ABSTRACT
Background@#Fibula free flap mandible reconstruction is the standard procedure after wide resection of the mandible. Establishment and maintenance of normal occlusion are important in mandible reconstruction both intraoperatively and after surgery. However, scar formation on the surgical site can cause severe fibrosis and atrophy of soft tissue in the head and neck region.Case presentationHere, we report a case of severe soft tissue atrophy that appeared along with scar formation after mandibular reconstruction through the fibular free flap procedure. This led to normal occlusion collapse after it was established, and the midline of the mandible became severely deviated to the affected side that was replaced with the fibula free flap, leading to facial asymmetry. We corrected the malocclusion with a secondary operation: a sagittal split ramus osteotomy on the unaffected side and a sliding osteotomy on the previous fibula graft. After a healing time of 3 months, implants were placed on the fibula graft for additional occlusal stability. @*Conclusion@#We report satisfactory results from the correction of malocclusion after fibula reconstruction using sliding fibula osteotomy and sagittal split ramus osteotomy. The midline of the mandible returned to its original position and the degree of facial asymmetry was reduced. The implants reduced difficulties that the patient experienced with masticatory function.
ABSTRACT
Background@#Fibula free flap mandible reconstruction is the standard procedure after wide resection of the mandible. Establishment and maintenance of normal occlusion are important in mandible reconstruction both intraoperatively and after surgery. However, scar formation on the surgical site can cause severe fibrosis and atrophy of soft tissue in the head and neck region.Case presentationHere, we report a case of severe soft tissue atrophy that appeared along with scar formation after mandibular reconstruction through the fibular free flap procedure. This led to normal occlusion collapse after it was established, and the midline of the mandible became severely deviated to the affected side that was replaced with the fibula free flap, leading to facial asymmetry. We corrected the malocclusion with a secondary operation: a sagittal split ramus osteotomy on the unaffected side and a sliding osteotomy on the previous fibula graft. After a healing time of 3 months, implants were placed on the fibula graft for additional occlusal stability. @*Conclusion@#We report satisfactory results from the correction of malocclusion after fibula reconstruction using sliding fibula osteotomy and sagittal split ramus osteotomy. The midline of the mandible returned to its original position and the degree of facial asymmetry was reduced. The implants reduced difficulties that the patient experienced with masticatory function.
ABSTRACT
PURPOSE: To investigate the prevalence and risk factors in stenosis of the extracranial carotid artery in a healthy Korean population. METHODS: Seventeen thousand two hundred and eighty one patients, without previous history of transient ischemic attacks, amaurosis of fugax and/or any neurologic deficit, who underwent carotid artery ultrasonography, were evaluated retrospectively. The patients were divided into six groups according to the degree of carotid artery stenosis, using real time B-mode high resolution ultrasonography; Group A-normal, Group B-from 1 to 15% carotid artery stenosis, Group C-from 16 to 49% carotid artery stenosis, Group D-from 50 to 79% carotid artery stenosis, Group E-from 80 to 90% carotid artery stenosis and Group F-carotid artery occlusion (100%). Medical the records of all patients were investigated for the following factors; age, gender, diabetes mellitus, hypertension, smoking, over weight, total cholesterol, HDL- cholesterol, LDL-cholesterol, TG (triglyceride), and HbA-1c (hemoglobinA-1c). RESULTS: There were 950 (5.5%) cases in Group A, 82 (0.5%) in Group B, 710 (4.1%) in Group C, 138 (0.8%) in Group D, 2 (0.01%) in Group E, 18 (0.1%) in Group F. The age, total cholesterol, LDL-cholesterol, and HbA-1c were higher in Groups B, C, D, E and F than in Group A, with statistical significance. Other factors, however, were no different among the groups. CONCLUSION: Asymptomatic carotid stenosis is not uncom mon in Korea. To prevent a stroke caused by carotid stenosis, carotid ultrasonography would be necessary in patients at high risk of atherosclerosis, such as hypertension, diabetes and a high serum cholesterol level.