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Transoral approach to tumours of the clivus
Free oral communications 71 Advanced Osseointegration in the Atrophic Maxilla
Maiorana C. Department of Oral Surgery, University of Milan, Milano, Italy Several surgical procedures are at present available in order to treat the atrophic maxilla. The authors present their experience after using the titanium meshes and cancellous bone and deproteinized bovine graft technique in cases needing a prosthetic rehabilitation with implants. When compared to other procedures, this one offers some advantages: (i) short (3 years) bone graft resorption (10-15%), (ii) contemporaneous ridge augmentation either on a vertical or transverse dimension and possibility to perform a two stage sinus lift and (iii) obtaining of a consistent keratinized mucosa over the ridge, this is very useful in view of the implants placement. The whole procedure has to be carried out in three different stages: (i) bone graft and ridge augmentation using a tailor made titanium mesh; (ii) mesh removal after 3-4 months and keratinized mucosa augmentation; and (iii) implant placement 1 month later. After the last stage, 4 months have to pass in order to obtain the osseointegration, then the prosthetic rehabilitation can be carried out. The authors present some cases of partial or whole atrophic maxillas that have been treated from a surgical and prosthetic point of view. Transoral Approach to Tumours of the Clivus
Makhmudov U.B., Tcherekaev V.A., TanyashinS. V., Shimansky EN., Mukhametjanov D.J., Usachev D. Y.
Burdenko Neurosurgical Institute, Moscow, Russia Surgical removal of a tumour of the clivus is very difficult. Approximately 30 years ago, these lesions were regarded as inaccessible for surgical removal. Today, surgeons use different surNcal approaches for the clivus area; frontotemporal, subtemporal, suboccipital extradural posterolateral and extradural anterior. All these different techniques have advantages and disadvantages, particularly in patients with extensive tumour involvement. The transoral surgical approach to the clivus and the upper cervical spine is the most direct route for removal of tumours in these areas. This approach was oriNnally used by surgeons for access to the posterior pharynx at the base of the tongue. Currently, it is believed that the transoral approach may be safely used in patients with intradural lesions. When the tumours require a dural opening, there is danger of serious complications such as cerebrospinal fluid leak and meningitis. A transoral approach was used in 5 patients with clivus tumours (3 chordomas, 1 fibrochondrosarcomas and 1 fibroma). The choice of approach was based on data provided by craniofacial examination, radiographic examinations, magnetic resonance imaging, computed tomographic scans and vertebral angiography, all of which suggested a tumour involving the oropharynx and nasopharynx, with destruction of the clivus bone structure. There was no postoperative mortality. These reports demonstrate the feasibility of the transoral approach.
The Versatility of the Vascularized Flaps, Based Upon the Superficial Temporal Vessels
Malakhovskaya E, Osipov G.
Central Research Institute of Stomatology, Moscow, Russia
The superficial temporal artery and its branches are the source of blood supply of the frontal, temporoparietal and auricular donor sites. It gives the possibility for the harvest of various flaps for the reconstruction a broad spectrum of complex defects of the face. The thin sheet of vascularized temporoparietal fascia may be transferred alone or as a carrier of subjacent bone or overlying skin and scalp. As a pedicled flap we used a variety of the temporoparietal and frontal flaps for the reconstruction of defects of the ear, orbital and malar regions and resurface of the cheek. As a free tissue transfer, we utilized fasciocutaneous flaps in the restoration of the beard of man, composite auricular free flap and epithelized temporoparietal fascia in the reconstruction of the nose. The versatility of the flaps present of the donor material in the same operative field, minimal morbidity and a hidden scar are the advantages of these donor sites. The clinical cases and the results of surgical treatment will be presented.
Ten-Year Experience of Temporomandibular Joint Recovery by Autometatarsophalangeal Joint
Malanchuk V.A.
Department of Maxillo-Facial Surgery, National Medical University, Kiev, Ukra&e Recovery of temporomandibular joint (TMJ) after loss of its function and development of ankylosis is a difficult task. Growth of cicatricial or osseous tissues after inflammation or traumatic injuries is evidence of osseous tissue reparative potential changes in the joint zone - of decreasing, or more often increasing, reparative potential. That its why use of some methods of TMJ recovery without due regard for biologic tissue properties of the joint do not show changes in tissues which can be pathophysiologically or pathogenetically proven. In 1986-1995, we used the following treatment principles on patients with TMJ ankylosis: (i) obligatory removal of damaged osseous tissues; (ii) recovery of the TMJ by healthy autojoint with low reparative properties, (iii) development of optimal biomechanical conditions for mandibular movement by stretching the muscles simultaneously with the stretching of the mandible, and (iv) minimal exfoliation of muscles from the mandible. Thirty patients aged 6-50 years were operated on. Thirty-three metatarsophalangeal joints were transplanted for arthroplasty of TMJ; 30 by the free method, 3 by microvascular method. Relapse occured in 10% of patients who had general diseases, thus showing the effectiveness of a systemic approach.
Distractive Removal of Mandibular End Defects
Malanchuk V.A., Beresovskaya N.A., Yatsenko D. V.
Department of Maxillo-Facial Surgery, National Medical University, Kiev, Ukraine Defects of the ramus mandibulae and articular process with 3-8 cm length usually need artificial prosthesis for temporomandibular joint or osseous transplantation. For postradial defects these methods are not used because of the absence of affected soft tissues. From 1988 we used distractive method in such cases. In healthy mandibular regions an osteotomy was made, and an osseous graft from the mandibular body according defects size was formed, then it was transplanted by distractive apparatus into the ramus
Maiorana C. Department of Oral Surgery, University of Milan, Milano, Italy Several surgical procedures are at present available in order to treat the atrophic maxilla. The authors present their experience after using the titanium meshes and cancellous bone and deproteinized bovine graft technique in cases needing a prosthetic rehabilitation with implants. When compared to other procedures, this one offers some advantages: (i) short (3 years) bone graft resorption (10-15%), (ii) contemporaneous ridge augmentation either on a vertical or transverse dimension and possibility to perform a two stage sinus lift and (iii) obtaining of a consistent keratinized mucosa over the ridge, this is very useful in view of the implants placement. The whole procedure has to be carried out in three different stages: (i) bone graft and ridge augmentation using a tailor made titanium mesh; (ii) mesh removal after 3-4 months and keratinized mucosa augmentation; and (iii) implant placement 1 month later. After the last stage, 4 months have to pass in order to obtain the osseointegration, then the prosthetic rehabilitation can be carried out. The authors present some cases of partial or whole atrophic maxillas that have been treated from a surgical and prosthetic point of view. Transoral Approach to Tumours of the Clivus
Makhmudov U.B., Tcherekaev V.A., TanyashinS. V., Shimansky EN., Mukhametjanov D.J., Usachev D. Y.
Burdenko Neurosurgical Institute, Moscow, Russia Surgical removal of a tumour of the clivus is very difficult. Approximately 30 years ago, these lesions were regarded as inaccessible for surgical removal. Today, surgeons use different surNcal approaches for the clivus area; frontotemporal, subtemporal, suboccipital extradural posterolateral and extradural anterior. All these different techniques have advantages and disadvantages, particularly in patients with extensive tumour involvement. The transoral surgical approach to the clivus and the upper cervical spine is the most direct route for removal of tumours in these areas. This approach was oriNnally used by surgeons for access to the posterior pharynx at the base of the tongue. Currently, it is believed that the transoral approach may be safely used in patients with intradural lesions. When the tumours require a dural opening, there is danger of serious complications such as cerebrospinal fluid leak and meningitis. A transoral approach was used in 5 patients with clivus tumours (3 chordomas, 1 fibrochondrosarcomas and 1 fibroma). The choice of approach was based on data provided by craniofacial examination, radiographic examinations, magnetic resonance imaging, computed tomographic scans and vertebral angiography, all of which suggested a tumour involving the oropharynx and nasopharynx, with destruction of the clivus bone structure. There was no postoperative mortality. These reports demonstrate the feasibility of the transoral approach.
The Versatility of the Vascularized Flaps, Based Upon the Superficial Temporal Vessels
Malakhovskaya E, Osipov G.
Central Research Institute of Stomatology, Moscow, Russia
The superficial temporal artery and its branches are the source of blood supply of the frontal, temporoparietal and auricular donor sites. It gives the possibility for the harvest of various flaps for the reconstruction a broad spectrum of complex defects of the face. The thin sheet of vascularized temporoparietal fascia may be transferred alone or as a carrier of subjacent bone or overlying skin and scalp. As a pedicled flap we used a variety of the temporoparietal and frontal flaps for the reconstruction of defects of the ear, orbital and malar regions and resurface of the cheek. As a free tissue transfer, we utilized fasciocutaneous flaps in the restoration of the beard of man, composite auricular free flap and epithelized temporoparietal fascia in the reconstruction of the nose. The versatility of the flaps present of the donor material in the same operative field, minimal morbidity and a hidden scar are the advantages of these donor sites. The clinical cases and the results of surgical treatment will be presented.
Ten-Year Experience of Temporomandibular Joint Recovery by Autometatarsophalangeal Joint
Malanchuk V.A.
Department of Maxillo-Facial Surgery, National Medical University, Kiev, Ukra&e Recovery of temporomandibular joint (TMJ) after loss of its function and development of ankylosis is a difficult task. Growth of cicatricial or osseous tissues after inflammation or traumatic injuries is evidence of osseous tissue reparative potential changes in the joint zone - of decreasing, or more often increasing, reparative potential. That its why use of some methods of TMJ recovery without due regard for biologic tissue properties of the joint do not show changes in tissues which can be pathophysiologically or pathogenetically proven. In 1986-1995, we used the following treatment principles on patients with TMJ ankylosis: (i) obligatory removal of damaged osseous tissues; (ii) recovery of the TMJ by healthy autojoint with low reparative properties, (iii) development of optimal biomechanical conditions for mandibular movement by stretching the muscles simultaneously with the stretching of the mandible, and (iv) minimal exfoliation of muscles from the mandible. Thirty patients aged 6-50 years were operated on. Thirty-three metatarsophalangeal joints were transplanted for arthroplasty of TMJ; 30 by the free method, 3 by microvascular method. Relapse occured in 10% of patients who had general diseases, thus showing the effectiveness of a systemic approach.
Distractive Removal of Mandibular End Defects
Malanchuk V.A., Beresovskaya N.A., Yatsenko D. V.
Department of Maxillo-Facial Surgery, National Medical University, Kiev, Ukraine Defects of the ramus mandibulae and articular process with 3-8 cm length usually need artificial prosthesis for temporomandibular joint or osseous transplantation. For postradial defects these methods are not used because of the absence of affected soft tissues. From 1988 we used distractive method in such cases. In healthy mandibular regions an osteotomy was made, and an osseous graft from the mandibular body according defects size was formed, then it was transplanted by distractive apparatus into the ramus