- Email: [email protected]
Reconstruction of the anopthalmic orbit with free forearm flap
1122 Abstracts recipient and donor sites were documented and clinical outcomes were assessed. Results: A total of 11 cases of mandibular reconstruction have been done in ten patients. Six (60%) of them are females and 4 (40%) are males. The age range was between 19 and 61 years. Primary reconstruction with both iliac bone graft and plate were done in 3 patients, primary reconstruction with iliac bone graft only and secondary reconstruction with both rib graft and plate in 1 patient, primary reconstruction with only iliac bone in 5 patients and, primary reconstruction with Steinman’s pin in 1 patient. Conclusion: All bone grafts were non vascularized and there was 100% take. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.321
59 Latissimus dorsi flap as a rescue flap ∗
J. Acero , C. Maza, A.M. Lopez, I. Vila, R.E. Asensio, A. Thomas, C. Navarro Gregorio Mara˜nón Universitary Hospital, Madrid, Spain
The latissimus dorsi flap was the first described in medical literature. The first use is attributed to Tansini in 1896, when applied it to breast reconstruction after radical mastectomy. In 1978 Quillen used the pedicle form for face and neck defects reconstruction. One year later, Watson created the first application of it as a free vascularized flap. This flap, in both forms, was really popular in the 80s because it is easy to dissect, the neurovascular pedicle is long and wide, it has a large area and low donor site morbidity. We present 2 cases of secondary reconstruction with latissimus dorsi muscle flap: First case: 40 year old woman who presented a right craniofacial giant basal cell carcinoma. It was observed facial nerve paralysis. We performed resection and reconstruction with rectus abdominis microsurgical flap. After checking that this flap was not viable, we took it out and then we secondary reconstructed the defect with microsurgical latissimus dorsi flap. Second case: 63 year old man who presented a left retromolar trigone and a synchronous larynx squamous cell carcinoma. We performed tumor resection with segmental mandibulectomy, an horizontal supraglottic laryngectomy, a left functional cervical dissection, and reconstructed it with microsurgical fibula free flap. After dehiscence and necrosis of soft tissue flap, a new flap reconstruction using
pedicle pectoralis major was done. Then, the patient presented a new cervical dehiscence because of a pharyngostoma. He had to be intervened again to cover dehiscence and repair the pharyngostoma with a pedicle latissimus dorsi flap. Conflict of interest: None declared.
needs to be bridged properly to avoid disabling functional and cosmetic results. This case report describes an innovative method of reconstruction in a case of chronic suppurative osteomyelitis of mandible which is simple and effective and gives good long term results. Conflict of interest: None declared.
doi:10.1016/j.ijom.2011.07.322 doi:10.1016/j.ijom.2011.07.324
60 Reconstruction of the anopthalmic orbit with free forearm flap M. Artajona 1,∗ , C. Bescós 2 , M. Sáez 1 , J. Pamias 1 , G. Raspall 1 , R. Medel 3 1 Maxillofacial Surgery, Spain 2 Vall d’Hebron Hospital, Spain 3 Ophthalmology, Hospital Vall d’Hebron, Barcelona, Spain
Introduction: Patients with acquired anopthalmic orbits in childhood have a specific anatomical features making hard to fit properly the ocular prostheses, especially those who have received radiotherapy. The reconstruction of the anopthalmic orbits is a challenge for the surgeon because there is no protocol described for treatment. Material and methods: We present the case of a young male who in the childhood received an enucleation of the eye and radiotherapy due to a retinoblastoma in his left eye. Later shows atrophy of the orbit and periorbital region making hard to fit properly the ocular prostheses; so we decided to perform an orbitary reconstruction with a free forearm flap. Results: After the surgery the patient presents an increased volume in the periorbital region with a well-positioned ocular prostheses and an aesthetic improvement. Conclusions: In cases of severe anopthalmic orbits, the use of microvascular flaps gives us an increased volume, as well as it allows us to improve facial aesthetic results and provides a proper adjustment of the ocular prostheses. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.323
61 Innovation in oral maxillofacial surgery P. Mehra Oral Maxillofacial Surgery, Lady Hardinge Medical College, New Delhi, India
Reconstruction of the bony defects in the mandible following sequestrectomy
62 Alveolar graft in lip and palate clefts: results and complications A.M. Borba 1,2,∗ , C.S.V. da Silva 2 , P.S. Cé 2 , O. Ribeiro Júnior 1 , M.C.Z. Deboni 1 , M.G. Naclério-Homem 1 1 Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Universidade de São Paulo - USP, São Paulo, Brazil 2 Cleft & Craniofacial Center, Hospital Geral Universitário, Cuiabá, Brazil
Introduction: Orofacial clefts are the most common congenital deformities and reconstruction of the alveolar cleft in lip and palate clefts patients are paramount to proper eruption of permanent teeth, for an eventual prosthetic rehabilitation and closure of oronasal fistula. Methods: The present study intends to evaluate the result of autogenous osseous graft performed for reconstruction of the alveolar region in patients with lip and palate clefs at the Cleft & Craniofacial Center of the Hospital Geral Universitário, analyzing post-surgical complications. The data was obtained from hospital files within the period of 2004 and 2010. As for the complications, the following variables were recorded: cleft type, gender, age, donor area, type of graft and teeth surrounding the cleft. Results: Seventy-one patients composed the total number of patients submitted to alveolar cleft bone graft and among then, thirty two presented some sort of complication in which nineteen needed to be reoperated. The total sample displayed a median of 16 years old at the time of surgery, 39 females and 32 males, one palate cleft, 31 lip clefts and 39 lip and palate clefts, iliac anterior crest used in 48 patients, cortical and cancellous bone used in 50 patients. Conclusion: The obtained results emphasized the greater incidence of complications associated with late alveolar graft, the one that occurs after the eruption of permanent teeth. This suggests that
59 Latissimus dorsi flap as a rescue flap ∗
J. Acero , C. Maza, A.M. Lopez, I. Vila, R.E. Asensio, A. Thomas, C. Navarro Gregorio Mara˜nón Universitary Hospital, Madrid, Spain
The latissimus dorsi flap was the first described in medical literature. The first use is attributed to Tansini in 1896, when applied it to breast reconstruction after radical mastectomy. In 1978 Quillen used the pedicle form for face and neck defects reconstruction. One year later, Watson created the first application of it as a free vascularized flap. This flap, in both forms, was really popular in the 80s because it is easy to dissect, the neurovascular pedicle is long and wide, it has a large area and low donor site morbidity. We present 2 cases of secondary reconstruction with latissimus dorsi muscle flap: First case: 40 year old woman who presented a right craniofacial giant basal cell carcinoma. It was observed facial nerve paralysis. We performed resection and reconstruction with rectus abdominis microsurgical flap. After checking that this flap was not viable, we took it out and then we secondary reconstructed the defect with microsurgical latissimus dorsi flap. Second case: 63 year old man who presented a left retromolar trigone and a synchronous larynx squamous cell carcinoma. We performed tumor resection with segmental mandibulectomy, an horizontal supraglottic laryngectomy, a left functional cervical dissection, and reconstructed it with microsurgical fibula free flap. After dehiscence and necrosis of soft tissue flap, a new flap reconstruction using
pedicle pectoralis major was done. Then, the patient presented a new cervical dehiscence because of a pharyngostoma. He had to be intervened again to cover dehiscence and repair the pharyngostoma with a pedicle latissimus dorsi flap. Conflict of interest: None declared.
needs to be bridged properly to avoid disabling functional and cosmetic results. This case report describes an innovative method of reconstruction in a case of chronic suppurative osteomyelitis of mandible which is simple and effective and gives good long term results. Conflict of interest: None declared.
doi:10.1016/j.ijom.2011.07.322 doi:10.1016/j.ijom.2011.07.324
60 Reconstruction of the anopthalmic orbit with free forearm flap M. Artajona 1,∗ , C. Bescós 2 , M. Sáez 1 , J. Pamias 1 , G. Raspall 1 , R. Medel 3 1 Maxillofacial Surgery, Spain 2 Vall d’Hebron Hospital, Spain 3 Ophthalmology, Hospital Vall d’Hebron, Barcelona, Spain
Introduction: Patients with acquired anopthalmic orbits in childhood have a specific anatomical features making hard to fit properly the ocular prostheses, especially those who have received radiotherapy. The reconstruction of the anopthalmic orbits is a challenge for the surgeon because there is no protocol described for treatment. Material and methods: We present the case of a young male who in the childhood received an enucleation of the eye and radiotherapy due to a retinoblastoma in his left eye. Later shows atrophy of the orbit and periorbital region making hard to fit properly the ocular prostheses; so we decided to perform an orbitary reconstruction with a free forearm flap. Results: After the surgery the patient presents an increased volume in the periorbital region with a well-positioned ocular prostheses and an aesthetic improvement. Conclusions: In cases of severe anopthalmic orbits, the use of microvascular flaps gives us an increased volume, as well as it allows us to improve facial aesthetic results and provides a proper adjustment of the ocular prostheses. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.323
61 Innovation in oral maxillofacial surgery P. Mehra Oral Maxillofacial Surgery, Lady Hardinge Medical College, New Delhi, India
Reconstruction of the bony defects in the mandible following sequestrectomy
62 Alveolar graft in lip and palate clefts: results and complications A.M. Borba 1,2,∗ , C.S.V. da Silva 2 , P.S. Cé 2 , O. Ribeiro Júnior 1 , M.C.Z. Deboni 1 , M.G. Naclério-Homem 1 1 Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Universidade de São Paulo - USP, São Paulo, Brazil 2 Cleft & Craniofacial Center, Hospital Geral Universitário, Cuiabá, Brazil
Introduction: Orofacial clefts are the most common congenital deformities and reconstruction of the alveolar cleft in lip and palate clefts patients are paramount to proper eruption of permanent teeth, for an eventual prosthetic rehabilitation and closure of oronasal fistula. Methods: The present study intends to evaluate the result of autogenous osseous graft performed for reconstruction of the alveolar region in patients with lip and palate clefs at the Cleft & Craniofacial Center of the Hospital Geral Universitário, analyzing post-surgical complications. The data was obtained from hospital files within the period of 2004 and 2010. As for the complications, the following variables were recorded: cleft type, gender, age, donor area, type of graft and teeth surrounding the cleft. Results: Seventy-one patients composed the total number of patients submitted to alveolar cleft bone graft and among then, thirty two presented some sort of complication in which nineteen needed to be reoperated. The total sample displayed a median of 16 years old at the time of surgery, 39 females and 32 males, one palate cleft, 31 lip clefts and 39 lip and palate clefts, iliac anterior crest used in 48 patients, cortical and cancellous bone used in 50 patients. Conclusion: The obtained results emphasized the greater incidence of complications associated with late alveolar graft, the one that occurs after the eruption of permanent teeth. This suggests that