Management of Ameloblastoma with Free Tissue Flap in Comparison with Other Reconstructive Options Available.

AIM: To review the management and reconstruction of ameloblastoma of mandible in different age groups over a period of 11 years. METHODOLOGY: This retrospective study includes 51 cases operated in the Maxillofacial Unit, Bhagwan Mahaveer Jain Hospital, Bangalore, from the year 2007 to 2017. The data of these patients were collected to record demographic data such as age, gender with site of tumour and type of reconstruction after resection, follow-up period and incidence of complications. This study evaluated the outcome in terms of aesthetics, function and choice of reconstruction in different age groups. RESULTS: Most patients were of 21-40 age group. 37 (72.5%) were found to be unicystic ameloblastoma. 41 (80.3%) patients underwent reconstruction following the resection. There was a change in trend seen over a period of time with free grafts and reconstruction plate being historical, except in special situations like old age and unfit patients. According to one-way ANOVA and Tukey's post hoc analysis, free flaps were known to take a longer duration (mean = 503 min) compared to other modes of reconstruction. However, free grafts and free flaps were demonstrated to have a good facial contour and speech with most cases dentally rehabilitated with implants. Among the complications, 1 (16%) case with reconstruction plate showed screw loosening, 2 (28%) cases with free grafts showed graft exposure, and 1 (3.5%) case with free flap had venous congestion, making free flaps the most reliable option. CONCLUSION: Free fibula is the gold standard of mandible reconstruction, but depending on age, medical condition, economic status and size of the defect other modes of reconstruction can be chosen with the acceptance of suboptimal results.

A Woman Oral and Maxillofacial Surgeon of India: Is She Satisfied with Her Career Choice?

Just as other surgical fields, maxillofacial surgery also was considered a male-dominated field since long. In the recent past, though, we are witnessing change in this trend. Dentistry in general, and maxillofacial surgery in particular, is seeing a large number of women choosing it as their career option, more so in the last decade and a half. This study was conducted in order to understand issues affecting women maxillofacial surgeons in their career as an academician or a private practitioner. We wanted to analyze the factors leading to career satisfaction and estimate the current work scenario for women maxillofacial surgeons. Since the study is one of its first in the country, the conclusions are not definite. Further studies in the future are needed to understand various factors affecting position of women maxillofacial surgeons in academics, private practice, and residents and role of gender in career advancement and in pursuing leadership positions.

Versatility of Fibula Free Flap in Reconstruction of Facial Defects: A Center Study.

PURPOSE: To study a series of cases where vascularised fibula flap was used in various combinations of bone with muscle and skin along with its modifications for reconstruction of simple and composite defects of the facial region. PATIENTS AND METHODS: The investigators designed a retrospective study composed of patients with any pathology or defect who underwent reconstruction of maxilla or mandible with vascularised fibula free flap from 2009 to 2013. All patients were evaluated for age, gender, location and type of defect, incorporation of adjoining skin paddle and muscle, number of fibula osteotomies, ischaemia time, anticoagulant regimen, length of hospital stay, flap failure rate, dental implant rehabilitation. All patients with a minimum follow-up of 3 months post-operatively, were included in this study. RESULTS: The study sample composed of 30 patients with average age of 39.5 years. Immediate reconstruction was done in 86.66 % of patients. 93.1 % were mandibular reconstructions. In 40 % of patients, the fibula was double barrelled. Skin island was included with the fibula in 20 % of patients. 10 % patients underwent dental rehabilitation using implants with 6.66 % requiring distraction osteogenesis of the fibula which was not required with double barrel reconstructions. Hematoma at the recipient site was the commonest post-operative complication, although its frequency was low. A significant donor site morbidity of around 3.33 % was seen. Average stay in hospital was about 7 days. Post-operatively all patients ambulated normally and none used assisted devices. A reconstruction plate was used to achieve the ideal contour of the jaw in most cases. Aesthetic results were usually good, especially in young patients. The overall success rate was 93.33 %. CONCLUSION: The fibula has many assets which make it the ideal choice for bony reconstruction of facial skeleton and adjoining soft tissue with predictable results.

Osteonecrosis of maxilla secondary to bisphosphonate therapy: a case report.

Bisphosphonate chemotherapy is commonly used in the treatment of bone diseases such as osteoporosis, Paget disease, and multiple myeloma and to limit bone pain and hypercalcemia associated with malignant metastatic bone lesions. The introduction of bisphosphonate therapy has improved the quality of life in a vast majority of patients. However, since 2003 a growing number of reports have described necrotic bone lesions (bisphosphonate-associated Osteonecrosis of the jaw [BR-ONJ]) a bone lesion affecting maxillofacial bones in patients who have received high dosage chemotherapy with intravenous bisphosphonate therapy especially when the patient undergoes subsequent dental procedures. Sequential removal of sequestra as required seems to be the current conservative approach, but if large-volume debridement becomes necessary, removal of the bone sequestrum with minimal epithelial manipulation associated with topical and systemic antibiotics seem to be the treatment modality of choice. In our case, surgical salvage was performed successfully for BR-ONJ. Our experience indicates that with appropriate technique, primary surgical treatment may offer benefit to selected patients with BR-ONJ.

Maxillectomy through mandibulotomy--a retrospective clinical review.

PURPOSE: To review retrospectively the benefits of using mandibulotomy as an access for tumors involving the maxilla and infratemporal fossa. PATIENTS AND METHODS: Twenty-four consecutive patients with tumors involving the maxilla and infratemporal fossa underwent maxillectomy through mandibular access osteotomy. Patient details and postoperative follow-up were reviewed and recorded. Postoperative complications such as neural morbidity and problems relevant to the procedure were evaluated. Ethical clearance from the medical practices board of the hospital was not required for this study. RESULTS: All but 1 patient underwent en bloc resection of the maxillary tumor with a histologically negative margin. One patient with adenoid cystic carcinoma had a positive orbital margin. Residual mouth opening smaller than 2.5 cm was observed in 4 patients. Healing of the osteotomy site was satisfactory in 21 patients. Three patients had osteotomy-related complications that required secondary intervention. Neural morbidity was temporary and cosmetic outcome of the procedure was excellent. CONCLUSION: Mandibular access osteotomy is an acceptable approach to tumors involving the maxilla and infratemporal fossa. The advantages of wide exposure, minimal morbidity, and good cosmesis make it superior to the conventional panfacial approach. This article highlights the advantages of this procedure and discusses conventional approaches with review of the literature.