- Email: [email protected]
OP014
Abstracts / Oral Oncology 49 (2013) S4–S79
respectively. Sixteen resected maxillae were surgically reconstructed followed by insertion of 60 implants, resulting in 9 implant failures. 23 resected maxillary defects remained open and received 96 implants for oral rehabilitation, ending up with 5 implant losses. Unsplinted implants showed a non-statistically significant higher risk for failures (Logrank, P-value < 0.05). Discussion: If considering the clinical challenge by the oral rehabilitation of maxillectomy patients, the 4-year implant survival rate was surprisingly high. A larger sample size and a longer observation time are needed to identify risk factors for implant failures. doi:10.1016/j.oraloncology.2013.03.020
OP013 Rehabilitation of oral cancer patients with mandibular implants placed per ablationem: Up to 14 years follow-up Anke Korfage, Arjan Vissink, Jan L.N. Roodenburg, Gerry M. Raghoebar, Harry Reintsema University Medical Center Groningen, Department of Oral and Maxillofacial Surgery and Maxillofacial Prosthetics, Groningen, The Netherlands Purpose: The objective of this study was to evaluate the treatment outcomes (implant survival, denture satisfaction, subjective chewing ability, oral function and quality of life) of oral cancer patients with implant-retained mandibular overdentures, in whom the implants were installed during ablative tumor surgery, up to 14 years after placement of the implants. Methods and materials: Edentulous oral cancer patients with the need for surgery and in whom prosthetic problems were expected after oncological treatment, were offered implant-based treatment in the mandibula. All implants were installed during ablative tumor surgery in native bone in the interforaminal area. The patients and implants were evaluated by clinical assessments and standardized questionnaires. Results: Of the 181 patients that fulfilled the inclusion criteria, 165 patients were included. One hundred patients received postoperative radiotherapy. In total 138 patients were rehabilitated with an implant-based prosthesis (84%). Of the 528 placed implants, 35 implants were lost during the follow-up (overall survival rate = 93.4%). Implant loss was higher in irradiated patients. Rehabilitation not depend on radiotherapy, type of reconstruction used during surgery or the number of implants placed. Irradiated patients reported lower scores on several items of the quality of life and oral functioning questionnaires. Patients not wearing the prosthesis had lower scores on oral functioning questionnaires and reported less chewing ability. The type of reconstruction used or the number of implants placed did not give different outcome of the questionnaires. Conclusions: It was concluded that oral cancer patients can benefit from implants installed during ablative surgery, with a high survival rate of the implants, a high percentage of rehabilitated patients and short time between surgery and prosthetic rehabilitation. Patients not receiving post-operative radiotherapy report a better oral function and more prosthesis-related satisfaction. When possible from a prosthetic point of view, two mandibular implants should be placed. doi:10.1016/j.oraloncology.2013.03.021
OP014 Prosthetic rehabilitation in oncologic patients treated with microvascular free fibula flap for mandibular reconstruction: A series of 24 patients
S9
Anne-Gaëlle Bodard a, Charlotte Attier a, Aline Desoutter a, Matthieu Fabris a, Samuel Salino a, Pierre Breton b a b
Centre Léon Bérard and University Claude Bernard, Lyon, France Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
Purpose: Mandibular reconstruction with microvascular free fibula flap (MFFF) is widely used after oncologic resection as it allows functional and aesthetical restoration of the mandibular arch and implant-retained prostheses. The aim of the series is to propose a decisional tree diagram to choose the type of prosthesis through clinical experience and review of the literature. Material and method: Patients treated with MFFF and prosthetically rehabilitated were included. Number of osteotomies, number of implants, type of prosthesis, follow up after the placement of prosthesis, pre-implant surgery and peri-implant complications were reported. Subjective criteria such as patient’s satisfaction and improvement of masticatory function were collected. Results: Twenty-four patients were included. Number of osteotomies ranges from 0 (9 patients) to 2 (2 patients). Four patients underwent preimplantation surgery on soft tissues and 3 on bone. Seventy-four implants were placed, 4 remained unloaded, and 1 was lost before loading. Ten patients had implant-supported dentures and 14 had fixed prostheses. Prosthetic follow-up was over 5 years for 15 patients and under 1 year for 1 patient. Peri-implant complication was hyperplasia for 7 patients. Patients’ satisfaction was good and masticatory improvement was moderate. Discussion: Prosthetic rehabilitation on MFFF evolutes to fixed prosthesis. Nonetheless, it is more complicated to realize, and requires a sufficient number of implants. Peri-implant complications such as hyperplasia seem to occur more often. Implant-retained dentures seem preferable in case of important aesthetical alteration, although fixed hybrid ‘‘Branemark like’’ prosthesis remain a good alternative. Improvement of mastication is more important in patients with large rehabilitations but remain quite disappointing. Finally, one should wonder whether dental restoration is necessary in case of small lateral flaps. doi:10.1016/j.oraloncology.2013.03.022
OP015 Reconstruction of combined intracranial–extracranial defects by mycutaneuous free flap Zhengxue Han, Jingzhong Li, Hua Li Department of Oral & Maxillocacial Surgery, Beijing Stomatological Hospital, Capital Medical University, Beijing, China Objective: The purpose of this study was to evaluate experiences of combined intracranial–extracranial defects reconstruction and to identify reconstructive management principles that may assist in achieving successful multidisciplinary approaches. Method: Clinical records of 11 patients with recurrence tumor who required skull base reconstruction with mycutaneuous free flaps were reviewed retrospectively. Patients had undergone skull base surgeries through multidisciplinary approaches with simultaneous reconstruction for the anterior and middle cranial fossa skull base in 5 patients each, and the posterior fossa in 1. Donor sites included the latissimus dorsi (9), pectoralis major muscle (2). Results: Reconstruction was performed as planned in all patients with a low incidence of complications. Necrosis of the flaps was not encountered. The postoperative recovery time was from 7 to 15 days.
respectively. Sixteen resected maxillae were surgically reconstructed followed by insertion of 60 implants, resulting in 9 implant failures. 23 resected maxillary defects remained open and received 96 implants for oral rehabilitation, ending up with 5 implant losses. Unsplinted implants showed a non-statistically significant higher risk for failures (Logrank, P-value < 0.05). Discussion: If considering the clinical challenge by the oral rehabilitation of maxillectomy patients, the 4-year implant survival rate was surprisingly high. A larger sample size and a longer observation time are needed to identify risk factors for implant failures. doi:10.1016/j.oraloncology.2013.03.020
OP013 Rehabilitation of oral cancer patients with mandibular implants placed per ablationem: Up to 14 years follow-up Anke Korfage, Arjan Vissink, Jan L.N. Roodenburg, Gerry M. Raghoebar, Harry Reintsema University Medical Center Groningen, Department of Oral and Maxillofacial Surgery and Maxillofacial Prosthetics, Groningen, The Netherlands Purpose: The objective of this study was to evaluate the treatment outcomes (implant survival, denture satisfaction, subjective chewing ability, oral function and quality of life) of oral cancer patients with implant-retained mandibular overdentures, in whom the implants were installed during ablative tumor surgery, up to 14 years after placement of the implants. Methods and materials: Edentulous oral cancer patients with the need for surgery and in whom prosthetic problems were expected after oncological treatment, were offered implant-based treatment in the mandibula. All implants were installed during ablative tumor surgery in native bone in the interforaminal area. The patients and implants were evaluated by clinical assessments and standardized questionnaires. Results: Of the 181 patients that fulfilled the inclusion criteria, 165 patients were included. One hundred patients received postoperative radiotherapy. In total 138 patients were rehabilitated with an implant-based prosthesis (84%). Of the 528 placed implants, 35 implants were lost during the follow-up (overall survival rate = 93.4%). Implant loss was higher in irradiated patients. Rehabilitation not depend on radiotherapy, type of reconstruction used during surgery or the number of implants placed. Irradiated patients reported lower scores on several items of the quality of life and oral functioning questionnaires. Patients not wearing the prosthesis had lower scores on oral functioning questionnaires and reported less chewing ability. The type of reconstruction used or the number of implants placed did not give different outcome of the questionnaires. Conclusions: It was concluded that oral cancer patients can benefit from implants installed during ablative surgery, with a high survival rate of the implants, a high percentage of rehabilitated patients and short time between surgery and prosthetic rehabilitation. Patients not receiving post-operative radiotherapy report a better oral function and more prosthesis-related satisfaction. When possible from a prosthetic point of view, two mandibular implants should be placed. doi:10.1016/j.oraloncology.2013.03.021
OP014 Prosthetic rehabilitation in oncologic patients treated with microvascular free fibula flap for mandibular reconstruction: A series of 24 patients
S9
Anne-Gaëlle Bodard a, Charlotte Attier a, Aline Desoutter a, Matthieu Fabris a, Samuel Salino a, Pierre Breton b a b
Centre Léon Bérard and University Claude Bernard, Lyon, France Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
Purpose: Mandibular reconstruction with microvascular free fibula flap (MFFF) is widely used after oncologic resection as it allows functional and aesthetical restoration of the mandibular arch and implant-retained prostheses. The aim of the series is to propose a decisional tree diagram to choose the type of prosthesis through clinical experience and review of the literature. Material and method: Patients treated with MFFF and prosthetically rehabilitated were included. Number of osteotomies, number of implants, type of prosthesis, follow up after the placement of prosthesis, pre-implant surgery and peri-implant complications were reported. Subjective criteria such as patient’s satisfaction and improvement of masticatory function were collected. Results: Twenty-four patients were included. Number of osteotomies ranges from 0 (9 patients) to 2 (2 patients). Four patients underwent preimplantation surgery on soft tissues and 3 on bone. Seventy-four implants were placed, 4 remained unloaded, and 1 was lost before loading. Ten patients had implant-supported dentures and 14 had fixed prostheses. Prosthetic follow-up was over 5 years for 15 patients and under 1 year for 1 patient. Peri-implant complication was hyperplasia for 7 patients. Patients’ satisfaction was good and masticatory improvement was moderate. Discussion: Prosthetic rehabilitation on MFFF evolutes to fixed prosthesis. Nonetheless, it is more complicated to realize, and requires a sufficient number of implants. Peri-implant complications such as hyperplasia seem to occur more often. Implant-retained dentures seem preferable in case of important aesthetical alteration, although fixed hybrid ‘‘Branemark like’’ prosthesis remain a good alternative. Improvement of mastication is more important in patients with large rehabilitations but remain quite disappointing. Finally, one should wonder whether dental restoration is necessary in case of small lateral flaps. doi:10.1016/j.oraloncology.2013.03.022
OP015 Reconstruction of combined intracranial–extracranial defects by mycutaneuous free flap Zhengxue Han, Jingzhong Li, Hua Li Department of Oral & Maxillocacial Surgery, Beijing Stomatological Hospital, Capital Medical University, Beijing, China Objective: The purpose of this study was to evaluate experiences of combined intracranial–extracranial defects reconstruction and to identify reconstructive management principles that may assist in achieving successful multidisciplinary approaches. Method: Clinical records of 11 patients with recurrence tumor who required skull base reconstruction with mycutaneuous free flaps were reviewed retrospectively. Patients had undergone skull base surgeries through multidisciplinary approaches with simultaneous reconstruction for the anterior and middle cranial fossa skull base in 5 patients each, and the posterior fossa in 1. Donor sites included the latissimus dorsi (9), pectoralis major muscle (2). Results: Reconstruction was performed as planned in all patients with a low incidence of complications. Necrosis of the flaps was not encountered. The postoperative recovery time was from 7 to 15 days.