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P.100 Distraction osteogenesis for maxillary reconstruction
Posters provide the patient with high-grade tooth prostheses for all season of rehabilitation. P.099 Distraction osteogenesis for mandibular reconstruction after partial mandibulectomy S. Arroyo, J. Calder´on, J. Antonio Garc´ıa Marcos, M. Galdeano. Complejo Hospitalario Universitario de Albacete, Albacete, Spain Objectives: to show a simple, efficient and low morbility technique for mandibular reconstruction. Methods: A 66 years old man with a mandibular ameloblastoma that required partial mandibulectomy from midline to second molar region. In the same procedure of the resection surgery, a reconstruction plate was placed with a Threadlock Transport distractor. This device was used to transport a distal bone fragment to the sinfisis, creating bone in the mandibular defect. Results: New bone was created at the rate of 1 mm/day, and the distractor was removed in three months. The 1.5 cm bone defect at the medial end was closed posteriorly with a Zurich Martin distractor. Conclusions: Distraction osteogenesis is an alternative treatment to the bone reconstruction with microvascular flaps, specialy in benign lesions, with low morbidity and very good results. P.100 Distraction osteogenesis for maxillary reconstruction M. Mancha de la Plata, Pl. Martos Diaz, M. Mu˜noz Guerra, L. Naval Gias, Gy. Cho Lee, S. Roson, V. Escorial Hernandez, J. Sastre Perez, F.J. Rodriguez Campo, P. Rubio Bueno, F.J. Diaz Gonzalez. University Hospital La Princesa, Madrid, Spain Introduction: Distraction osteogenesis has been widely used for reconstruction of segmental bone defects. Bone transport is a modality of distraction osteogenesis were a vascularized bone disc is moved slowly across the defect inducing new bone formation. The advantages of applying the distraction technique for reconstruction of maxillary defects after ablative surgery for oral malignancies is its lack of donor site morbidity and its ability to increase the overlying soft tissue histiogenesis. Methods: We report three patients who underwent bifocal distraction osteogenesis for secondary reconstruction of maxillary defects after ablative surgery. One patient received adjuvant radiotherapy. In two patients premaxilla region was included in the reconstruction. Distraction was performed by unidirectional semi-buried devices. Results: The consolidation period ranged from 12 to 22 weeks before distractor device was removed. At the end of the follow-up period successful bone regeneration was achieved in all patients and osseointegrated implants were placed in the distracted bone. Conclusion: Bone transport is a reliable method for maxillary reconstruction. Using this method, more aggressive procedures can be avoided. The bone obtained after distraction is suitable for placement of osseointegrated implants. P.101 Double continuous radial forearm flap for the reconstruction W. Nam, S.-H. Kang, N.-H. Cha, S.-W. Chung, S.-K. Choi, H.-J. Kim. Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Republic of Korea Objectives: With buccal cheek cancer, a complete excision of the full thickness buccal cheek is unavoidable to provide a safe margin if the lesion is large or deep, which would require a reconstruction of the oral mucosa area and face skin. Several flaps are used for the reconstruction, and the reconstruction becomes complicated when it includes the oral commissure. Therefore, in many cases, the reconstruction is performed using two other forms of flaps including a musculocutaneous flap. The
Facial reconstructive surgery
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most commonly used flap in a buccal cheek reconstruction is the RFFF because this flap is most suitable for a buccal cheek reconstruction. Moreover, elevation of the flap is easy, blood flow is good and there is low donor site morbidity. When using the RFFF, a single RFFF is used to fold a flap or make two separated skins to reconstruct the full-thickness buccal cheek, and prevent sacrifice of the radial arteries on both sides and damage to another donor area that can occur when using bilateral RFFF. However, a long pedicle is needed if the size of the excised buccal area is large or there are no blood vessels to be used for microvascular anastomosis of the ipsilateral neck. Hence, there are cases in which two RFFF are needed. In such cases, rather than using each RFFF individually, the connection of two RFFF in reconstruction is believed to be an alternative method. P.102 Early nasal reconstruction in fetal warfarin syndrome C. Portinho, M. Vincius Martins Collares, A. Castelo Branco de Castro, G. Juliani Faller. Hospital de Cl´ınicas de Porto Alegre, Porto Alegre, Brazil Objective: The authors present a case report and discuss nasal reconstruction for fetal warfarin syndrome (FWS) in neonatal period. Method: A 23-day-old, premature born (32 weeks of gestation), male patient underwent a reconstruction to correct nasal hypoplasia deformity. Such patient had presented an isolated characteristic of FWS. Genetics evaluation demonstrated no others features of FWS. His mother had a prothetic mitral valve and used warfarin regularly. She had not interrupted its use during such pregnancy. He had failure to thrive and nasoenteric tube placement was not possible because of such deformity. An open rhinoplasty with columellar incision was performed. Two cartilage grafts of tragus were harvested and introduced at the tip, caudal portion of septum and inferior lateral cartilage regions. A V-Y central lip extended flap was made to lengthen the columella and protect the cartilage graft. He leaved the hospital 3 weeks after the procedure. Results: The patient has demonstrated improvement in ventilation permeability, inspiratory noise, weight gain, and morphology. After a 12-month follow-up, result was still satisfactory. Conclusions: Early intervention may demonstrate good results and minimize future procedures, once it may favor facial growth forces. As facial growth is mainly related to breath and muscle strength, airway permeability increase due to surgery may have allowed and accelerated nasal hypoplasia rehabilitation. P.103 Early orthopedic treatment in cleft lip and palate children N. Starikova, Lv. Ageeva, Ag. Nadtochiy, Mv. Korolenkova. Moscow Center of Children’s Maxillofacial Surgery, Moscow, Russia Objective: To analyze the effectiveness of early presurgical orthopedic treatment in children with cleft lip and palate. Methods: The study involved 47 children aged from 3 to 8 months with bilateral cleft lip, alveolar bone and palate. All children had medial shift of alveolar bone fragments, mostly in the frontal region, as well as premaxilla protrusion. Stone casts were made before, 3 and 6 months after treatment. We used the Latham approach (intramaxillar fixation to palatal plates), but device was modified with distraction screw (“Leone”) and distal stopper. Being localized outside the oropharynx, the screw makes easier child’s adaptation to the device, and elastics over the screw are easier to care. Screw activation started on the first day after device fixation. Distraction period lasted 3 to 4 weeks with the retention period of 2 weeks. Device removal was performed simultaneously with Millard or Manchester cheiloplasty.
Facial reconstructive surgery
S193
most commonly used flap in a buccal cheek reconstruction is the RFFF because this flap is most suitable for a buccal cheek reconstruction. Moreover, elevation of the flap is easy, blood flow is good and there is low donor site morbidity. When using the RFFF, a single RFFF is used to fold a flap or make two separated skins to reconstruct the full-thickness buccal cheek, and prevent sacrifice of the radial arteries on both sides and damage to another donor area that can occur when using bilateral RFFF. However, a long pedicle is needed if the size of the excised buccal area is large or there are no blood vessels to be used for microvascular anastomosis of the ipsilateral neck. Hence, there are cases in which two RFFF are needed. In such cases, rather than using each RFFF individually, the connection of two RFFF in reconstruction is believed to be an alternative method. P.102 Early nasal reconstruction in fetal warfarin syndrome C. Portinho, M. Vincius Martins Collares, A. Castelo Branco de Castro, G. Juliani Faller. Hospital de Cl´ınicas de Porto Alegre, Porto Alegre, Brazil Objective: The authors present a case report and discuss nasal reconstruction for fetal warfarin syndrome (FWS) in neonatal period. Method: A 23-day-old, premature born (32 weeks of gestation), male patient underwent a reconstruction to correct nasal hypoplasia deformity. Such patient had presented an isolated characteristic of FWS. Genetics evaluation demonstrated no others features of FWS. His mother had a prothetic mitral valve and used warfarin regularly. She had not interrupted its use during such pregnancy. He had failure to thrive and nasoenteric tube placement was not possible because of such deformity. An open rhinoplasty with columellar incision was performed. Two cartilage grafts of tragus were harvested and introduced at the tip, caudal portion of septum and inferior lateral cartilage regions. A V-Y central lip extended flap was made to lengthen the columella and protect the cartilage graft. He leaved the hospital 3 weeks after the procedure. Results: The patient has demonstrated improvement in ventilation permeability, inspiratory noise, weight gain, and morphology. After a 12-month follow-up, result was still satisfactory. Conclusions: Early intervention may demonstrate good results and minimize future procedures, once it may favor facial growth forces. As facial growth is mainly related to breath and muscle strength, airway permeability increase due to surgery may have allowed and accelerated nasal hypoplasia rehabilitation. P.103 Early orthopedic treatment in cleft lip and palate children N. Starikova, Lv. Ageeva, Ag. Nadtochiy, Mv. Korolenkova. Moscow Center of Children’s Maxillofacial Surgery, Moscow, Russia Objective: To analyze the effectiveness of early presurgical orthopedic treatment in children with cleft lip and palate. Methods: The study involved 47 children aged from 3 to 8 months with bilateral cleft lip, alveolar bone and palate. All children had medial shift of alveolar bone fragments, mostly in the frontal region, as well as premaxilla protrusion. Stone casts were made before, 3 and 6 months after treatment. We used the Latham approach (intramaxillar fixation to palatal plates), but device was modified with distraction screw (“Leone”) and distal stopper. Being localized outside the oropharynx, the screw makes easier child’s adaptation to the device, and elastics over the screw are easier to care. Screw activation started on the first day after device fixation. Distraction period lasted 3 to 4 weeks with the retention period of 2 weeks. Device removal was performed simultaneously with Millard or Manchester cheiloplasty.