ABSTRACT
Background: Reconstruction of continuity defect of mandible is challenging, and there has been a lot of advancement in this field with variety of options for restoration. However, choice often becomes restricted in resource limited settings due to lack of trained manpower, time, infrastructure, supply of graft materials, etc. In this context, we aim to test the reliability of Kirschner wire (K-wire) with adaptation of looped-end for immediate interim reconstruction of continuity defect of mandible. Methods: Retrospectively, medical records of 10 years data were reviewed to include 22 patients who underwent immediate interim reconstruction of mandible with K-wire with looped-end adaptation for continuity defect of mandible. Data regarding patient demographic, type and length of mandibular defect, diameter of the wire and complications were recorded. Result: Among 22 patients within a follow-up period of 1-60 months (median 7.5), complications developed in 7 (31.8%) patients. Three patients (13.6%) had major complications which required interventions, and 5 patients (22.3%) with minor complications were managed conservatively. Total wire removal in our study is only 9%, which is lowest among the reported literature, migration or extrusion through bone was nil, and overall aesthetic and functional result was good in majority except few where either wire had to be removed or got deformed. Conclusion: Kirschner wire (K-wire) should be considered in resource limited setting as an immediate interim reconstructive method of mandible for being cheap and widely available. Our technique of looped-end adaptation results in better stabilisation leading to less removal rate, migration or extrusion.
ABSTRACT
BACKGROUND: Although free flaps are nowadays considered 'Gold standard' of head and neck reconstruction, pectoralis major myocutaneous (PMMC) flap is still popular among many reconstructive cancer surgeons in developing countries for its many advantages and also due to lack of resources for free flaps in most of the centers, large number of cancer patients with poor nutritional status and economic condition. However, many studies have reported high complication rate in PMMC flap. So, the purpose of our study was to evaluate the reliability of PMMC flap. METHODS: Within a span of 2 years, 20 reconstructions were done with PMMC flaps in patients with oral cancer and they were followed for a period of 1 year. Documentation was done for patient demographics, site of lesion, duration for reconstruction, occurrence of complications, etc. RESULT: Among 17 males and 3 female patients, complications developed in 4 males and all female patients (total 7 patients, overall 35%). Flap-related complications were - one major (5%) and six minor (30%), which were comprised of three orocutaneous fistula (15%), three partial flap loss (15%), two marginal necrosis (10%), and one donor site necrosis (5%). Total necrosis was nil in our study. All the complications were managed conservatively except the patient with major complication which required intervention. Final cosmetic and functional outcome was acceptable in majority of patients. CONCLUSION: PMMC flap is still 'workhorse' of reconstruction in head neck cancer patients in developing countries and can be used effectively with acceptable morbidity.
ABSTRACT
Research into finding the perfect replacement for lost dentition is an ever-evolving and rapidly advancing subject involving many scientific disciplines. The present consensus appears to be that regeneration of tooth in morphological and functional form is the ideal answer to lost tooth replacement. This article traces the milestones in this elusive search for the ultimate tooth replacement. The various research developments are highlighted that are aimed at the final goal of being able to "re-grow a natural tooth". Whole tooth regeneration is technically challenging and further research into this field of complex molecular biology, embryology, biomaterials and stem cells is required to answer the unsolved questions. However, the milestones that have been crossed in the attempts at whole tooth regeneration have been remarkable and the future is quite promising. This article highlights the noteworthy research work that is being done in the field of whole tooth regeneration with a view to not only inform the clinicians of the significant developments but also inspire them to actively participate in this rapidly evolving field.
