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Mandibular reconstruction using a vascularised osteocutaneous scapular flap
586 Free Papers—Poster Presentations the postoperative defect of oral cancer. 4 of them were Chinese flap combined with pectoralis major myocutaneous flap, and the left were two Chinese flap combination. The evaluation indicator was the survived rate of flaps, the masticatory and linguistic function of the patients, and the mouth opening of patients after 6 months follow up. Results: All of the flaps were survived. The width of mouth opening of patients was all above 2.5 cm after operation and 6 months follow up. The masticatory and linguistic function and the appearance of the patients were satisfactory. Conclusion: Composite flaps are suitable for large area defect, especially for radical resection of cranial-maxillofacial region. But higher operation skills are needed. doi:10.1016/j.ijom.2009.03.658
P186 Mandibular reconstruction using a vascularised osteocutaneous scapular flap K. Ota ∗ , S. Shinriki, T. Ota, H. Nakayama, A. Hiraki, T. Obayashi, M. Shinohara Department of Oral and Maxillofacial Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Background and Objectives: For patients with oral cancer who has undergone segmental mandibulectomy, mandibular reconstruction provides not only lower facial contour, but also masticatory function. The vascularised osteocutaneous scapular flap has a significant potential for reconstruction of mandible. We evaluated the effect of mandibular reconstruction using a free scapular flap on masticatory function. Methods: Between 1999 and 2006, we performed 19 mandible reconstructions using vascularised osteocutaneous scapular flaps. All patients were reconstructed immediately by one-stage transfer. Seventeen parascapular flaps, one scapular flap, one combined flap with a parascapular flap and scapular flap were reconstructed soft tissues and monitored. The masticatory ability was evaluated by a questionnaire survey from all patients. Results: All vascularised bone graft, except one, survived. Skin flap necrosis was observed in two patients and their bone viabilities were confirmed by scintigraphy when available. The skin defects in these patients were regenerated by gingiva. Complete loss of a osteocutaneous
scapular flap was recovered by a pectoralis major myocutaneous flap and titan plate as a secondary procedure. Seven patients utilised the remaining teeth and three patients used the partial dentures for eating. In two cases, dental reconstruction was performed by implanting an artificial dental root. These patients had higher ability for chewing than the patient who used remaining teeth and/or dentures. Conclusions: Vascularised osteocutaneous scapular flap for mandibular defects would improve the masticatory function in the presence of dental implants. doi:10.1016/j.ijom.2009.03.659
P187 Management of a mandibular fracture accompanying a gunshot wound: a case report Y. Emes ∗ , B. Atalay, I. Aktas, B. Oncu, B. Aybar, S. Yalcin Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Kadikoy, Istanbul, Turkey
Gunshot injuries of the mandible can result in high rates of complications, especially in cases of bone loss. A fractured mandible accompanying a gunshot wound almost always has an external wound; the fracture is always compound and comminuted. Sometimes the management of these injuries may require multiple surgical interventions. In this case report, treatment of a patient, who had a mandibular fracture due to a gunshot wound, is presented. A 52-year-old male patient, with a mandibular fracture in the right mandibular body accompanying a gunshot wound was operated. Due to a non union, a second surgery was performed using reconstruction plates following hyperbaric oxygen treatment. The healing was uneventful after the second surgical intervention. doi:10.1016/j.ijom.2009.03.660
P188 Reconstruction of the tongue with lateral arm free flap after hemiglossectomy G.Q. Liao ∗ , Y.X. Su, H.C. Liu, J. Li, D.M. Ou, Q. Wang, N. Fahmha, T.H. Zhang Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China
Background and Objectives: To investigate the value of microsurgical reconstruction of the tongue after hemiglossectomy with
lateral arm free flaps in the treatment of tongue cancer. Methods: From October 2006 to April 2007, ten patients underwent simultaneous reconstruction of the tongue and oral floor defects with lateral arm free flaps after resection of squamous cell carcinoma of tongue in our hospital. The flaps ranged from 8 cm × 5 cm to 9 cm × 6 cm in size, and were adjusted to the defect of the tongue. The vascular pedicle included the posterior radial collateral artery and the accompanying veins. The outcome of reconstruction was evaluated by follow-up examinations, considering the contour and mobility of the reconstructed tongue, the swallowing function and the speech function. Results: All patients recovered uneventfully from surgery, with no immediate postoperative complications: no flap necrosis, no wound infection or wound dehiscence. All transplanted flaps survived. During the follow-up period the contour of the reconstructed tongues was satisfactory. The patients demonstrated good functional mobility of the reconstructed and remaining tongue. Postoperatively, the swallowing and speech function was nearly at normal levels and the patients could ingest a solid or semisolid diet. Conclusions: The initial experience indicates that microvascular reconstruction of the tongue with lateral arm free flaps after hemiglossectomy is an ideal, safe and usable method. Yet further studies on the function of tongue after reconstruction are required for reaching some final conclusions. doi:10.1016/j.ijom.2009.03.661
P189 Hemitongue reconstruction with free forearm flap for the preservation of tongue function G.Q. Liao ∗ , Y.X. Su, H.C. Liu, J. Li, N. Fahmha, D.M. Ou, Q. Wang Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China
Background and Objectives: To investigate the value of microsurgical reconstruction of the tongue after hemiglossectomy with free forearm flaps for preservation of tongue function in the treatment of tongue cancer. Methods: From July 2002 to November 2006, forty patients with tongue cancer underwent hemiglossectomy and primary reconstruction with radial forearm free
P186 Mandibular reconstruction using a vascularised osteocutaneous scapular flap K. Ota ∗ , S. Shinriki, T. Ota, H. Nakayama, A. Hiraki, T. Obayashi, M. Shinohara Department of Oral and Maxillofacial Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Background and Objectives: For patients with oral cancer who has undergone segmental mandibulectomy, mandibular reconstruction provides not only lower facial contour, but also masticatory function. The vascularised osteocutaneous scapular flap has a significant potential for reconstruction of mandible. We evaluated the effect of mandibular reconstruction using a free scapular flap on masticatory function. Methods: Between 1999 and 2006, we performed 19 mandible reconstructions using vascularised osteocutaneous scapular flaps. All patients were reconstructed immediately by one-stage transfer. Seventeen parascapular flaps, one scapular flap, one combined flap with a parascapular flap and scapular flap were reconstructed soft tissues and monitored. The masticatory ability was evaluated by a questionnaire survey from all patients. Results: All vascularised bone graft, except one, survived. Skin flap necrosis was observed in two patients and their bone viabilities were confirmed by scintigraphy when available. The skin defects in these patients were regenerated by gingiva. Complete loss of a osteocutaneous
scapular flap was recovered by a pectoralis major myocutaneous flap and titan plate as a secondary procedure. Seven patients utilised the remaining teeth and three patients used the partial dentures for eating. In two cases, dental reconstruction was performed by implanting an artificial dental root. These patients had higher ability for chewing than the patient who used remaining teeth and/or dentures. Conclusions: Vascularised osteocutaneous scapular flap for mandibular defects would improve the masticatory function in the presence of dental implants. doi:10.1016/j.ijom.2009.03.659
P187 Management of a mandibular fracture accompanying a gunshot wound: a case report Y. Emes ∗ , B. Atalay, I. Aktas, B. Oncu, B. Aybar, S. Yalcin Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Kadikoy, Istanbul, Turkey
Gunshot injuries of the mandible can result in high rates of complications, especially in cases of bone loss. A fractured mandible accompanying a gunshot wound almost always has an external wound; the fracture is always compound and comminuted. Sometimes the management of these injuries may require multiple surgical interventions. In this case report, treatment of a patient, who had a mandibular fracture due to a gunshot wound, is presented. A 52-year-old male patient, with a mandibular fracture in the right mandibular body accompanying a gunshot wound was operated. Due to a non union, a second surgery was performed using reconstruction plates following hyperbaric oxygen treatment. The healing was uneventful after the second surgical intervention. doi:10.1016/j.ijom.2009.03.660
P188 Reconstruction of the tongue with lateral arm free flap after hemiglossectomy G.Q. Liao ∗ , Y.X. Su, H.C. Liu, J. Li, D.M. Ou, Q. Wang, N. Fahmha, T.H. Zhang Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China
Background and Objectives: To investigate the value of microsurgical reconstruction of the tongue after hemiglossectomy with
lateral arm free flaps in the treatment of tongue cancer. Methods: From October 2006 to April 2007, ten patients underwent simultaneous reconstruction of the tongue and oral floor defects with lateral arm free flaps after resection of squamous cell carcinoma of tongue in our hospital. The flaps ranged from 8 cm × 5 cm to 9 cm × 6 cm in size, and were adjusted to the defect of the tongue. The vascular pedicle included the posterior radial collateral artery and the accompanying veins. The outcome of reconstruction was evaluated by follow-up examinations, considering the contour and mobility of the reconstructed tongue, the swallowing function and the speech function. Results: All patients recovered uneventfully from surgery, with no immediate postoperative complications: no flap necrosis, no wound infection or wound dehiscence. All transplanted flaps survived. During the follow-up period the contour of the reconstructed tongues was satisfactory. The patients demonstrated good functional mobility of the reconstructed and remaining tongue. Postoperatively, the swallowing and speech function was nearly at normal levels and the patients could ingest a solid or semisolid diet. Conclusions: The initial experience indicates that microvascular reconstruction of the tongue with lateral arm free flaps after hemiglossectomy is an ideal, safe and usable method. Yet further studies on the function of tongue after reconstruction are required for reaching some final conclusions. doi:10.1016/j.ijom.2009.03.661
P189 Hemitongue reconstruction with free forearm flap for the preservation of tongue function G.Q. Liao ∗ , Y.X. Su, H.C. Liu, J. Li, N. Fahmha, D.M. Ou, Q. Wang Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China
Background and Objectives: To investigate the value of microsurgical reconstruction of the tongue after hemiglossectomy with free forearm flaps for preservation of tongue function in the treatment of tongue cancer. Methods: From July 2002 to November 2006, forty patients with tongue cancer underwent hemiglossectomy and primary reconstruction with radial forearm free