ABSTRACT
El colgajo de peroné ha demostrado ser el más versatil para la reconstrucción oromandibular, gracias a la gran longitud ósea que podemos utilizar y a la posibilidad de incorporar una amplia paleta cutánea para cobertura de tejidos blandos intraorales.El uso de implantes dentales osteointegrados proporciona un importante método terapéutico para la rehabilitación oral de estos pacientes. Los implantes osteointegrados proporcionan la forma más rígida de estabilización protésica para soportar las fuerzas masticatorias. Estos implantes pueden ser insertados de forma inmediata o diferida. A la hora de utilizar el colgajo libre de peroné realizamos la implantología de forma diferida a los 6-12 meses debido a la gran cantidad de material de osteosíntesis necesaria para la fijación del colgajo. Cuatro o seis meses después, cuando el proceso deosteointegración ha ocurrido, los implantes son cargados con una rehabilitación dental
Free fibula flap has proved to be one of the most versatile for oromandibular reconstruction due to the available length of bone and the possibility of incorporating a long skin paddle to cover intraoral soft tissuesThe use of osseointegrated dental implants is an important technique for the oral rehabilitation of these patients. Osseointegrated implants provide the most rigid prosthetic stabilization available to withstand masticatory forces.These implants can be placedimmediately or in a second time procedure.In our case, implantation in the fibula free flap is done after 6-12 months because of the large amount of osteosynthesis material required forthe fixation of the flap. Four or six months later, when osseointegration has taken place, the implants are loaded with a dental rehabilitation. We analize 12 cases of mandibular reconstruction with fibula free flap and their aesthetic and functional rehabilitation with osseointegrated implants with a 2 year follow up Fifty-six dental implants were placed developing all of them but one a correct osseointegration. All these patients recovered masticatory function and underwent a considerable improvement in labial competence, salival continence,speech articulation and facial harmony
Subject(s)
Humans , Surgical Flaps , Soft Tissue Neoplasms/rehabilitation , Transplants , Fibula/transplantation , Dental Implantation, Endosseous/methods , Transplantation ToleranceABSTRACT
Free fibula flaps have proved to be one of the most versatile for oromandibular reconstruction due to the available length of bone and the possibility of incorporating a long skin paddle to cover intraoral soft tissues. The use of a osseointegrated dental implants is an important technique for the oral rehabilitation of these patients. Osseointegrated implants provide the most rigid prosthetic stabilization available to withstand masticatory forces. These implants can be placed immediately or in second time procedure. In our case, implantation in the fibula free flap is done after 6-9 months because of the large amount of osteosynthesis material required for the fixation of the flap. Four or six months later, when osseointegration has taken place, the implants are loaded with a dental rehabilitation. We analize 10 cases of mandibular reconstruction with fibula free flap and their aesthetic and functional rehabilitation with osseointegrated implants with a 2 year follow up. Forty-six dental implants were placed developing all of them but one a correct osseointegration. All these patients recovered masticatory function and underwent a considerable improvement in labial competence, salivary continence, speech articulation and facial harmony.
Subject(s)
Mandible/surgery , Osseointegration , Surgical Flaps , Adult , Aged , Female , Humans , Male , Middle Aged , Mouth/surgery , Plastic Surgery Procedures/methodsABSTRACT
Squamous-cell carcinoma of the maxillary sinus is an infrequent neoplasm of poor prognosis. Symptoms are evident when the disease is in an advanced stage. Lymph-node metastases are relatively infrequent. The survival rate of patients with this tumor has improved slightly since Obgren reported his experience in 1933, thanks to oncological and surgical advances since then. We report our experience with 28 surgically treated cases of maxillary-sinus squamous-cell carcinoma in the last 10 years, analyzing the reconstructive procedures applied, the disease-free survival rate, and our treatment protocol. A bibliographic review was made to examine all current therapeutic possibilities.
Subject(s)
Carcinoma, Squamous Cell/surgery , Maxillary Sinus Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/pathology , Female , Humans , Male , Maxillary Sinus Neoplasms/pathology , Middle Aged , Neoplasm StagingABSTRACT
The trapezius osseomyocutaneous flap is the only pedicled flap that is able to transfer vascularized bone for mandibular reconstruction as well as skin for intra-extra oral reconstruction. The trapezius muscle also helps to fill the defect created by the neck dissection and covers the vessels of the neck. This flap has been used in our maxillofacial surgery service during the past 14 years. In spite of having incorporated microvascular flaps in our reconstructive techniques it continues to be one of the flaps we use in selected patients for bone and soft tissue compound defects of the oral cavity. We describe in this article our experience using this flap with dental implants in order to achieve a functional reconstruction. We also discuss when we use this flap for mandibular reconstruction and when a free vascularized flap is used.
