Application of facial-submental artery island flap in reconstruction of oral and maxillofacial defects / 口腔疾病防治

@#The facial submental artery island flap (FSAIF) is a fasciocutaneous flap supplied by the facial submental artery. It is in close proximity with many oral and maxillofacial regions, and its tex ture and color are similar to those of the head and face. The flap has a constant and sufficient blood supply, and it is easy to prepare and has high survival rates and few complications. According to the tissue carried, FSAIF can be divided into fasciocutaneous flaps, myocutaneous flaps and simple flaps. The flap can also be made into an osteofasciocutaneous (myocutaneous) flap with a mandible to repair maxillary defects. Because this flap is a pedicled flap, it can greatly shorten the operation time, bed rest time and hospitalization time and has been widely used in repairing medium-sized defects of the oral and maxillofacial region. The indications for FSAIF in repairing maxillofacial defects should be strictly controlled. It can be safely used for benign or malignant tumors without cervical lymph node metastasis. For malignant tumors with cervical lymph node metastasis but without extranodal extension, the flap can be used on the premise of thorough neck dissection. The contraindication is cervical lymph node metastasis and extranodal extension of malignant tumors; therefore, other flaps should be selected for repair.

Case management of a patient with gingival cancer who took the obturator prosthesis combined with orofacial myofunctional therapy to promote the rehabilitation of oral and maxillofacial function / 中国实用护理杂志

Objective:To summarize the case management of promoting the rehabilitation of oral and maxillofacial function of a patient with gingival cancer.Methods:The patient took the obturator prosthesis and orofacial myofunctional therapy to promote the rehabilitation of oral and maxillofacial function. The key points of nursing included: nursing of obturator prosthesis, orofacial myofunctional therapy, psychological nursing and evaluation of oral and maxillofacial function rehabilitation.Results:after one year of case management, the total score of the Chinese version of the obturator functioning scale was 18 points, the mouth opening was 4cm, and the speech distinctness was 98%. The quality of life of the patient was good.Conclusions:When the obturator prosthesis and orofacial myofunctional therapy are taken, all-round cooperation of the medical staff of different specialties from the perioperative period to the discharge follow-up should be strengthened in order to promote the rehabilitation of oral and maxillofacial function.

Application of soleus perforator flapfrom the lateral leg in repair of oral and maxil-lofacial defects / 医学研究生学报

ObjectiveReconstruction of oral and maxillofacial defects following resection of oral and maxillofacial malignant tumors is required to restore the patient's appearance and oral function. The aim of this study was to evaluate the application and value ofsoleus perforator flap from the lateral leg in repair of oral and maxillofacial defects.MethodsIn this retrospective study, ten patients with oral and maxil-lofacial malignancies who were admitted to the Department of Oral and Maxillofacial Surgery in Fuyang People's Hospital during the period from May 2015 to March 2019 were enrolled. The effect of soleus perforator flap from the lateral leg was ana-lyzed.At 1 month and 3 months after surgery, the recovery of oral function and donor sites, quality of life and surgical satisfaction were followed.ResultsAllpatients underwent operation successfully without skin flap necrosis or serious complications.At 3 months after surgery,voice function and swallowing func-tion were level 3. The scar hyperplasia was 1 case,donor itching1 case and paresthesia or dysfunction 0 case.Compared with those at 1 month after surgery, the scores at 3 months after surgery were increased using the University of Washington Quality of Life (UW-QOL) questionnaire(P<0.05). At 1 month and 3 months after sur-gery,patient satisfaction rateswere 80.00% and 90.00%, respectively.ConclusionThe soleus perforator flap from the lateral leg isideal for repairing oral and maxillofacial defects. The postoperative recovery of oral functio-nand donor sites is goodwith high quality of life and surgical satisfaction.

Recent advances in the reconstruction of cranio-maxillofacial defects using computer-aided design/computer-aided manufacturing / 대한악안면성형재건외과학회지

With the development of computer-aided design/computer-aided manufacturing (CAD/CAM) technology, it has been possible to reconstruct the cranio-maxillofacial defect with more accurate preoperative planning, precise patient-specific implants (PSIs), and shorter operation times. The manufacturing processes include subtractive manufacturing and additive manufacturing and should be selected in consideration of the material type, available technology, post-processing, accuracy, lead time, properties, and surface quality. Materials such as titanium, polyethylene, polyetheretherketone (PEEK), hydroxyapatite (HA), poly-DL-lactic acid (PDLLA), polylactide-co-glycolide acid (PLGA), and calcium phosphate are used. Design methods for the reconstruction of cranio-maxillofacial defects include the use of a pre-operative model printed with pre-operative data, printing a cutting guide or template after virtual surgery, a model after virtual surgery printed with reconstructed data using a mirror image, and manufacturing PSIs by directly obtaining PSI data after reconstruction using a mirror image. By selecting the appropriate design method, manufacturing process, and implant material according to the case, it is possible to obtain a more accurate surgical procedure, reduced operation time, the prevention of various complications that can occur using the traditional method, and predictive results compared to the traditional method.

Submental island flap for repairing oral defect after radical resection of oral cancer / 天津医药

Objective To summarize the surgery skills and evaluate the clinical outcome of submental island flap for repairing oral defect after radical resection of oral cancer. Methods A total of 25 consecutive patients underwent submental island flap reconstruction after ablative surgery for oral cancer from January 2015 to May 2017 were enrolled in this study. The patterns of venous return, the technique notes and postoperative complications were summarized. The oncological safety of submental island flap in oral reconstruction was analyzed. Results The submental island flaps were harvested with the sizes ranging from(5 cm×3 cm)to(12 cm×5 cm).The mean operation time was(350.5±50.5)min.The vein of the flap was found to drain into the facial vein,and then returned to the internal jugular vein in 17 patients(68.0%), into the external jugular vein in 4 patients(16%),and into the anterior jugular vein in 4 patients(16%).Twenty-four flaps survived completely,and 1 flap failed due to the damage of the submental artery.Wound infection occurred in only 1 patient, and primary wound healing was observed in the other 24 patients. Eight patients (32.0%) with cervical lymph node metastases were verified by the postoperative pathological examination, 4 patients were submandibular lymph node metastases.The prevalence of occult lymph node metastasis involving level Ⅰwas 16.0%.The mean follow-up period was (14.3 ± 5.2) months. Local recurrence was found in 1 patient and cervical recurrence in 2 patients without postoperative radiotherapy during the follow-up. Conclusion There are three various drainage patterns for the venous return of submental island flap.Our data suggest that vein drainage of the flap into the external jugular vein and the anterior jugular vein,which are previously overlooked,should receive greater attention during the harvest of submental flap to avoid venous congestion and flap loss.Close follow-up or postoperative radiotherapy are recommended for patients without cervical lymph node metastases.

Reconstruction of maxillofacial defect using free anterolateral thigh flaps after resection / 中华显微外科杂志

Objective To explore the value of free anterolateral thigh flaps in the reconstruction of maxillofacial defects after resection.Methods Patients were recruited from January,2008 to March,2016 in the Department of Oral and Maxillofacial Surgery of Nanjing University.All patients sunder when reconstructive surgery employing anterolateral thigh myocutaneous flaps follow-up of 3 months to 84 months after operation.Results Among 422 cases,survived completely with satisfied configuration,the survival rate was 98.6％.Postoerative vessel thrombosis occurred in flaps,21 patients required operative exploration in the perioperative period including 10 flaps with thrombotic events and 11 flaps with venous thrombosis were complete survival after the salvages,and 6 flaps were failure.The mean follow-up was 36.5 months (range:3 to 84 months).Conclusion The free anterolateral thigh flap is an ideal choice for reconstruction of maxillofacial defects,as it has many advantages such as abundance volume,easily molding and adjusting the thickness,possessing,long vascular pedicle,composition need to be adjusted according to defects,easily concealed donor site,and little donor site complications and malformation.

Clinical observation of individualized forearm flap in reconstruction of oral and maxillofacial defects / 中华显微外科杂志

Objective To investigate the forearm flap personalized design method and the curative effect in repairing maxillofacial defects.Methods From March,2011 to September,2015,16 cases with oral maxillofacial tumor and facial tissue defect were treated.There were 8 males and 8 females with an age range of 41-70 years (mean,54 years).According to the shape and size of the defect after tumor resection in each patient,the forearm flap was designed to repair the defect.The effectiveness was evaluated after operation by observing the survival of the forearm flap transplantation,the patient's facial appearance,the functions of speech,swallowing.Results The incision healed by first intention in this group,16 cases of forearm flap survived.All cases were followed-up 8-36 months without tumor recurrence.The functions of speech,swallowing were basically normal.The facial appearance was satisfactory.The patients were satisfied with their appearance and functional recovery after operation.Conclusion Take personal way of forearm flap design according to maxillofacial soft tissue defect,can restore the maximum facial appearance and function of patients,improve the quality of life of patients after surgery to repair,can obtain satisfactory results.

Removable prosthetic rehabilitation in patient with maxillofacial defects caused by gunshot: A case report / 대한치과보철학회지

Maxillofacial defect comes from congenital defect, trauma and surgical resection. Patients with intraoral defect are commonly related to maxillary defect and they need prosthetic rehabilitation. Functional reconstruction of partially edentulous mandible has many limitations. However, if both condyles are intact, maxillofacial prosthesis using partial denture give competent results. In this case, a patient of 58 year-old male has a defect on palate and left mandibular posterior teeth from gunshot. The maxillary defect of this patient is Class IV according to Aramany classification and the mandibular one is Type V according to Cantor and Curtis classification. For retention of the obturator, remaining teeth are fully utilized and artificial teeth are arranged harmoniously to provide stable occlusion. Mandibular RPD covered limited range of deformed soft tissue derived from mandibular resection surgery. With these treatments, the patient in this case showed improvements in mastication, swallowing and speech.

Advantages and disadvantages of forearm skin flap and lateral femoral skin flap in repair of oral and maxillofa-cial defects / 局解手术学杂志

Objective To compare and analyze the advantages and disadvantages of the forearm skin flap and the lateral femoral skin flap in the repair of oral and maxillofacial defects.Methods Of the 34 patients of oral and maxillofacial tumor resection received postopera-tive reconstruction of maxillofacial defects treatment,18 patients repaired by forearm flap( forearm flap group) ,16 patients repaired by antero-lateral thigh flap ( anterolateral thigh flap group) .The clinical effect and the restoration of two groups after surgery were compared.Results The survival rate of disposable surgical flap in forearm flap group was 94.44%,the survival rate of the anterolateral thigh flap group was 87.50%.The difference between two groups was not statistically significant (P>0.05).The difference of swallowing function in 3 months after surgery between two groups was not statistically significant (P>0.05).The difference of survival quality score between the two groups was not statistically significant (P >0.05) in 6 months after surgery.The scar proliferation rate (27.78%), pigment deposition rate (88.89%), temporary sexual dysfunction rate(66.67%),a permanent disability rate (27.78%) of forearm flap group were significantly higher than those of the femoral anterolateral flap group patients (P<0.05).Conclusion The forearm skin flap and the lateral femoral skin flap have a good clincal effect on the repair of oral and maxillofacial defects,and the incidence of complications of the femoral anterior lateral femoral flap is lower.

Free submental flap for defects reconstruction after oral cancer ablation / 中华显微外科杂志

Objective To investigate the clinical application of free submental flap for defects reconstruction after oral cancer ablation.Methods Eleven cases of free submental flaps for defects reconstruction after oral cancer ablation from April,2013 to May,2014 were reviewed.The primary disease,defect type,flap side,flap size and flap survival rate were recorded.The follow-up data of tumor recurrence,lymph node metastasis,as well as postoperative facial appearance and function of marginal mandibular branch of facial nerve were collected.Results Primary disease of all 11 cases was oral squamous cell carcinoma.No flap failure was reported and the overall flap survived.The follow-up period was 6-18 months with the average of 9 months.There was no tumor recurrence and metastasis of lymph node.Postoperative facial appearance was satisfactory and there was no nerve injury of marginal mandibular branch which showed normal and symmetrical expression motion.Conclusion Free submental flap owns many ad vantages including constant anatomy,long vascular pedicle,wide range of indications and low donor-site morbidity.Contralater submental flap may avoid potential lymph node metastasis.Free submentai flaps is an ideal choice for reconstruction of oral and maxillofacial defects after cancer ablation.

Morbilidad por defectos bucomaxilofaciales en las provincias orientales durante el período 2000-2013 / Morbidity due to oral maxillofacial defects in the eastern provinces during the period 2000-2013

Se realizó un estudio descriptivo y retrospectivo de 2441 pacientes, atendidos en el Servicio de Prótesis Bucomaxilofacial de Santiago de Cuba, desde el 2000 hasta el 2013, con vistas a caracterizar la morbilidad por defectos bucomaxilofaciales en los afectados. Hubo un promedio de 200 ingresos y 159 altas anuales de pacientes atendidos. La mayoría de los casos (63,8 %) pertenecieron a la provincia antes citada. Prevalecieron el sexo masculino (63,0 %), el grupo etario de 60 años y más (33,7 %), el nivel escolar primario (32,6 %), los defectos oculares (80,3 %) y el trauma (53,8 %). En los afectados de 0-19 años predominaron los defectos congénitos, en los de 40-59 los traumas, en personas de más de 60 años los oncológicos y por otras causas. Los defectos oculares se produjeron por traumas en 59,0 %, los nasales por causas oncológicas en 100,0 %, los craneales y auriculares por traumas en 78,6 y 76,5 %, respectivamente.

A descriptive and retrospective study of 2441 patients, assisted in the Service of Oral and Maxillofacial Prosthesis in Santiago de Cuba was carried out from the 2000 to 2013, aimed at characterizing the morbidity due to oral and maxillofacial defects in those affected. There was an average of 200 admissions and 159 annual discharges of assisted patients. Most of the cases (63.8%) belonged to the above mentioned province. Male sex (63.0%), the age group 60 years and over (33.7%), the primary school level (32.6%), the ocular defects (80.3%) and trauma (53.8%) prevailed. In the affected age group 0-19 years, the congenital defects prevailed, in the 40-59 years traumas prevailed, in patients over 60 years the oncological causes and others prevailed. Ocular defects were caused by traumas in 59.0%, the nasal defects were caused by oncological causes in 100.0%, the cranial and ears defects were due to traumas in 78.6 and 76.5%, respectively.

Clinical Study on Tibial Bone Graft

The purpose of this retrospective study was to evaluate the treatment outcome of proximal tibial graft. Thirty-nine patients were grafted with proximal tibia for the repair of maxillofacial defect. Complications can be considered incidental and neglectable clinical significance. It is concluded that the proximal tibial metaphysis offers a promising alternative sources of cancellous bone for the repair of maxillofacial defect.