A comparative study between submandibular-facial artery island flaps (including perforator flap) and submental artery perforator flap: A novel flap in oral cavity reconstruction.

OBJECTIVE: The purpose of this study was to introduce submandibular-facial artery island flaps (S-FAIF), including the perforator flap, and to evaluate their application for intraoral reconstruction in comparison with submental artery perforator flaps (SMAPF). METHODS: Ninety-six patients who underwent intraoral reconstruction using an S-FAIF (n = 34) or SMAPF (n = 62) after cancer resection were recruited in this study. The flap characteristics (viz., pedicle length, flap size, venous drainage pattern, and harvest time), short-term outcomes (viz., flap partial loss, intraoral wound dehiscence, fistula, and wound infection), and long-term morbidity (viz., facial nerve palsy, neck motion restriction, and hair growth) were compared. RESULTS: Nine S-FAIFs were authentic perforator flaps pedicled by level Ⅰ facial artery perforators, while the rest were island flaps based on level Ⅱ facial artery perforators. The survival rates of S-FAIF and SMAPF were both 100 percent. Flap partial loss occurred in two patients in each group. The pedicle length of S-FAIF was shorter than that of SMAPF (p < 0.001). Statistics analysis revealed no significant difference regarding flap size, venous drainage pattern, short-term outcomes, neck motion restriction, or facial nerve palsy between the groups. S-FAIF required less harvest time (p < 0.001) and experienced less hair growth when compared to SMAPF (p = 0.011). CONCLUSIONS: The S-FAIF is a robust and reliable novel flap and on par with SMAPF for reconstruction of small and medium-sized intraoral defects. It is preferred to SMAPF when technical requirements for flap harvest and hair problems are considered. It should be supplemented to the armamentarium for intraoral reconstruction.

Reconstruction of complex orbital fracture with titanium implants.

AIM: To evaluate the effectiveness and safety of complex orbital fracture reconstruction with titanium implants. METHODS: A retrospective review of 46 patients treated with complex orbital fractures reconstruction using titanium implants from January 2005 to December 2008 was conducted. The following data were recorded: age, gender, mechanism of injury, preoperative and postoperative orbital CT, visual acuity, diplopia, ocular motility and Hertel exophthalmometer. RESULTS: The most common cause was motor vehicle accident (47.8%), followed by industrial injury (30.4%). All patients had improved appearance after operation and CT scan at one week after operation showed the fracture defects of orbit and neighboring areas had been reconstructed. Forty-six cases had various degrees of enophthalmos before operation. Among them, 32 cases were completely corrected, 11 cases improved obviously and 3 cases had no improvement after operation. Thirty-six patients with visual acuity ≥20/60 revealed diplopia of various degrees, including 26 patients had diplopia in right ahead and/or reading positions. At the sixth month after operation, diplopia disappeared in five patients, 7 patients still had diplopia in right ahead and/or reading positions, 14 patients had diplopia in positions rather than right ahead and reading positions (<20°) and ten patients had diplopia only at peripheral gazing (>20°). All patients had various degrees of ocular motility disorders before operation. At the sixth month after operation, eyeball movement disorder disappeared in 9 patients, 31 patients showed improvement and 6 patients had no improvement. Complications of implant infection, rejection and displacement were not reported after operation. CONCLUSION: The application of titanium implants in the repair of complex orbital fractures greatly improves the appearance and functional results, which is a favorable material for plastic surgery of complex orbital fracture.

[Maxillofacial deformity caused by cancrum oris: a case report].

Cancrum oris is a kind of gangrenous disease happening on the maxillofacial region. It is characterized by developing rapidly, high lethality and deforming rate. This article reported a case of maxillofacial deformity caused by cancrum oris, and discussed based on relevant literatures.

[An investigation of restoration of alveolar cleft with engineered bone].

OBJECTIVE: To investigate restoration of alveolar cleft with engineered bone constructed by sponge collagen protein combined bone mesenchymal stem cells (BMSC). METHODS: Twelve dogs were divided into 4 groups, the third incisor and alveolar bone with periosteum in bilateral maxilla were removed to form alveolar cleft model. The BMSCs were isolated from dog bone marrow. After being cultured and induced, the BMSCs were seeded in sponge collagen protein and cultured for 48 hours. The composites of BMSCs and collagen were implanted into the defect of alveolar cleft. After 12 weeks' feeding, those dogs were sacrificed. Three-dimensional CT and histological examination were used to observe the progress of bone formation. RESULTS: The defects healed at 12 weeks after being implant BMSCs-collagen composites, the width of engineered bone is resembled with positive control, but the height is less than positive control. CONCLUSIONS: The engineered bone can restore the defect of alveolar bone effectively, it can be used clinically to treat alveolar cleft.

[Effect of surgically induced bilateral cleft alveolar on maxillary growth in dogs].

OBJECTIVE: To establish an animal model of bilateral alveolar cleft and to determine the effect of cleft on maxillary growth. METHODS: Eight dogs (12 weeks old) were divided into unoperated control groups (n = 4) and the model group (n = 4). The model dogs were operated to establish a bilateral alveolar cleft. All the dogs were killed and the craniofacial morphology on clean skull was analyzed by the direct detection and CT. RESULTS: The length, the foreside width, and the foreside height of the maxillary in the model group were shrunken compared with those of the control group (P < 0.05). CONCLUSION: The alveolar cleft plays an important role in the maxillary aberration.