Postoperative position change of fibular bone after reconstruction of maxillary defect using free fibular flap / 北京大学学报(医学版)

OBJECTIVE@#To investigate the position change of the fibular bone after maxillary reconstruction by free fibular flap and to analyze the factors affecting the position change.@*METHODS@#Patients who underwent maxillary reconstruction by free fibular flap in the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from November 2012 to November 2016 were enrolled in this study. CT scans 1 week and 1 year postoperatively were collected and stored in DICOM format. The ProPlan CMF software was used to reconstruct the CT scans and separate the maxilla and each segment of the fibular flap. The Geomagic Control software was used to measure the long axis direction vector of each fibular segment. And the position change direction was recorded. The patients were divided into groups according to the use of the fibula or titanium plate to reconstruct the zygomaticmaxillary buttress.@*RESULTS@#A total of 32 patients were enrolled. Among them, 21 were in the titanium plate group and 11 in the fibula bone group. The angle between the long axis of the fibular segment and the X axis in the X-Y plane was 95.65°±53.49° and 95.53°±52.77°, 1 week and 1 year postoperatively, and there was no statistical difference (P>0.05). The angle between the long axis of the fibular segment and the X axis in the X-Z plane was 96.88°±69.76° and 95.33°±67.42°, respectively, with statistical difference (P=0.0497). The angular changes of the long axis of the fibular segment in the titanium plate group and the fibular bone group were 3.23°±3.93° and 1.94°±1.78°, respectively, and the angular changes in the X-Z plane were 6.02°±9.89° and 3.27°±2.31°, respectively. There was no significant difference between the groups (P>0.05). The long axis changes of the fibular segment in the X-Y plane for reconstruction of the anterior alveolar, posterior alveolar, and buttress were 3.13°±3.78°, 2.56°±3.17°, and 5.51°±4.39°, respectively. There was a statistical difference (P = 0.023) between the posterior and buttress. In the X-Z plane, theses were 4.94°±4.75°, 5.26°±10.25°, 6.69°±6.52°, respectively. There was no statistical difference among the three groups (P>0.05). The main positional deviation directions of the titanium plate group and the fibular bone group were interior and superior sides, and there was no statistical difference between the two groups (P>0.05).@*CONCLUSION@#One year postoperatively, the position of the free fibular flap was changed compared with 1 week postoperatively. The position of the free fibular flap was mainly changed to the interior and superior sides.

Prosthetic Rehabilitation Of Hemimaxillectomy Patient: A Case Report

Rehabilitation of hemimaxillectomy patients can be challenging. The most common problem with prosthetic treatment in such patients is in getting adequate retention, stability, and support. Maxillary obturator prosthesis is most commonly fabricated for patient's undergone surgical maxillectomy. It helps in mastication, deglutition and aids in speech. Various methods have been described in literature to make it hollow for reduction of weight of prosthesis. This case report describes another method of making a hollow prosthesis.

Prosthetic rehabilitation for a maxillectomy patient using 3D printing assisted closed hollow bulb obturator: a case report

This case report presents a closed hollow bulb obturator made by 3D printing for a maxillectomy patient. Final impression was taken according to the instructions and impression trays provided by the Magic denture™ system. Vertical dimension, facial appearance, and retention had been checked with the try-in denture. The try-in denture was corrected and adjusted to fulfill the demand of the patients, then these were reflected to the final design of the denture. The defect area was designed as a closed hollow bulb shape to reduce the weight and to provide uniform thickness of the denture. The patient satisfied with the esthetics and function of the denture.

Intraoral anastomosis for maxillary reconstruction with medial femoral condyle periosteal flap: a case report / 华西口腔医学杂志

Maxillary defects result in esthetic and functional defects in patients. Several techniques are available for ma-xillary reconstruction. Herein, we present a case of maxillary reconstruction with medial femoral condyle periosteal flap by intraoral anastomosis. The characteristics of medial femoral condyle periosteal flap and the advantages of intraoral anasto-mosis are introduced.

Perioperative nursing care to patients with maxillary defect repaired by 3D printing individualized titanium mesh / 现代临床护理

Objective To summarize the care points of nursing to patients with maxillary defect repaired by 3D printing individualized titanium mesh. Methods Nursing staff cooperated with doctors to control the disease of the whole body and prevent oral infection by performing psychological nursing, keeping the respiratory tract smooth after operation, preventing bleeding and infection of the wound, conducting oral, eye and pain care, preventing cerebrospinal fluid leakage, intracranial infection and venous blood thrombus of lower extremity and helping the patients with rehabilitation training. Results The hospitalization time of 5 patients was 11～20d with an average of (14.80 ± 3.31) d. 1 case had cerebrospinal fluid leakage during the operation and 1 had postoperative corneal edema. After treatment and nursing, all the patients were discharged from the hospital. Follow-up of 6 months showed no recurrence and good appearance in the maxillofacial region. Conclusion The nursing measures for the patients with to patients with maxillary defect repaired by 3D printing individualized titanium mesh include respiratory tract management, oral cavity, eye and pain nursing, prevention of bleeding and infection of wound, prevention of cerebrospinal fluid leakage, intracranial infection and venous thrombosis of lower extremities, which can promote the recovery of the patients soon.

Study on comparative questionnaire of quality of life of unilateral maxillary defect patients after reconstruction with free anterolateral thigh perforator flap and free fibula flap / 中华整形外科杂志

Objective@#The difference in quality of life between patients with unilateral maxillary defect repaired by free fibular flap and anterior lateral femoral perforator flap was compared with questionnaire analysis.@*Methods@#In March 2014 to June 2015, 40 cases of tumor resection caused unilateral maxillary defects were included in this study, which were treated with free fibula flap or femoral anterolateral perforator flap in Peking University Stomatological Hospital. Two groups of patients were followed up one year after surgery, and the University of Washington Quality of Life Scale score was obtained.@*Results@#The score of fibular flap group was 89.37± 15.34 and score of anterior lateral femoral perforator flap group was 88.04±15.78(t=0.17, P=0.36).@*Conclusions@#There was no significant difference between free fibular flap and anterior lateral femoral perforator flap in improving postoperative quality of life.

Investigation of personalized titanium mesh combined with free flap for reconstruction of maxillary defect / 口腔疾病防治

Objective @#To explore the clinical effect of personalized titanium mesh combined with free flap in the repair of maxillary defect.@*Methods@#36 cases of maxillary defect patients as the research object were selected in our hospital during May of 2010 to May of 2016. 36 defect cases were repaired with personalized titanium mesh combined with free flap, and summarize the treatment programs to explore the value of clinical application.@*Results @#By the end of follow-up, all of the flap survived, tumor recurrence rate was 5.56% with paitient satisfaction was 100%; Diplopia and dysphagia occurred in no cases; Masticatory function declined accompanied with a longer chewing time but language communication was not affected.@*Conclusion@# The application of personalized titanium mesh and free flap repair methods in maxillary defect is significant, which effectively improve the quality of life of patients whereas still have difficulties in late denture at the same time.

Clinical effect of prosthesis on type Ⅴ maxillary defects / 口腔疾病防治

Objective @#To investigate the clinical efficacy of prosthesis retained by metal clasp and flexible clasp in the repair of type Ⅴ maxillary defects after tumor resection. @*Methods@#23 maxillary tumor surgical patients were selected in this study and restored with maxillofacial prosthesis. Total 24 prosthesis combined with metal clasp and flexible dentures were followed up for half a year to 2 years. @*Results @#After the application of prosthesis, better maxillofacial appearances are presented in all of the patients, Watian drinking water tests are improved to grade Ⅰ or Ⅱ from grade Ⅳ or Ⅴ in 21 patients, there was significant difference (P < 0.05); Soft diet can be masticated on affected side in 15 patients; The mean speech intelligibility score with and without prosthesis were (83.2 ± 7.3)% and (36.6 ± 5.6)%, there was significant difference (P < 0.05); Favorable hygienic situations of oral cavity and prosthesis are maintained in 18 patients.@*Conclusion @#Prosthesis combined with metal clasp and flexible denture performed favorable clinical efficacy and contributed to improve the living quality and mental health after tumor resection.

Use of artificial palate for improving facial support in the fabrication of a maxillary obturator: A case report / 대한치과보철학회지

Patients with maxillectomy defects predisposed to not only difficulty in deglutition, mastication, speech but also psychological depression from impaired facial esthetics that affect life quality. Obturator prostheses play a important role in restoring the lost form, function and the quality of life for patients with maxillectomy defects. This clinical report presents the simplified approach to predict the degree of adequate facial support by Artificial palate which reflected from a maxillary interim obturator during the stabilization period after maxillectomy.

Prosthetic rehabilitation of a fully edentulous patient after maxillectomy: A case report / 대한치과보철학회지

Most patients with acquired maxillary surgical defects have difficulties such as functional impairments of mastication, speech, and deglutition as well as various degrees of facial deformity. The purpose of a prosthetic approach is to restore function and appearance with an obturator as normal as possible. This goal can be achieved when there is thoughful preoperative communication between a prosthodontist and a surgeon regarding a rehabilitation. In this case report, prosthetic rehabilitation was planned before the surgery for the patient diagnosed with squamous cell carcinoma in the right maxillary sinus with careful oral examination. Four months after maxillectomy, a definitive obturator was fabricated following the surgical and interim obturation phase. The objective of this case report is to describe the satisfactory results of the patient with improved rehabilitation of mastication, speech, deglutition, and appearance.

Maxillofacial rehabilitation of hemi-maxillectomy patient using a closed hollow bulb obturator fabricated by one-step polymerization technique: a clinical report / 대한치과보철학회지

The maxillary defects lead to anatomical and functional deformity of the maxillofacial region. As far as functions are concerned, such defects can produce difficulty in speech, mastication, and deglutition. Obturator prostheses play a very important role in functional recovery for post-maxillectomy patients. To achieve rigidity of the obturator, appropriate retention should be given, and the weight of the prosthesis be reduced. There are two types of hollow bulb obturator: open and closed. A closed type has many advantages. Nevertheless, some problems, including complexity of fabrication and water leakage into the bulb, have the closed hollow obturator not be widely used. The one-step polymerization technique described in this case overcomes the shortcomings by easily constructing a small hollow bulb with two thermoplastic resin sheets.

Prosthetic rehabilitation of partially edentulous patient after maxillectomy: A case report / 대한치과보철학회지

Patients undergone partial maxillectomy experience post-operative masticatory, phonetic, and swallowing difficulties. They also encounter social and psychological challenges due to changes in their facial appearances. Thus, functional and esthetic recovery through maxillofacial prosthesis becomes significant for these patients. The objective of an appropriate obturator is to restore palate and improve phonetic and swallowing ability by separating the oral cavity, nasal cavity, maxillary sinus, and nasopharynx. In this case report, an obturator was fabricated for a patient who had partial resection from the maxillary posterior region to the pharynx due to squamous cell carcinoma. The purpose of this case study is to describe the results because the patient was successfully improved both functionally and esthetically.

Reconstruction of Maxilla and Midface with Microvascular Free Flaps / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study is to report the clinical results of maxillary reconstruction with free flap. SUBJECTS AND METHOD: Patients who had undergone free flap reconstruction after maxillectomy from January 2009 to January 2013 were included in the study. The medical records of the maxillary defect classification, the type of flap used for reconstruction, follow-up results including the survival rate of flap and postoperative complications were analyzed retrospectively. RESULTS: A total of 13 cases underwent maxillary reconstruction after maxillectomy. Maxillary resection were classified from Ia to V according to the Brown classlification system, and various composite flaps including rectus abdominis, latissimus dorsi, radial forearm and iliac crest were used. One case (class Ia) was reconstructed with a radial forearm free flap while six cases (classes II, III) were reconstructed with the osteomuscular free flap type, such as iliac crest. Another six cases needed orbital exenteration (class IV, V) and were reconstructed with a soft tissue free flap type, such as a rectus abdominis or latissimus dorsi. Of the 13 cases, four patients had postoperative wound dehiscence and two had preoperative radiotherapy. In all 13 cases, the flaps survived. CONCLUSION: Maxillary reconstructions were performed successfully with various free flaps according to the extent of maxillary defect.

Biomechanical evaluation on prosthetic retention program for hemi-maxillary defects / 医用生物力学

Objective To make biomechanical evaluation on three prosthesis retention schemes for unilateral maxillary defects-clasp retention, one or two zygomatic implants and zygomatic implant and clasp united retention. Methods A three-dimensional (3D) finite element model of normal human skull was constructed based on CT scan data. The maxillary complex stress distributions on three reconstructed models were calculated and analyzed by 3D finite element method to make comprehensive comparison on stress level of the prosthesis, abutment, clasp, implants and zygoma. Results For single clasp retention, peak stress of the abutment was 130.7 MPa, and displacement of the prosthesis was 4.439 mm, while peak stress of the clap was 452.4 MPa, and stress of the contralateral orbital rim was 23.32 MPa. After one zygoma was implanted, the stress of the clap was reduced to 118.1 MPa, while peak stress of the abutment was 31.12 MPa, and stress of the contralateral orbital rim was only 5.387 MPa. For two zygomatic implant retention, zygomatic stress was decreased from 66.11 MPa to 48.12 MPa, and the maximum stress on the zygomatic implants was reduced from 500.2 MPa to 313.8 MPa. Conclusions For zygomatic implant and clasp united retention, the maxillofacial skeleton stress distributions were more consistent with the rules of bite force transduction. The research findings will provide important references for design and optimization of human unilateral maxillary defect reconstruction program.

Prelaminated free flap for the reconstruction of maxillary defects

BACKGROUND In contrast to defects of the mandible and mouth floor region, in the defect of maxilla, the availability of firmly attached oral and nasal mucosal linings is needed. In addition to it, in consider of operation field, operating convenience, and esthetics, reconstruction using prelaminated flap is strongly recommended. Therefore we consider the prelaminated flap through the cases that is reconstructed using prelaminated forearm flap and prelaminated scapular flap. PATIENTS AND METHODS From 2001 to 2008, in OMFS SNUDH, there were 6 cases that had reconstruction using prelaminated forearm free flap and other 3 cases that had reconstruction using prelaminated scapular flap of maxilla. The average age of patients that were reconstructed using prelaminated forearm free flap was 47.5 years, the average prelaminated period (after 1st operation ~ until 2nd operation) was 51.8 days and the average follow-up period after 2nd operation was 35.3 months. As well, the average age of patients that were reconstructed using prelaminated scapular free flap was 37 years, the average prelaminated period (after 1st operation ~ until 2nd operation) was 57 days and the average follow-up period after 2nd operation was 42.3 months. RESULTS Except 1 case that were reconstructed using prelaminated scapular flap, we could get firmly attached oral and nasal stable skin(mucosal like) lining, more adequate thickness flap than any other flap and improved esthetic and functional results in the other 8 cases that were reconstructed using prelaminated flap. The complications of the prelaminated forearm flap cases were inconvenient swallowing, sputum, limitation of mouth opening and difficult mastication. It came from flap shrinkage of the flap in some aspect, as well as other combined operations such as mass resection or RND. The difficult point of the reconstruction of prelaminated scapular flap was the possibility of vascular damage at preparation of flap in 2nd surgery. The damage could cause the failure of the prelaminated scapular flap. And the skin-lining of the prelaminated flap had limitations, so it is needed to study about the cultured oral epithelium-lining flap instead of the skin-lining flap. CONCLUSION We considered about advantages, complications and notable things of prelaminated flap through maxillary reconstruction cases using prelaminated forearm flap and prelaminated scapular flap so far. Furthermore, we should go on studying for functional reconstruction of prelaminated fasciomucosal flap using cultured oral epithelium.

Prelaminated free flap for the reconstruction of maxillary defects

BACKGROUND In contrast to defects of the mandible and mouth floor region, in the defect of maxilla, the availability of firmly attached oral and nasal mucosal linings is needed. In addition to it, in consider of operation field, operating convenience, and esthetics, reconstruction using prelaminated flap is strongly recommended. Therefore we consider the prelaminated flap through the cases that is reconstructed using prelaminated forearm flap and prelaminated scapular flap. PATIENTS AND METHODS From 2001 to 2008, in OMFS SNUDH, there were 6 cases that had reconstruction using prelaminated forearm free flap and other 3 cases that had reconstruction using prelaminated scapular flap of maxilla. The average age of patients that were reconstructed using prelaminated forearm free flap was 47.5 years, the average prelaminated period (after 1st operation ~ until 2nd operation) was 51.8 days and the average follow-up period after 2nd operation was 35.3 months. As well, the average age of patients that were reconstructed using prelaminated scapular free flap was 37 years, the average prelaminated period (after 1st operation ~ until 2nd operation) was 57 days and the average follow-up period after 2nd operation was 42.3 months. RESULTS Except 1 case that were reconstructed using prelaminated scapular flap, we could get firmly attached oral and nasal stable skin(mucosal like) lining, more adequate thickness flap than any other flap and improved esthetic and functional results in the other 8 cases that were reconstructed using prelaminated flap. The complications of the prelaminated forearm flap cases were inconvenient swallowing, sputum, limitation of mouth opening and difficult mastication. It came from flap shrinkage of the flap in some aspect, as well as other combined operations such as mass resection or RND. The difficult point of the reconstruction of prelaminated scapular flap was the possibility of vascular damage at preparation of flap in 2nd surgery. The damage could cause the failure of the prelaminated scapular flap. And the skin-lining of the prelaminated flap had limitations, so it is needed to study about the cultured oral epithelium-lining flap instead of the skin-lining flap. CONCLUSION We considered about advantages, complications and notable things of prelaminated flap through maxillary reconstruction cases using prelaminated forearm flap and prelaminated scapular flap so far. Furthermore, we should go on studying for functional reconstruction of prelaminated fasciomucosal flap using cultured oral epithelium.

Speech outcomes of the obturator prostheses for maxillary defects / 实用口腔医学杂志

Objective:To evaluate speech outcomes following prosthetic obturation of maxillary defects.Methods:The speech intelligibility(SI)of 21 patients with maxillary defects with and without prostheses was measured postoperatively.In addition,the acoustic characteristics of vowels of 21 individuals were analyzed with and without an obturator in place by sound spectrograph.Results:Following the placement of maxillary obturator prostheses,there was significant improvement in SI.The mean SI score of the patients without and with the prosthesis was(23.2?7.4)% and(81.8?9.4)% respectively(P

The Reconstruction of the maxillary wall defect using micro-titanium mesh

Maxillary defect may be induced by trauma, inflammation, cyst, tumor and surgical procedure. In case of limited wall defect, free bone graft has been preferred. But it has some problems such as postoperative bone resorption and soft tissue inclusion to recipient site. And we can not use free bone in the case who has inflammation in the donor site. So we used the micro-titanium mesh as reconstructive material for the maxillary wall defect. We had operated 8 patients who were diagnosed as maxillary partial defects from June 1997 to September 1998 in the Chin-Hae military hospital. They were 1 case of antral wall defect, 1 case of palatal wall defect, 5 cases of infra-orbital wall defects and 1 case of oro-antral fistula case. As a result, the micro-titanium mesh has shown the morphological stability and biocompatibility and it could be used in case who has infection. And mesh structure could prevent soft tissue ingrowth to bony defect area. Thus it can be used to the case of maxillary partial defect successfully.

Closed and three-dimensional reconstruction of maxillary defects with titanium mesh and free forearm flap / 实用口腔医学杂志

Objective: To study the feasibility of closed and three-dimensional reconstruction of maxillary defects with titanium mesh and free forearm flap. Methods: Maxillary defects, 3 of type Ⅱ and 7 of type Ⅲ, due to tumor or trauma were closely reconstructed with titanium mesh to restore the profile of maxilla and with radial flap to close the oral and the nasal wound surfaces following total maxillectomy (in 3 cases) and subtotal maxillectomy(in 7 cases). Results: 10 cases were followed up for 3～18 months. All the flaps were alive. The maxilla nasal and oral cavity were restored in all the cases and denture was applied in 3 cases. No neoplasm were fond by CT. Mouth opening was 2.5～4.0cm. Epithelium on the surface of the titanium mesh was found by nasopharyngoscope in 2 cases. Conclusion: The closed and three-dimensional reconstruction of maxillary defect with titanium mesh and free forearm flap can restore the shape and the function of maxilla.