Ronald R. Hollins

Comparison of miniplates and reconstruction plates in fibular flap reconstruction of the mandible.

Background: Mandibular reconstruction using free fibular flaps can be performed using various plating techniques. Miniplates (≤2.0 mm) and reconstruction plates (>2.0 mm) have different characteristics that provide theoretical advantages and disadvantages with regard to successful neomandibular fixation. Methods: A retrospective review of 117 patients undergoing free fibular reconstruction of segmental mandibular defects over the past 10 years was performed. Characteristic data and complication rates were recorded; the authors compared patients who had fibular reconstruction of their mandibular defect with miniplates (n = 86) with those who underwent repair using reconstruction plates (n = 31). Results: No statistically significant difference was identified when comparing miniplates and reconstruction plates with regard to overall cumulative complication rates (46 versus 48 percent), flap failure (15 percent versus 27 percent), plate extrusion (23 percent versus 25 percent), malunion or nonunion (14 percent versus 13 percent), and plate fracture (10 percent versus 0 percent). (The cumulative percentage incidence weighs patient data according to length of follow-up.) The authors’ data did suggest a decreased incidence of osteonecrosis in the miniplate group (5 percent versus 38 percent; p = 0.02), but these results must be interpreted cautiously because of the small sample size. Conclusion: Selection of plate size, miniplate versus reconstruction plate, does not appear to affect the overall rate of complications in free fibular reconstruction of the mandible.

Multiple idiopathic root resorption: Diagnostic considerations

Multiple idiopathic root resorption is a specific entity that must be delineated from all other resorptive processes. We present a case report and discuss the diagnostic possibilities that must be considered before arrival at this diagnosis.

Problems in evaluation of penetrating foreign bodies with computed tomography scans: Report of cases

Computed tomography is the best radiologic modality available in the evaluation of penetrating injuries to the soft tissues. The technique is the best available when the foreign body has a density similar to the surrounding tissues. Limitations of CT scanning include difficulty in identifying small foreign bodies, objects with densities similar to surrounding structures, and detecting vascular injury. Interpretation of postoperative changes is also difficult. Two cases have been presented to illustrate the advantages, and limitations of CT scanning in penetrating soft tissue trauma.

Laparoscopic Gastrostomy Versus Open Gastrostomy in Head and Neck Cancer Patients

Alimentation in the surgically treated head and neck cancer patient frequently requires bypassing the upper aerodigestive tract. The laparoscopic gastrostomy fulfills this criterion. The authors compared 25 laparoscopic gastrostomies (group 1) with 18 open gastrostomies (group 2) performed on head and neck cancer patients. The length of operation, morbidity, mortality, and cost were evaluated. Operative time was significantly shorter in group 1 (40± 2 minutes) than in group 2 (56 ± 4 minutes), with P=.003. The major complication rate was 9% for group 1 and 11% for group 2. There was no procedure‐related mortality in group 1, but 1 patient died in the immediate postoperative period in group 2. The cost was not significantly different. It is concluded that the laparoscopic gastrostomy is a safe and cost‐effective alternative to open gastrostomy in this patient group.

Use of the Free Fibula Flap in Patients with Prior Failed Mandibular Reconstruction

PURPOSE The purpose of this study was to assess the efficacy of the free fibula flap in patients who had failed prior attempts at bony reconstruction. PATIENTS AND METHODS The records of all patients who had undergone free fibula reconstruction for segmental mandibular resections between 1993 and 1995 were retrospectively reviewed. Patients were divided into group I (14 patients who had failed previous bony reconstruction attempts) and group II (50 patients who had no previous reconstruction), and the two groups were compared. RESULTS No statistical differences were found between group I and group II for mean age, mean hospital stay, mean intensive care unit stay, mean operating room time, mean intraoperative blood loss, mean colloid usage, or mean blood units transfused. Although group I had a statistically higher proportion of both patients with osteoradionecrosis and those receiving hyperbaric oxygen therapy (HBO), the number with a history of radiation therapy was not different in the two groups. Wound complication rates were not statistically different between groups I and II for all patients, or between those group I patients who did or did not receive HBO therapy. CONCLUSION There was no increase in wound complications in the patients who had failed prior bony reconstructive attempts who underwent free fibula flaps. The free fibula flap is suggested as the reconstructive method of choice in this patient population.

Mesenchymal chondrosarcoma: A case report

Mesenchymal chondrosarcoma is a rare tumor distinctly different from the more common chondrosarcoma. It shows a predilection for the head and neck in both osseous and extraosseous forms. The prognosis for cure is poor, with a high incidence of local recurrence as well as regional and distant metastasis. Treatment is based on radical surgical excision, although combination chemo-therapy has recently shown promise. Additional experience with this tumor is required to define the most efficacious form of treatment.

The team concept in mandibular reconstruction after ablative oncologic surgery.

PURPOSE This study evaluated the efficiency and cost-effectiveness of using a reconstructive team for mandibular reconstruction. METHODS An outcome-based retrospective review of 64 patients who had undergone microvascular fibular reconstruction of the mandible was performed. Operating room time, use of blood products, intraoperative fluid replacement, and hospital and intensive care unit stay were evaluated. Patients were divided into 2 groups on a chronologic basis. Group 1 was the first 34 consecutive patients and group 2 was the next 30 consecutive patients. RESULTS Group 2 had a significantly shorter operating room time (P < .0001), hospital stay (P = .012), and used significantly less blood (P = .002) and colloid (P = .044) than group 1, resulting in significant cost savings, (

Distal radial artery lesion as a source of digital emboli

5,061.47/patient). Analysis showed no differences between groups demographically or for wound complications. CONCLUSIONS Experience and the development of a team concept significantly decreased the cost for mandibular reconstruction with free fibula flaps without increasing wound complications.

Pseudoankylosis of the Mandible after Temporal Bone Attached Craniotomy

Ischemic changes of the digits caused by emboli are rare. When they do occur, the typical sites of origin include the heart, the proximal subclavian artery, and the thoracic outlet. Dialysis access or iatrogenic injuries may be a more distal source of emboli. Two patients, each with embolization to the thumb and index finger from a lesion in the anatomical snuff-box, were studied. Neither patient had any other atherosclerotic occlusive disease, and both lesions occurred precisely where the extensor pollicis longus crossed the artery and would be expected to compress it against the proximal epiphysis of the first metacarpal when the hand was closed. These lesions were excised, and bypass was performed, with rapid resolution of symptoms. This is an unusual cause of digital embolization that should be considered in patients with emboli to the thumb and index finger.

Microvascular Reconstruction of the Head and Neck After Tumor Ablation

Mandibular hypomobility after intracranial surgical procedures is seldom encountered. A case of limited oral opening after temporal bone attached craniotomy is described. The condition is due to fibrosis of the temporalis muscle resulting in a pseudoankylosis of the temporomandibular joint. The appropriate operative intervention is transoral coronoidectomy, which restores normal joint function.