Efectividad del uso de la bolsa adiposa de bichat para la reconstrucción de defectos en el paladar: reporte de un caso / Effectiveness of the use of the bichats fat pad for the reconstructionof defects in the palate. report a case

La bolsa adiposa de Bichat está constituida por un cuerpo y tres extensiones de tejido adiposo, se localiza dentro del espacio bucal y seextiende siguiendo el borde anterosuperior del músculo masetero. En la actualidad su uso como colgajo pediculado ha demostrado excelentesresultados en el tratamiento de reconstrucción de defectos postumorales de tejido blando en el paladar. Lo anterior se debe a su gran aporte vascular, composición histológica y a la presencia de células madre en tejido adiposo que fomentan una metaplasia del tejido, convirtiéndose en tejido fibroso y superfi cialmente con epitelio en tan sólo cinco semanas. La técnica de abordaje y reposicionamiento del colgajo pediculado en paladar fue modifi cada con la extirpación de la tuberosidad del maxilar para corregir el defecto ocasionado por un adenoma pleomorfo en el paladar. Se destacan las características y cualidades de la bolsa adiposa de Bichat para su uso en reconstrucción de defectos tumorales.

Bichat’s buccal fat pad is constituted by a body and three extensions ofadipose tissue within the buccal space and extending to the anteriorsuperiorborder of the masseter muscle. To this days, the use of thebuccal fat pad as a pedicled graft has shown excellent results onoral post tumoral reconstruction treatment. This is due to its greatvascularity, histological composition and perhaps to the presenceof stem cells that promotes a metaplasia, turning adipose tissue intofi brous and superfi cially epithelized tissue within fi ve week aftersurgery. Surgical approach and repositioning technique of the pedicledgraft was modifi ed, extirpating part of the maxillary tuberosity, topreserve vascularity and cover up a hard-soft tissue defect caused by apleomorphic adenoma on a patient’s palate. Buccal fat pad’s qualitiesand characteristics are taken into consideration to demonstrate theeff ectiveness on its surgical reconstructive uses.

A Case Report on the Use of the Rapid-onset Opioid Fentanyl Resulting in Numbness and Pain in the Mouth and Taste Disturbance

<p>Introduction: The rapid-onset opioid fentanyl is used to treat breakthrough pain in the management of cancer pain. Case Report: A 33-year-old woman started to receive palliative radiation for multiple spinal metastases and pathological fracture of the sacrum following surgery for right breast cancer. Although oxycodone sustained-release tablets and oxycodone powder had been used for the treatment of pain, there had been no alleviation in response to oxycodone powder at times that she experienced breakthrough pain. Therefore, the patient was switched to rapidly acting fentanyl citrate sublingual tablets. An analgesic effect was obtained, but numbness of the lower lip and taste disturbance emerged. Furthermore, pain in the lower jaw emerged and eating became difficult. Therefore, the patient was switched to fentanyl citrate buccal tablets. However, once the agents were dissolved and spread inside the mouth, the same symptoms emerged. Conclusion: Because the same symptoms were observed even after switching agents, fentanyl citrate or the common ingredient contained in both agents appeared to be the cause of this event.</p>

Availability of radial forearm free flap in reconstruction of intraoral soft tissue defects: review of 50 cases

Usage of nasolabial skin flaps for the reconstruction of various intraoral defects

Appropriate Selection of Free Flap Donor Sites for Functional Reconstruction of Intraoral Defect

As the oral cavity plays a vital role in swallowing, speech articulation and intelligibility, a variety of surgical techniques have been devised to reconstruct the intraoral defect which remains after ablative surgery. The ideal method of intraoral reconstruction has not yet been established, but microvascular free flaps have rapidly become the "gold standard" compared to other techniques, and nowadays interest is focused on the improvement of detailed function following reconstruction. The purposes of this study are to understand the main goal of reconstruction and to suggest the appropriate donor sites of free flap depending on the location and size of defects. From July 1988 to December 1999, 42 patients underwent intraoral reconstruction with various kinds of free flaps in accordance with the location nd size of defects. We divided the location of intraoral defects into tongue, mouth floor, buccal mucosa, and palate, retromolar trigone, pharyngeal wall according to the anatomical structures. We tried to select the most appropriate donor tissue for the requisites of defect area. After partial glossectomy, we used free jejunal patch flap as a first choice. Free lateral arm flap has been used to reconstruct the defect of hemi-glossectomy, and free rectus abdominis flap for the defect of total glossectomy. For the reconstructions of mouth floor and buccal mucosa, transversely designed and two skin paddles free radial forearm flaps have been used as a first choice. For the defects of palate, retromolar trigone or pharyngeal wall, free jejunal patch flap has been a first choice. The postoperative courses of these cases are uneventful. There was no orocutaneous fistula during follow up periods. The patients could recover their intelligible speech, deglutition and mastication. We conclude that appropriate selection of free flap donor site for intraoral reconstruction depending on the location and size of defects can improve detailed function and aesthetics, and enhance the rehabilitation and remaining quality of life.

Experimental study of the cytokeratin expression pattern of regenerated epithelia of dermal tissue flaps transferred for intraoral mucosal defect reconstruction / 第三军医大学学报

Objective To observe the changes in cytokeratin expression pattern of the regenerated epithelia of dermal tissue flaps transferred for intraoral mucosal reconstruction. Methods Mucosal defects were made on the right buccal mucosa of 12 healthy adult dogs, and then were reconstructed immediately by pedicled platysma myodermal flaps (PMDF). Changes in the expression patterns of CK10 and CK19 of the epithelia on the flaps were observed by immunohistochemical staining. Results Low level of CK19 expression was found in the basal layer and the layers superior to the basal layer of the regenerated epithelia at 4 week after transferring the dermal tissue flaps. The expression pattern of keratin in PMDF was identical to that of the normal skin 12 weeks later. Conclusion The regenerated epithelia remain the original structure without mucosal changes.