Clinical application of perforator vessel location guide plate for fibular musculocutaneous flaps / 口腔疾病防治

Objective@#Based on 3D printing technology, explore the precision of a perforator vessel location guide plate for fibular musculocutaneous flaps before the transplantation of fibular osteocutaneous flaps and evaluate its application effects.@*Methods@#This study was reviewed and approved by the ethics committee, and informed consent was obtained from the patients. From May 2019 to October 2022, 14 patients with jaw defects who needed to undergo fibular perforator flap transplantation at the First Affiliated Hospital of Xinjiang Medical University were selected. For the seven patients in the guide plate group, CTA was combined with Mimics software to reconstruct both lower limbs, and the perforator vessel positioning guide for locating perforator vessels was designed; the two ends of the guide plate were designed as fixed ends, with the upper end fixed to the knee joint and the lower end fixed to the ankle joint, and the guide plate was fabricated by a 3D printer. For the seven patients in the control group, a conventional handheld Doppler probe was used for perforator vessel location. The average operation time, bleeding volume, recovery time, deviation of perforator vessel location, postoperative flap-related complications, postoperative donor site shape satisfaction, and lower extremity functional scale (LEFS) score were recorded. SPSS 25.0 software was used for statistical analysis.@*Results@#The average operation time, bleeding volume, recovery time, deviation of perforator vessel location and postoperative donor site shape satisfaction were significantly better in the guide plate group than in the control group (P<0.05); moreover, the differences in postoperative flap-related complications and LEFS scores were not statistically significant (P>0.05).@*Conclusion@#Based on 3D printing technology, fibular musculocutaneous flap perforator vessels can be more accurately located using a guide plate and the knee and ankle as fixed points, and this method can effectively stabilize the guide position, prevent soft tissue offset, and improve positioning accuracy and thus deserves to be generalized.

Fibula Jaw-during-Admission.

BACKGROUND: Fibula Jaw-in-a-Day (JIAD) is considered the most advanced approach for segmental mandibular defect reconstruction and dental rehabilitation. However, it has limitations and challenges for further pursuit. We propose Fibula Jaw-during-Admission (JDA) as a solution. MATERIALS AND METHODS: From 2019 to 2021, six patients received fibula "Jaw-during-Admission." Segmental mandibulectomy, fibula transfer, and immediate dental implantation were performed simultaneously during a single surgery. Intraoral scans were used to fabricate temporary light occlusion contact dental prostheses while on the ward prior to discharge during the first and second week post operation. The prostheses were installed before discharge and changed to permanent ones with normal occlusal contact in the clinic at about six months after X-ray confirmation of bone healing. RESULTS: All six surgeries succeeded. Four patients received palatal muco-periosteal graft after debridement of peri-implant overgrown granulation tissue. Follow-up ranged from 12 to 34 months (average 21.2 months) and revealed good function and appearance in all patients. CONCLUSION: Fibula JDA is superior to the Fibula JIAD approach for simultaneous mandibular reconstruction with fibula and dental rehabilitation. There is no need for postoperative intermaxillary fixation. The surgery can be performed more reliably with less stress. It provides an additional opportunity for dental rehabilitation if initial dental prosthesis installation during JIAD fails. Postreconstruction intraoral scans provide greater precision and more flexibility in milling dental prosthesis which are mapped to the reconstructed mandible during the postoperative period.

Dental implant treatment in vascularized bone flaps after jaw reconstruction.

Jaw defects caused by various reasons often seriously affect appearance and function. The goal of the treatment of oral and maxillofacial tumors should include the cure of the tumor and the restoration of premorbid function. The development of microsurgery and digital surgery technology has promoted the development of jaw reconstruction with vascularized free bone flap. Good appearance and improved predictability could be obtained with the help of preope-rative visual design. How to rehabilitate occlusal function on the reconstructed jaw and improve the quality of life of patients has become an important research direction. This article discusses the challenge of jaw reconstruction, the selection of vascularized bone flap, the choice of implant timing, the treatment of peri-implant soft tissue, and the influence of radiotherapy on implants after jaw reconstruction.

Application of a vascularized bone free flap and survival rate of dental implants after transplantation: A systematic review and meta-analysis.

PURPOSE: As maxillofacial surgical techniques have advanced, vascularized bone free flap transplantation has become the standard treatment for repairing maxillofacial defects. In this meta-analysis, we summarize the survival rates of implants after VBFF surgery for maxillary and mandibular reconstructions and investigate the factors affecting patient outcomes. METHODS: The PubMed, Embase, and Wanfang databases were searched up to May 31, 2022. The results of the treatment effect are presented as the risk ratio or odds ratio, using 95% confidence intervals. Statistical significance was calculated at α = 0.05 (two-tailed z tests). RESULTS: 35 studies were included in our analysis. The results revealed a 3-year and 5-year implant survival rate of 95.2% and 85.4% in VBFFs, respectively. The location of jaw defects (maxilla or mandible) or timing of implantation was not found to have a statistically significant influence on the survival rate. However, statistically significant differences were observed in the failure of implants placed in irradiated bone tissue. CONCLUSIONS: Statistically significant differences were not found in the implant survival rate between simultaneous and delayed implantation, or between maxillary and mandibular defects. However, dental implants placed in irradiated flaps tended to have a lower survival rate than those surgically placed in non-irradiated flaps.

Factors related to masticatory performance in patients with removable dentures for jaw defects following oral tumor surgery.

Purpose In the treatment of oral tumors, extensive jaw defects due to surgical resection can reduce masticatory performance. Herein, we aimed to clarify the factors related to masticatory performance in patients with jaw defects.Methods In total, 76 patients (42 male and 34 female) underwent prosthetic treatment with a removable denture for a jaw defect following oral tumor surgery. Data on history of radiation therapy, period of time since surgery, period of use of the present denture, number of remaining teeth, and site of the jaw defect were collected. Masticatory performance was evaluated using test gummy jelly. In addition, maximum bite force, tongue pressure, tongue-lip motor function (oral diadochokinesis /pa/, /ta/, /ka/), and oral dryness were evaluated. Logistic regression analysis was performed with lower masticatory performance scores as the dependent variable. Since multicollinearity was suspected between the oral diadochokinesis /ta/ and /ka/ syllables, two logistic regression analyses were conducted: Model 1 with the /ta/ syllable as an explanatory variable, and Model 2 with the /ka/ syllable as an explanatory variable.Results In Model 1, a history of radiation therapy, maximum bite force, number of remaining teeth, tongue pressure, and oral diadochokinesis /ta/ were significant explanatory variables. In Model 2, a history of radiation therapy, maximum bite force, number of remaining teeth, and tongue pressure were significant explanatory variables.Conclusions A history of radiation therapy, maximum bite force, tongue pressure, number of remaining teeth, and motor function of the proglossis are related to decreased masticatory performance in patients with jaw defects.

Dental implant treatment in vascularized bone flaps after jaw reconstruction / 华西口腔医学杂志

Jaw defects caused by various reasons often seriously affect appearance and function. The goal of the treatment of oral and maxillofacial tumors should include the cure of the tumor and the restoration of premorbid function. The development of microsurgery and digital surgery technology has promoted the development of jaw reconstruction with vascularized free bone flap. Good appearance and improved predictability could be obtained with the help of preope-rative visual design. How to rehabilitate occlusal function on the reconstructed jaw and improve the quality of life of patients has become an important research direction. This article discusses the challenge of jaw reconstruction, the selection of vascularized bone flap, the choice of implant timing, the treatment of peri-implant soft tissue, and the influence of radiotherapy on implants after jaw reconstruction.

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.

PAP Polypeptide Promotes Osteogenesis in Jaw Bone Defect Repair by Inhibiting Inflammatory Reactions.

Jaw defects are common in oral and maxillofacial diseases and require surgical repair in extreme cases. Given the limitations in availability and efficacy of autologous bone grafts or allografts, great effort has been made in finding suitable, biocompatible, and effective artificial bone materials. Considering the key role of inflammation in bone resorption, we sought to identify a polypeptide with anti-inflammatory and bone-promoting effects. Rat bone marrow-derived mesenchymal cells (BMSCs) were treated with lipopolysaccharide (LPS) to induce an inflammatory environment, and 1,538 differentially abundant polypeptides were identified using mass spectrometry. Based on mass spectrometry signal intensity, multiple of difference, and structural stability, PAP was screened out as the polypeptide with the lowest abundance in the inflammatory condition. PAP showed no cytotoxicity to BMSCs with increasing concentrations. PAP (10 µM) also increased alkaline phosphatase activity and mRNA expression of Ocn, Bmp2, and Runx2 in a concentration-dependent manner, which confirmed that it can promote osteogenic induction of rat BMSCs. Moreover, PAP reduced LPS-induced expression of inflammatory cytokines (TNF-α, IL-1ß, IL-6) and reactive oxygen species and inhibited polarization of RAW 264.7 macrophages to the inflammatory type. Finally, a skull defect mouse model was established, and mice were injected with LPS and/or PAP. Micro-CT, histological analysis, and immunohistochemical staining showed that PAP significantly reduced the number of LPS-induced bone resorption pits and maintained bone integrity. Overall, the polypeptide PAP screened using LPS stimulation of BMSCs is not cytotoxic and can inhibit the inflammatory reaction process to promote osteogenesis. This study thus provides a basis for development of PAP as a new osteogenic material in the repair of jaw defects.

Effectiveness of the Sequential Use of Plastic and Titanium Implants for Experimental Replacement of the Mandibular Defect in Animals Using Preliminary Digital Design.

Using the templates preliminarily made by 3D design and prototyping methods, defects in the lateral area of the lower jaw of sheep were created using the piezosurgical technique. The defects were replaced by plastic implants obtained by the method of layer-by-layer fusion of the FDM printing-fusing deposition modeling and fixation with titanium screws to the jaw body. In the time interval, plastic implants are replaced by titanium implants obtained by selective laser sintering (SLS) using a 3D printer. To study the processes of reparative osteogenesis, microsamples of tissues of the preimplantation zone were analyzed. As a result, signs of osteo- and fibro-osseointegration were identified. The obtained data are regarded as a prerequisite for further clinical trials of the developed protocols for the sequential replacement of jaw defects using 3D printing.

Expert Consensus for the Treatment Algorithm for Navigationassisted Reconstruction of Maxillofacial Deformities.

Deformities of the maxillofacial region following trauma and ablative surgery are devastating and not uncommon. Reconstruction of such defects is a surgically challenging procedure. Conventionally, reconstruction of dental arch defects lacks preoperative customised planning and relies heavily on the surgeon experience to ensure optimum surgical outcomes. The restoration of the dental arch shape and function has taken precedence after an extensive tumour resection surgery, especially in the current age of technological advancement. Thus, personalised and accurate reconstruction of dental arch defects has become a new goal. Computer-assisted surgery, especially navigation-assisted surgery, has gained popularity of late, in reconstructing deformities and restoring facial symmetry, appearance and function in the maxillofacial region. This technology provides a clearer three-dimensional visualisation of the area of interest and its relationship with the adjacent vital structures. Together with preoperative virtual surgical planning, it allows more specific and accurate osteotomies, thus reducing the ischemia and total operating times substantially. The risk of complications is also minimised whilst improving the final surgical outcomes. The use of the intraoperative navigation system and other computer-assisted surgical techniques during surgery can significantly improve the precision of the reconstruction of dental arch deformities, and achieve personalised and functional reconstructive goals while enhancing the quality of life of patients postoperatively. The Society of Oral and Maxillofacial Surgery, Chinese Stomatological Association provides the present professional perspective and treatment protocol for navigation-guided reconstruction of dental arch defects, to allow standardisation of the technique while promoting its application among oral and maxillofacial surgeons.

Jaw reconstruction with vascularized fibular flap: The 11-year experience among 104 patients.

BACKGROUND: A vascularized fibular osteomyocutaneous flap with severe vascular crisis often results in serious consequences. This study aims to examine the clinical effect of non-vascularized fibular graft on patients with severe vascular crisis after reconstruction of the defect jaw with vascularized fibular osteomyocutaneous flap. MATERIALS AND METHODS: From December 2007 to December 2018, a total of 104 patients with jaw neoplasms that underwent reconstruction with free vascularized fibular flap were retrospectively analyzed; seven of these cases had postoperative vascular crisis during mandibular reconstruction. RESULTS: Of the seven cases with postoperative vascular crisis, the vascularized fibular flaps in three patients survived completely, thanks to early detection; two cases were completely necrotic and removed in the end, and the remaining two cases had severe vascular crisis after the removal of the soft tissue attached to the fibular flap. The non-vascular fibular grafts were retained regardless of the severe absorption after follow-ups for 25 and 69 months, respectively. CONCLUSIONS: If vascular crisis occurs following jaw reconstruction with a vascularized fibular osteomyocutaneous flap, early re-surgical exploration effectively improves the salvage rate. In addition, when a severe vascular crisis occurs, the vascularized fibular flap can be changed to a non-vascular fibular graft to reconstruct the mandibular defect, thus avoiding the serious consequences resulting from the complete failure of fibular graft.

[Expert consensus on techniques of navigation-guided reconstruction of jaw defect].

Deformities of the maxillofacial region following trauma and ablative surgery are devastating and not uncommon. Reconstruction of such defects is a surgically challenging procedure. Conventionally, reconstruction of the jaw defects lacks pre-operative customized planning and relies heavily on surgeons' experiences to ensure optimum surgical outcomes. The restoration of jaw shape and function has taken precedence after an extensive tumor resection surgery, especially in the current age of technological advancement. Thus, personalized and accurate reconstruction of jaw defects has become a new goal. Computer-assisted surgery especially navigation-assisted surgery has gained popularity of late, in reconstructing deformities and restoring facial symmetry, appearance and function in the maxillofacial region. This technology provides a clearer three-dimensional visualization of the area of interest and its relationship with the adjacent vital structures. With pre-operative virtual surgical planning, it allows more specific and accurate osteotomies, thus reducing the ischemia and total operating times substantially. The risk of complications is also minimized whilst improving the final surgical outcomes. The use of intra-operative navigation system and other computer-assisted surgical techniques in the surgery can significantly improve the precision of the reconstruction of jaw deformities and achieve personalized and functional reconstructive goals while enhancing the patients' quality of life post-operatively. The Society of Oral and Maxillofacial Surgery, Chinese Stomatological Association provides this professional perspective and present treatment protocol for navigation-guided reconstruction of jaw defect to allow standardization of the techniques while promoting its application among the oral and maxillofacial surgeons.

Expert consensus on techniques of navigation-guided reconstruction of jaw defect / 中华口腔医学杂志

Deformities of the maxillofacial region following trauma and ablative surgery are devastating and not uncommon. Reconstruction of such defects is a surgically challenging procedure. Conventionally, reconstruction of the jaw defects lacks pre-operative customized planning and relies heavily on surgeons' experiences to ensure optimum surgical outcomes. The restoration of jaw shape and function has taken precedence after an extensive tumor resection surgery, especially in the current age of technological advancement. Thus, personalized and accurate reconstruction of jaw defects has become a new goal. Computer-assisted surgery especially navigation-assisted surgery has gained popularity of late, in reconstructing deformities and restoring facial symmetry, appearance and function in the maxillofacial region. This technology provides a clearer three-dimensional visualization of the area of interest and its relationship with the adjacent vital structures. With pre-operative virtual surgical planning, it allows more specific and accurate osteotomies, thus reducing the ischemia and total operating times substantially. The risk of complications is also minimized whilst improving the final surgical outcomes. The use of intra-operative navigation system and other computer-assisted surgical techniques in the surgery can significantly improve the precision of the reconstruction of jaw deformities and achieve personalized and functional reconstructive goals while enhancing the patients' quality of life post-operatively. The Society of Oral and Maxillofacial Surgery, Chinese Stomatological Association provides this professional perspective and present treatment protocol for navigation-guided reconstruction of jaw defect to allow standardization of the techniques while promoting its application among the oral and maxillofacial surgeons.

Expert consensus on techniques of navigation-guided reconstruction of jaw defect / 中华口腔医学杂志

Deformities of the maxillofacial region following trauma and ablative surgery are devastating and not uncommon. Reconstruction of such defects is a surgically challenging procedure. Conventionally, reconstruction of the jaw defects lacks pre-operative customized planning and relies heavily on surgeons′ experiences to ensure optimum surgical outcomes. The restoration of jaw shape and function has taken precedence after an extensive tumor resection surgery, especially in the current age of technological advancement. Thus, personalized and accurate reconstruction of jaw defects has become a new goal. Computer-assisted surgery especially navigation-assisted surgery has gained popularity of late, in reconstructing deformities and restoring facial symmetry, appearance and function in the maxillofacial region. This technology provides a clearer three-dimensional visualization of the area of interest and its relationship with the adjacent vital structures. With pre-operative virtual surgical planning, it allows more specific and accurate osteotomies, thus reducing the ischemia and total operating times substantially. The risk of complications is also minimized whilst improving the final surgical outcomes. The use of intra-operative navigation system and other computer-assisted surgical techniques in the surgery can significantly improve the precision of the reconstruction of jaw deformities and achieve personalized and functional reconstructive goals while enhancing the patients′ quality of life post-operatively. The Society of Oral and Maxillofacial Surgery, Chinese Stomatological Association provides this professional perspective and present treatment protocol for navigation-guided reconstruction of jaw defect to allow standardization of the techniques while promoting its application among the oral and maxillofacial surgeons.

Clinical study of removable prosthesis fabricated for upper jaw defect by altered cast impression technique / 实用口腔医学杂志

Objective:To evaluate the subjective feeling and the objective chewing effect of the patients with the prosthesis made for upper jaw defect by altered cast impression technique.Methods:A self-control experiment was conducted for 30 patients with the pros-thesis made for upper jaw defect by specific tray impression technique and altered cast impression technique respectively.As soon as the impression was finished,the patients were required to finish 2 questionnaires,one was about their self-comfortable sensation and the other one was the STAI(State-Trait Anxiety Inventory)about their feeling of anxiety.Then the chewing-effect was tested.Data were analysed by SPSS 20.0 software (T-test and Rank-sum test).Results:Most prosthesis made by altered cast impression technique showed increased masticatory function(P <0.05).The subjective-felling evaluation indicated that the altered cast impression technique was more comfortable but there was no difference between the 2 methods in the whole course of the impression(P =0.051).STAI score showed that the patients suffered lower anxiety with altered cast impression.Conclusion:The altered cast impression technique can en-hance masticatory efficiency and increase the satisfaction of patients for preparation of the posthesis for upper jaw defect.