw Implants in Maxillofacial Region. Weingart D, Steinemann S, Schilli W, et aI. Int J Oral Maxillofac Surg 23:450, 1994 The vast majority of oral implants are made of titanium and previous studies have found high titanium levels in the organs of minipigs, particularly in the lungs, after the placement of only two endosseous titanium fixtures. It is common to place six times that many implants in patients. This study examined the deposition of titanium in regional lymph nodes in 19 beagle dogs following the insertion of plasma-spraycoated titanium screw implants. Five additional animals with no implants served as controls. The animals underwent extraction and after 6 months of healing, up to 12 implants were placed. In the mandible, insertion was combined with simultaneous bone grafting for ridge augmentation. After 3 months, the implants were exposed and 9 months after implantation, the animals were killed. Very fine particles of
Musculomucosal Nasolabial Island Flaps for Floor of Mouth Reconstruction. Uglesic V, Virag M. Br J Plastic Surg 48:8, 1995 The nasolabial flap has been used for palatal and floor of mouth reconstruction for many years. During this time it has undergone numerous modifications in technique. This article presents another modification of the nasolabial flap used for reconstruction of defects created by resection of T1 and T2 cancers of the floor of the mouth. The flap is outlined on the buccal mucosa vertically extending from the maxillary to the mandibular buccal vestibule. The incision starts 1 cm posterior to the labial commisure and ends posteriorly anterior to Stenson's duct. The intraoral incisions are made down to the buccinator muscle. The extraoral incision is made in the nasolabial fold without excising any skin and is carried through skin, subcutaneous tissue, risorus, levator anguli otis, and zygomaticus major until the facial artery is identified. No attempt is made to identify the facial vein, but venous congestion has not been a problem. The facial artery is then ligated distally in the flap and dissection is performed intraorally and extraorally to create an island of tissue consisting of buccal mucosa and buccinator muscle with the facial artery coursing through it. The flap is then rotated 180° and inset into the defect. The donor site is closed primarily in a layered fashion. Defects up to 5 cm in diameter can be reconstructed with bilateral flaps. After 14 flaps in eight patients, the only complication was wound dehiscence in one patient. There were no signs of vascular congestion and only one flap that showed signs of ischemia in a patient who also had a neck dissection performed concomitantly. The flap circulation, however, returned to normal after a few hours. The authors also found no evidence of facial nerve impairment. Some drawbacks to this procedure are that it can only be performed in edentulous patients or patients who are having a marginal mandibulectomy and that it still leaves a visible scar. The flaps do not create cheek distortion, speech problems or ectropion and there is no risk of formation of inclusion cysts.--S. DORSCH Reprint requests to: Dr Uglesic: Klinika za kirurgiju lica, celijusti i usta, KBC Salata 6, 41000 Zagreb, Croatia.
Healing of Incisions in the Tongue: A Comparison of Results With Milliwatt Carbon Dioxide Laser Tissue Welding Versus Suture Repair. Greene CH, Debias DA, Henderson MJ, et al. Ann Otol Rhinol Laryngol 103:964, 1994
731 The healing of carbon dioxide laser weld closures produced by two commercial instruments of differing design were compared. Healing after laser welding was also compared with healing after conventional suture closure on experimental rabbits. Healing was evaluated histologically and by measurement of tensile strength over time. No histologic differences were found between closures produced by different lasers; however, in all cases suture closure resulted in slower healing times consistent with a foreign body reaction prolonging the healing process. Tensile strength measurements were performed at intervals over the first 21 days after the operation. Laser repair was found to be equivalent to or stronger than suture repair at every interval measured. The clinical use of the carbon dioxide laser for tissue welding of oral injuries should be investigated further because it appears to be a good alternative to suture repair.--G.H. Sr,Ert~Er~ Reprint requests to Dr Greene: Departments of Physiology and Pharmacology, Philadelphia College of Osteopathic Medicine, 4150 City Ave, Philadelphia, PA 19131.
Bone Substitute With Osteoinduetive Biomaterials: Current and Future Clinical Applications. Hotz G, Herr G. Int J Oral Maxillofac Surg 23:413, 1994 In craniomaxillofacial surgery, there are several indications for the use of osteoinductive biomaterials. Recent research has shown that it is possible to combine osteoinductive proteins (bone morphogenetic protein, BMP) with suitable carrier materials (such as calcium phosphate ceramics, collagen or inactive collagenous bone matrix, and other organic and inorganic carriers) to obtain new composite osteoinductive biomaterials. The carrier material functions as a slow-delivery system for BMP. Without a carrier, the proteins tend to diffuse too rapidly, before induction can occur. This study investigated nine different calcium phosphate ceramics and inactive rat bone matrix, for their use as a BMP carrier material. The materials were implanted into abdominal wall muscle pouches of immunodeficient adult rats. Results of the study showed that all tested calcium phosphate ceramics are suitable for use as delivery systems for BMP. Commercially available, recombinant human BMP is being awaited in the marketplace.--R.E. ALEXANDER Reprint requests to Dr Hotz: Department of Maxillofacial and Plastic Surgery, University Hospital of Heidelberg, Im Neuenheimer Field 400, 69120 Heidelberg Germany.
Titanium Deposition in Regional Lymph Nodes After Insertion of Titanium Screw Implants in Maxillofacial Region. Weingart D, Steinemann S, Schilli W, et aI. Int J Oral Maxillofac Surg 23:450, 1994 The vast majority of oral implants are made of titanium and previous studies have found high titanium levels in the organs of minipigs, particularly in the lungs, after the placement of only two endosseous titanium fixtures. It is common to place six times that many implants in patients. This study examined the deposition of titanium in regional lymph nodes in 19 beagle dogs following the insertion of plasma-spraycoated titanium screw implants. Five additional animals with no implants served as controls. The animals underwent extraction and after 6 months of healing, up to 12 implants were placed. In the mandible, insertion was combined with simultaneous bone grafting for ridge augmentation. After 3 months, the implants were exposed and 9 months after implantation, the animals were killed. Very fine particles of