G. De Riu

Delayed Iliac Abscess as An Unusual Complication of an Iliac Bone Graft in an Orthognathic Case

The reconstruction of large maxillofacial defects generally requires harvesting bone from extra-oral sites. The main source of autogenous bone is the iliac crest. This donor site is used to obtain bone for augmentation in orthopaedic surgery, neurosurgery, and oral and maxillofacial surgery, where the main indications are secondary and tertiary osteoplasty in patients with cleft-lip and palate, reconstruction of bony defects after operations for tumours, and augmentation of severe atrophy of the alveolar crest in preprosthetic surgery. A review of the literature on complications following bone harvesting from the anterior iliac crest reveals persistent pain, nerve injury, haemorrhage, limping, persistent gait abnormalities, conspicuous scarring, bone contour alteration, infection, fracture, meralgia paraesthetica, peritonitis, and herniation. The authors report an unusual complication: a huge iliac abscess that appeared 4 years after bimaxillary surgery involving iliac bone grafts.

Islanded facial artery musculomucosal flap for tongue reconstruction

We read with great interest the technical note by Joseph et al., concerning the use of a ‘‘technical modification to the FAMM flap” in order to reconstruct a post-ablative lingual side defect. This modification consists in the harvest of a buccinator myomucosal island flap pedicled on the facial vessels. The flap is then carried in the neck through a paramandibular passage and finally brought back into the oral cavity through a lingual tunnel. This modification allows the flap’s arc of rotation to be increased and avoids secondary pedicle section. Joseph et al. called this modified flap an ‘‘islanded FAMM flap”. We would like to congratulate the authors for reporting this technique, which has been developed and performed routinely in over 100 patients in our department since 2005. A description of the flap harvesting technique and the results of several studies performed by our group have been published previously. We named this flap the tunnelized facial artery myomucosal island flap (t-FAMMIF). Ayad and Xie, in an extensive review on the myomucosal flap that was cited by Joseph et al., certified our authorship of the t-FAMMIF, reporting the references to our works and an image of flap harvesting. We were somewhat surprised that the article by Joseph et al. refers to ‘‘propose a technical modification to the FAMM flap” that has already been described, and also to find that our papers were not cited in their references list. Their flap harvesting technique is absolutely identical to the technique that we have presented previously, and its application to tongue reconstruction, an area in which we

An elderly female patient with tardive oromandibular dystonia after prolonged use of the histamine analog betahistine

Tardive oromandibular dystonia (OMD) is iatrogenic in origin and is characterised by orofacial and lingual stereotypes more frequently than the idiopathic form of OMD Tardive OMD is often associated with anti-dopaminergic treatment involving drugs such as anti-psychotics, anti-emetics, and anti-vertigo agents, although the syndrome can also be triggered by anti-epileptic or anti-depressant drugs that do not have anti-dopaminergic properties. We report an elderly female patient with OMD after prolonged, self-administered treatment with betahistine dihydrochloride, a histamine analogue.

Soft palate functional reconstruction with buccinator myomucosal island flaps

Oropharyngeal reconstruction after ablative surgery is a challenge. The results of a retrospective study of 17 patients who underwent total or sub-total soft palate reconstruction with a buccinator myomucosal island flap, between 2008 and 2016, are reported herein. An analysis of flap type and size, harvesting time, and postoperative complications was performed. Patients underwent standardized tests to assess the recovery of sensitivity, deglutition, quality of life (QoL), and donor site morbidity, at >6 months after surgery or the end of adjuvant therapy, if performed. All flaps were transposed successfully. Only minor donor and recipient site complications occurred. The sensitivity assessment showed that touch, two-point discrimination, and pain sensations were recovered in all patients. Significant differences between the flap and native mucosa were reported for tactile (P=0.004), pain (P=0.001), and two-point discrimination (P=0.001) thresholds. The average deglutition score reported was 6.1/7, with only minimal complaints regarding deglutition. The QoL assessment showed high physical (24.6/28), social (25/28), emotional (19.1/24), and functional (24.6/28) scores. No major donor site complications were noted in any patient; the average donor site morbidity score was 8.1/9. Buccinator myomucosal island flaps represent a valuable functional oropharyngeal option for reconstruction, requiring a short operating time and presenting a low donor site morbidity rate.