Tissue-engineered oral mucosa grafts for intraoral lining reconstruction of the maxilla and mandible with a fibula flap.

PURPOSE: Many types of soft tissue grafts have been used for grafting or prelaminating bone flaps for intraoral lining reconstruction. The best results are achieved when prelaminating free flaps with mucosal grafts. We suggest a new approach to obtain keratinized mucosa over a fibula flap using full-thickness, engineered, autologous oral mucosa. PATIENTS AND METHODS: We report on a pilot study for grafting fibula flaps for mandibular and maxilla reconstruction with full-thickness tissue-engineered autologous oral mucosa. We describe 2 different techniques: prelaminating the fibula flap and second-stage grafting of the fibula after mandibular reconstruction. Preparation of the full-thickness tissue-engineered oral mucosa is also described. RESULTS: The clinical outcome of the tissue-engineered intraoral lining reconstruction and response after implant placement are reported. A peri-implant granulation tissue response was not observed when prelaminating the fibula, and little response was observed when intraoral grafting was performed. CONCLUSION: Tissue engineering represents an alternative method by which to obtain sufficient autologous tissue for reconstructing mucosal oral defects. The full-thickness engineered autologous oral mucosa offers definite advantages in terms of reconstruction planning, donor site morbidity, and quality of the intraoral soft tissue reconstruction, thereby restoring native tissue and avoiding peri-implant tissue complications.

Minimally invasive surgically assisted rapid palatal expansion with limited approach under sedation: a report of 283 consecutive cases.

PURPOSE: An adequate transverse maxillary dimension is one of the critical aspects of a functional and stable occlusion. Surgically assisted rapid palatal expansion consists of a surgical liberation of the sites of resistance combined using orthopedic forces. Most technical descriptions advocate the use of general anesthesia with hospital admission. MATERIALS AND METHODS: Between March 2000 and July 2008, surgery was performed on 283 consecutive cases with transverse skeletal maxillary hypoplasia. The incision ran horizontally to reach the level of the laterals. Osteotomies of lateral walls and pterygoid disjunction were performed in all cases. A V-Y closure was performed in 2 layers. Patients were discharged after recovery from sedation. RESULTS: One hundred seventy-two of the 283 patients were male. Mean age was 18.3 years. Mean surgical time from incision to last suture was 19 minutes. Expanders were Hyrax in 221 cases and Haas in 61, and a bone-borne expander was used in 1 case. At the 1-year follow-up visit, mean expansion was 8.0 at the canines and 8.9 at the mesiovestibular cuspid of the first molar. General anesthesia has been classically advocated for these procedures, the argument being that pterygomaxillary disjunction was too traumatic to be performed under sedation. The surgical technique used sought to attain a balance between maximum mobilization of the maxilla with a complete liberation of all the buttresses and minimum morbidity to avoid further complications. CONCLUSIONS: The new technique that we report seeks to combine both aspects and allows for rapid intervention with local anesthesia plus sedation and a minimal approach with a total liberation of the maxillary resistances (piriform aperture pillars, zygomatic buttresses, midpalatal suture, and pterygoid junctions). The minimal approach and incision used in the technique guarantee vascular support to the maxilla via the vestibular corridors.