Preliminary clinic study on computer assisted mandibular reconstruction: the positive role of surgical navigation technique.

BACKGROUND: The objectives of the present study were to investigate the reliability and outcomes of computer-assisted techniques in mandibular reconstruction with a fibula flap and verify whether the surgical navigation system was feasible in mandible reconstructive surgery. METHODS: Eight cases were enrolled in the computer assisted surgery (CAS) group and 14 cases in the traditional group. The shaping and fixation of the fibula grafts were guided by computer assisted techniques, which could be monitored with the BrainLAB surgical navigation system. The variation of mandible configuration was evaluated by CT measurement in the Mimics software, including the variation of length, width, height and gonial angle of the mandible. The 3D facial soft tissue alteration was also analyzed in 3D chromatogram by Geomagic software. RESULTS: All 22 fibula flaps survived. The mandibular configurations and facial contours had a better clinic result in the CAS group. The length, width, height and gonial angle of the reconstructive mandible were more similar to the original one. The Wilcoxon rank sum test analysis suggested significant differences in the measurements. The chromatographic analysis also visually showed superiority over the traditional group. CONCLUSIONS: The computer assisted surgical navigation method used in mandibular reconstruction is feasible and precise for clinical application. The contour of the reconstructed mandible and facial symmetry are improved with computer techniques.

Fibular free flap reconstruction for the management of advanced bilateral mandibular osteoradionecrosis.

Fibular osteoseptocutaneous flap has been widely used for unilateral mandibular reconstruction. However, reports about the effects of fibular osteoseptocutaneous flap for the reconstruction of bilateral mandibular defects are limited. In this study, we used free vascularized fibular flaps to successfully manage bilateral mandibular osteoradionecrosis(ORN) in 5 patients. Functional aspects were evaluated during the reconstruction process. All 5 patients had bilateral refractory ORN of the mandible and underwent radical resection between 2003 and 2011. The reconstruction surgery was performed in 2 stages using 2 free fibular flaps in 3 patients. In the other 2 patients, reconstruction was performed in a single stage using 2 separate flaps prepared from a single fibula. All patients had a healthy mandibular symphysis and meniscus of the temporomandibular joint, and these structures were preserved during the reconstruction.Of the 10 defects involving the mandible sides, 9 were successfully reconstructed. One microvascular composite flap failed because of radiation injury to the arterial endothelium at the recipient site. After the treatments, all patients had good esthetic and functional outcomes. Preoperative clinical features such as trismus and dysphagia were also markedly improved. Our surgical method may be an effective alternative for the clinical management of advanced bilateral mandibular ORN.

[Electromyographic monitoring of facial nerve during parotid surgery].

OBJECTIVE: To analyze the benefits of facial nerve electromyographic monitoring during parotid tumor surgery. METHODS: In the study, 92 patients with parotid tumor who underwent surgery were surveyed. The study group consisted of 46 patients who underwent intraoperative electromyographic monitoring, and 46 patients served as the control group. The incidence of postoperative facial nerve weakness and the operation time were recorded. RESULTS: In the primary parotid tumor resection,the operation time of the study group (6 cases)was (50.0 ± 9.1) min, that of control group (7 cases) was (42.9 ± 5.2) min (P = 0.064) when the facial nerve needed no dissecting; the operation time of the study group (32 cases)was (74.7 ± 28.0) min, that of control group (33 cases) was (75.6 ± 29.8) min (P = 0.893) when the facial nerve needed dissecting. For the patients with revision surgery, the mean operation time in the study group [(117.5 ± 37.8) min] was significantly lower than that of the control group [(175.0 ± 47.8) min], P < 0.05. In the study group, 8 patients suffered from postoperative facial nerve weakness because of tumor characteristics; in the control group, 6 patients suffered from postoperative facial nerve weakness, with 4 cases because of tumor characteristic, and 2 cases because of operator error. CONCLUSION: The results suggest that continuous electromyographic monitoring of facial nerve during parotidectomy reduces the mean operation time in patients with revision surgery, but not the incidence of postoperative facial paralysis.

[Surgical treatment of transected peripheral facial nerve injury].

OBJECTIVE: To evaluate the results of peripheral facial nerve reconstruction by surgical treatment and determine the influence factors for recovery. METHODS: From 1999 to 2009, 104 patients underwent surgical rehabilitation for transected peripheral facial nerve injury in the department of oral and maxillofacial surgery, Peking University School and Hospital of Stomatology. The age ranged from 2 to 77 years with a median age of 30 years. Sixty-five of the 72 cases (90.2%) who underwent facial nerve anastomosis and 24 of the 32 patients (75.0%) underwent facial nerve grafting. All these patients were followed for the final results. Facial nerve function was scored by the gross and regional House-Brackmann (HB) facial grading system. Statistical analysis was performed using SPSS 13.0 software package by χ2 test or Fisher exact test. RESULTS: In the facial nerve anastomosis group, HB I, HB II, HB III and HB IV function were achieved in 37 (56.9%), 11 (16.9%), 15 (23.1%) and 2 (3.1%) patients respectively. The regional grades showed that the recovery rate of HB I and II were 27.3% in forehead, 97.6% in eye region, 97.9% in midface and 78.6% in the mouth region. In the facial nerve grafting group, HB grades I, II, III and IV were achieved in 4 (16.7%), 5 (20.8%), 7 (29.2%) and 8 (33.3%) patients respectively. By regional HB grades, HB I and II rate were 37.5% in forehead, 73.7% in eye region, 72.7% in midface, 44.4% in mouth region. The facial nerve anastomosis group had a higher HB I and II recovery rate than facial nerve grafting group (P=0.002). CONCLUSION: Facial nerve anastomosis and facial nerve grafting are effective surgical options for transected peripheral facial nerve injury. The site and range of facial nerve injury, the time post onset until repair, and the age of patient are factors that influence the clinical outcomes.

Efficacy of functional training of the facial muscles for treatment of incomplete peripheral facial nerve injury.

OBJECTIVE: To investigate the efficacy of functional training of facial mimic muscles for patients with incomplete peripheral facial nerve injury. METHODS: Ninety-two patients with 241 injured branches of incomplete peripheral facial nerve injury were divided into a treatment group and a control group. The treatment group consisted of 58 cases that received functional training of facial mimic muscles. The rest of the cases served as controls. Assessment parameters included the House-Brackmann grading system, a quantitative facial nerve function estimating system and electroneurography. According to the three assessments, the facial nerve injury was divided into four grades: normal, minor, moderate and severe. The treatment group started training facial mimic muscle activity 2 weeks after facial nerve injury. After follow-ups of 1 to 4 years, the outcomes were statistically analysed. RESULTS: In the minor facial nerve injury group, there was no significant difference in the time needed for initial recovery (Ti, the time needed for significant recovery of the facial nerve function after injury) and final recovery (Tf, the time point after which no further improvement of facial nerve function was obtained) between the two groups (P > 0.05). No adverse effect was found in these cases. In the moderate facial nerve injury group, the Ti and Tf of the treatment group were shorter than those of the control group (P < 0.05). One case had synkinesis. In the patients with severe facial nerve injury, the recovery rate of facial nerve function in the treatment group was higher than that of the control group and the sequelae were less. CONCLUSION: Functional training of facial mimic muscles cannot shorten the time of recovery for the patients with minor facial nerve injury but it can speed up the recovery and reduce the undesirable sequelae such as synkinesis and hemifacial spasm for the patients with moderate and severe facial nerve injury.

One-stage operation for noma-induced bilateral ankylosis accompanied with mouth verrucous carcinoma - a case report and review of literature.

A rare case of a male patient who suffered from noma with sequelae of ankylosis in bilateral temporomandibular joints for 52 years and a neoplasm in the right commissure of the lips for 1 year, was operated on to resolve the ankylosis, remove the neoplasm and reconstruct the soft tissue defect with a forearm flap through a one-stage operation. The neoplasm pathology was verrucous carcinoma.

[Clinical analysis of 182 cases with facial nerve injury].

OBJECTIVE: To investigate the recovery patterns and the influencing factors of facial nerve injury in maxillofacial surgery by retrospective analysis of a serial clinical data. METHODS: A total of 182 patients with facial nerve injury were reviewed. The cause of injury, the initial facial nerve function after trauma, the treatment, the initial recovery time of facial nerve function and the total recovery time were recorded. The factors that influenced the outcome of facial nerve function were analyzed. RESULTS: The facial nerve branch injury was common in maxillofacial injury. The injury pattern, location, age and reconstruction time all had effects on the function recovery of the facial nerve. Within 6 months, 45 of 49 (92%) anatomic injured patients completely recovered in 6 months; 53 of 59 patients (90%) began to recover when nerve had been ruptured. In 12 months, 33 of 35 patients (94%) after nerve anastomosed and 5 of 8 patients (62%) with nerve transplantation got complete recovery. CONCLUSIONS: Preserving the facial nerve during surgery is very important. If the facial nerve is injured, reconstructive surgery should be applied as soon as possible.