Radially Pedicled In-Situ Split-Thickness Skin Grafts, an Alternative to Distal Split-Thickness Skin Grafts.

OBJECTIVE: This study aimed to introduce a novel radially pedicled in-situ split-thickness skin graft (STSG). The morbidity, esthetic, and functional outcomes of the radially pedicled in-situ STSG were in comparison with those of the distal STSG. STUDY DESIGN: Retrospective analysis. SETTING: A single-institution review. METHODS: Seventy patients with oral cancer who underwent radical surgical resection and simultaneous radial forearm free flap (RFFF) reconstruction from July 2021 to March 2022 were included. De-epithelialized RFFFs and traditional RFFFs were used to repair oral defects of 35 patients in Group A and Group B, respectively, while radially pedicled in-situ STSGs and distal STSGs taken from abdomens were used to repair donor site defects in the above groups, respectively. Patient demographics, wound healing complications, and esthetic and functional outcomes of the forearms were compared between the 2 groups. RESULTS: No significant difference between Group A and Group B was observed in terms of donor site and recipient site complications. The esthetic outcome was superior in Group A compared to Group B (P = .011). The extension range, sensation, and pinch strength of operated forearms were significantly reduced in both groups after surgery (P < .05), however, intergroup differences were not observed. CONCLUSION: Taken together, our results suggest that radially pedicled in-situ STSG is an applicable technique for direct closure and better esthetic outcomes in the forearm donor site.

Modified tragus edge incision and transmasseteric anteroparotid approach to condyle reconstruction.

OBJECTIVES: This study aimed to analyze the application value of a modified tragus edge incision and transmasseteric anteroparotid approach to condyle reconstruction. METHODS: Condyle reconstruction was performed in 16 patients (9 females and 7 males) with modified tragus edge incision and transmasseteric anteroparotid approach. After regular follow-up, the function of condyle reconstruction was evaluated by clinical indicators, such as parotid salivary fistula, facial nerve function, mouth opening, occlusal relationship, and facial scar. The morphology of rib graft rib cartilage was evaluated by imaging indicators, such as panoramic radiography, CT, and three-dimensional CT image reconstruction. RESULTS: At 6-36 months postoperative follow-up, all patients had good recovery of facial appearance, concealed incisional scar, no parotid salivary fistula, good mouth opening, and occlusion. One case had temporary facial paralysis and recovered after treatment. Radiographic evaluation further showed that costochondral graft survived in normal anatomic locations. CONCLUSIONS: The modified tragus edge incision and transmasseteric anteroparotid approach can effectively reduce parotid salivary fistula and facial nerve injury in condylar reconstruction. The surgical field was clearly exposed, and the incision scar was concealed without increasing the incidence of other complications. Thus, this approach is worthy of clinical promotion.

Reconstruction of orbital wall fractures with superior orbital fissure syndrome using individualized preformed titanium mesh: a pilot study.

OBJECTIVE: The aim was to preliminarily evaluate the effect of individualized preformed titanium mesh in the treatment of orbital wall fractures with superior orbital fissure syndrome (SOFS). STUDY DESIGN: This study consisted of 10 patients of orbital wall fracture and SOFS who were treated at the Affiliated Stomatology Hospital of Southwest Medical University. On the basis of preoperative computed tomography data, individualized titanium mesh was produced by mirror engineering and rapid prototyping, and it was implanted into defects in the orbital walls to restore the normal anatomy. Early orbital wall reconstruction was performed to improve the SOFS. Postoperatively, the ocular and facial appearance and eye function were evaluated. RESULTS: The orbital structure, volume, and size of the SOF were restored in the 10 patients using the individualized titanium mesh. The symptoms of SOFS completely disappeared in all patients with no severe postoperative complications. Significant recovery of ocular and facial appearance and eye function was reported. CONCLUSIONS: This pilot study demonstrated that individualized preformed titanium mesh can accurately restore the orbital walls and the structure and size of the SOF, and it is useful in the treatment of SOFS without intraorbital bone fragment displacement.

Computed tomography angiography-aided individualized anterolateral thigh flap design in the reconstruction of oral and maxillofacial soft tissue defects.

PURPOSE: To evaluate a novel method and computed tomography angiography (CTA) for locating anterolateral thigh flap (ALTF) perforators to design individualized ALTFs to reconstruct maxillofacial soft tissue defects. STUDY DESIGN: This study comprised a group of 36 patients (CTA group) with malignant oral and maxillofacial tumors who underwent CTA and who received individualized ALTFs and a group of 28 patients (control group) with the same condition but without preoperative CTA examination and with nonindividualized ALTFs. ALTFs in the CTA group were designed and harvested using the locating device and CTA, whereas ALTFs in the control group were designed and harvested according to each surgeon's experience. RESULTS: Fifty perforators were located and 36 ALTFs harvested in the CTA group. In the control group, 34 perforators were located and 28 ALTFs harvested. Less time was required to locate the perforators in the CTA group. Moreover, the CTA group had a higher flap survival rate and better patient satisfaction regarding the postoperative aesthetics and phonetic and swallowing functions. CONCLUSIONS: The results suggest that CTA and the locating device can be used to accurately locate ALTF perforators and that this method aids in the design and harvesting of individualized ALTFs to achieve good functional and aesthetic outcomes.

[Application of a modified paramedian lower lip-submandibular approach in maxillary (subtotal) total resection].

OBJECTIVE: To investigate the clinical efficacy of a modified paramedian lower lip-submandibular approach for maxillary (subtotal) total resection. METHODS: Eleven patients of maxillary tumors underwent maxillary (subtotal) total resection through the modified paramedian lower lip-submandibular approach. Clinical follow-up visits were conducted to evaluate appearance restoration, facial nerve functional status, parotid gland functional status, and orbital region complication. RESULTS: During the follow-up period of 6-36 months, the appearance of all 11 patients recovered well. All cases presented hidden scars. No facial nerve and parotid duct injury, lower eyelid edema, lower eyelid ectropion, or epiphora in all cases was observed. CONCLUSIONS: Applying modified paramedian lower lip-submandibular approach to maxillary (subtotal) total resection effectively reduces incidence of orbital region complications including lower eyelid edema, lower eyelid ectropion, and epiphora, which often occur to traditional approach. The modified approach produces more subtle scars than other methods and should be applied to treatment of maxillary (subtotal) total resection.

[Application of anteromedial thigh flap as a alternative flap in maxillofacial soft tissue defects].

Objective:To explore the application value of anteromedial thigh flap（AMT） as alternative flap in repairing maxillofacial soft tissue defects. Method:Sixty patients were scheduled to underwent anterolateral thigh flap（ALT） reconstruction. Preoperative CT angiography were conducted. Imaging workstations were used to locate perforator vessels in the anterolateral and anteromedial areas respectively. Four patients had no suitable perforator during the preparation of AMT flaps. In the same operation area, ALT flaps were prepared to reconstruct the defect according to the location of the perforator vessels in the anteromedial areas. Result:All four AMT flaps survived uneventfully. Flap sizes ranged from 9 cm×6 cm to 7 cm×4 cm. The follow-up period ranged from 6 to 12 months, the functions of recipient and donor sites recovered well. Conclusion:Preoperative CT angiography can improve the accuracy of the preparation of skin flap effectively. When no sizable perforator is available during harvest of the ALT flap, successful reconstruction can be achieved using the ipsilateral AMT flap.

[Clinical application of free fibular flap based on digital technology in mandibular defects].

Objective:To investigate the application of free fibular flap based on digital technology in mandibular defects. Method:Eight cases of mandibular defects underwent virtual surgery and guide plate design before operation. The mandibular osteotomy guide plate, fibula plastic guide plate and mandibular reconstruction model were prepared by rapid prototyping technology. The individualized reconstruction titanium plates were prefabricated on the mandibular reconstruction model. Based on the guide plates and the individualized reconstruction titanium plates, the mandibular defects were repaired accurately. At the same time, CT angiography was used to observe the variation of peroneal artery. For patients with soft tissue defects, the superficial position of the point going out muscle of perforator vessels was located, and the skin flaps were designed to repair the soft tissue defect. Result:The free fibular flaps survived in all patients. The guide plates were successfully implanted, the position of the individualized reconstruction titanium plates were accurate, and the occlussions were well recovered. Preoperative CT angiography was carried out without complication in all patients, the desired anatomy was adequately demonstrated in all patients. The superficial position of the point going out muscle of perforator vessels during operation were basically in accordance with those detected by CT angiography. Conclusion:The free fibular flaps based on digital technology can successfully repair mandibular defects with good aesthetic and functional results.

Modified Tragus Edge and Transmasseteric Anteroparotid Approach for Intracapsular and Condylar Neck Fractures.

The aim of this study was to evaluate the effects of protecting the facial nerve and reducing the scar visibility using a modified tragus edge and transmasseteric anteroparotid approach compared to classic preauricular approach for intracapsular and condylar neck fractures. This retrospective study included 64 patients (78 sides) who underwent surgical treatment for intracapsular or condylar neck fractures from January 2014 to June 2018. Patients were divided into the experimental group (treated via a modified tragus edge and transmasseteric anteroparotid approach), and the control group (treated via the classical preauricular approach). Therapeutic outcome assessment parameters included facial nerve injury, salivary fistulae, wound infection, restricted mouth opening, postoperative occlusion disorders, and scar visibility. In the control group, there were 3 cases of facial nerve injuries and 2 cases of salivary fistulae. One case of temporary facial nerve injury occurred in the experimental group, with complete recovery within 1 month. The scars were less visible in the experimental group than in the control group. These results suggest that a modified tragus edge and transmasseteric anteroparotid approach reduced the incidences of facial nerve injuries, minimized the scar visibility, improved exposure of the operative site and fixation of titanium screws or plates, and did not increase the frequency of other complications.

[Vascularized composite flap with iliac crest and internal oblique muscle of abdomen for half mandibular reconstruction].

OBJECTIVE: To investigate the effect of vascularized composite flap with iliac crest and nternal oblique muscle of abdomen for half mandibular reconstruction. METHODS: From July 2009 to Sept. 2013, 14 cases with half mandibular defect after tumor resection were treated with composite flap of iliac crest and internal oblique muscle of abdomen pedicled by deep circumflex iliac vessels. During operation, one group performed tumor resection and got the recipient area vessels ready for anastomosis. The other group performed harvesting of composite flap. Then the flap was trimmed and fixed to construct the defect with vessel anastomosis. RESULTS: All the 14 composite flaps survived with local infection only in 1 case. The size of harvested iliac crest ranged from 6 cm x 3 cm to 9 cm x 3 cm. The size of harvested internal oblique muscle of abdomen ranged from 5 cm x 4 cm to 7 cm x 5 cm. The patients were followed up for 6 months to 26 months (mean, 13 months) with satisfactory results and no complication. Mandibular panoramic radiographs showed new bone formation and good union. CONCLUSIONS: Vascularized composite flap with iliac crest and internal oblique muscle of abdomen has the advantages of abundant bone volume, as well as soft tissue reconstruction in one stage. The reconstructed mandible can attain normal function and appearance.

[Application of anterolateral thigh myocutaneous flap in the reconstruction of tongue and mouth floor defect after tongue carcinoma].

OBJECTIVE: To investigate the application of free anterolateral thigh myocutaneous flap in the reconstruction of tongue and mouth floor defect after radical resection of tongue carcinoma. METHODS: From June 2006 to April 2009, 14 cases with tongue carcinoma underwent radical resection, leaving tongue and mouth floor defects which were reconstructed by anterolateral thigh myocutaneous flaps at the same stage. These 14 cases included tongue carcinoma at lingual margin (n=9), at ventral tongue (n=3) and at mouth floor (n=2). The flap size ranged from 7 cm x 9 cm to 5 cm x 7 cm. RESULTS: All the 14 flaps survived completely with primary healing. There was no functional morbidity in the lower extremities. The patients were followed up for 12-26 months with satisfied esthetic and functional results in reconstructed tongue. Only one case (T4 N1 M0) died of metastasis carcinoma 14 months after operation. No local recurrence happened. CONCLUSIONS: The anterolateral thigh myocutaneous flap has abundant tissue volume to reconstruct the tongue and mouth floor defect, while leaving less morbidity at donor site. Both satisfied esthetic and functional results can be achieved.

A new approach to accelerate orthodontic tooth movement in women: Orthodontic force application after ovulation.

Tooth movement occurs as a consequence of periodontal tissue remodeling. The goal of every orthodontist is to investigate better approaches to accelerate tooth movement. Estrogen, by binding with its receptors in periodontal tissue, regulates the remodeling of alveolar bones, promotes bone formation, and inhibits bone resorption. Estrogen secretion in vivo is characterized by a nearly lunar rhythm. The estrogen expression level is low during menstruation and the luteal phase, and reaches the highest at 1-2days before ovulation. Estrogen physiological fluctuations can cause physiological fluctuations in the serum markers of bone turnover. Therefore, orthodontic therapy should be planned according to the menstrual cycle since tooth movement, under the application of force, is faster during low estrogen levels. In this paper, we propose a hypothesis that application of orthodontic force after each ovulation may promote tooth movement, thereby shortening the course of orthodontic treatment.

[A case report of infantile myofibromatosis of left mandibular angle].

The clinical data of one case of infantile myofibromatosis of left mandibular angle were analyzed, and the clinicopathological characteristics, imaging diagnosis, treatment and prognosis of infantile myofibromatosis were discussed.