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P2.71. Bone impacted fibula (bif), a new technique of increasing bone density for placing dental implants
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184
Poster session II / Oral Oncology Supplement 3 (2009) 162–200
Methods: In the current presentation, these problems have been addressed by emphasizing on subtle technical points that we have used those in our last 5 years experiences from 2001 to 2006 on passing the pedicle deeply to the clavicle. Following flap harvest, the pedicle was passed in the subclavicular plane in 32 head and neck cancer patients for primary and secondary reconstruction. Results: It was possible to increase the medium length of PMF to 2–3 cm compared to the supraclavicular route by using this route. We have not total flap necrosis. Minor complications were observed in 5 of 32 cases (15/6%): partial flap necrosis occurred in 3 cases and fistula formation was observed in 2 cases. Discussion: The subclavicular route increases the length and arc of rotation without compromising vascular supply to a higher degree than with the conventional supraclavicular route. Furthermore, this concept decreases the bulk of the flap pedicle which is functionally and cosmetically favourable. doi:10.1016/j.oos.2009.06.473
P2.70. Masseter flap for reconstruction of the mucosal defects following excision of the selected buccal mucosa cancers P. Chaturvedi*, P. Pai Tata Memorial Hospital, Mumbai, India Introduction: Oral cancer is one of the commonest cancer in Indian men. Buccal mucosa is one of the commonest site affected by oral cancer. Reconstruction of the defect following oral cancer surgery is extremely challenging. Microvascular surgery has revolutionized the head and neck reconstruction in general. For buccal mucosa defect with intact mandible and overlying skin, Free radial artery forearm flap (FRAFF) appears the best means of reconstruction. However, due to constraints of infrastructure and expertise, not all patients can be offered FRAFF. We recommend Masseter flap as an alternative to FRAFF for such defects in highly selected patients. Material and method: We collected data on 17 Masseter flaps that we have performed in last 5 years at our service. It was done for buccal mucosa cancers. We followed them for mean of 6 months to assess for post-operative morbidities, initiation of oral feeds, duration of hospitalization, mouth opening and appearance. Results: The masseter flap is a described flap that has been previously reported in the literature. It is based on the branches of the superficial temporal artery. In our series, the flap was successful in all patients. However, 2 patients experienced partial necrosis and self limiting oro-cutaneous fistula. Most patients achieved a mean inter-incisal distance of 3.5 cm at 6 months. All patients underwent intensive post operative rehabilitation to avoid trismus that is a common sequel of this flap. The mean time to oral allowance was 5 days, mean duration of hospitalization was 6 days. Parotid fistula was seen in 1 patient. When indicated, all patient completed their RT on time. Conclusion: Masseter flap is a simple and sturdy technique of reconstruction with a small learning curve. Surgeons working in centres lacking the expertise and infrastructure to offer micro-vascular flap should master this flap. doi:10.1016/j.oos.2009.06.474
P2.71. Bone impacted fibula (bif), a new technique of increasing bone density for placing dental implants H. Seikaly*, A.M. Mlynarek, J. Rieger, J.R. Harris University of Alberta, Canada
Introduction: The principal advantage of osseous free flaps in head and neck reconstruction is potential of implant placement implants which would facilitate oral or craniofacial rehabilitation. The fibula is the most commonly used bone in these reconstructions. The bone density of most fibular free flaps is usually sufficient to place implants but the bone stock can be diminished in some head and neck cancer patients because they tend to be elderly, malnourished and have significant peripheral vascular disease. The fact that the fibular marrow becomes deficient in bone with age also makes osteointegration of implants more challenging. We have developed a new technique to increase the bone density at the time of free flap transfer in order to facilitate post operative implantation. We use bone chips from the discarded fibula and impact them in to the hollow marrow of the portion of the bone used for the reconstruction. Objective: To assess the modification of bone impaction of the fibula on: (1) Bone density of the fibula free flap postoperatively, (2) Ease of placement and retention of implants. Study design: Prospective cohort study. Methods: All patients who underwent maxillary or mandibular reconstruction with fibular microvascular free flaps were included in the study. Fibular bones impacted with autologous bone were compared to unmodified fibular bones. Bone density was measured from post-operative CT scans, and the ease and retention of implant placement was assessed by measuring the degree of vibration at the time of the implantation. Results: Bone impacted fibulas were found to have a higher marrow bone density as compared to the unmodified fibular free flaps. Lower degree of dental implant vibration was observed in the bone impacted fibulas as compared to unmodified fibulas. All modified fibular free flaps survived. Conclusion: Bone impaction fibula (BIF) modification of osseus free flaps, presented for the first time in this paper, increases bone density and facilitates the primary osteointegration of implants. doi:10.1016/j.oos.2009.06.475
P2.72. The clavipectoral osteomyocutaneous free flap: A new flap for oromandibular reconstruction H. Seikaly*, J. Chau, J.R. Harris University of Alberta, Canada Introduction: Mandibular reconstruction continues the challenge most head and neck reconstructive surgeons despite the tremendous advances in surgical and fixation techniques. We have recently described the clavipectoral osteocutaneous flap for mandibular reconstruction. This flap encompasses the clavicle, clavicular head of pectoralis major with overlying skin. Objectives: The purpose of this manuscript is to report our prospective clinical experience with the use of clavipectoral osteocutaneous flap in reconstruction of oromandibular defects. Study design: Prospective case series. Methods: Five patients with significant mandibular defects underwent reconstruction using the newly described clavipectoral flap. All patients had shoulder range of motion testing preoperatively, and at 3 and 6 months postoperatively. Panorex and bone scans were obtained on the 7th postoperative day. Results: All five flaps survived in total. The transferred clavicles demonstrated good vascularity on the postoperative bone scans. The shoulder morbidity was minimal with all patients resumed preoperative level of activity. Conclusions: The clavipectoral flap has bone and soft tissue components that are especially suited for composite mandibular defects
184
Poster session II / Oral Oncology Supplement 3 (2009) 162–200
Methods: In the current presentation, these problems have been addressed by emphasizing on subtle technical points that we have used those in our last 5 years experiences from 2001 to 2006 on passing the pedicle deeply to the clavicle. Following flap harvest, the pedicle was passed in the subclavicular plane in 32 head and neck cancer patients for primary and secondary reconstruction. Results: It was possible to increase the medium length of PMF to 2–3 cm compared to the supraclavicular route by using this route. We have not total flap necrosis. Minor complications were observed in 5 of 32 cases (15/6%): partial flap necrosis occurred in 3 cases and fistula formation was observed in 2 cases. Discussion: The subclavicular route increases the length and arc of rotation without compromising vascular supply to a higher degree than with the conventional supraclavicular route. Furthermore, this concept decreases the bulk of the flap pedicle which is functionally and cosmetically favourable. doi:10.1016/j.oos.2009.06.473
P2.70. Masseter flap for reconstruction of the mucosal defects following excision of the selected buccal mucosa cancers P. Chaturvedi*, P. Pai Tata Memorial Hospital, Mumbai, India Introduction: Oral cancer is one of the commonest cancer in Indian men. Buccal mucosa is one of the commonest site affected by oral cancer. Reconstruction of the defect following oral cancer surgery is extremely challenging. Microvascular surgery has revolutionized the head and neck reconstruction in general. For buccal mucosa defect with intact mandible and overlying skin, Free radial artery forearm flap (FRAFF) appears the best means of reconstruction. However, due to constraints of infrastructure and expertise, not all patients can be offered FRAFF. We recommend Masseter flap as an alternative to FRAFF for such defects in highly selected patients. Material and method: We collected data on 17 Masseter flaps that we have performed in last 5 years at our service. It was done for buccal mucosa cancers. We followed them for mean of 6 months to assess for post-operative morbidities, initiation of oral feeds, duration of hospitalization, mouth opening and appearance. Results: The masseter flap is a described flap that has been previously reported in the literature. It is based on the branches of the superficial temporal artery. In our series, the flap was successful in all patients. However, 2 patients experienced partial necrosis and self limiting oro-cutaneous fistula. Most patients achieved a mean inter-incisal distance of 3.5 cm at 6 months. All patients underwent intensive post operative rehabilitation to avoid trismus that is a common sequel of this flap. The mean time to oral allowance was 5 days, mean duration of hospitalization was 6 days. Parotid fistula was seen in 1 patient. When indicated, all patient completed their RT on time. Conclusion: Masseter flap is a simple and sturdy technique of reconstruction with a small learning curve. Surgeons working in centres lacking the expertise and infrastructure to offer micro-vascular flap should master this flap. doi:10.1016/j.oos.2009.06.474
P2.71. Bone impacted fibula (bif), a new technique of increasing bone density for placing dental implants H. Seikaly*, A.M. Mlynarek, J. Rieger, J.R. Harris University of Alberta, Canada
Introduction: The principal advantage of osseous free flaps in head and neck reconstruction is potential of implant placement implants which would facilitate oral or craniofacial rehabilitation. The fibula is the most commonly used bone in these reconstructions. The bone density of most fibular free flaps is usually sufficient to place implants but the bone stock can be diminished in some head and neck cancer patients because they tend to be elderly, malnourished and have significant peripheral vascular disease. The fact that the fibular marrow becomes deficient in bone with age also makes osteointegration of implants more challenging. We have developed a new technique to increase the bone density at the time of free flap transfer in order to facilitate post operative implantation. We use bone chips from the discarded fibula and impact them in to the hollow marrow of the portion of the bone used for the reconstruction. Objective: To assess the modification of bone impaction of the fibula on: (1) Bone density of the fibula free flap postoperatively, (2) Ease of placement and retention of implants. Study design: Prospective cohort study. Methods: All patients who underwent maxillary or mandibular reconstruction with fibular microvascular free flaps were included in the study. Fibular bones impacted with autologous bone were compared to unmodified fibular bones. Bone density was measured from post-operative CT scans, and the ease and retention of implant placement was assessed by measuring the degree of vibration at the time of the implantation. Results: Bone impacted fibulas were found to have a higher marrow bone density as compared to the unmodified fibular free flaps. Lower degree of dental implant vibration was observed in the bone impacted fibulas as compared to unmodified fibulas. All modified fibular free flaps survived. Conclusion: Bone impaction fibula (BIF) modification of osseus free flaps, presented for the first time in this paper, increases bone density and facilitates the primary osteointegration of implants. doi:10.1016/j.oos.2009.06.475
P2.72. The clavipectoral osteomyocutaneous free flap: A new flap for oromandibular reconstruction H. Seikaly*, J. Chau, J.R. Harris University of Alberta, Canada Introduction: Mandibular reconstruction continues the challenge most head and neck reconstructive surgeons despite the tremendous advances in surgical and fixation techniques. We have recently described the clavipectoral osteocutaneous flap for mandibular reconstruction. This flap encompasses the clavicle, clavicular head of pectoralis major with overlying skin. Objectives: The purpose of this manuscript is to report our prospective clinical experience with the use of clavipectoral osteocutaneous flap in reconstruction of oromandibular defects. Study design: Prospective case series. Methods: Five patients with significant mandibular defects underwent reconstruction using the newly described clavipectoral flap. All patients had shoulder range of motion testing preoperatively, and at 3 and 6 months postoperatively. Panorex and bone scans were obtained on the 7th postoperative day. Results: All five flaps survived in total. The transferred clavicles demonstrated good vascularity on the postoperative bone scans. The shoulder morbidity was minimal with all patients resumed preoperative level of activity. Conclusions: The clavipectoral flap has bone and soft tissue components that are especially suited for composite mandibular defects