Mandibular reconstruction with the scapula tip free flap.

INTRODUCTION: The scapula tip free flap has been described for reconstruction of short mandible defects with extensive soft tissue needs. The versatility of this flap has not been extensively described. METHODS: Retrospective case series of patients who underwent mandibulectomy and reconstruction with the scapula tip free flap from 2005 to 2016. Outcomes include bony union, complications, dental rehabilitation, and donor site morbidity. RESULTS: A total of 120 patients were identified. Average harvested bone was 7.7 cm, with 54% undergoing one osteotomy, and 76.7% harvested as a chimeric flap. Radiographically, average inset bone was 6.6 cm. Complete or partial bony union was observed at 74.4% of proximal and 82.6% of distal osteotomies. A 95% of reconstructions met criteria for dental implants. Mean disabilities of the arm, shoulder and hand score was 21.2. CONCLUSIONS: The scapular tip is an excellent option for reconstruction of segmental mandible defects with the option of osteotomy, excellent bony union rates, low donor site morbidity, and potential for dental rehabilitation.

Chronic osteomyelitis following an uncomplicated dental extraction.

The general dentist is usually the first health care practitioner to evaluate oral disease, initiate treatment and manage complications. Although rare, devastating outcomes of dental surgery can include Ludwig angina, mediastinitis, hemorrhage, necrotizing fasciitis, Lemierre syndrome and osteomyelitis. Osteomyelitis is a well known, but rare complication of dental extractions that can mimic multiple benign and malignant processes. In this case report, we review the diagnosis and management of an advanced postoperative mandibular osteomyelitis that developed following the removal of a mandibular third molar.

Clinical success in harvesting autogenous bone using a minimally invasive trephine.

PURPOSE: Autogenous bone grafting is well established for use in the maxillofacial skeleton. We present our experience with minimally invasive bone harvesting using a power-driven trephine, with favorable patient and clinical results. MATERIALS AND METHODS: This retrospective study evaluation patients requiring autogenous bone harvested using a trephine, treated consecutively over a 3-year period. Mean patient age was 27.2 years (range, 8 to 77 years). Only those patients requiring elective surgery and admission on the same day were included in the study. Intraoperative assessment included the description of complications and the quantity and volume of the bone cores harvested. The complications monitored included bleeding, nerve injury, and perforation of the medial or lateral walls of the ilium. Postoperatively, patients were assessed for ambulation, pain, bleeding, and suitability for discharge. The patients were evaluated 1 week after surgery and were examined for wound complications (incision breakdown, infection, paresthesia, pain) and ambulatory deficits. All patients were then surveyed using a questionnaire outlining short-term (1 to 14 days), and long-term (>6 months postoperative) deficits, pain, and general remarks about the procedure. RESULTS: A total of 84 patients underwent bone harvesting using a power-driven trephine. Bone was harvested from a total of 86 anterior iliac crest sites, for a total of 333 cores (3.96 cores per patient). Forty-one patients were discharged on the day of surgery. Intraoperatively, the volume of bone obtained ranged from 3 to 21 mL per harvest site (1 to 7 cores, 4 mm x 30 to 38 mm). The bone volume obtained was dependent on the size of the defect to be filled. Intraoperatively, 1 complication occurred (1 of 333 cores; 0.3%)-a broken instrument-and there were no perforations of the medial or lateral walls of the ilium or excessive bleeding. The complications totaled 3 (3.6%); none of these produced long term effects. Patients surveyed up to 6 months postoperatively noted positive results. CONCLUSIONS: The harvesting of bone from the anterior iliac crest using a power driven trephine appears to be safe and results in minimal morbidity and ample bone volume for many maxillofacial procedures, without delaying discharge from hospital.