Julio Jesús Acero Sanz

Mandibular Reconstruction With Iliac Crest Free Flap, Nasolabial Flap, and Osseointegrated Implants

PURPOSE Oncologic patients undergoing segmental mandibulectomy with soft tissue resection develop several esthetic and functional sequelae; therefore, the defect must be reconstructed immediately. The iliac crest flap is the only flap that allows reconstruction of the previous dimensions of the mandible. However, the excessive soft tissue of this flap prevents optimal reconstruction of intraoral soft tissue defects. MATERIALS AND METHODS This report describes a reconstructive technique used in 12 patients who underwent segmental mandibulectomy because of soft tissue defects resulting from tumor resection. The technique involves reconstruction of the mandible using an iliac crest flap combined with a nasolabial flap to enable subsequent reconstruction of the intraoral soft tissue and immediate placement of osseointegrated implants. RESULTS The osseointegration success rate was 95.2% with a failure rate of 4.8%. Failure particularly affected the irradiated patients. Excellent functional and aesthetic results were obtained with the iliac crest free flap, nasolabial flap and osseointegrated dental implants. CONCLUSIONS This technique has several advantages. On the one hand, it enables reconstruction of the original dimensions of the mandible, thus allowing immediate placement of implants in an ideal position for subsequent rehabilitation with a dental prosthesis. On the other hand, the nasolabial flap provides a thin layer of tissue that can be used to reconstruct the anatomy of the oromandibular soft tissue.

Enteral nutrition in patients with tumours of the head and neck

Summary An evaluation is presented of the nutritional status of 30 patients out of the 45 submitted to head and neck surgery, involving the buccal cavity, in the Maxillofacial Surgery Service of the General Hospital “Gregorio Maranon” of Madrid, between October 1985 and December 1986, before and after being submitted to excision of a tumour in the head or neck, by administration, in the postoperative period, of a liquid comprehensive diet via a nasogastric catheter. Neither in the postoperative period nor after stopping the enteral nutrition was the existence of malnutrition detected, in any of the parameters studied. One patient inhaled gastric juice with a fatal outcome, while the rest of the patients had no severe complications. Therefore, we think that the administration of enteral nutrition in this kind of patient is very useful and is indeed necessary to avoid energy-protein malnutrition during the postoperative period. At the same time it avoids possible infection by food remaining in the oral cavity.

Reconstruction of the Cranio-Orbital Region

Treatment of tumors of the cranio-orbital region is a challenge for the surgeon. It requires appropriate presurgical evaluation and planning of the reconstructive approach in order to ensure a favorable cosmetic and functional outcome and prevent potentially fatal complications. One of the main objectives of reconstruction of defects of the cranio-orbital region is that of ensuring complete closure of the dura mater using well-vascularized tissue that separates endocranial structures from the upper aerodigestive tract. The incorporation of microvascular flaps has made it possible to reach this objective with a low complication rate. In the case of bone resection that alters facial harmony, restoration should be based on bone grafts or biomaterial implants. Virtual planning techniques and surgical navigation constitute a major advance in the reconstruction of craniofacial skeletal defects.

Functional Implant-Supported Dental Rehabilitation in Oncologic Patients

Functional restoration of the oral cavity after ablative surgery to treat cancer is one of the main challenges facing the head and neck surgeon. Reconstruction of teeth and bone and rehabilitation of occlusion play a key role in restoring quality of life. Osseointegrated implants have revolutionized reconstructive treatment in patients with cancer of the oral cavity, since they enable stabilization of dental prostheses.