Maxillo-mandibular Defect Reconstruction with Bilateral Free Fibula Flaps with Dental Implant Placement and Immediate Loading: A Case Report of the Three-team Approach.

Patients with advanced malignant tumors, including both jaws, is a challenging task for a head and neck surgeon. Current treatment landscape demonstrates good functional, anatomical, and aesthetic results in patients who could previously receive only palliative care. The extensive tissue defects resulting from oncological resections in the head and neck region require immediate reconstruction due to the exposure of vital structures and their contact with the external environment. A patient was operated using a three-team multidisciplinary approach involving simultaneous work of three specialized teams of maxillofacial and reconstructive microsurgeons, as well as an implantologist and a prosthodontist. This approach allowed simultaneous tumor resection with subsequent reconstruction of the intraoperative defect involving bilateral harvesting of two revascularized free fibular osteomusculocutaneous flaps with dental implantation and simultaneous rehabilitation of dentition with crowns.

A prospective study of novel mathematical analysis of the contrast-enhanced computed tomography vs renal scintigraphy in renal function evaluation.

PURPOSE: whilst renal scintigraphy (RS) can be associated with interobserver variability, it remains the standard method of evaluating split renal function. AIM: to compare the efficacy of the novel technique of kidney function assessment and renal scintigraphy. METHOD: for this prospective single-arm study we recruited patients who were recommended dynamic renal scintigraphy with 99mTc-DTPA (diethylenetriaminepentacetate). After scintigraphy, mathematical analysis of computed tomography (MACT) was done in all patients, by a single person (SK) blinded to RS results. RESULTS: the study included a total of 97 patients with mean age of 50.9 (range, 23-78) years. From this sample, 65 were females and 32 males. All patients underwent both RS and contrast-enhanced computed tomography for further MACT in 2016-2018. CT results were found to be similar to renal scintigraphy results with Pearson correlation coefficient of 0.945 (р < 0.001). Substantial similarities in renal plasma flow for both kidneys were also observed (0.815, р < 0.001). CONCLUSION: MACT proved feasible, effective and safe in estimating renal function. Its results are closely correlated with RS findings and could be easily integrated into surgical practice.