- Email: [email protected]
Reconstruction of complex composite oromandibular defects with single fibula osteocutaneous flap
Reconstructive Surgery and 11 females and age ranging from 17 to ˆ 9.4, in 67 years old, average of 54.8A age distribution. The timing of reconstruction was only one immediate reconstruction at the same time of resection others were delayed. The length of harvested fibula was from 6 to 20 cm, the average being 10.8 cm, and all flaps were performed osteotomy to reform the bony contour. Fifty-two dental implants were installed eight flaps. Cumulative successful rate of this reconstruction was 88.5% and successful rate of dental implant placement was 92.0%, respectively. doi:10.1016/j.ijom.2007.08.343
O14.17 Reconstruction of complex composite oromandibular defects with single fibula osteocutaneous flap A. K. Sheorain*, P. S. Yadav, Q. G. Ahmad, E. Z. Siddiqui, V. R. Patel, N. K. Deepu Department of Plastic, Reconstructive & Microvascular Services, Tata Memorial Hospital, Mumbai, India Complex composite defects of oral cavity are formidable problems. They require reconstruction of oral lining, soft tissue cover and bony continuity of mandible. Immediate reconstruction of such defects is protocol at most of the large centres dealing with head and neck malignancy. Microsurgical tissue transfer is the chief mode of reconstruction of complex defects. However, as the complexity of the defect increases, meeting all the demands with one free tissue transfer may not be possible. Hence, double free flaps or free flaps in combination with local pedicled flaps have been used. Our experience of reconstruction of such complex composite defects with single osteomyocutaneous free fibula has been encouraging. From January 2005 to March 2007, we have performed 481 free flaps. Of this total of 183 cases of free fibula for mandibular reconstruction was performed. Contrary to the earlier experiences of unreliability of skin paddle, we had only 4 cases of inadequate perfusion of skin paddle (2.18%). We feel that routine inclusion of flexor hallucis longus results in increased reliability of skin paddle and at the same time it results in negligible incidence of plantar contracture of great toe. Our overall success rate with free fibula is over 98.5%. doi:10.1016/j.ijom.2007.08.344
O14.18 Chinese flap for reconstruction of large defect after radical ablation of carcinoma of tongue and floor of mouth: some new modifications Y.-N. Wu*, X.-M. Song, Y. Yuan, Z.-J. Tao, X.-H. Shi Stomatological Institute, Department of Oral and Maxillofacial Surgery, College of Stomatology, Nanjing Medical University, Nanjing 210029, Jiangsu Province, China Objective: Thin microsurgical radial flap used for reconstruction of the tongue and floor of mouth have some disadvantages such as no sufficient tissue bulk, poor function and usually complicated with healing delay and orocutaneous fistula. New modified radial flap was designed to rehabilitate the function and reduce the complications of both the donor and acceptor site. Methods: Between 2003 and 2006, nine patients with infiltrating squamous cell carcinomas of tongue or/ and floor of mouth underwent about 1/2 to 2/3 tongue and floor of mouth resection and microvascular reconstruction using modified Chinese flap, which was a bifoliate-shaped and partially de-epithelialized flap rolled or overlapped on itself. The average size of the forearm flap was 7.5 cm 14 cm, requiring no skin graft from abdomen to the donor site using the triangular incision combined with deepithelialized technique. Results: All the flaps were successfully transferred. No obvious complications were found either in oral–maxillofacial or forearm region. Eight patients were evaluated for swallowing and speech at 6 months postoperation. There was no obvious complaint. An acceptable function of speech and swallowing was achieved. Conclusion: Partially de-epithelialized bifoliate-shaped flap to reconstruct large defect of tongue and floor of mouth is an option to improve functional outcome in T3 and T4 oral carcinomas, new modified forearm flap can replace the pectoralis major myocutaneous flap to some extent.
There are many methods of reconstructing intra oral defects following surgical treatment of cancer. Over the past few decades, many advances have been made in the field of reconstruction, but the pectoralis major myocutaneous flap which was first described by Hueston and Mc Conchie in 1968 and important modifications were presented by Stephen Ariyan in 1979 who has demonstrated the great versatility of this flap in reconstruction following surgical ablation of head and neck cancers. The advantages besides the ease of technique and low complication rate include improved viability and effective carotid artery protection. It can reliably provide and abundance of well vascularized tissue. The flap can be used for wide range of defects in head and neck area including the oral cavity, neck, maxilla as well as tempero-orbital area. The concept that muscular portion provides excellent coverage of the neck contents after radical neck dissection makes this flap most viable in the reconstruction of head and neck cancers. Here I am presenting a paper on our experience with pectoralis major myocutaneous flap in the reconstruction of head and neck cancers. doi:10.1016/j.ijom.2007.08.346
O14.20 Craniofacial implants for extra-oral prosthetic reconstruction I. Sharp*, P. Jeynes, U. Waheed, S. Parmar, T. Martin, S. Worrollo Department of Maxillofacial Surgery, University Hospital Birmingham, Edgbaston, Birmingham, UK Craniofacial osseointegration is one of the most significant advances in maxillofacial reconstruction. This has enabled patients to improve their quality of life. Aim: Retrospective study of over 350 patients and over 1000 implants over a 17-year period. Results: Implant positions, implant type and length, potential causes of implant failure and the effects of radiotherapy will be discussed.
doi:10.1016/j.ijom.2007.08.345
doi:10.1016/j.ijom.2007.08.347
O14.19
O14.21
Versatility of pectoralis major myocutaneous flap K. T. Chavan*, B. P. Reddy, R. Desai, S. Manjunath, S. Shubhalakshmi, K. V. Umashankar College of Dental Sciences, Davangere, Karnataka, India
1055
Maxillectomies—Dharwad experience P.R. Sanoo*, C.B. Rao, G. Krishnan, D.P. Tauro Craniofacial Surgery & Research Centre, Department of Oral and Maxillofacial Surgery, S.D.M. College of Dental
O14.17 Reconstruction of complex composite oromandibular defects with single fibula osteocutaneous flap A. K. Sheorain*, P. S. Yadav, Q. G. Ahmad, E. Z. Siddiqui, V. R. Patel, N. K. Deepu Department of Plastic, Reconstructive & Microvascular Services, Tata Memorial Hospital, Mumbai, India Complex composite defects of oral cavity are formidable problems. They require reconstruction of oral lining, soft tissue cover and bony continuity of mandible. Immediate reconstruction of such defects is protocol at most of the large centres dealing with head and neck malignancy. Microsurgical tissue transfer is the chief mode of reconstruction of complex defects. However, as the complexity of the defect increases, meeting all the demands with one free tissue transfer may not be possible. Hence, double free flaps or free flaps in combination with local pedicled flaps have been used. Our experience of reconstruction of such complex composite defects with single osteomyocutaneous free fibula has been encouraging. From January 2005 to March 2007, we have performed 481 free flaps. Of this total of 183 cases of free fibula for mandibular reconstruction was performed. Contrary to the earlier experiences of unreliability of skin paddle, we had only 4 cases of inadequate perfusion of skin paddle (2.18%). We feel that routine inclusion of flexor hallucis longus results in increased reliability of skin paddle and at the same time it results in negligible incidence of plantar contracture of great toe. Our overall success rate with free fibula is over 98.5%. doi:10.1016/j.ijom.2007.08.344
O14.18 Chinese flap for reconstruction of large defect after radical ablation of carcinoma of tongue and floor of mouth: some new modifications Y.-N. Wu*, X.-M. Song, Y. Yuan, Z.-J. Tao, X.-H. Shi Stomatological Institute, Department of Oral and Maxillofacial Surgery, College of Stomatology, Nanjing Medical University, Nanjing 210029, Jiangsu Province, China Objective: Thin microsurgical radial flap used for reconstruction of the tongue and floor of mouth have some disadvantages such as no sufficient tissue bulk, poor function and usually complicated with healing delay and orocutaneous fistula. New modified radial flap was designed to rehabilitate the function and reduce the complications of both the donor and acceptor site. Methods: Between 2003 and 2006, nine patients with infiltrating squamous cell carcinomas of tongue or/ and floor of mouth underwent about 1/2 to 2/3 tongue and floor of mouth resection and microvascular reconstruction using modified Chinese flap, which was a bifoliate-shaped and partially de-epithelialized flap rolled or overlapped on itself. The average size of the forearm flap was 7.5 cm 14 cm, requiring no skin graft from abdomen to the donor site using the triangular incision combined with deepithelialized technique. Results: All the flaps were successfully transferred. No obvious complications were found either in oral–maxillofacial or forearm region. Eight patients were evaluated for swallowing and speech at 6 months postoperation. There was no obvious complaint. An acceptable function of speech and swallowing was achieved. Conclusion: Partially de-epithelialized bifoliate-shaped flap to reconstruct large defect of tongue and floor of mouth is an option to improve functional outcome in T3 and T4 oral carcinomas, new modified forearm flap can replace the pectoralis major myocutaneous flap to some extent.
There are many methods of reconstructing intra oral defects following surgical treatment of cancer. Over the past few decades, many advances have been made in the field of reconstruction, but the pectoralis major myocutaneous flap which was first described by Hueston and Mc Conchie in 1968 and important modifications were presented by Stephen Ariyan in 1979 who has demonstrated the great versatility of this flap in reconstruction following surgical ablation of head and neck cancers. The advantages besides the ease of technique and low complication rate include improved viability and effective carotid artery protection. It can reliably provide and abundance of well vascularized tissue. The flap can be used for wide range of defects in head and neck area including the oral cavity, neck, maxilla as well as tempero-orbital area. The concept that muscular portion provides excellent coverage of the neck contents after radical neck dissection makes this flap most viable in the reconstruction of head and neck cancers. Here I am presenting a paper on our experience with pectoralis major myocutaneous flap in the reconstruction of head and neck cancers. doi:10.1016/j.ijom.2007.08.346
O14.20 Craniofacial implants for extra-oral prosthetic reconstruction I. Sharp*, P. Jeynes, U. Waheed, S. Parmar, T. Martin, S. Worrollo Department of Maxillofacial Surgery, University Hospital Birmingham, Edgbaston, Birmingham, UK Craniofacial osseointegration is one of the most significant advances in maxillofacial reconstruction. This has enabled patients to improve their quality of life. Aim: Retrospective study of over 350 patients and over 1000 implants over a 17-year period. Results: Implant positions, implant type and length, potential causes of implant failure and the effects of radiotherapy will be discussed.
doi:10.1016/j.ijom.2007.08.345
doi:10.1016/j.ijom.2007.08.347
O14.19
O14.21
Versatility of pectoralis major myocutaneous flap K. T. Chavan*, B. P. Reddy, R. Desai, S. Manjunath, S. Shubhalakshmi, K. V. Umashankar College of Dental Sciences, Davangere, Karnataka, India
1055
Maxillectomies—Dharwad experience P.R. Sanoo*, C.B. Rao, G. Krishnan, D.P. Tauro Craniofacial Surgery & Research Centre, Department of Oral and Maxillofacial Surgery, S.D.M. College of Dental