Kazuhiro Yagihara

Complications and Outcome of Free Flap Transfers for Oral and Maxillofacial Reconstruction: Analysis of 213 Cases

Abstract Microvascular free flap transfers have become a preferred reconstructive technique; however, rare complications may still prove devastating. This study reviewed 213 consecutive freetissue transfers in order to assess the incidence and causes of complications in patients undergoing microvascular free flap reconstruction in the oral and maxillofacial region. In most cases, reconstruction was undertaken after resection of a malignant tumor. The flap donor sites were the radial forearm (n=111), rectus abdominis (n=88), scapula (n=13), and latissimus dorsi (n=1). The superior thyroid artery and the external jugular vein were commonly used as recipient vessels for anastomosis. The overall flap success rate was 99%. There were 7 cases of postoperative vascular thrombosis (6 venous and 1 arterial), constituting 3.3% of the entire series. Five flaps were salvaged, representing a 71.4% successful salvage rate in cases of vascular complications. Most of the successful salvage attempts were made within 24 hours of the end of the initial operation, and the successful salvage rate for re-exploration was 100%. Finally, the total flap loss rate was 0.9% and the partial flap loss rate was 2.3%. We conclude that early re-exploration should be the first choice for management of vascular compromised flaps. Complications at the donor site occurred in 17 cases (8.0%), the most common complication of which was partial skin graft loss after harvesting a radial forearm flap (n=10; 9.0%). Recipient and donor site morbidity was limited and considered acceptable.

A case of necrotizing sialometaplasia clinically mimicking a malignant tumor of the palate

Abstract Necrotizing sialometaplasia is a rare lesion that mimics malignant neoplasm, which is characterized by salivary gland metaplasia, necrosis, and inflammation. We present a case of necrotizing sialometaplasia that presented as an ugly ulcer at the junction of the soft and hard palates; the lesion was clinically suspected to be a malignant lesion. A 62-year-old man was referred to our department with a complaint of severe pain during swallowing. A crater-like ulcer lesion was observed extending from the maxillary tuberosity to the soft palate. Histopathological diagnosis of necrotizing sialometaplasia was confirmed on biopsy. This lesion was spontaneously relieved.

Application of Regenerative Medicine to Mandibular Reconstruction

Among the various methods of mandibular reconstruction, regeneration using poly-L-lactic acid mesh and particulate cancellous bone and marrow attained good efficacy and safety in a multi-institution prospective clinical study in Japan (Project No. GM941). This mandibular reconstruction method is not difficult to perform and is minimally invasive to the patient. If the use of this surgical technique spreads worldwide, elimination of disparities among medical treatment outcomes is expected.

Ultrasonic study of schwannoma of the oral and maxillofacial region: Comparison of ultrasonograms and pathologic findings

Ultrasonographic study of a schwannoma of the oral and maxillofacial region have rarely been reported. Here we report ultrasonographic findings from the nine cases of schwannoma located in that region that we encountered between 1984 and 1995. The tumor was delineated as a hypoechoic mass with a sharply demarcated contour and posterior echo enhancement. Change in the internal echo followed pathologic degenerative changes: cystic change, bleeding, myxomatous change, and hyaline degeneration. The internal echo was in agreement with the description of Antoni type A tissue, showing hemorrhagic and hyaline degeneration in the tumor. The cystic pattern of the ultrasonogram corresponded to cystic change, and hypoechoic area of the ultrasonogram corresponded to Antoni type B tissue and myxomatous change. The internal echo pattern on the ultrasonogram of a schwannoma was found to reflect the pathologic structure of the tumor.