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Tissue expanders in facial reconstructive surgery
1058
Reconstructive Surgery
of composite bony defects within the facial skeleton.
advantage of autogenous bone graft from mandible.
doi:10.1016/j.ijom.2007.08.356
doi:10.1016/j.ijom.2007.08.358
O14.30
O14.32
Use of buccal fat pad for reconstruction of intraoral defects
Tissue expanders in facial reconstructive surgery M. Ramanathan*, S. Kumar, G. Shetkar Meenakshi Ammal Dental College & Hospital, Chennai, India
A. K. Das Department of Oral & Maxillofacial Surgery, Dr. R. Ahmed Dental College & Hospital, 114 A.J.C. Bose Road, Kolkata 700014, India The buccal fat pad (BFP) is a mass of specialized fatty tissue located between the buccinator muscle and the mandibular ramus, separating the masticatory muscles from each other, from zygomatic arch and from the ramus of mandible. Owing to the ease of access and rich blood supply, the BFP is used in the repair of minor to moderate surgical defects in the oral cavity. This paper is an endeavour to highlight some cases of intraoral reconstruction of surgical defects with the pedicled BFP graft. doi:10.1016/j.ijom.2007.08.357
O14.31 Mandible as a source of free bone graft A. Ramavat Department of OMFS, Rajah Muthiah Dental College and Hospital, Annamalai University, Annamalai Nagar 608002, India Primum non-nocere – Hippocrates bone graft has become an integral part of reconstruction and orthognathic surgeries. The choice of donor site for harvested bone is dependent not only on the type of bone required but also on the age and growth potential of the patient. Donor site morbidity should be kept to minimum, so that the patient concern does not shift from recipient site to donor site. Autogenous graft sourcing from mandible has the advantage of being usually in the same site as the surgery, less technique sensitive and easily accessible and hence indicated. In implant surgery in the form of chips or onlay graft. Orbital floor reconstruction. Comminuted fracture of middle 3rd (bridging graft). Filling of cystic cavity. Advancement of maxillofacial skeleton in orthognathic surgery, etc. This presentation intends to highlight the indications and
Objectives: (1) To evaluate the versatility of tissue expanders for reconstruction of different facial anatomical subunits. (2) To assess tissue expansion as an augmentation to regional flap for facial reconstruction. Materials and methods: Sample size 6. Material: Tissue expander made of silicone elastomer shell. Six patients requiring reconstruction of difficult anatomical subunits including lip, cheek, nose and chin were selected for soft tissue expansion using silicone elastomer tissue expanders. The efficacy of expanders to produce the optimal skin envelope for local transfer was assessed. Following parameters were addressed; amount of tissue defect covered, quality of skin envelope produced, ease of tissue transfer, rejection and the complications encountered. The techniques, advantages and the disadvantages are also discussed. Results: Expansion was done to achieve tissue coverage deficiencies ranging from 10 cm2 to 30 cm2. One expansion failed with eventual rejection of tissue expander through a dehisced wound at the site of entry. Conclusion: This is a novel method to increase the amount of local tissue available for transfer with the same quality of colour and texture which is of paramount importance in facial reconstruction. doi:10.1016/j.ijom.2007.08.359
O14.33 Buccal fat pad graft—our experience in reconstruction P. Mehra Oral and Maxillofacial Surgery, Dental Wing, Lady Hardinge Medical College, New Delhi 110001, India Various local flaps and distant flaps and microvascular flaps including tongue flap, palatal island flap and buccal flap as well as skin grafts have been used in oral and maxillofacial reconstruction. In the posterior region of oral cavity and the buccal
cheek area, buccal fat pad can be used as a pedicled graft. There are many advantages in pedicled buccal fat pad graft for the closure of oral mucosal defect. The procedure is easy, there is no visible scar in the donor site, it is capable of reconstruction of various contours, and it has good viability. We had used buccal fat pad as a pedicled graft for the closure of oroantral fistula and closure of mucosal defect following release of fibrous bands in a case of oral submucous fibrosis. From the results of these cases, we conclude that the use of the buccal fat pad flaps was worth the consideration for reconstruction in oral and maxillofacial surgery. doi:10.1016/j.ijom.2007.08.360
O14.34 Reconstruction of surgical defects of facial skeleton in children R. Chigurupati*, A. Cussano, T. Kasai, B. Schmidt Department of Oral and Maxillofacial Surgery, University of California, San Francisco, CA, USA Objective: To review reconstruction methods used in the management of tumours of the jaws in children. Patients and methods: This is a retrospective review of medical records of individuals between the ages of 0–18 years, who underwent resection of benign and malignant tumours in the head and neck region at a tertiary care referral centre. Information regarding the diagnosis, size and location of defect, reconstruction technique and donor site, growth of the affected facial skeleton and rehabilitation of dento-alveolar complex was obtained. Initial results: Two patients with malignant and 11 patients with benign disease met inclusion criteria. Six male and seven female patients ranging in age from 2 to 18 years (mean 10.4 years) underwent reconstruction of 1 maxillary and 13 mandibular continuity defects. Donor sites included one rectus myocutaneous free flap, seven costo-chondral grafts and six anterior iliac crest block grafts. Diagnoses: Fibrosarcoma (n = 1), spindle cell/myxoid sarcoma (n = 1), desmoplastic fibroma (n = 3), ameloblastoma (n = 4), aneurysmal bone cyst (n = 1) and arteriovenous malformation (n = 3). Follow-up ranged from 3 months to 4.5 years with a mean follow-up of 1 year 7 months. Conclusion: This review will provide better insight and help to establish protocols for reconstruction in growing children and adolescents. doi:10.1016/j.ijom.2007.08.361
Reconstructive Surgery
of composite bony defects within the facial skeleton.
advantage of autogenous bone graft from mandible.
doi:10.1016/j.ijom.2007.08.356
doi:10.1016/j.ijom.2007.08.358
O14.30
O14.32
Use of buccal fat pad for reconstruction of intraoral defects
Tissue expanders in facial reconstructive surgery M. Ramanathan*, S. Kumar, G. Shetkar Meenakshi Ammal Dental College & Hospital, Chennai, India
A. K. Das Department of Oral & Maxillofacial Surgery, Dr. R. Ahmed Dental College & Hospital, 114 A.J.C. Bose Road, Kolkata 700014, India The buccal fat pad (BFP) is a mass of specialized fatty tissue located between the buccinator muscle and the mandibular ramus, separating the masticatory muscles from each other, from zygomatic arch and from the ramus of mandible. Owing to the ease of access and rich blood supply, the BFP is used in the repair of minor to moderate surgical defects in the oral cavity. This paper is an endeavour to highlight some cases of intraoral reconstruction of surgical defects with the pedicled BFP graft. doi:10.1016/j.ijom.2007.08.357
O14.31 Mandible as a source of free bone graft A. Ramavat Department of OMFS, Rajah Muthiah Dental College and Hospital, Annamalai University, Annamalai Nagar 608002, India Primum non-nocere – Hippocrates bone graft has become an integral part of reconstruction and orthognathic surgeries. The choice of donor site for harvested bone is dependent not only on the type of bone required but also on the age and growth potential of the patient. Donor site morbidity should be kept to minimum, so that the patient concern does not shift from recipient site to donor site. Autogenous graft sourcing from mandible has the advantage of being usually in the same site as the surgery, less technique sensitive and easily accessible and hence indicated. In implant surgery in the form of chips or onlay graft. Orbital floor reconstruction. Comminuted fracture of middle 3rd (bridging graft). Filling of cystic cavity. Advancement of maxillofacial skeleton in orthognathic surgery, etc. This presentation intends to highlight the indications and
Objectives: (1) To evaluate the versatility of tissue expanders for reconstruction of different facial anatomical subunits. (2) To assess tissue expansion as an augmentation to regional flap for facial reconstruction. Materials and methods: Sample size 6. Material: Tissue expander made of silicone elastomer shell. Six patients requiring reconstruction of difficult anatomical subunits including lip, cheek, nose and chin were selected for soft tissue expansion using silicone elastomer tissue expanders. The efficacy of expanders to produce the optimal skin envelope for local transfer was assessed. Following parameters were addressed; amount of tissue defect covered, quality of skin envelope produced, ease of tissue transfer, rejection and the complications encountered. The techniques, advantages and the disadvantages are also discussed. Results: Expansion was done to achieve tissue coverage deficiencies ranging from 10 cm2 to 30 cm2. One expansion failed with eventual rejection of tissue expander through a dehisced wound at the site of entry. Conclusion: This is a novel method to increase the amount of local tissue available for transfer with the same quality of colour and texture which is of paramount importance in facial reconstruction. doi:10.1016/j.ijom.2007.08.359
O14.33 Buccal fat pad graft—our experience in reconstruction P. Mehra Oral and Maxillofacial Surgery, Dental Wing, Lady Hardinge Medical College, New Delhi 110001, India Various local flaps and distant flaps and microvascular flaps including tongue flap, palatal island flap and buccal flap as well as skin grafts have been used in oral and maxillofacial reconstruction. In the posterior region of oral cavity and the buccal
cheek area, buccal fat pad can be used as a pedicled graft. There are many advantages in pedicled buccal fat pad graft for the closure of oral mucosal defect. The procedure is easy, there is no visible scar in the donor site, it is capable of reconstruction of various contours, and it has good viability. We had used buccal fat pad as a pedicled graft for the closure of oroantral fistula and closure of mucosal defect following release of fibrous bands in a case of oral submucous fibrosis. From the results of these cases, we conclude that the use of the buccal fat pad flaps was worth the consideration for reconstruction in oral and maxillofacial surgery. doi:10.1016/j.ijom.2007.08.360
O14.34 Reconstruction of surgical defects of facial skeleton in children R. Chigurupati*, A. Cussano, T. Kasai, B. Schmidt Department of Oral and Maxillofacial Surgery, University of California, San Francisco, CA, USA Objective: To review reconstruction methods used in the management of tumours of the jaws in children. Patients and methods: This is a retrospective review of medical records of individuals between the ages of 0–18 years, who underwent resection of benign and malignant tumours in the head and neck region at a tertiary care referral centre. Information regarding the diagnosis, size and location of defect, reconstruction technique and donor site, growth of the affected facial skeleton and rehabilitation of dento-alveolar complex was obtained. Initial results: Two patients with malignant and 11 patients with benign disease met inclusion criteria. Six male and seven female patients ranging in age from 2 to 18 years (mean 10.4 years) underwent reconstruction of 1 maxillary and 13 mandibular continuity defects. Donor sites included one rectus myocutaneous free flap, seven costo-chondral grafts and six anterior iliac crest block grafts. Diagnoses: Fibrosarcoma (n = 1), spindle cell/myxoid sarcoma (n = 1), desmoplastic fibroma (n = 3), ameloblastoma (n = 4), aneurysmal bone cyst (n = 1) and arteriovenous malformation (n = 3). Follow-up ranged from 3 months to 4.5 years with a mean follow-up of 1 year 7 months. Conclusion: This review will provide better insight and help to establish protocols for reconstruction in growing children and adolescents. doi:10.1016/j.ijom.2007.08.361