Maxillary reconstruction using a multi-element free fibula flap based on a three-dimensional polyacrylic resin model.

Preoperative preparation of working models of the skull and free bone flaps using the digital print technology and photocured polyacrylic resins may be of a great benefit to the patient, for whom a virtual resection and reconstruction procedure may be planned in detail and performed. The purpose of mid-facial reconstruction using 3D models is to plan a functional mid-facial reconstruction procedure in order to restore supportive function of intraorbital structures and to make placement of dental implants and further prosthetic rehabilitation possible.Maxillary and mid-facial reconstruction using a free fibula flap based on a three-dimensional working model was performed in a patient diagnosed with a squamous cell carcinoma of the left maxillary sinus penetrating to the orbit, the ethmoid complex, and the pterygopalatine fossa. The use of three-dimensional polyacrylic models allowed for detailed preoperative planning and a virtual resection and reconstruction procedure with a highly satisfying functional and cosmetic effect.A procedure based on methods discussed here may be significantly shorter and more precise.

Salvage surgery of recurrence after laryngectomy--when should the alt free flap be modified?

BACKGROUND: Reconstruction of the pharynx and cervical esophagus has significantly progressed in the last 2 decades. A revolution in microvascular surgery has provided numerous choices for primary restoration, or in secondary reconstructions necessary for recurrences or complications of primary surgery. The goals of reconstruction after laryngopharyngoesophagectomy are to provide continuity of the alimentary tract, to protect major blood vessels, to heal the primary wound, and to restore the swallowing and breathing functions with minimal donor site and neck morbidity and deformation. CASE REPORT: We present 3 cases with complex defects of the laryngopharynx, cervical esophagus and trachea and anterior neck skin following central neck exenteration safely reconstructed with a single anterolateral thigh flap. No postoperative complications occurred in any of the 3 cases of reconstructions, each using a single anterolateral thigh flap. CONCLUSIONS: This approach significantly simplified the reconstruction, with quick recovery, short hospital stay and excellent functional and aesthetic results.

The use of prefabrication technique in microvascular reconstructive surgery.

AIM OF THE STUDY: The aim of the study was to develop standards for the prefabrication of free microvascular flaps in an animal model, followed by their application in clinical practice, and quantitative/qualitative microscopic assessment of the extent of development of a new microvascular network. MATERIAL AND METHODS: The study was carried out in 10 experimental pigs. As the first stage, a total of 20 prefabricated flaps were created using polytetrafluoroethylene (PTFE) as a support material, placed horizontally over an isolated and distally closed vascular pedicle based on superficial abdominal vessels. After completing the animal model study, one patient was selected for the grafting of the prefabricated free flap. RESULTS: All 20 free flaps prefabricated in the animal model were analyzed microscopically, exhibiting connective tissue rich in fibroblasts and small blood vessels in the porous areas across the entire thickness of the PTFE element. CONCLUSIONS: Flap prefabrication is a new and fast developing reconstruction technique. The usefulness of prefabrication techniques and their status in reconstructive surgery still needs to be investigated experimentally and clinically. The method based on prefabricated free flaps is the first step towards anatomical bioengineering that will make it possible to replace missing organs with their anatomically perfect equivalents.

Recurrent benign pleomorphic adenoma of the lacrimal gland--a case report.

UNLABELLED: Benign pleomorphic adenoma (mixed tumor) is the most frequently occurring tumor of epithelial origin. It occurs in serous glands, most frequently in parotid glands and rarely in small palatine glands, cheek glands, palatine tonsils and the lacrimal gland. This study is a description of the therapeutic management of a patient with recurrent pleomorphic adenoma of the lacrimal gland. In 1996, a 35 year old male patient underwent surgery to remove a tumor of the left orbit. Histopathological examination revealed pleomorphic adenoma. From 1998, the patient had observed increasing exophthalmus of the left eyeball. In 1999, vision distortion and headaches had begun. In 2005, from a cut along the upper-outer edge of the left orbit, an elastic and soft tumor 1 cm in diameter was removed from soft tissues of the upper eyelid. Then, with the use of the side orbitotomy technique, the orbit was opened through incision of the temporal muscle and removal of the orbital side wall. An eyelid nodule of 0.8 mm in diameter was removed together with an elastic and hard tumor of size 2.5 x 1 cm. The result of the histopathological examination of the palpebral tumor was pseudocystic tumor and of the orbital tumor was pleomorphic adenoma. CONCLUSION: patients resected for pleomorphic adenoma of the lacrimal gland require a long period of postoperative observation and periodic ophthalmologic examination.

[Calcifying epithelial odontogenic tumor (Pindborg tumor)]. / Nablonkowy wapniejacy guz zebopochodny (guz Pindborga).

The calcifying epithelial odontogenic tumor (CEOT) is a rare benign odontogenic neoplasm which was first described by Pindborg in 1955 representing only 1% of all odontogenic tumors. The tumor has an ectodermal odontogenic origin. This tumor are considered benign but can be locally aggressive in nature with recurrence rates of 10-15% reported. Surgical treatment varies from simply enucleation to partial resection of the affected bone. Since 1973 three cases only of the Pinborg tumor have been presented in the Polish literature. We described the case of a 44-year-old man with Pindborg tumor in the right maxilla. Standard x-ray examinations and CT scan were performed in order to obtain information about tumor's localization. Autors discuss the radiologic features of calcifying epithelial odontogenic tumor and treatment method and the relevant literature.