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Prosthetic orbital reconstruction with osseointegrated implants following radiation therapy
Otolaryngology Head and Neck Surgery P 164
August 1995
Scientific Posters
perforations surgically created. After 3 weeks the perforations were repaired with temporalis fascia or dermis placed between mucoperichondrial flaps. The dermal graft group had an average closure of 80% of the defect, whereas the temporalis fascia group had no closure. Histologic examination of the healed dermal graft group revealed normal mucosal surfaces. Dermal grafts placed between mucoperichondrial flaps are a viable alternative for the closure of nasal septal perforations. 4 Multiple Primary Z-Plasties in Midline Lip-Splitting Procedures ROGER J. LEVIN, MD, FRED G. FEDOK, MD, and NICHOLAS G. HAMILL, MD, Hershey, Pa.
Surgical resections of oral cavity or oropharyngeal neoplasms frequently require a midline lip-splitting incision. Either a cheek flap or mandibular swing procedure can then easily be performed with wide exposure. These wounds usually heal well, although attention must be paid to accurate approximation of the vermillion border and to realignment of the cervical skin flaps. Several authors have commented on initially marking the flaps either with methylene blue or cross-hatching with a knife blade. Further discussion surrounds whether to incise vertically through the mentum or curve around it. Even when closed meticulously, scarbanding can occur, which can tether the mentum and neck. We now incorporate multiple z-plasties into our cervicofacial incisions to obviate these surgical and woundhealing problems. Three z-plasties are usually performed: the first at the mental crease, the second at the submental crease, and the third at the transition from a horizontal to a vertical incision, around the hyoid. We further make a step incision at the vermillion border. These modifications assist not only in accurately realigning the flap but also in camouflaging the incision. Also, the z-plastics allow for lengthening the incision if there is concern for scar-banding. We have performed these modifications in 10 patients requiring midline lip-splitting procedures. We discuss our results and compare the cosmetic and functional outcome between these 10 patients and previous patients requiring a lip-splitting operation.
48 joules/cm 2. By applying 20 to 30 pulses all cartilage samples were remoulded. An explanation of the mechanism responsible for this phenomenon is presented based on the histologic observations with light and election microscopy. Irradiated rabbit cartilage samples were then implanted in the rabbits' back and are retrieved after 6 months. The histologic study showed viable-shaped cartilage. Clinical studies were also conducted on six patients with severe deformities of the cartilaginous septum. The deformed septal cartilage was removed, straightened up with the CO 2 laser irradiation, and then put back in place. All patients were evaluated at 6 months and 1 year. 6 Prosthetic Orbital Reconstruction With Osseointegrated Implants Following Radiation Therapy GARY F. MOORE, MD, FACS, GORDON K. MAHANNA, DDS, and ROBERTA. EHRHARD, MD, Omaha, Neb.
Facial defects created by ablative cancer surgery can create significant cosmetic, functional, and secondary psychological problems for patients. The advent of new surgical techniques and medical grade material developed by Branemark has made titanium osseointegrated implants feasible in practically any facial osseous-supported structure. A relative contraindication to osseointegrated implantation is bone that has been irradiated. The use of radiation therapy is common in head and neck cancers; therefore these cases have some of the most challenging reconstructive problems. Once the cancer has been removed, further rehabilitation includes both functional and aesthetic rehabilitation. This poster display depicts rehabilitation of a patient who underwent a maxillectomy and orbital exenteration for a T3NoMo squamous cell carcinoma of the maxillary sinus. This was followed by radiation therapy. A small lead shield was fabricated to protect the orbital rim during radiation therapy. The ports included the orbit and maxillary sinus. Subsequently, osseointegrated implants were implanted to secure a framework used to support an orbital prosthesis. The use of carefully designed radiation shield and osseointegrated implants makes it possible to safely and predictably help meet the complex maxillofacial prosthodontic needs of patients with head and neck cancer.
5 Laser Thermochontroplasty: Experimental Data and Clinical Application M. VOLITAKIS, MD, G. VELEGRAKIS, MD, IRENE NAUMIDI, PhD, and E. HELIDONIS, MD, FACS, Heraklion, Crete, Greece
Laser thermochendroplasty is a new method for changing the cartilage shape. Using a CO 2laser cartilage samples about 1 to 2 mm thick, taken from rabbits ears and from patients, who underwent septal surgery, were irradiated with the single-pulse mode. The total energy dose of each pulse was
7 Finite Element Analysis Around Endosseous Implants JOSE M. ALBERTOS, JUAN C. DEVICENTE, EEDER/CO ESPARZA, and LUISM. JUNQUERA, Oviedo, Spain
Objectives: (1) To study the tensional distribution of loadings when they are applied over an endosseous implant; (2) to investigate the influence of implant design in the distribution of this loading in the jaws; and (3) to point out the previsible criteria of tensional failure in biologic tissues. Methods: Three different endosseous implants are selected,
August 1995
Scientific Posters
perforations surgically created. After 3 weeks the perforations were repaired with temporalis fascia or dermis placed between mucoperichondrial flaps. The dermal graft group had an average closure of 80% of the defect, whereas the temporalis fascia group had no closure. Histologic examination of the healed dermal graft group revealed normal mucosal surfaces. Dermal grafts placed between mucoperichondrial flaps are a viable alternative for the closure of nasal septal perforations. 4 Multiple Primary Z-Plasties in Midline Lip-Splitting Procedures ROGER J. LEVIN, MD, FRED G. FEDOK, MD, and NICHOLAS G. HAMILL, MD, Hershey, Pa.
Surgical resections of oral cavity or oropharyngeal neoplasms frequently require a midline lip-splitting incision. Either a cheek flap or mandibular swing procedure can then easily be performed with wide exposure. These wounds usually heal well, although attention must be paid to accurate approximation of the vermillion border and to realignment of the cervical skin flaps. Several authors have commented on initially marking the flaps either with methylene blue or cross-hatching with a knife blade. Further discussion surrounds whether to incise vertically through the mentum or curve around it. Even when closed meticulously, scarbanding can occur, which can tether the mentum and neck. We now incorporate multiple z-plasties into our cervicofacial incisions to obviate these surgical and woundhealing problems. Three z-plasties are usually performed: the first at the mental crease, the second at the submental crease, and the third at the transition from a horizontal to a vertical incision, around the hyoid. We further make a step incision at the vermillion border. These modifications assist not only in accurately realigning the flap but also in camouflaging the incision. Also, the z-plastics allow for lengthening the incision if there is concern for scar-banding. We have performed these modifications in 10 patients requiring midline lip-splitting procedures. We discuss our results and compare the cosmetic and functional outcome between these 10 patients and previous patients requiring a lip-splitting operation.
48 joules/cm 2. By applying 20 to 30 pulses all cartilage samples were remoulded. An explanation of the mechanism responsible for this phenomenon is presented based on the histologic observations with light and election microscopy. Irradiated rabbit cartilage samples were then implanted in the rabbits' back and are retrieved after 6 months. The histologic study showed viable-shaped cartilage. Clinical studies were also conducted on six patients with severe deformities of the cartilaginous septum. The deformed septal cartilage was removed, straightened up with the CO 2 laser irradiation, and then put back in place. All patients were evaluated at 6 months and 1 year. 6 Prosthetic Orbital Reconstruction With Osseointegrated Implants Following Radiation Therapy GARY F. MOORE, MD, FACS, GORDON K. MAHANNA, DDS, and ROBERTA. EHRHARD, MD, Omaha, Neb.
Facial defects created by ablative cancer surgery can create significant cosmetic, functional, and secondary psychological problems for patients. The advent of new surgical techniques and medical grade material developed by Branemark has made titanium osseointegrated implants feasible in practically any facial osseous-supported structure. A relative contraindication to osseointegrated implantation is bone that has been irradiated. The use of radiation therapy is common in head and neck cancers; therefore these cases have some of the most challenging reconstructive problems. Once the cancer has been removed, further rehabilitation includes both functional and aesthetic rehabilitation. This poster display depicts rehabilitation of a patient who underwent a maxillectomy and orbital exenteration for a T3NoMo squamous cell carcinoma of the maxillary sinus. This was followed by radiation therapy. A small lead shield was fabricated to protect the orbital rim during radiation therapy. The ports included the orbit and maxillary sinus. Subsequently, osseointegrated implants were implanted to secure a framework used to support an orbital prosthesis. The use of carefully designed radiation shield and osseointegrated implants makes it possible to safely and predictably help meet the complex maxillofacial prosthodontic needs of patients with head and neck cancer.
5 Laser Thermochontroplasty: Experimental Data and Clinical Application M. VOLITAKIS, MD, G. VELEGRAKIS, MD, IRENE NAUMIDI, PhD, and E. HELIDONIS, MD, FACS, Heraklion, Crete, Greece
Laser thermochendroplasty is a new method for changing the cartilage shape. Using a CO 2laser cartilage samples about 1 to 2 mm thick, taken from rabbits ears and from patients, who underwent septal surgery, were irradiated with the single-pulse mode. The total energy dose of each pulse was
7 Finite Element Analysis Around Endosseous Implants JOSE M. ALBERTOS, JUAN C. DEVICENTE, EEDER/CO ESPARZA, and LUISM. JUNQUERA, Oviedo, Spain
Objectives: (1) To study the tensional distribution of loadings when they are applied over an endosseous implant; (2) to investigate the influence of implant design in the distribution of this loading in the jaws; and (3) to point out the previsible criteria of tensional failure in biologic tissues. Methods: Three different endosseous implants are selected,