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Journal of Surgical Oncology Jun 2018Rehabilitation of oral functions following surgery on the jaws is a goal that is often difficult to achieve. Removable dentures supported by remaining teeth or gum are... (Review)
Review
Rehabilitation of oral functions following surgery on the jaws is a goal that is often difficult to achieve. Removable dentures supported by remaining teeth or gum are often unstable and seldom satisfactory. On the other hand, endosseous (dental) implants offer a mechanism to provide stability to the dentures. This review, discusses factors related to the tumor, patient, treatment, and physicians which impact upon the feasibility and success of dental implants in patients with oral cancer.
Topics: Alveolar Bone Loss; Antineoplastic Agents; Bisphosphonate-Associated Osteonecrosis of the Jaw; Bone Density Conservation Agents; Dental Implants; Dentures; Humans; Jaw, Edentulous; Mandibular Osteotomy; Maxilla; Mouth Neoplasms; Patient Care Team; Patient Selection; Postoperative Complications; Radiotherapy
PubMed: 29723421
DOI: 10.1002/jso.25075 -
The Bulletin of Tokyo Dental College Nov 2018An iliac block graft is the most commonly used biomaterial for reconstruction following resection of the mandible. Its use has some disadvantages, however, including...
An iliac block graft is the most commonly used biomaterial for reconstruction following resection of the mandible. Its use has some disadvantages, however, including limitations on the amount of bone that may be harvested, and the subsequent increase in burden on the iliac bone. Therefore, recently, free vascularized fibular grafts have been used as an alternative in some cases. Here, we report the advantages of, and issues related to reconstruction using free vascularized fibular grafts observed at Tokyo Dental College Chiba Hospital. Eight patients undergoing mandibular reconstruction using free vascularized fibular grafts between January 2003 and January 2017 were investigated. Of these, 6 were men, and 2 were women. Age ranged from 38 to 74 years (average, 54 years). Primary diseases comprised malignant tumor in 3 patients, benign tumor in 3, and radiation osteomyelitis of the mandible in 2. The defects were classified as follows according to the CAT system (Condylar Head, Mandibular Angle, Mental Tubercle): 3 cases of Body, 2 of AT, and 1 case each of TT, ATTA, and CATT. The resection range of the mandible was 5-16 cm (average, 10 cm). The single barrel technique was used in 7 cases, and the double barrel technique in 1. In terms of the flap survival ratio, complete engraftment was achieved in 6 out of the 8 cases. Two cases of radiation osteomyelitis of the mandible, with necrosis caused by vascular breakdown after wound infection, were observed, however. While the advantages of mandibular reconstruction by this method include comparatively safe conditions and functional recovery, there were also some problems. It was inappropriate for cases of radiation osteomyelitis of the mandible; those where anti-inflammatory therapy was ineffective; and those where greater resection of the soft tissue was required. Further study is needed to clarify the criteria for selecting this procedure.
Topics: Adult; Aged; Bone Transplantation; Female; Fibula; Humans; Male; Mandible; Mandibular Neoplasms; Mandibular Osteotomy; Mandibular Reconstruction; Middle Aged; Oral Surgical Procedures; Osteomyelitis; Surgical Flaps; Tokyo; Treatment Outcome; Wound Infection
PubMed: 30333367
DOI: 10.2209/tdcpublication.2017-0025 -
Journal of Clinical Medicine Oct 2021The purpose of present study was to review the literature regarding the postoperative skeletal stability in the treatment of mandibular prognathism after isolated... (Review)
Review
PURPOSE
The purpose of present study was to review the literature regarding the postoperative skeletal stability in the treatment of mandibular prognathism after isolated sagittal split ramus osteotomy (SSRO) or intraoral vertical ramus osteotomy (IVRO).
MATERIALS AND METHODS
The articles were selected from 1980 to 2020 in the English published databases (PubMed, Web of Science and Cochrane Library). The articles meeting the searching strategy were evaluated based on the eligibility criteria, especially at least 30 patients.
RESULTS
Based on the eligibility criteria, 9 articles (5 in SSRO and 4 in IVRO) were examined. The amounts of mandibular setback (B point, Pog, and Me) were ranged from 5.53-9.07 mm in SSRO and 6.7-12.4 mm in IVRO, respectively. In 1-year follow-up, SSRO showed the relapse (anterior displacement: 0.2 to 2.26 mm) By contrast, IVRO revealed the posterior drift (posterior displacement: 0.1 to 1.2 mm). In 2-year follow-up, both of SSRO and IVRO presented the relapse with a range from 0.9 to 1.63 mm and 1 to 1.3 mm respectively.
CONCLUSION
In 1-year follow-up, SSRO presented the relapse (anterior displacement) and IVRO posterior drift (posterior displacement). In 2-year follow-up, both of SSRO and IVRO showed the similar relapse distances.
PubMed: 34768470
DOI: 10.3390/jcm10214950 -
Medicine Aug 2020Medication-related osteonecrosis of the jaw decreases quality of life of patients with cancer. The debate about it continues regarding the risk factors, etiology, and... (Review)
Review
RATIONALE
Medication-related osteonecrosis of the jaw decreases quality of life of patients with cancer. The debate about it continues regarding the risk factors, etiology, and treatment methods, and so on. Also, spontaneous regeneration of the mandible is clinically rare.
PATIENT CONCERNS
A 67-year-old woman presented to the authors' department complaining of pain, swelling, and pus discharge from a fistula. She previously had breast cancer bone metastases and had received antiresorptive intravenous bisphosphonate.
DIAGNOSIS
The patient was diagnosed with medication-related osteonecrosis of the jaw.
INTERVENTIONS
She received conservative therapy with antibiotics and surgical therapy as sequestrectomy under general anesthesia; however, the lesion did not heal. Thirty months after the MRONJ diagnosis, when she was 70 years' old, she underwent a left hemimandibulectomy without reconstruction under general anesthesia.
OUTCOMES
Spontaneous regeneration of the mandible was observed by follow-up imaging examinations. The patient has no current subjective or objective symptoms.
LESSONS
This is the first case report of the spontaneous mandibular regeneration after surgery for medication-related osteonecrosis of the jaw. Additionally, this case was the oldest patient among the published mandibular regeneration cases.
Topics: Aged; Bisphosphonate-Associated Osteonecrosis of the Jaw; Bone Regeneration; Female; Humans; Mandible; Mandibular Osteotomy; Radiography, Panoramic
PubMed: 32872069
DOI: 10.1097/MD.0000000000021756 -
African Health Sciences Sep 2019Reconstruction of mandibular defects can be challenging because an acceptable aesthetic and functional outcome must be achieved simultaneously.
BACKGROUND
Reconstruction of mandibular defects can be challenging because an acceptable aesthetic and functional outcome must be achieved simultaneously.
AIM
To evaluate the pattern of mandibulectomy and reconstruction materials used in the reconstruction of mandibular defects.
MATERIALS AND METHODS
This was a retrospective study of mandibulectomies with reconstruction in Sokoto, Nigeria between 2012 and 2016. Data such as demographics, type of tumour, type of resection and type of reconstruction materials used were extracted and stored.
RESULTS
Fifty-two cases of mandibulectomies were done comprising 24 males and 28 females (ratio 1:1.2). Age ranged 5-80 years with mean±SD (37.8±15). Most of the cases 30 (57.7%) were on the right. There are 35 (67.3%) benign and 17 (32.7%) malignant cases. Thirty (57.7%) lateral, 16 (30.8%) condylar, 1 (1.9%) central and 5 (9.6%) combined mandibular defects were seen. Reconstruction plate alone was used in 11 (21.2%) cases, reconstruction plate with rib and tibia grafts in 16 (30.8%) cases, reconstruction plate with Iliac crest and tibia grafts in 15 (28.8%) cases. Graft length ranged from 0-20cm. There was satisfactory outcome altogether in 32 (80.0%).
CONCLUSION
This study has shown the types of mandibulectomies and reconstruction materials used in our centre.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone Transplantation; Child; Child, Preschool; Female; Humans; Male; Mandibular Neoplasms; Mandibular Osteotomy; Mandibular Reconstruction; Middle Aged; Nigeria; Patient Satisfaction; Retrospective Studies; Socioeconomic Factors; Young Adult
PubMed: 32127850
DOI: 10.4314/ahs.v19i3.53 -
Cureus Dec 2017Severe dentofacial deformities require both orthodontics and surgical management to repair. Modern mandibular orthognathic surgery commonly uses sagittal split ramus... (Review)
Review
Severe dentofacial deformities require both orthodontics and surgical management to repair. Modern mandibular orthognathic surgery commonly uses sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO) methods to treat patients. However, complications like neurosensory disturbances and temporomandibular joint disorders are common following both procedures. In 1992, Choung introduced the intraoral vertico-sagittal ramus osteotomy (IVSRO) which led to a decrease in postoperative complications. The 'straight' IVSRO or Choung's type II osteotomy has a 'condylotomy' effect that reduces iatrogenic temporomandibular joint symptoms and treats preoperative temporomandibular joint symptoms. This osteotomy type is especially applicable for prognathism with excessive flaring of the ramus and with temporomandibular joint dysfunction. The 'L-shaped' IVSRO or Choung's type I osteotomy is indicated for patients with condylar hyperplasia and high condylar process fractures.
PubMed: 32760640
DOI: 10.7759/cureus.1924 -
BioMed Research International 2021This study explored the effects of genioplasty (Gep) and anterior subapical osteotomy of the maxilla and mandible (ASOMx+ASOMd) on the pharyngeal airway dimensions of... (Comparative Study)
Comparative Study
PURPOSE
This study explored the effects of genioplasty (Gep) and anterior subapical osteotomy of the maxilla and mandible (ASOMx+ASOMd) on the pharyngeal airway dimensions of patients with bimaxillary protrusion (BiP).
METHOD
Thirty-two patients were divided into 2 groups. Group 1 received ASOMx+ASOMd, and group 2 received ASOMx+ASOMd+Gep. The cephalograms of the patients were collected before surgery and 2 months after surgery. Changes in the landmarks, related cephalometric angles (gonial, SN-GoGn, -axis, and SN-C2C4 angles), and 2 pharyngeal airway dimensions (uvulo-pharyngeal airway [UOP] and tongue-pharyngeal airway [TOP]) were analyzed.
RESULTS
Before surgery, the parameters (incisor superius, incisor inferius, menton, most superior and anterior point of the hyoid bone, tip of the uvula, inferoanterior point on the second cervical vertebra, and inferoanterior point on the fourth cervical vertebra) and measured angles (SNA, SNB, ANB, gonial, SN-GoGn, -axis, and C4C2-SN) of both groups showed no significant differences. Following ASOMx, the patients in groups 1 and 2 exhibited a setback by 7.0 and 6.6 mm, respectively. After ASOMd, groups 1 and 2 exhibited 4.9 and 5.3 mm setbacks, respectively. No significant difference in the amount of setback was observed between groups 1 and 2. The postoperative horizontal and vertical positions of Me in group 2 were significantly forward by 6.1 mm and upward by 1.5 mm, respectively. Regarding pharyngeal airway dimensions, TOP was decreased in group 1 (1.7 mm) and group 2 (1.3 mm). In the postoperative Pearson correlation coefficient test, the horizontal and vertical positions of Me showed no significant correlation with TOP in both groups. Therefore, Gep did not prevent the reduction of TOP in group 2.
CONCLUSION
After bimaxillary anterior subapical osteotomy, the TOP of patients with BiP was decreased, and this situation was unavoidable, regardless of whether Gep was performed.
Topics: Adult; Anatomic Landmarks; Cephalometry; Female; Genioplasty; Humans; Male; Malocclusion; Mandibular Osteotomy; Maxillary Osteotomy; Pharynx; Treatment Outcome; Young Adult
PubMed: 34423041
DOI: 10.1155/2021/9978588 -
Frontiers in Oncology 2021To evaluate the feasibility and accuracy of mixed reality combined with surgical navigation in oral and maxillofacial tumor surgery.
OBJECTIVE
To evaluate the feasibility and accuracy of mixed reality combined with surgical navigation in oral and maxillofacial tumor surgery.
METHODS
Retrospective analysis of data of seven patients with oral and maxillofacial tumors who underwent surgery between January 2019 and January 2021 using a combination of mixed reality and surgical navigation. Virtual surgical planning and navigation plan were based on preoperative CT datasets. Through IGT-Link port, mixed reality workstation was synchronized with surgical navigation, and surgical planning data were transferred to the mixed reality workstation. Osteotomy lines were marked with the aid of both surgical navigation and mixed reality images visualized through HoloLens. Frozen section examination was used to ensure negative surgical margins. Postoperative CT datasets were obtained 1 week after the surgery, and chromatographic analysis of virtual osteotomies and actual osteotomies was carried out. Patients received standard oncological postoperative follow-up.
RESULTS
Of the seven patients, four had maxillary tumors and three had mandibular tumors. There were total of 13 osteotomy planes. Mean deviation between the planned osteotomy plane and the actual osteotomy plane was 1.68 ± 0.92 mm; the maximum deviation was 3.46 mm. Chromatographic analysis showed error of ≤3 mm for 80.16% of the points. Mean deviations of maxillary and mandibular osteotomy lines were approximate (1.60 ± 0.93 mm vs. 1.86 ± 0.93 mm). While five patients had benign tumors, two had malignant tumors. Mean deviations of osteotomy lines was comparable between patients with benign and malignant tumors (1.48 ± 0.74 mm vs. 2.18 ± 0.77 mm). Intraoperative frozen pathology confirmed negative resection margins in all cases. No tumor recurrence or complications occurred during mean follow-up of 15.7 months (range, 6-26 months).
CONCLUSION
The combination of mixed reality technology and surgical navigation appears to be feasible, safe, and effective for tumor resection in the oral and maxillofacial region.
PubMed: 35096559
DOI: 10.3389/fonc.2021.715484 -
Acta Cirurgica Brasileira Jun 2016To compare bone healing in mandibular vertical body osteotomies (MVBO) after fixation with a resorbable 2.0mm-profile fixation system in the first and third...
PURPOSE
To compare bone healing in mandibular vertical body osteotomies (MVBO) after fixation with a resorbable 2.0mm-profile fixation system in the first and third postoperative months in rabbits.
METHODS
Twenty hemimandibles of ten rabbits were divided into two groups according to duration of resorbable fixation-one or three months. The MVBOs were performed and one four-hole, resorbable, 2.0mm mini-plate fixation system was used on each side. The computed tomography (CT) scans, scanning electron microscopy (SEM), and histomorphometric outcomes of groups I and II were compared.
RESULTS
Significant differences were found between the one- and three- month assessments in terms of newly formed bone ratio values (p<0.05). There was more new bone formation at the third month on both the CT and histomorphometric examinations. A better adaptation of the bone tissues to the resorbable mini-plate and screws was observed on SEM at three months.
CONCLUSION
The resorbable mini-plates provided a fixation stable enough to allow immediate oral alimentation and callus formation in both groups.
Topics: Absorbable Implants; Animals; Bone Remodeling; Bone and Bones; Female; Internal Fixators; Mandibular Osteotomy; Microscopy, Electron, Scanning; Models, Animal; Osteogenesis; Postoperative Period; Rabbits; Tomography, X-Ray Computed; Wound Healing
PubMed: 27355742
DOI: 10.1590/S0102-865020160060000001 -
Annals of Plastic Surgery Jul 2020Adipose-derived stem cells mitigate deleterious effects of radiation on bone and enhance radiated fracture healing by replacing damaged cells and stimulating...
Adipose-derived stem cells mitigate deleterious effects of radiation on bone and enhance radiated fracture healing by replacing damaged cells and stimulating angiogenesis. However, adipose-derived stem cell harvest and delivery techniques must be refined to comply with the US Food and Drug Administration restrictions on implantation of cultured cells into human subjects prior to clinical translation. The purpose of this study is to demonstrate the preservation of efficacy of adipose-derived stem cells to remediate the injurious effects of radiation on fracture healing utilizing a novel harvest and delivery technique that avoids the need for cell culture. Forty-four Lewis rats were divided into 4 groups: fracture control (Fx), radiated fracture control (XFx), radiated fracture treated with cultured adipose-derived stem cells (ASC), and radiated fracture treated with noncultured minimally processed adipose-derived stem cells (MP-ASC). Excluding the Fx group, all rats received a fractionated human-equivalent dose of radiation. All groups underwent mandibular osteotomy with external fixation. Following sacrifice on postoperative day 40, union rate, mineralization, and biomechanical strength were compared between groups at P < 0.05 significance. Compared with Fx controls, the XFx group demonstrated decreased union rate (100% vs 20%), bone volume fraction (P = 0.003), and ultimate load (P < 0.001). Compared with XFx controls, the MP-ASC group tripled the union rate (20% vs 60%) and demonstrated statistically significant increases in both bone volume fraction (P = 0.005) and ultimate load (P = 0.025). Compared with the MP-ASC group, the ASC group showed increased union rate (60% vs 100%) and no significant difference in bone volume fraction (P = 0.936) and ultimate load (P = 0.202). Noncultured minimally processed adipose-derived stem cells demonstrate the capacity to improve irradiated fracture healing without the need for cell proliferation in culture. Further refinement of the cell harvest and delivery techniques demonstrated in this report will enhance the ability of noncultured minimally processed adipose-derived stem cells to improve union rate and bone quality, thereby optimizing clinical translation.
Topics: Adipocytes; Adipose Tissue; Animals; Cells, Cultured; Fracture Healing; Rats; Rats, Inbred Lew; Stem Cells
PubMed: 32187072
DOI: 10.1097/SAP.0000000000002354