S. Parmar

Craniofacial implants at a single centre 2005-2015: retrospective review of 451 implants

Craniofacial endosseous implants are regularly used to support prostheses in the rehabilitation of complex defects, but reported success rates vary. To review our own clinical practice over 10 years, and particularly to examine the impact of radiotherapy and the timing of placement on the survival of implants, we retrospectively audited the records for all patients who had endosseous implants for prosthetic rehabilitation in our unit between 2005 and 2015. We reviewed 167 records, which gave 451 implants, of which, 222 (49%) were auricular, 98 (22%) nasal, and 131 (29%) orbital. Most were placed after ablative operations for cutaneous malignancy (n=103 patients, 62%). The failure rate of implants placed in bone that was irradiated either before or after placement was significantly higher than that of those placed in non-irradiated bone (univariate analysis: 11% compared with 2%, p<0.001: Kaplan-Meier survival analysis: p<0.001). The timing of placement in relation to radiotherapy (before compared with after) seemed to have no impact on success (p=0.96). Our findings are in keeping with previous reports, and the principal observation is that radiotherapy adversely affects success. We work closely with our maxillofacial prosthetists and place implants at the time of ablation. Our findings seem to support this practice regardless of whether or not the patient will later require adjuvant radiotherapy.

Oral Prosthodontic Rehabilitation of Head and Neck Cancer Patients

When patients are first diagnosed with head and neck (H&N) cancer, their main concern is with survival. However, following cancer treatment, their concerns can rapidly shift towards reobtaining and maintaining a good quality of life (QoL) [1]. Oral prosthodontic rehabilitation forms a major component of QoL improvement contributing not only functionally but also psychologically. H&N cancer treatment can leave the patient with significant disability and deformity. Oral prosthodontic rehabilitation aims to address the acquired functional and cosmetic deficits by providing treatment to restore the defect, re-establish oral function, improve cosmetic appearance and allow the patient to interact in society with confidence. Rehabilitation should be patient-centred aiming to meet each individual’s unique and specific needs.

The fat–fascia paddle only with a composite fibula flap: marked reduction in donor site morbidity

Fibula free flaps are used widely in head and neck reconstruction, primarily for their versatility and contribution to aesthetic and functional outcomes. The literature suggests that early complications such as wound dehiscence and skin graft loss can occur in up to a third of patients. The healing of these donor sites can be prolonged, and in certain cases may require an operative intervention. A method to overcome this problem is described herein. In raising the skin paddle, a standard lateral approach to the fibula harvest is used. The skin paddle is not isolated and the posterior margin of the paddle is maintained. The skin paddle epithelium is separated with a small cuff of adipose tissue from the underlying fat-fascia layer. This fat-fascia paddle is then raised with the fibula as normal and tacked to the margins of the recipient soft tissue defect. The fat-fascia paddle heals, resulting in a thin mucosal covering for prosthetic dental rehabilitation. This technique can reduce the incidence of donor site wound complications when raising a composite fibula flap.