ABSTRACT
@#Mandibular defects in adolescents are mostly caused by surgical resection of benign and malignant tumors, trauma and jaw inflammation. The reconstruction of mandibular defects in adolescents is challenging. In addition to solving the problem of jaw reconstruction in adults, some clinical factors, including the influence of surgery on the growth of donor and recipient areas, the long-term effects of reconstruction, and the outcome of bone grafts, must also be considered. At present, the main reconstructive methods include autogenous bone grafts and distraction osteogenesis. Autogenous bone grafts are still the gold standard due to their long-term effects. Favorable growth potential after repair was shown in adolescent cases of mandibular reconstruction with fibula flap. Normal occlusion was restored, and a long-term stable effect was achieved in cases of condylar reconstruction with costal cartilage. The safety and clinical effects of distraction osteogenesis have been confirmed, but the long-term effects of large-scale mandibular defects are still uncertain. In addition, other tissue engineering techniques also have good application prospects for the repair and reconstruction of adolescent mandible defects, but more in-depth basic research and more extensive clinical trials should be performed to verify the efficacy.
ABSTRACT
@#Marsupialization is effective in the treatment of cystic lesions of the jaw. It is a simple operation that can result in minimal trauma, the reduction of postoperative recurrence, and maximum preservation of the surrounding tissue structure and function. However, there is a certain failure rate in clinical treatment due to the improper grasp of indications and nonstandard operation. The highest failure rate reported in the literature is 32.6%. To further standardize the clinical application of marsupialization and improve the success rate of treatment, we put forward an expert consensus of marsupialization in the treatment of jaw cystic lesions by reviewing the domestic and foreign literature and summarizing the experience in marsupialization from some famous domestic experts. In this consensus, we propose three elements of marsupialization: the establishment of the opening, the maintenance of cyst plugs and regular washing. The scope of application of marsupialization includes jaw cysts and cystic ameloblastomas. It is necessary to standardize the position of the opening, the size of the opening and the manufacture of the cyst plug, and a panoramic film or cone beam computed tomography(CBCT) should be used to observe the changes in the cystic cavity before and after operation. A second-stage operation should be performed when the lesion is significantly reduced by more than 50% or at least 5 mm from important structures; furthermore, the teeth of focus should be treated according to the relationship between the lesion and tooth and the type of tooth.
ABSTRACT
@#Osteoradionecrosis of the jaw (ORNJ) is a common complication after radiotherapy for head and neck malignant tumors. Surgery is the main treatment method for ORNJ with large lesions. In the case of serious maxillofacial and cervical soft and hard tissue damage caused by radiation, surgical treatment may have some difficulties and risks. In this paper, we discuss the main points for indication selection and treatment as well as surgical difficulties and their causes, including local inflammation and radiation injury during the operation, timing of bone defect reconstruction, condylar preservation, selection of recipient vessels, implant bed treatment, common complications of ORNJ operations (i.e., wound healing and nerve injury), severe complications (i.e., vascular crisis and tissue flap necrosis), pulmonary infection, cerebral pulmonary embolism, important vascular rupture, and severe psychological trauma, including its prevention and treatment. This information will enable clinicians to fully understand the various difficulties and risks that may be encountered during the ORNJ operation and will minimize serious complications, ensure the life, health and safety of the patients, and provide a reference for improvement of the clinical efficacy of ORNJ treatment.