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Cureus Sep 2023Restoration of hemimandibulectomy defects following tumour extirpation to restore oral function is a herculean task for practitioners. Prosthetic treatment alternatives... (Review)
Review
Restoration of hemimandibulectomy defects following tumour extirpation to restore oral function is a herculean task for practitioners. Prosthetic treatment alternatives available for rehabilitation of acquired hemimandibulectomy defects according to mandibular reconstruction type and extent (Cantor-Curtis classification) are unclear. This systematic review aims to assess the spectrum of prosthodontic rehabilitation approaches with regard to reconstruction type and extent of mandibular surgical defects. The databases incorporated for literature search were Google Scholar and Medline (PubMed). Relevant search terms for hemimandibulectomy and reconstruction with prosthetic rehabilitation were used. Two reviewers independently assessed the articles using eligibility criteria; published case reports and case series in the English language and depicting prosthodontic treatment modality of patients greater than 15 years were included. A total of 202 records were identified from the database search of which 19 duplicates were removed. The remaining articles were assessed for eligibility, and 55 articles (comprising 58 cases) were finally included in the study. This review revealed various prosthetic alternatives ranging from guide flange, twin occlusion, palatal ramp, conventional to hybrid partial and complete dentures to implant-supported prosthesis including a few innovative prosthetic approaches. This systematic review provides a plethora of prosthodontic rehabilitation approaches according to the extent of hemimandibular surgical defect and type of reconstruction. This will facilitate practitioners and prosthodontists in sequential treatment planning and management of hemimandibulectomy cases in their routine practice.
PubMed: 37799255
DOI: 10.7759/cureus.44647 -
Innovative Surgical Sciences Sep 2023In mandibular reconstruction, computer-assisted procedures, including virtual surgical planning (VSP) and additive manufacturing (AM), have become an integral part... (Review)
Review
In mandibular reconstruction, computer-assisted procedures, including virtual surgical planning (VSP) and additive manufacturing (AM), have become an integral part of routine clinical practice. Especially complex cases with extensive defects after ablative tumor surgery benefit from a computer-assisted approach. Various CAD/CAM-manufactured tools such as surgical guides (guides for osteotomy, resection and predrilling) support the transition from virtual planning to surgery. Patient-specific implants (PSIs) are of particular value as they facilitate both osteosynthesis and the positioning of bone elements. Computer-based approaches may be associated with higher accuracy, efficiency, and superior patient outcomes. However, certain limitations should be considered, such as additional costs or restricted availability. In the future, automation of the planning process and augmented reality techniques, as well as MRI as a non-ionizing imaging modality, have the potential to further improve the digital workflow.
PubMed: 38077486
DOI: 10.1515/iss-2021-0045 -
Ecancermedicalscience 2023Mucoepidermoid carcinoma starts in the salivary glands and accounts for 5%-10% of all salivary gland tumours. Its intraosseous occurrence is rare and only accounts for...
BACKGROUND
Mucoepidermoid carcinoma starts in the salivary glands and accounts for 5%-10% of all salivary gland tumours. Its intraosseous occurrence is rare and only accounts for 2%-3% of all mucoepidermoid carcinomas. This neoplasm often follows a long and indolent course. Also, given its ambiguous presentation and similarities to other dental pathologies, it often has a late diagnosis. In this instance, we present the case of a patient with an asymptomatic mandibular lesion, who underwent mandibular resection and reconstruction with fibula free flap.
CASE REPORT
A 32-year-old male patient reported discomfort when chewing, which was attributable to a self-detected mass localised in proximity to teeth 47 and 48. The lesion presented as a slight swelling without clear expression in the oral cavity mucosa. The rest of the physical examination revealed no abnormalities. Both the panoramic radiograph and computed tomography of the maxillary bones revealed lytic lesions in proximity to teeth 47 and 48, close to the mandibular angle. An incisional biopsy was performed, for which the pathological anatomy showed low-grade mucoepidermoid carcinoma. A resection was then performed, which involved a right hemimandibulectomy with ipsilateral cervical lymphadenectomy. The reconstruction was performed with a right fibula-free flap. Upon histological evaluation of the surgical specimen, an intermediate-grade mucoepidermoid carcinoma was found. The patient presented good post-operative evolution. Following a multidisciplinary assessment, the use of adjuvant radiation therapy was deemed necessary. The patient currently presents good evolution and has regular check-ups.
CONCLUSION
Intraosseous mucoepidermoid carcinoma is a rare salivary gland tumour. Given its low frequency, there are no studies that accurately describe its biological behaviour and prognosis.
PubMed: 37799952
DOI: 10.3332/ecancer.2023.1599 -
Annals of Medicine Dec 2023Osteoporotic individuals suffer from various complications such as spontaneous bone fractures due to decreased bone strength and failure in bone healing as a result of...
OBJECTIVE
Osteoporotic individuals suffer from various complications such as spontaneous bone fractures due to decreased bone strength and failure in bone healing as a result of decreased bone mineral density and deterioration of bone microstructure. In this study, the effects of Extracorporeal Shock Wave Therapy (ESWT) in a distraction osteogenesis model in osteoporotic rabbits were investigated to prevent these failures and improve bone microstructure.
MATERIAL AND METHODS
A total of 28 female New Zealand rabbits underwent mandibular distraction osteogenesis and were divided into four groups: non-ovariectomized control (Cont), ovariectomized control (O-Cont), ovariectomized ESWT1 (O-ESWT1) and ovariectomized ESWT2 (O-ESWT2). ESWT was only applied to the ESWT2 group before the osteotomy, and to both the ESWT1 and ESWT2 groups after the osteotomy. Dual-energy x-ray absorptiometry was used to determine bone mineral density on both the 7th and 28th day of the consolidation. Stereological methods were used to identify new bone formation, connective tissue and neoangiogenesis volume.
RESULTS
According to the dual-energy x-ray absorptiometry examination both at the 7th and 28th day of the consolidation, lower bone mineral density was seen in the ESWT groups. However, the stereological examination showed that shock wave therapy significantly increased new bone formation both ESWT1 and ESWT2 compared with O-Cont, significantly increased neoangiogenesis in O-ESWT1 compared with O-Cont.
CONCLUSIONS
The application of ESWT in these parameters after osteotomy was beneficial for bone regeneration in mandibular distraction in osteoporotics. However, ESWT has been shown to be ineffective in improving bone mineral density.KEY MESSAGESThe osteoporotic model can be successfully established in rabbits and the subjects can tolerate the distraction procedures.Stereology is a useful analysis method that can determine the volume of the new bone formation and neoangiogenesis.Extracorporeal shock wave therapy has biostimulatory effects on bone tissue.
Topics: Rabbits; Female; Humans; Animals; Bone Regeneration; Bone Density; Mandible; Osteogenesis, Distraction; Osteotomy
PubMed: 36995151
DOI: 10.1080/07853890.2023.2192958 -
Journal of Personalized Medicine Oct 2023This retrospective study aimed to: (1) investigate the surgical accuracy of maxillomandibular advancement (MMA) in obstructive sleep apnea (OSA) patients, with a...
This retrospective study aimed to: (1) investigate the surgical accuracy of maxillomandibular advancement (MMA) in obstructive sleep apnea (OSA) patients, with a specific focus on maxillary and mandibular advancement and counter-clockwise rotation and (2) investigate the correlation between the amount of achieved advancement and the reduction in the relative apnea hypopnea index (AHI). Sixteen patients, for whom a three-dimensional virtual surgical plan was generated preoperatively and a computed tomography scan (CT) or cone-beam computer tomography (CBCT) was acquired postoperatively, were included. The postoperative CT or CBCT was compared to the virtual surgical plan, and differences in the mandibular and maxillary advancement and counter-clockwise rotation were assessed. Maxillary and mandibular advancement (median 3.1 mm, = 0.002 and 2.3 mm, = 0.03, respectively) and counter-clockwise rotation (median 3.7°, = 0.006 and 4.7°, = 0.001, respectively) were notably less than intended. A significant correlation was found between the planned maxillary advancement and the difference between the planned and actual maxillary advancement ( = 0.048; adjusted R = 0.1979) and also between the planned counter-clockwise rotation and the difference between the planned and actual counter-clockwise rotation for the mandible ( = 0.012; adjusted R = 0.3261). Neither the maxilla-first nor the mandible-first surgical sequence proved to be superior in terms of the ability to achieve the intended movements ( > 0.45). Despite a significant reduction ( = 0.001) in the apnea hypopnea index (AHI) from a median of 62.6 events/h to 19.4 events/h following MMA, no relationship was found between the extent of maxillary or mandibular advancement and AHI improvement in this small cohort ( = 0.389 and = 0.387, respectively). This study underlines the necessity for surgeons and future research projects to be aware of surgical inaccuracies in MMA procedures for OSA patients. Additionally, further research is required to investigate if sufficient advancement is an important factor associated with MMA treatment outcome.
PubMed: 37888128
DOI: 10.3390/jpm13101517 -
Journal of Oral & Maxillofacial Research 2023Dentofacial deformity following juvenile idiopathic arthritis with temporomandibular joint involvement is associated with functional, aesthetic, and psychosocial...
OBJECTIVES
Dentofacial deformity following juvenile idiopathic arthritis with temporomandibular joint involvement is associated with functional, aesthetic, and psychosocial impairment. Surgical treatment may involve combinations of orthognathic surgery. The aims of this retrospective study were to assess orofacial symptoms, functional and aesthetic status, and stability after orthognathic surgery.
MATERIAL AND METHODS
Nineteen patients with juvenile idiopathic arthritis of the temporomandibular joint (TMJ) and dentofacial deformities were included. All patients were treated with combinations of bilateral sagittal split osteotomy, Le Fort I and/or genioplasty, between September 10, 2007 and October 17, 2017. Analysis of patient symptoms and clinical registrations, and frontal/lateral cephalograms was performed pre- and postoperative and long-term (mean: 3.8 and 2.6 years, respectively).
RESULTS
Patients experienced no changes in orofacial symptoms or TMJ function, and stable normalisation of horizontal and vertical incisal relations at long-term (horizontal overbite; vertical overbite: P < 0.05). Mandibular lengthening was achieved postoperatively (from mean 79.7 to 87.2 mm; P = 0.004) and was stable. Sella-nasion to A point (SNA) and sella-nasion to B point (SNB) angles increased postoperatively (SNA, mean 79.9° to 82.8°; P = 0.022 and SNB, mean 73.9° to 77.8°; P = 0.003), however, largely reverted to preoperative status at long-term.
CONCLUSIONS
Orthognathic surgery normalized incisal relations while providing stable mandibular lengthening without long-term deterioration of temporomandibular joint function or orofacial symptoms. No long-term effect on jaw advancements was observed.
PubMed: 38222878
DOI: 10.5037/jomr.2023.14404 -
Application of digital guide plate with drill-hole sharing technique in the mandible reconstruction.Journal of Dental Sciences Oct 2023With the development of computer-assisted surgery, digital guide plate was widely used in vascularized bone flap grafts for mandibular reconstruction. The purpose of...
BACKGROUND/PURPOSE
With the development of computer-assisted surgery, digital guide plate was widely used in vascularized bone flap grafts for mandibular reconstruction. The purpose of this study was to design and manufacture a digital guide plate with drill-hole sharing for mandibular reconstruction and assess for surgical accuracy.
MATERIALS AND METHODS
17 patients that required mandibular reconstruction using fibula free flap or iliac crest free flap were included in the study. The computed tomography (CT) data of the patient's mandible and pelvis or fibula were acquired preoperatively. A surgical simulation was then performed using computer-aided surgical simulation (CASS) technology based on above date, which allowed the design of two cutting guide and a repositioning guide for mandibular reconstruction. After surgery, the accuracy of reconstruction was evaluated by superimposing the postoperative image onto the preoperative image of mandible, recording the linear and angular deviation of landmarks, measuring the differences between the planned and actual outcomes.
RESULTS
The osteotomy and repositioning of fibula or iliac crest segments were successfully performed as planned using surgical guides. The digital guide plate with drill-hole sharing showed excellent accuracy, When the iliac crest or the fibula free flap were used for mandibular reconstruction, the largest mean differences between the preoperative and postoperative were 1.11 mm and 2.8° or 1.3 mm and 3.87°.
CONCLUSION
The digital guide plate with drill-hole sharing designed preoperatively provides a reliable method of for the mandibular reconstruction. This can assist surgeons in accurately performing osteotomy and repositioning fibula or iliac crest segments during the mandibular reconstruction.
PubMed: 37799907
DOI: 10.1016/j.jds.2023.02.006 -
SAGE Open Medical Case Reports 2023The objective of prosthetic rehabilitation of patients with hemimandibulectomy is to regain the masticatory function, comfort, esthetics, and self-esteem. This article...
The objective of prosthetic rehabilitation of patients with hemimandibulectomy is to regain the masticatory function, comfort, esthetics, and self-esteem. This article presents a plan for the management of hemimandibulectomy with a removable maxillary double occlusal table prosthesis. A male patient, aged 43 years, was referred to Prosthodontic Out Patient Department with complaints of compromised aesthetics, difficulty in speaking, and lack of ability to chew. The patient underwent surgery 3 years ago in which hemimandibulectomy was performed due to oral squamous cell carcinoma. The patient had a Cantor and Curtis Type II defect. The mandible was resected distally from canine region on the right side of the arch. A prosthodontic device was planned with a double occlusal table, also known as twin occlusion prosthesis. The rehabilitation of hemimandibulectomy patients with a double occlusal table is of considerable importance. This report describes a simple prosthetic device that will help patients in regaining their functional and psychological well-being.
PubMed: 37342420
DOI: 10.1177/2050313X231181976 -
International Journal of Surgery Case... Sep 2023Osteoma is a benign tumor that can arise from compact or cancellous bone and is more commonly found in the face or skull. The incidence of osteoma believed to be...
INTRODUCTION AND IMPORTANCE
Osteoma is a benign tumor that can arise from compact or cancellous bone and is more commonly found in the face or skull. The incidence of osteoma believed to be underreported as most are asymptomatic. To date, the best modality to diagnose osteoma is CT scan. We report a unique case of osteoma presenting with cranial and extracranial manifestations and highlight the importance of bone survey in evaluating patients with osteoma.
CASE PRESENTATION
A 26-year-old female complained of bilateral pain in the jawbone and several areas of her head. On physical examination, there were several masses in the head with the largest on the left mandible measuring 5.6 × 6.0 × 4.5 cm from MSCT examination. Hemi-mandibulectomy, histopathological and cytopathology examination were performed on the tissue obtained from the left mandible which concluded osteoma. Post-operative bone survey was performed and found osteoma on left ulna and bilateral fibula. Suspected Gardner syndrome with multiple osteoma manifestation was excluded from normal results of colon in-loop examination. We conservatively monitored the patient and most recent 6-month follow-up found no complaint nor changes in the extracranial osteoma manifestation on left ulna and both fibulas.
CLINICAL DISCUSSION
The benign tumor osteoma is incredibly uncommon to present both intra and extracranially. We suggest thorough skeletal studies such as bone survey to be performed as they are crucial in the full evaluation of patients with multiple osteomas. Osteoma treatment is based on the patient's symptoms, surgery for patients with symptoms and periodic monitoring for asymptomatic patients.
CONCLUSION
It is necessary to consider radiological modality for diagnosing osteoma patients. The majority of osteomas are asymptomatic and the choice of radiological examination sometimes still misses the lesion. It is important to evaluate histologically if the lesion difficult to diagnose.
PubMed: 37634429
DOI: 10.1016/j.ijscr.2023.108713 -
Journal of Reconstructive Microsurgery Jan 2024Oromandibular defects involving the external skin are a reconstructive challenge. This study aimed to evaluate the use of the fibula osteocutaneous free flap (FOCFF)...
BACKGROUND
Oromandibular defects involving the external skin are a reconstructive challenge. This study aimed to evaluate the use of the fibula osteocutaneous free flap (FOCFF) for through-and-through oromandibular defects by comparing the surgical outcomes and complications of different techniques to close the external skin defect.
METHODS
A retrospective analysis was conducted of patients who underwent reconstruction of through-and-through oromandibular defects after oncologic segmental mandibulectomy between January 2011 and December 2014. Five groups were analyzed according to the method of external skin coverage: primary closure, locoregional flaps, deepithelialized double-skin paddle FOCFF (deEpi-FOCFF), division of the skin paddle for double-skin paddle FOCFF (div-FOCFF), and a simultaneous second free flap. Intraoperative and postoperative outcomes along with complications were analyzed between groups.
RESULTS
A total of 323 patients were included. The mean total defect area requiring a simultaneous second free flap was larger in comparison to other groups ( < 0.001). Reconstructions performed with div-FOCFF had a higher number of perforators per flap when compared with deEpi-FOCFF ( < 0.001). External defects closed with another free flap exhibited higher intraoperative time for the reconstructive segment in comparison to other groups ( < 0.05). The overall rate of complications was comparable between groups (24%, = 0.129).
CONCLUSION
The FFOCF is a reliable alternative to harvesting multiple simultaneous free flaps for through-and-through oromandibular defects. The authors recommend appropriate curation of the surgical plan based on individual patient characteristics and reconstructive requirements.
Topics: Humans; Plastic Surgery Procedures; Retrospective Studies; Mandibular Osteotomy; Fibula; Mandible; Free Tissue Flaps
PubMed: 36958344
DOI: 10.1055/a-2060-9950