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Immediate reconstruction following radical maxillectomy
118 Journal of Cranio-Maxillofacial Surgery 2. Length of bone contact and degree of bone volume, were approximately 70% and 60% at the loaded maxilla, 80% and 70% at the loaded mandible, respectively, 1 year later after initial loading and kept these high values until 16 years.
Current techniques and potential limitations will be discussed in detail.
Immediate Reconstruction following Radical Maxillectomy Cleft Maxillary Advancement: Previously Bone Grafted vs Simultaneously Bone Grafted Repaired Patients
Turvey T.A., Tejera T.J.
Department of Oral and Maxillofacial Surgery, University of North Carolina, Chapel Hill, North Carolina, USA Maxillary and palatal bone grafts for cleft patients have been widely endorsed as improving tooth eruption, periodontal health, fistula repair, and eliminating the need for prosthetic tooth replacement. Maxillary and palatal bone grafts may also simplify later maxillary osteotomies. This retrospective study compares the surgical experience of Le Fort I osteotomy for 24 cleft patients. The records of 12 cleft patients with prior maxillary and palatal bone grafts (age 16.8 years, range 15-21 years) were compared to 12 cleft patients without previous bone grafts (age 17.25 years, range 15-21 years) to assess if operating time, blood loss, peri-operative complicationS and need for dental prosthesis were different. There were 9 bilateral clefts in the bone grafted group (BG) and 11 in the non-bone grafted group (NBG). The mean length of surgery in group BG was 4.73 h (2.5-6.0 h) and 4.92 h (3.5-7h) in the NBG group. Mean blood loss for BG group 667 cc (330-1550 cc) and for the NBG group was 731 cc (350-2900 cc). Infection/dehiscence occurred in 3 in the NBG group and none in the BG group. The need for dental prosthesis was noted in 4 in the BG group and 12 of the NBG group (p < .022 Fischer's exact test).
Conclusion: Increased operating time, increased blood loss, increased complication rate, combined with greater need for dental prosthesis all suggest an additional benefit from early bone grafting for cleft patients who may need later maxillary advancement. Minimizing Relapse with Sagittal Osteotomy for Mandibular Prognathism
Turvey T.A.
Department of Oral and Maxillofacial Surgery, University of North Carolina, Chapel Hill, North Carolina, USA Surgical correction of mandibular prognathism (MP) has been performed for over a century and a variety of surgical procedures have been employed. Sagittal osteotomy (BSSO) is currently the most commonly used procedure for correction of this problem, even though several stability studies have reported varying results. A series of 50 patients who underwent isolated BSSO correction of MP have been followed for at least 5 years following surgery. Cephalometric and clinical data have been analyzed comprehensively. An association between postsurgical instability (forward movement of the mandible) and posterior/inferior displacement of the mandibular angle at the time of surgery has been observed. The suspected reason for this observation is the stretching of the pterygo-massetric complex. Techniques for minimizing the displacement of the pterygomassetric complex at the time of surgery include appropriate trimming and placement of the proximal and distal segments and the type of fixation used to secure the segments.
Uglesic V.., Virag M., Aljinovic N. Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia Reconstruction following maxillectomy is not mentioned in textbooks or in journals and is very seldom described. However, the defect following this type of surgery is devastating and prosthetic appliances do not mimic live tissues. A series of 14 patients with immediate reconstruction of the defect following maxillectomy is presented. Exenteration of the orbit was done in all patients except for one. The reconstruction was accomplished with a microvascular latissimus dorsi, scapula, serratus anterior and combination of these flaps. The skin paddle of the flaps was used for facial skin reconstruction or to provide lining of the oral cavity, the muscle to provide bulk under the skin to for cover intraoral defects and the bone to reconstruct the zygoma, alveolar ridge or both. The eyelids and the conjunctival sac were preserved in most of the patients and an eye prosthesis could be fitted. The evolution of the technique and the final results will be presented. A total of 15 flaps in 14 patients were accomplished (osteocutaneous scapula 5, myocutaneous latissimus dorsi 5, latissimus dorsi and scapula 4, latissimus dorsi, scapula and serratus anterior with rib 1). One scapula flap failed completely and was later replaced with a latissimus dorsi flap, and the latissimus dorsi, scapula and serratus anterior combination flap had partial necrosis of skin and muscle, the remaining 13 flaps healed uneventfully.
The Musculus-Temporalis Fascia Flap in Reconstruction of Temporomandibular Joint Structures
Umstadt H.E., Austermann K.H., Tiille P.
Klinik fiir Mund-, Kiefer- und Gesiehtsehirugie, Philipps- Universitgit Marburg/Lahn, Marburg/Lahn, Germany Temporomandibular joint diseases with disk destruction can force to reconstructive measures because of persisting symptoms of pain. The insertion of allogenous materials mostly was disappointing. It seems useful to take autologous material. Aim of study was to judge the reconstruction of the TMJ after disk replacement by fascia-flaps at different diseases. Fifteen of our patients have been treated, having persisting arthrogeneous pain although being treated with sufficient splints for more than 6 months. Preoperative diagnosis has been accomplished with transcranial plain radiographs (Graf), magnetic resonance imaging (MRI) and arthroscopy; 6 months postoperative documentation of morphology and function of the flaps by clinical and instrumental analysis of function (electronical axiography) and MRI. A newer examination was performed 1 year postoperatively at complete mastication. All 15 patients were redeemed of pain. None attained the same mobility of contralateral joint. Five curvatures were shortened but harmonious. Seven condyles had irregular movements of translation at shortened curvature. Three patients had distinct restriction at irregular course. All MRI findings result in stable situations of the interponates from 6 months to 5 years post-operatively. Painlessness with satisfactory mobility of the mandible was obtained in every case. Fascia
Current techniques and potential limitations will be discussed in detail.
Immediate Reconstruction following Radical Maxillectomy Cleft Maxillary Advancement: Previously Bone Grafted vs Simultaneously Bone Grafted Repaired Patients
Turvey T.A., Tejera T.J.
Department of Oral and Maxillofacial Surgery, University of North Carolina, Chapel Hill, North Carolina, USA Maxillary and palatal bone grafts for cleft patients have been widely endorsed as improving tooth eruption, periodontal health, fistula repair, and eliminating the need for prosthetic tooth replacement. Maxillary and palatal bone grafts may also simplify later maxillary osteotomies. This retrospective study compares the surgical experience of Le Fort I osteotomy for 24 cleft patients. The records of 12 cleft patients with prior maxillary and palatal bone grafts (age 16.8 years, range 15-21 years) were compared to 12 cleft patients without previous bone grafts (age 17.25 years, range 15-21 years) to assess if operating time, blood loss, peri-operative complicationS and need for dental prosthesis were different. There were 9 bilateral clefts in the bone grafted group (BG) and 11 in the non-bone grafted group (NBG). The mean length of surgery in group BG was 4.73 h (2.5-6.0 h) and 4.92 h (3.5-7h) in the NBG group. Mean blood loss for BG group 667 cc (330-1550 cc) and for the NBG group was 731 cc (350-2900 cc). Infection/dehiscence occurred in 3 in the NBG group and none in the BG group. The need for dental prosthesis was noted in 4 in the BG group and 12 of the NBG group (p < .022 Fischer's exact test).
Conclusion: Increased operating time, increased blood loss, increased complication rate, combined with greater need for dental prosthesis all suggest an additional benefit from early bone grafting for cleft patients who may need later maxillary advancement. Minimizing Relapse with Sagittal Osteotomy for Mandibular Prognathism
Turvey T.A.
Department of Oral and Maxillofacial Surgery, University of North Carolina, Chapel Hill, North Carolina, USA Surgical correction of mandibular prognathism (MP) has been performed for over a century and a variety of surgical procedures have been employed. Sagittal osteotomy (BSSO) is currently the most commonly used procedure for correction of this problem, even though several stability studies have reported varying results. A series of 50 patients who underwent isolated BSSO correction of MP have been followed for at least 5 years following surgery. Cephalometric and clinical data have been analyzed comprehensively. An association between postsurgical instability (forward movement of the mandible) and posterior/inferior displacement of the mandibular angle at the time of surgery has been observed. The suspected reason for this observation is the stretching of the pterygo-massetric complex. Techniques for minimizing the displacement of the pterygomassetric complex at the time of surgery include appropriate trimming and placement of the proximal and distal segments and the type of fixation used to secure the segments.
Uglesic V.., Virag M., Aljinovic N. Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia Reconstruction following maxillectomy is not mentioned in textbooks or in journals and is very seldom described. However, the defect following this type of surgery is devastating and prosthetic appliances do not mimic live tissues. A series of 14 patients with immediate reconstruction of the defect following maxillectomy is presented. Exenteration of the orbit was done in all patients except for one. The reconstruction was accomplished with a microvascular latissimus dorsi, scapula, serratus anterior and combination of these flaps. The skin paddle of the flaps was used for facial skin reconstruction or to provide lining of the oral cavity, the muscle to provide bulk under the skin to for cover intraoral defects and the bone to reconstruct the zygoma, alveolar ridge or both. The eyelids and the conjunctival sac were preserved in most of the patients and an eye prosthesis could be fitted. The evolution of the technique and the final results will be presented. A total of 15 flaps in 14 patients were accomplished (osteocutaneous scapula 5, myocutaneous latissimus dorsi 5, latissimus dorsi and scapula 4, latissimus dorsi, scapula and serratus anterior with rib 1). One scapula flap failed completely and was later replaced with a latissimus dorsi flap, and the latissimus dorsi, scapula and serratus anterior combination flap had partial necrosis of skin and muscle, the remaining 13 flaps healed uneventfully.
The Musculus-Temporalis Fascia Flap in Reconstruction of Temporomandibular Joint Structures
Umstadt H.E., Austermann K.H., Tiille P.
Klinik fiir Mund-, Kiefer- und Gesiehtsehirugie, Philipps- Universitgit Marburg/Lahn, Marburg/Lahn, Germany Temporomandibular joint diseases with disk destruction can force to reconstructive measures because of persisting symptoms of pain. The insertion of allogenous materials mostly was disappointing. It seems useful to take autologous material. Aim of study was to judge the reconstruction of the TMJ after disk replacement by fascia-flaps at different diseases. Fifteen of our patients have been treated, having persisting arthrogeneous pain although being treated with sufficient splints for more than 6 months. Preoperative diagnosis has been accomplished with transcranial plain radiographs (Graf), magnetic resonance imaging (MRI) and arthroscopy; 6 months postoperative documentation of morphology and function of the flaps by clinical and instrumental analysis of function (electronical axiography) and MRI. A newer examination was performed 1 year postoperatively at complete mastication. All 15 patients were redeemed of pain. None attained the same mobility of contralateral joint. Five curvatures were shortened but harmonious. Seven condyles had irregular movements of translation at shortened curvature. Three patients had distinct restriction at irregular course. All MRI findings result in stable situations of the interponates from 6 months to 5 years post-operatively. Painlessness with satisfactory mobility of the mandible was obtained in every case. Fascia