Ikenna Valentine Aboh

Scapula free flap for complex maxillofacial reconstruction.

Introduction:Composite tissue defects of the mandible and maxilla, after resection of head and neck malignancies, osteoradionecrosis, malformations, or traumas, cause functional and aesthetic problems. Nowadays, microvascular free flaps represent the main choice for the reconstruction of these defects. Among the various flaps proposed, the scapula flap has favorable characteristics that make it suitable for bone, soft tissue, or combined defects. Materials:We report 7 cases of reconstruction of complex maxillofacial defects with subscapular system flaps. The patients treated had Romberg syndrome (1 case), malignant tumors (5 cases), and result of previous trauma (1 case).Location of deficit was the maxilla (3 cases), the mandible (2 case), the ethmoidal-maxillary region (1 case) and the upper and middle thirds of the face in the last case. Methods:In 2 cases, a parascapular system flap was used; in 5 cases, a composite flap with latissimus dorsi muscle and scapular bone. Results:Neither failure of the harvested flaps nor complications in the donor site were evidenced. A good aesthetic and functional outcome was obtained in all cases. Discussion:Many free flaps have been proposed for the reconstruction of defects in the maxillofacial region such as fibula, deep circumflex iliac artery, scapula, among the bone flaps; and forearm, rectus abdominis, and anterolateral thigh, among the soft tissue flaps. The choice of the flap to use depends on the length of the bone defect and the amount of soft tissues required. The subscapular system has the advantage of providing different flaps based on the same pedicle. The osteofasciocutaneous scapular free flap, in particular, allows wide mobility of soft tissues (parascapular flap) with respect to its bone component (scapular bone), resulting suitable for defects of large size involving both the soft tissues and the bone. Conclusions:Although the fibula flap and the deep circumflex iliac artery flap remain the first choice for bone reconstructions of the mandible and maxilla, the scapula flap has some features that make its use extremely advantageous in some circumstances. In particular, we advocate the use of the osteomuscular latissimus dorsi-scapula flap for reconstruction of large-volume defects involving the bone and soft tissues, whereas fasciocutaneous parascapular flaps represent a valid alternative to forearm flap and anterolateral thigh flap in the reconstruction of soft tissue defects.

Iliac crest flap: donor site morbidity.

Introduction:Starting from the 1980s, with the advent of microsurgery, microvascular flaps are used for the reconstruction of wide and complex bone defects of the maxillomandibular district. Compared with conventional and implant-supported prostheses, the free flaps allow aesthetic-functional rehabilitations more adapt to answer to problems that these wide disablements involve. The anatomic characteristics of the crest flap make it one of the best available flap in the maxillomandibular bone reconstruction. Methods:The authors introduce a retrospective analysis of their own experience in the reconstruction of wide and complex bone defects of the maxillomandibular district. Specifically, the attention is focused on the use of the iliac crest flap. The surgical technique of flap preparation is discussed. Moreover, a review of results from international studies about the morbidity of the donor site is presented and compared with own experience. Result:As reported in the literature, the iliac crest flap donor site may encounter several complications. Among these, chronic pain, loss of regional sensibility or paresthesias, hematoma, seroma, walking troubles, unaesthetic scars, abdominal hernia, and loss of the normal bone profile of the hip. Discussion:At present, the use of the iliac crest free flap in the microvascular reconstruction of the complex deficits of the maxillomandibular district represents a well-established method in the experience of the maxillofacial surgeon. Several information about results obtained in the maxillomandibular rehabilitation are available from the literature; however, little attention has been addressed to complications and morbidity of the donor site. Such aspect will be discussed in this work.

Complications of Orbital Floor Repair With Silastic Sheet: the Skin Fistula

AbstractTreatment of orbital floor fracture is a subject of great interest in maxillofacial surgery. Many materials have been described for its reconstruction.In this article, the authors report a case of a patient who, 7 years from a previous orbital floor fracture and treatment with silastic sheet, presented herself to their clinic for the failure of the material used for its reconstruction and a skin fistula.Orbital floor repair with silastic sheet is an old method that no one uses anymore, but we still observe cases of late complications with this material. So a fine knowledge of silastic sheet complications is needed for young surgeons.The authors report the case and perform a literature review about the use of more modern biomaterials for orbital floor reconstruction.

Naked microvascular bone flap in oral reconstruction

AbstractSince the 1980s, bone free flaps have been used to reconstruct the maxilla and the mandible. The vascular pedicle, through the supply of nutritional substances and drugs from the bloodstream, ensures the vitality of the flap, rapid bone integration, and reduced risk of infection.However, due to many surgeons’ concerns about orocervical and orosinusal fistulas and infections, bone flaps are usually buried and protected by mucosal flaps or a second skin flap whenever it is not possible to harvest a skin paddle together with the bone flap.The authors, convinced that naked bone free flaps, if well vascularized, are capable of healing and repairing the osteomucosal deficit on their own, with no risk of infection or fistulas, began to harvest, for oral reconstructions, naked bone flaps, that is, bone flaps covered only by a muscle layer 5 to 20 mm thick.In this study, the authors present a review of their experience in oral cavity reconstructions by harvesting naked and covered bone free flaps, retrospectively evaluating the occurrence of major and minor, early and late complications, associated with the different reconstructive technique.

Inferior alveolar nerve lateralization: A dual technique

Dear Editor We read the article ‘Rehabilitation of edentulous posterior atrophic mandible: inferior alveolar nerve lateralization by piezotome and immediate implant placement’ by Fernández Dı́az & Naval Gı́as with great interest, and we congratulate the authors for their review of inferior alveolar nerve lateralization (IANL) and for describing the challenges in re-using an updated technique. The use of piezosurgery is an appealing concept in maxillofacial surgery due to the frequent proximity of the bone surgical site to the nerve and/or vascular tissues; many studies have suggested this application in implant surgery, and have reported satisfactory in vivo and in vitro results compared with the bur technique. In the discussion section, Fernández Dı́az and Naval Gı́as refer to the common habit of the surgeon to choose techniques based on their own experience. We partially agree with this concept, as young surgeons and researchers often introduce new techniques or use validated theories from other medical disciplines to find better postoperative outcomes; hence this appears to be a related condition, more due to the specific personal characteristics of some surgeons than to a common habit. Fernández Dı́az and Naval Gı́as discuss mandibular atrophy, a common case in prosthetic dentistry, and refer to the occurrence of vertical bone resorption and postoperative infections due to wound dehiscence as complications in mandibular bone grafts that could suggest the use of IANL to obtain the needed vertical bone instead. They also relate the use of a sandwich technique as a key factor in decreasing the occurrence

LEOPARD syndrome: maxillofacial care.

This article reports a case of a boy with LEOPARD syndrome with unusual mandibular osteolytic osteoclastic-like lesions and eruption disorder. The patient was referred to our department for bilateral facial swelling: systemic examinations, diagnosis, and dental and maxillofacial care are reported.

Giant palatal schwannoma.

Schwannoma is a benign tumor that arises from nerves that contain Schwann cells. We report a case of giant schwannoma of the hard palate, which originated from the greater palatine nerve and is interesting for its large dimensions.

Role of a new orthognathic surgery in maxillomandibular reconstruction by free flaps.

Purpose: The objective of this study was to describe the orthognathic surgery techniques for the treatment of occlusal anomalies in those patients who underwent complex maxillomandibular reconstruction with bony free flap. Materials and Methods: The authors describe their personal technique developed over years of experience with reconstruction of mandibular defects with bony free flaps. Results: The outcomes in these patients who were treated according to our surgical planning were completely satisfying, with a 100% stability of the treated bones. Conclusions: Orthognathic procedure on bony free flaps for the reconstruction of mandibular defects is nowadays accepted. Patients who underwent major mandibular destruction due to oncologic disease or trauma outcomes can now benefit from this technique.

Relationship Between the Quantity of Nerve Exposure During Bilateral Sagittal Split Osteotomy Surgery and Sensitive Recovery

Aim and Objectives: The purpose of this study was to evaluate how different exposures of the V3 nerves during orthognathic surgery impact neurosensory disturbances. Methods: The study included 127 patients who underwent either bilateral sagittal split osteotomy (BSSO) or BSSO with maxillary le Fort 1. They were divided into 6 groups, identified by the quantity of V3 nerve exposure. All patients were examined in a pre-op period and again after 1, 3, 6 months post-op. The standardized tests used were to clarify the objective and subjective neurosensory status of the exposed nerve. Neurosensory evaluation included; a pin prick test, the 2 points discriminator, light touch, warm and cold tests, and blunt discrimination. They were all done bilaterally on the lower lip area. Results: In only 2 patients the nerve was damaged during surgery and thus they were not included in this study. In 10.2% of patients there was no nerve exposure, 25.2% had longitudinal vestibular segment nerve exposed, 22.8% had the longitudinal upper-vestibular segment exposed, 20.5% had the longitudinal lower-vestibular segment exposed, 14.2% had the longitudinal upper-lower-vestibular segment exposed, and in 7.1% of patients the nerve was totally exposed. Given the estimated time of 1 month there was 100% recovery in patients whose nerve was unexposed. Considering the other patients, the authors had a variable number of patients who did not recover completely. Conclusion: The authors estimate a correlation between the recovery time and the quantity of the exposed nerve. There is a high incidence of neurosensory disturbance in the lower lip and chin after BSSO and intraoperative quantity of nerve exposure.

Postsurgical predictive theoretical thickness (PTT) of frontal sinus anterior wall as key point in surgical management of frontal bossing: Proposal of a new analytic method

BackgroundFrontal bossing is a malformation characterized by peculiar prominent forehead, and commonly it can be associated with cranial synostosis and endocrine disorder; however, nonsyndromic conditions are described as well.Literature controversies on proper frontal bossing surgical treatment showed evidence of 2 main surgical procedures: frontal bone reshaping and bone en bloc mobilization.A decision-making criterion between these 2 techniques has never been described in literature. MethodsIn this paper, the authors introduce their brand-new analytic method for decision-making between bur shaping and en bloc mobilization in frontal bossing treatment, and describe a successful case of a nonsyndromic frontal bossing patient, treated with their unconventional surgical technique. ResultsOur analytic method indicated that bur shaping was not indicated in this particular case: aggressive remodeling of excessive thin wall could lead to sinus perforation, which could turn into unsatisfied aesthetic and functional outcome.So we planned for a bilateral orbitofrontal en bloc reposition, followed by internal rigid fixation. No postoperative complications occurred. Postoperative CT scan revealed good bone repositioning and recovery. ConclusionsThe authors explained their analytic method based on careful presurgical CT-scan measurements for decision-making between bur shaping and en bloc mobilization.