Mandibular Defects

Symposia ment has increased due to elimination of the fear associated with use of the palate for harvesting donor tissue. The postoperative experience with AlloDerm is less complicated without the sequellae associated with palatal donor surgery, and patients are not as reluctant to return for additional AlloDerm grafting procedures when required. Current surgical methods employ a minimally invasive microsurgical technique that enhances wound stability while reducing morbidity. The post-operative period is characterized by less discomfort, more rapid healing, and high patient satisfaction. AlloDerm grafting is used not only for successful treatment of reces-

sion defects on teeth, but also for treatment of soft tissue alveolar ridge defects and soft tissue implant problems. References Aichelmann-Reidy ME, Yukna RA, Evans GH, et al: Clinical evaluation of acellular allograft dermis for the treatment of human gingival recession. J Periodontol 72(8):998, 2001 Cummings LC, Kaldahl WB, Allen EP: Histologic evaluation of autogenous connective tissue and acellular dermal matrix grafts in humans. J Periodontol 76(2):178, 2005 Woodyard JG, Greenwell H, Hill M, et al: The clinical effect of acellular dermal matrix on gingival thickness and root coverage compared to coronally positioned flap alone. J Periodontol 75(1):44, 2004

SYMPOSIUM ON DENTAL REHABILITATION OF THE ORAL CANCER PATIENT Friday, October 6, 2006, 10:00 am—12:00 noon Moderator: Eric R. Carlson, DMD, MD, Knoxville, TN

Palatomaxillary Defects Daniel Buchbinder, DMD, MD, New York, NY This presentation will go over the systematic approach to palatomaxillary reconstruction that our multidisciplinary team has developed. Patient evaluation, defect classification and our reconstructive algorithm will be presented. When indicated, flap selection and soft tissue vs bone containing vascularized flaps will be discussed. The ability to transfer bone of sufficient stock to allow for the placement of endosteal fixtures to help anchor tissue or implant borne prostheses has allowed the reconstructive team to functionally restore these patients. The rationale and evidence for primary fixture placement will be made. The use of adjunctive hyperbaric oxygen in the previously irradiated patients will be presented. Finally, results of quality of life and objective functional testing performed on a subset of our patients will also be presented. Reconstructive success can no longer be measured by the satisfactory restoration of form but rather by the patient’s ability to function.

nary report. Arch Otolaryngol Head Neck Surg 129, No. 7, Jul 2003, pp 775-880

Mandibular Defects G.E. Ghali, DDS, MD, Shreveport, LA Mandibular reconstruction of the oral cancer patient begins with proper preoperative planning. Anticipation of margins, resultant hard and soft tissue deficiencies, and need for postoperative radiation therapy are critical factors for optimizing rehabilitative outcomes. The patient’s general health, including co-morbid conditions, as well as oncologic stage of disease, should be factored into the equation. Unfortunately in this age of managed care, economic variables must also be considered in the ultimate selection of a definitive reconstructive modality. There is no single reconstructive technique applicable to all mandibular post-oncologic defects. A variety of approaches will be reviewed with emphasis on site selection criteria. Reference

References Okay DJ, Genden E, Buchbinder D, Urken M: Prosthodontic guidelines for surgical reconstruction of the maxilla: A classification system of defects. J Prosthet Dent 86, No. 4, Oct 2001, pp 352-363 Genden EM, Wallace D, Buchbinder D, Okay D, Urken ML: Iliac crest internal oblique osteomusculocutaneous free flap reconstruction of the postablative palatomaxillary defect. Arch Otolaryngol Head Neck Surg 127, No. 7, Jul 2001, pp 854-861 Genden EM, Okay D, Stepp MT, Rezaee RP, Mojica JS, Buchbinder D, Urken ML: Comparison of functional and quality-of-life outcomes in patients with and without palatomaxillary reconstruction: A prelimi-

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Kim D, Ghali GE: Microvascular free tissue reconstruction of the oral cavity. Selected Readings in Oral & Maxillofacial Surgery, Volume 12:4, 2004 Schusterman MA: Free flap reconstruction of the mandible. Lippincott-Raven, 31, 1997

Surgical Alterations That Enhance the Prosthetic Prognosis John Beumer, DDS, MS, Los Angeles, CA AAOMS • 2006