Evaluation of Anterolateral Thigh Fascia Lata Rescue Flap for Mandibular Osteoradionecrosis.

Importance: Mandibular osteoradionecrosis (ORN) is a progressive disease that can be difficult to treat. Conservative measures often fail, while conventional definitive management requires a morbid segmental resection with osteocutaneous reconstruction. Evidence of the anterolateral thigh fascia lata (ALTFL) rescue flap technique's safety, effectiveness, and long-term outcomes is needed. Objective: To determine the long-term outcomes of the ALTFL rescue flap procedure for treating patients with mandibular ORN. Design, Settings, and Participants: This was a retrospective medical record review performed at a single tertiary-level academic health care institution with patients who were appropriate candidates for the ALTFL procedure to treat mandibular ORN from March 3, 2011, to December 31, 2022. Data analyses were performed from January 1 to March 26, 2023. Main Outcomes and Measures: Patient characteristics, preoperative radiographic Notani staging, intraoperative defect size, length of stay, complication rates, and clinical and radiographic findings of progression-free intervals. Results: The study population of 43 patients (mean [SD] age, 66.1 [47-80] years; 24 [55.8%] male individuals) included 52 cases of mandibular ORN. The preoperative Notani staging of the study population was known for 46 of the 52 total cases: 11 cases (23.9%) were stage I; 21 (45.7%), stage II; and 14 (30.4%), stage III. The mean defect area was 20.9 cm2. Successful arrest of ORN disease progression was noted in the clinical and radiographic findings of 50 of the 52 (96.2%) cases, with only 2 (3.8%) cases subsequently requiring fibular free flap reconstruction. The major complication rate was 1.9% (1 case). Clinical and radiographic progression-free intervals were assessed, and no statistically significant differences were noted between Notani staging groups (log-rank P = .43 and P = .43, respectively); ie, patients with stage III disease had no significant difference in risk of clinical (HR, 0.866; 95% CI, 0.054-13.853) or radiographic (HR, 0.959; 95% CI, 0.059-15.474) progression vs those with stage I disease. Weibull profiling revealed 96.9%, 94.6%, and 93.1% successful mandibular ORN arrest at 1, 3, and 5 years, respectively. The major complication rate was 1.9%. Mean (SD) length of stay was 2.7 (0.0-7.0) days. Mean (SD) radiographic follow-up was 29.3 (30.7) months. Conclusions and Relevance: The findings of this large retrospective patient case series support the continued success of the ALTFL rescue flap technique, a safe and highly effective long-term treatment for mandibular ORN in carefully selected patients.

Efficacy of Ozonised Water and 0.2% Chlorhexidine Gluconate in the Management of Chronic Periodontitis when Used as an Irrigant in Conjugation with Phase I Therapy.

AIM: To evaluate the efficacy of irrigation of periodontal pockets by using ozonated water and 0.2% chlorhexidine (CHX) gluconate as adjuncts to scaling and root planing in the management of chronic periodontitis. MATERIALS AND METHODS: For the present study, 20 patients in the age group of 30-60 years, suffering from chronic periodontitis presenting with at least one site with an almost similar pocket depth of 4-6 mm in both the quadrants of maxillary arch was taken. Irrigation was done after 2 weeks of scaling and root planning on the same day with ozonated water and 0.2% chlorhexidine gluconate for two and half minutes. The clinical parameters like gingival index, probing pocket depth (PPD) and clinical attachment level (CAL) were recorded for both the groups at the baseline visit.They were subsequently recalled after 4 weeks and 3 months interval from the baseline visit. Data thus collected was compiled and put to statistical analysis. RESULTS: The present study showed significant results in both the groups with regards to the improvement in the clinical parameters. When comparison was made between the two groups, ozonated water showed slightly better improvement than the chlorhexidine group. However, a statistically significant difference was seen only with Plaque score. CONCLUSION: Subgingival irrigation with ozonized water is beneficial than present conventional therapeutic modalities. Ozonated water restricts the formation of dental plaque and reduces the number of subgingival pathogens thereby treating periodontal diseases. CLINICAL SIGNIFICANCE: Ozone therapy is proving to be a new useful treatment modality which offers great benefits to the patients. The strong antimicrobial power of ozone, along with its ability to stimulate the circulatory system and modulate the immune response, makes it a remedial agent of choice in the treatment of various infectious oral diseases. The study was conducted to justify the routine use of ozone as a treatment modality in effective management of periodontal diseases.