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Mandibular reconstruction by fibular free flap: towards the use of new technologies! Review of the literature
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E-Poster Presentation
Mandibular reconstruction by fibular free flap: towards the use of new technologies! Review of the literature J. Bouguila 1,2,3,∗ , B. Guiga 1 , M. Ben Rejeb 1 , M. Omezzine 1,2 , R. Mani 1,2 , R. Moatemri 1,2 , H. Khochtali 1,2 1
Sahloul Hospital, Sousse, Tunisia Laboratory of Oral Health and Facial Rehabilitation, Mounastir, Tunisia 3 La Rabta Hospital, Tunis, Tunisia 2
Background: Currently, the free fibular flap is well accepted as the first choice for mandibular reconstruction. Achieving good cosmetic and functional results requires a great experience and an artistic sense of the surgical team. Today, technological advances essentially virtual surgery and 3D printing have restored the best anatomical contours and functional quality by improving the accuracy of these reconstructions. Objectives: In this study, we sought to examine critically our technique and results of mandibular reconstruction by fibular free flap and expose technological advances described in the literature. Methods: In a first part we conducted a retrospective study of our cases of mandibular reconstruction by free fibular flap. Data studied were: epidemiological (age, sex, comorbidity), clinical preoperative semiology, etiologies (TNM classification), characteristics of the defect, surgical procedures (operative time, hospital stay) and complications. Than we carried out a review of the literature on the application of new techniques in mandibular reconstruction. Keyword and/or MeSH search terms were: (1) mandibular reconstruction and fibula/fibula flap. (2) Virtual planning or technology or simulation 3D modelling or perspective. Findings: Twelve cases of mandibular reconstruction with free fibula with three secondary reconstructions. The main etiology was malignant tumour. The mean operative time was 10 h 54 min. The average score for quality of life according to UW-QOL was 65.47% with a minimum score attributed to chewing. The most important area, according to the patients was the appearance. Virtual simulation and design techniques and computer-aided manufacturing improves accuracy, morphological and functional outcomes and reduce the total operating time and the time of ischemia. Conclusions: Computer-aided design and manufacturing techniques have an important contribution and should be adapted to improve the results of these reconstructions become increasingly complex. http://dx.doi.org/10.1016/j.ijom.2015.08.031 Submental endotracheal intubation: another route for intubation in facial surgery J. Bouguila 1,2,3,∗ , B. Guiga 1 , M. Ayad 1 , M. Omezzine 1,2 , R. Mani 1,2 , R. Moatemri 1,2 , H. Khochtali 1,2 1
Sahloul Hospital, Sousse, Tunisia Laboratory of Oral Health and Facial Rehabilitation, Mounastir, Tunisia 3 La Rabta Hospital, Tunis, Tunisia 2
Background: Submental intubation involves passing the endotracheal tube through a surgical incision in the floor of the mouth. Since it was first described in 1986 by Hernandez Altemir it has been reported in many small series in both trauma and elective orthognathic patients with good success rates.
Objectives: The aim of this paper is to summarize the outcomes, complications, method of intubation including technique modifications, indications for the procedure, devices utilized to complete the submental intubation. Methods: A retrospective study was made over 5 year, from 2009 to 2013. Submental intubation was used in all patients with the same protocol. The studied data was: age, sex, indication, operative time, duration of ventilator disconnection, postoperative complications, and scar assessment. Findings: Submental intubation was performed in twelve patients with maxillofacial trauma (10 cases) and orthognathic surgery (1 case). The patients ranged in age from 16 to 42 years. The average operative time was 10 min. No complications due to submental intubation were observed Conclusions: Despite significant advances in anaesthesia and trauma airway management, the panfacial fracture patient continues to pose a challenge. For these cases the submandibular route for endotracheal intubation will remain a useful therapeutic manoeuver. This method allows temporary mandibulomaxillary fixation to achieve optimal occlusion and avoids interference of the endotracheal tube during repair of the midface. The technique of intraoperative airway access through the floor of mouth appears safe and effective but some complications can occur. http://dx.doi.org/10.1016/j.ijom.2015.08.032 Treatment of recurrent temporomandibular dislocation by displacement of the zygomatic arch: Bouguila and Khochtali’s technique J. Bouguila 1,2,3,∗ , H. Khochtali 1,2 1
Sahloul Hospital, Sousse, Tunisia Laboratory of Oral Health and Facial Rehabilitation, Mounastir, Tunisia 3 La Rabta Hospital, Tunis, Tunisia 2
Background: Many methods have been reported for the surgical treatment of recurrent anterior temporomandibular dislocation. Most of these techniques are designed to limit the forward migration of the condylar head. The great number of surgical techniques experimented illustrates the difficulty to find a satisfactory method for the treatment of these recurrent dislocations. Objectives: We present a modification of Gosserez and Dautrey’s1 surgical technique for the treatment of recurrent anterior temporomandibular joint dislocation. Methods: The surgical technique is described and its indications are discussed. Findings: With an impressive success rate, we believe that Bouguila and Khochtali’s technique offers the best chance for long-term resolution of recurrent temporomandibular dislocation. Conclusions: Dislocation of the temporomandibular joint occurs when the mandibular condyle is displaced anteriorly beyond the articular eminence. There are multiple causes for its occurrence, and treatments range from relatively conservative methods to complex surgical intervention.
E-Poster Presentation
Mandibular reconstruction by fibular free flap: towards the use of new technologies! Review of the literature J. Bouguila 1,2,3,∗ , B. Guiga 1 , M. Ben Rejeb 1 , M. Omezzine 1,2 , R. Mani 1,2 , R. Moatemri 1,2 , H. Khochtali 1,2 1
Sahloul Hospital, Sousse, Tunisia Laboratory of Oral Health and Facial Rehabilitation, Mounastir, Tunisia 3 La Rabta Hospital, Tunis, Tunisia 2
Background: Currently, the free fibular flap is well accepted as the first choice for mandibular reconstruction. Achieving good cosmetic and functional results requires a great experience and an artistic sense of the surgical team. Today, technological advances essentially virtual surgery and 3D printing have restored the best anatomical contours and functional quality by improving the accuracy of these reconstructions. Objectives: In this study, we sought to examine critically our technique and results of mandibular reconstruction by fibular free flap and expose technological advances described in the literature. Methods: In a first part we conducted a retrospective study of our cases of mandibular reconstruction by free fibular flap. Data studied were: epidemiological (age, sex, comorbidity), clinical preoperative semiology, etiologies (TNM classification), characteristics of the defect, surgical procedures (operative time, hospital stay) and complications. Than we carried out a review of the literature on the application of new techniques in mandibular reconstruction. Keyword and/or MeSH search terms were: (1) mandibular reconstruction and fibula/fibula flap. (2) Virtual planning or technology or simulation 3D modelling or perspective. Findings: Twelve cases of mandibular reconstruction with free fibula with three secondary reconstructions. The main etiology was malignant tumour. The mean operative time was 10 h 54 min. The average score for quality of life according to UW-QOL was 65.47% with a minimum score attributed to chewing. The most important area, according to the patients was the appearance. Virtual simulation and design techniques and computer-aided manufacturing improves accuracy, morphological and functional outcomes and reduce the total operating time and the time of ischemia. Conclusions: Computer-aided design and manufacturing techniques have an important contribution and should be adapted to improve the results of these reconstructions become increasingly complex. http://dx.doi.org/10.1016/j.ijom.2015.08.031 Submental endotracheal intubation: another route for intubation in facial surgery J. Bouguila 1,2,3,∗ , B. Guiga 1 , M. Ayad 1 , M. Omezzine 1,2 , R. Mani 1,2 , R. Moatemri 1,2 , H. Khochtali 1,2 1
Sahloul Hospital, Sousse, Tunisia Laboratory of Oral Health and Facial Rehabilitation, Mounastir, Tunisia 3 La Rabta Hospital, Tunis, Tunisia 2
Background: Submental intubation involves passing the endotracheal tube through a surgical incision in the floor of the mouth. Since it was first described in 1986 by Hernandez Altemir it has been reported in many small series in both trauma and elective orthognathic patients with good success rates.
Objectives: The aim of this paper is to summarize the outcomes, complications, method of intubation including technique modifications, indications for the procedure, devices utilized to complete the submental intubation. Methods: A retrospective study was made over 5 year, from 2009 to 2013. Submental intubation was used in all patients with the same protocol. The studied data was: age, sex, indication, operative time, duration of ventilator disconnection, postoperative complications, and scar assessment. Findings: Submental intubation was performed in twelve patients with maxillofacial trauma (10 cases) and orthognathic surgery (1 case). The patients ranged in age from 16 to 42 years. The average operative time was 10 min. No complications due to submental intubation were observed Conclusions: Despite significant advances in anaesthesia and trauma airway management, the panfacial fracture patient continues to pose a challenge. For these cases the submandibular route for endotracheal intubation will remain a useful therapeutic manoeuver. This method allows temporary mandibulomaxillary fixation to achieve optimal occlusion and avoids interference of the endotracheal tube during repair of the midface. The technique of intraoperative airway access through the floor of mouth appears safe and effective but some complications can occur. http://dx.doi.org/10.1016/j.ijom.2015.08.032 Treatment of recurrent temporomandibular dislocation by displacement of the zygomatic arch: Bouguila and Khochtali’s technique J. Bouguila 1,2,3,∗ , H. Khochtali 1,2 1
Sahloul Hospital, Sousse, Tunisia Laboratory of Oral Health and Facial Rehabilitation, Mounastir, Tunisia 3 La Rabta Hospital, Tunis, Tunisia 2
Background: Many methods have been reported for the surgical treatment of recurrent anterior temporomandibular dislocation. Most of these techniques are designed to limit the forward migration of the condylar head. The great number of surgical techniques experimented illustrates the difficulty to find a satisfactory method for the treatment of these recurrent dislocations. Objectives: We present a modification of Gosserez and Dautrey’s1 surgical technique for the treatment of recurrent anterior temporomandibular joint dislocation. Methods: The surgical technique is described and its indications are discussed. Findings: With an impressive success rate, we believe that Bouguila and Khochtali’s technique offers the best chance for long-term resolution of recurrent temporomandibular dislocation. Conclusions: Dislocation of the temporomandibular joint occurs when the mandibular condyle is displaced anteriorly beyond the articular eminence. There are multiple causes for its occurrence, and treatments range from relatively conservative methods to complex surgical intervention.