Modified Risdon approach using periangular incision in surgical treatment of subcondylar mandibular fractures.

Introduction: No consensus has been reached yet on the surgical approach for treatment of condylar fractures. Objective: The aim of this study was to present modified Risdon approach (without facial nerve identification) in the treatment of subcondylar mandibular fractures. Method: This is a retrospective study of a period 2005­2012. During this seven-year period, 25 condylar mandibular fractures in 22 men and three women (19­68 years old) were treated by modified Risdon approach without identifying the facial nerve. The main inclusion criterion was subcondylar fracture according to Lindahl classification. Results: No additional morbidity related to postoperative complications, such as infection or salivary fistula, was observed in this series. Only two (8%) patients developed temporary weakness of the marginal branch of the facial nerve, which resolved six weeks postoperatively. Each patient achieved good mouth opening postoperatively. Scar was camouflaged in the first cervical wrinkle. Two patients developed temporomandibular joint dysfunction. No patient had postoperative occlusal disturbance. In all of the patients good aesthetic result was achieved in a two-year follow-up. Conclusion: In comparison with techniques described in the literature, the main advantages of the modified Risdon approach are the following: no need for facial vessels identification; direct, fast, and safe approach to mandibular angle and subcondylar region; relatively simple surgical technique and good cosmetic result ­ due to aesthetically placed incision. This approach could be recommended for subcondylar fracture as a simplified and safe procedure.

Versatility of Radial Forearm Free Flap for Intraoral Reconstruction.

INTRODUCTION: The radial forearm free flap has an important role in reconstruction of the oncologic defects in the region of head and neck. OBJECTIVE: The aim was to present and evaluate clinical experience and results in the radial forearm free transfer for intraoral reconstructions after resections due to malignancies. METHODS: This article illustrates the versatility and reliability of forearm single donor site in 21 patients with a variety of intraoral oncologic defects who underwent immediate (19 patients, 90.5%) or delayed (2 patients, 9.5%) reconstruction using free flaps from the radial forearm. Fascio-cutaneous flaps were used in patients with floor of the mouth (6 cases), buccal mucosa (5 cases), lip (1 case) and a retromolar triangle (2 cases) defects, or after hemiglossectomy (7 cases). In addition, the palmaris longus tendon was included with the flap in 2 patients that required oral sphincter reconstruction. RESULTS: An overall success rate was 90.5%. Flap failures were detected in two (9.5%) patients, in one patient due to late ischemic necrosis, which appeared one week after the surgery, and in another patient due to venous congestion, which could not be salvaged after immediate re-exploration. Two patients required re-exploration due to vein thrombosis.The donor site healed uneventfully in all patients, except one, who had partial loss of skin graft. CONCLUSION: The radial forearm free flap is, due to multiple advantages, an acceptable method for reconstructions after resection of intraoral malignancies.

Madelung disease: a rare case associated with gynaecomastia and scrotal involvement.

Madelung disease is rare, and characterised by accumulation of fatty non-encapsulated tissue in the head, neck, shoulders, and upper extremities. The aetiology is not completely known, but the association with alcohol intake is clear. We present a neglected case that was associated with bilateral asymmetrical gynaecomastia. To the best of our knowledge, this is a pattern of involvement not previously reported. The treatment of choice is lipectomy for severe cases and liposuction for less extensive accumulations of fat.

Total mandibular reconstruction after resection of rare "honeycomb-like" ameloblastic carcinoma--a case report.

PURPOSE: This case report describes a rare and aggressive ameloblastic carcinoma that infiltrated the mandible in a "honeycomb" pattern. METHODS: A total mandibulectomy with bilateral modified neck dissection was followed by primary reconstruction with a single free vascularised fibula flap. RESULTS: The postoperative course was uneventful. The one year follow-up revealed no signs of recurrent tumour or metastases. Nine months later distant metastases occurred in the lung. CONCLUSION: Ameloblastic carcinoma is a highly malignant lesion, which requires aggressive therapy. Prognosis is poor. Further reporting of ameloblastic carcinoma is encouraged.