Stereoscopic lithography: customized titanium implants in orofacial reconstruction. A new surgical technique without flap cover.

Head and neck surgery may involve complex methods of composite reconstruction that do not replicate the volume and contour of the normal anatomy. 'Functional' reconstruction implies replication of the normal volume and contour of both hard and soft tissues to produce normal form and function of the face, mouth and jaws. Techniques such as stereoscopic lithography and computer-assisted design, and-manufacture (CAD-CAM) have been successfully used with computer-numerized control (CNC) milling to manufacture customized titanium implants for single-stage reconstruction of the maxilla, hemimandible and dentition without the use of composite flap cover after the removal of tumours. Reduction in theatre time and personnel, less need for intensive care, and earlier discharge from hospital, indicate possible savings of Pound Sterling 17,000-Pound Sterling 19,000 per patient. There are implications for surgery in general, and further research and development is advocated.

Mucous retention cyst of the soft palate: a case presentation.

This article describes a mucous retention cyst of the soft palate associated with an over-extended complete maxillary denture. The clinical and anatomical relevance of the fovea palatinae are discussed with respect to the posterior palatal seal and post-dam positioning.

Lymph node micro-metastasis: an investigation, including three-dimensional reconstruction.

The mechanism by which malignant cells metastasis to, and colonise, regional lymph nodes is not known. In an attempt to characterise micro-deposits an affected lymph node associated with a primary intra-oral squamous cell carcinoma was studied. Three-dimensional reconstructions of the node and micro-tumour were made and the relationships and distribution of apparently isolated malignant cells present within the node studied. Semi-serial ethanol-fixed paraffin was sections of the node were stained with monoclonal antibody AE3 (cytokeratin). Outlines of the node and occupying micro-tumour were traced onto polystyrene tiles and onto acetate sheets, permitting the construction of both a solid and a transparent three-dimensional model. Additionally, the positions of apparently 'isolated' AE3-positive malignant cells were noted. The solid reconstruction showed that the micro-tumour deposit grew most quickly into the node via the septa and more slowly around the subcapsular region. The transparent reconstruction was less useful. Most isolated, individual malignant cells were found in the peripheral margin of the node.

The facial nerve function coefficient: analysis of 100 normal subjects.

The Facial Nerve Function Index (FNFI) is a measure of asymmetrical facial movement and is a quick and easy method of monitoring the improvement of function in patients with facial nerve palsy. However, purely as a consequence of the way the index is formulated, and not primarily because of any tendency to biological asymmetry favoring one particular direction in the population, the FNFI has a highly skewed distribution. To remove the inherent asymmetry of the index, a modified index, the Facial Nerve Function Coefficient (FNFC), for which a symmetrical distribution is obtained, is proposed. A reference range for this index was derived.

Malignant melanoma of the oral cavity. A case report.

The oral cavity is a rare location for the development of primary malignant melanoma. Less than 2% of all malignant melanomas develop in the region. A case report is presented, illustrating the management in the site of the palate, together with a review of the relevant literature.

Pectoralis major muscle flap with bone graft in intra-oral reconstruction.

The use of the pectoralis major muscle only flap in conjunction with a free iliac crest bone graft for reconstruction of the mandible is described. These flaps were raised in 20 cadavers and found to be of consistently adequate length to be used as described.

Facial nerve function index: a clinical measurement of facial nerve activity in patients with facial nerve palsies.

An objective clinical assessment of facial nerve function is described in terms of a facial nerve function index (FNFI). This index is useful in monitoring the return of facial nerve function in patients with facial nerve palsies.

The pectoralis major muscle flap without skin in intra-oral reconstruction.

There are many methods of reconstructing intra-oral defects following surgical treatment of cancer. A very reliable flap is the pectoralis major myocutaneous flap which has the added advantage of carotid artery protection when a radical neck dissection has also been necessary. However this flap is very bulky, may cause distortion of the female breast and there is also the problem of continued hair growth in male patients. A description of the use of the pectoralis major muscle-only flap without any overlying skin, fascia or breast tissue is given. The advantages of rapid epithelialisation within the mouth of the muscle flap together with the minimal changes to the breasts are emphasised.

Reconstruction of the palate using bilateral temporalis muscle flaps: a case report.

The functional deformity following removal of the maxilla is considerable. Rehabilitation used to be very difficult with prostheses or traditional flaps. Temporalis muscle flaps have been described for reconstruction following hemi-maxillectomy, but not total maxillectomy. A case is now presented to illustrate the use of bilateral temporalis muscle flaps following almost total removal of the maxilla at a Le Fort I level.

Eosinophilic granuloma of the mandibular condyle.

An extremely rare location for eosinophilic granuloma of bone in the mandibular condyle has been described, illustrating the difficulties of diagnosis. Excision and reconstruction with a costochondral graft was successfully undertaken and remodelling of the graft occurred with the formation of a new condylar head. The patient is disease-free 17 months after surgery. The relevant literature is reviewed and suggestions made for management protocol.