Intraoral Approach and Stereolithographic-guided Large Mandibular Reconstruction with Fibula Free Flap.

SUMMARY: The reconstruction of mandibular defects has always been of great concern, and it still represents a challenge for head-and-neck reconstructive surgeons. The mandible plays a major role in mastication, articulation, swallowing, respiration, and facial contour. Thus, when undertaking mandibular reconstruction, restoration of both function and cosmetics should be considered as the measure of success. Microsurgical reconstruction is the gold-standard method to repair a segmental mandibular defect. Reconstruction of sizeable defects often needs a large neck incision, leading to unsatisfactory cosmetic outcomes. Virtual surgical planning and stereolithographic modeling are new techniques that offer excellent results and can provide precise data for mandibular reconstruction and improve postoperative outcomes. We present a case of complete intraoral resection and reconstruction of a large ameloblastoma of the mandible.

Acellular dermal matrix in soft tissue reconstruction prior to bone grafting. A case report

When hard tissue augmentation is scheduled as a part of an oral rehabilitation, prior to the treatment, it is importantto assess if the quality of the underlying gingiva at the recipient site can support the bone grafting procedure.The most frequent complication during autologous onlay grafts are wound dehiscences in the recipient site, so theintegrity of soft tissues is a basic aspect of successful reconstructive and plastic surgical procedure. Connectivetissue grafts can improve the quality and quantity of soft tissue in oral sites where a hard tissue reconstruction isgoing to take place. However, particularly when large grafts are harvested, the autogenous donor site can presentsignificant postoperative morbidity, such as necrosis of the palate fibromucosa and bone exposition, pain andbleeding. Another important limitation with the use of autogenous grafts is the limited supply of donor connectivetissue. If a large site needs to be grafted, more than one surgical procedure may be required. An Acellular DermalMatrix (ADM) graft has become increasingly popular as a substitute for donor connective tissue, eliminating thedisadvantages described for the autogenous donor graft. The amount of tissue harvested is unlimited, so it givesan option for treating patients that have inadequate harvestable tissue or that present a large defect to be treated.The outcome of using ADM as a matrix for soft tissue reconstruction 12 weeks before bone grafting can reducethe risk of exposure and failure of the bone graft (AU)

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Acellular dermal matrix in soft tissue reconstruction prior to bone grafting. A case report.

When hard tissue augmentation is scheduled as a part of an oral rehabilitation, prior to the treatment, it is important to assess if the quality of the underlying gingiva at the recipient site can support the bone grafting procedure. The most frequent complication during autologous onlay grafts are wound dehiscences in the recipient site, so the integrity of soft tissues is a basic aspect of successful reconstructive and plastic surgical procedure. Connective tissue grafts can improve the quality and quantity of soft tissue in oral sites where a hard tissue reconstruction is going to take place. However, particularly when large grafts are harvested, the autogenous donor site can present significant postoperative morbidity, such as necrosis of the palate fibromucosa and bone exposition, pain and bleeding. Another important limitation with the use of autogenous grafts is the limited supply of donor connective tissue. If a large site needs to be grafted, more than one surgical procedure may be required. An Acellular Dermal Matrix (ADM) graft has become increasingly popular as a substitute for donor connective tissue, eliminating the disadvantages described for the autogenous donor graft. The amount of tissue harvested is unlimited, so it gives an option for treating patients that have inadequate harvestable tissue or that present a large defect to be treated. The outcome of using ADM as a matrix for soft tissue reconstruction 12 weeks before bone grafting can reduce the risk of exposure and failure of the bone graft.

Lemierre Syndrome associated with dental infections. Report of one case and review of the literature.

The first publication on Lemierre Syndrome appears in 1936 by Lemierre. It is defined as an "oropharynx bacterial infection characterized by the thrombophlebitis in the internal jugular vein, derived in a systemic septic embolism". In 81% of the cases, the Fusobacterium necrophorum is the most frequent etiologic agent. Fever is the most common symptom, but it can depending on the primary infection, tonsillitis, mastoiditis or odontogenic infection. According to the literature the mortality is very low, but with a significant morbidity, that is why the diagnosis and early treatment is very important. The diagnosis it's clinical, even though the CT scan and other diagnosis methods (echography, MRI) help to determine the extent of the infection. It's necessary to administer the antibiotics endovenous at high dose, (keeping in mind that the most frequent micro organism is anaerobic), and vital support measures if necessary. We present a case report of Lemierre Syndrome associated to an odonthogenic infection caused by the 4.8 molar.

Lemierre Syndrome associated with dental infections. Report of one case and review of the literature

La primera publicación de Síndrome de Lemierre fue en 1936 por Lemierre. Se define como una “infección bacteriana orofaríngea que se caracteriza por la tromboflebitis de la vena yugular interna, complicándose con embolismos sépticos sistémicos”. El 81% de los casos, el agente etiológico más frecuente es Fusobacterium necrophorum. La fiebre suele ser el síntoma más frecuente, pero dependiendo de la infección primaria, ya sea amigdalitis, mastoiditis o infección odontógena. La mortalidad es muy baja según la literatura, pero con una morbilidad significativa, por eso es muy importante el diagnóstico y tratamiento precoz. El diagnóstico es clínico, aunque la TC y otros métodos diagnósticos (ecografía, RM) ayudar a determinar la extensión de la infección. Es necesaria la administración de antibióticos por vía endovenosos a dosis máxima, recordando que el microorganismo más frecuente es anaeróbico, y unas medidas de soporte vital. Presentamos un caso clínico de Síndrome de Lemierre asociado a una infección odontógena por causa del molar 4.8

The first publication on Lemierre Syndrome appears in 1936 by Lemierre. It is defined as an “oropharynx bacterial infection characterized by the thrombophlebitis in the internal jugular vein, derived in a systemic septic embolism”. In 81% of the cases, the Fusobacterium necrophorum is the most frequent etiologic agent. Fever is the most common symptom, but it can depending on the primary infection, tonsillitis, mastoiditis or odontogenic infection. According to the literature the mortality is very low, but with a significant morbidity, that is why the diagnosis and early treatment is very important. The diagnosis it´s clinical, even though the CT scan and other diagnosis methods (echography, MRI) help to determine the extent of the infection. It’s necessary to administrate the antibiotics endovenous at high dose, (keeping in mind that the most frequent micro organism is anaerobic), and vital support measures if neccessary. We present a case report of Lemierre Syndrome associated to an odonthogenic infection caused by the 4.8 molar