Mandibular talon cusp: a case report.

Talon cusp is a rare dental anomaly, especially when it occurs on mandibular teeth. A case of talon cusp on a permanent mandibular central incisor is described and illustrated. This case was associated with periodontitis, but was otherwise symptom free.     

Mandibular reconstruction: bone graft techniques

Results of treatment in a series of 60 patients undergoing mandibular reconstruction by a variety of methods are reported. Delayed reconstruction was performed, using a titanium mesh tray with cancellous bone fragments and block bone grafts removed from the iliac crest, rib, and mandible in 34 patients, with an overall success rate of 91%. Immediate reconstruction was performed with a wire mesh prosthesis containing particulate bone and composite flaps in 26 patients, with an overall success rate of 46%. Oral contamination of the graft at the time of surgery appeared to be the factor limiting the success of immediate mandibular reconstruction. Block grafts of bone were extremely reliable in reconstituting the continuity of the mandible when inserted through an extraoral approach as a delayed repair. Mandibular reconstruction was successfully accomplished even following high-dose radiotherapy.     

Cranial reconstruction using autologous split calvarial bone combined with calcium phosphate bone cement: a case report

We report a case of cranial reconstruction using autologous split calvarial bone combined with calcium phosphate bone cement (CPC). A 19-years-old man suffered from cranium defect and rhinorrhea originating from frontal skull base fracture in a traffic accident. After CSF hydration treatment had finished, continuously we performed cranial reconstruction with autologous split calvarial bone so that the patient could return to work at an early stage. The use of autologous split calvarial bone with CPC was able to increase stability of the construct and provide excellent cosmetic result in our short follow up period. The combination use of these two materials may be useful for cranial reconstruction in patients with cranium defect.     

Distal fibula reconstruction using a frozen allograft: a case report

We report the case of a 25-year-old woman who developed recurrent chondromyxoid fibroma involving the distal portion of the right fibula. This patient had been treated two years earlier with curettage without grafting. The treatment associated en bloc resection of the distal 12 cm of the fibula and reconstruction with a cryopreserved allograft fixed with a lateral plate and pin associated with a syndesmodesis screw for six weeks. The lateral collateral ligament and the tibiofibular ligaments were also repaired. At two years, the patient has no sign of recurrence and the ankle motion is satisfactory. The ankle is stable and pain free with an esthetic aspect similar to the healthy side. Allograft reconstruction is a novel alternative for reconstruction of the distal fibula. We have found only one other case reported in the literature.     

Pelvic support femoral reconstruction using the method of Ilizarov: a case report.

A 15-year-old boy presented with a fixed, irreducible congenital dislocation of the hip associated with other multiple lower extremity growth disturbances secondary to neonatal multifocal osteomyelitis. The affected hip had very limited abduction, and the patient had a very severe Trendelenburg gait secondary to the dislocation. The hip was reconstructed according to the Ilizarov method, by a combination of maximum proximal femoral adduction osteotomy in the subtrochanteric region and distal femoral corticotomy, to permit the gradual realignment of the knee into the new weight-bearing axis produced by the proximal osteotomy. Total fixation time for the femoral reconstruction was two months. Five months after removal of the apparatus, the patient was returned to full function with a remarkably improved gait.     

Case report: a free arterialized venous flap for intraoral cancer reconstruction

The free arterialized cephalic venous flap is a good option for intraoral reconstructions. It offers thin, pliable skin as a one-stage transfer without sacrifice of a major artery. The radial dominant hand poses a problem, which can be surmounted by this flap.     

Mandibular reconstruction.

The stainless steel 316 mesh tray with cancellous bone offers a method of mandibular reconstruction which theoretically is appealing from the viewpoint of basic osseous healing. The results in fity-two patients at twenty different institutions indicates encouraging results. Further evaluation of this method is recommended.     

Patellar ligament reconstruction using allograft patellar ligament: a case report

This report describes a method of patellar ligament reconstruction. Our patient sustained a rupture of the patellar ligament and had reconstruction with allograft patellar ligament after failed primary repair. At the 2-year follow-up, his range of motion was 0 degrees to 110 degrees and he was able to return to unrestricted standing work.     

Mandibular reconstruction using AO plates

The AO plate represents an acceptable reconstructive choice for mandibular defects, with an 86.7 percent success rate demonstrated in this series. Because this method utilizes an alloplast which is precisely and quickly applied, virtually all patients requiring mandibular resection can be considered candidates for reconstruction. Adequate vascularized soft tissue coverage is essential to prevent plate extrusion and fistula formation. This is even more important for radiated patients. The pectoralis major myocutaneous flap provides muscle and skin for large anterior defects. Frequently, lateral defects can be closed primarily without using regional flaps. We suggest bone reconstruction to avoid potential plate fracture and to allow placement of functional dentures. Resections in elderly patients and for palliation will result in ideal cosmetic and functional results with the plate alone. If we exclude the four patients reconstructed with calcium hydroxyapatite and the AO plate, the morbidity rate is quite acceptable. With this group excluded, only four fistulas and eight plate exposures occurred. Only four plate removals were required to achieve wound closure. Evaluation of the titanium plate is in progress. It is hoped that better osseous and soft tissue integration will help to decrease wound complications. A large prospective review of postoperative radiotherapy patients using the new titanium plate has been designed to address this issue. The therapeutic choice between the AO plate and free vascularized bone graft reconstruction remains. The decision process is dependent on the technical skills of the surgeon, the treatment plan, the survival characteristics of the tumor, and the physiologic condition of the patient.     

Mandibular reconstruction using vascularised fibula

The osteocutaneous fibula flap has been used to reconstruct large segments of mandible in cases following ablation for cancer or radionecrosis. The bone can be cut to the appropriate shape and the fasciocutaneous flap may be used simultaneously to provide oral cavity lining or skin cover. The technique is described and its successful use in seven patients is reported with details of the complications encountered.     

Mandibular reconstruction with an alloplastic bone tray in dogs.

OBJECTIVE: Mandibular alloplastic bone trays have an unacceptably high rate of extrusion. The introduction of resorbable mesh has renewed interest in such trays. This study evaluates the effect of resorbable trays on bone graft healing in a dog model. DESIGN: Unilateral, 20-mm mandibular body defects were created in 10 dogs, and repaired with cancellous bone grafts. A resorbable mesh bone tray was applied to 5 animals. All mandibles underwent gross examination, 4-point stress testing, and histologic and radiographic analysis. RESULTS: All animals had excellent bony unions. There was one intraoral mesh exposure. There was no difference between the control and treatment groups with regard to clinical findings, radiologic analysis, stress testing (P = 0.17), or histologic analysis (P = 0.66). CONCLUSION: The metabolic breakdown products of the resorbable mesh do not inhibit bone healing or strength. Resorbable mesh trays are a viable modality for reconstruction of segmental mandibular defects in a dog model.     

Mandibular bone metastasis of rectal cancer: Report of a case

A 56-year-old man was referred with lower rectal cancer showing anal canal invasion and liver metastasis. He underwent an abdominoperineal resection and a partial hepatectomy. Adjuvant therapy with tegafur-uracil and leucovorin was administered postoperatively. Lung metastasis was detected 2 years later and was resected. Right mandibular metastasis was diagnosed 2 months after the resection of the lung metastasis. A partial mandibular resection was performed after chemoradiotherapy, followed by reconstruction with a titanium frame and oral cavity reconstruction with a greater pectoral musculocutaneous flap. The pathological diagnosis was metastatic rectal cancer, and the therapeutic effect chemoradiotherapy was Grade 2. He is presently alive without any evidence of cancer, and has maintained a good quality of life 3 years after the mandibular resection and more than 5 years after his first operation. Mandibular metastasis from rectal cancer is very rare and the prognosis is poor according to the literature, so this case is considered to be very unusual.     

Vaginal reconstruction using a vertical rectus abdominis myocutaneous flap in a child: a case report.

Rhabdomyosarcoma is the most common soft tissue sarcoma in infants and children younger than 15 years old. Multimodal treatment using chemotherapy, radiation, and surgery have increased survival. Because of the potential for long-term survival, the importance of organ preservation and vaginal and pelvic reconstruction has been recognized. The authors report a case in which special circumstances led to vaginal reconstruction concomitantly with exenteration surgery. The authors present the first reported use of a vertical rectus abdominis myocutaneous flap in a child and describe the technique and its potential advantages.     

Mandibular reconstruction with microvascular bone transfer. Series of 10 patients

Mandibular reconstruction with microvascular bone transfer was carried out in 10 patients, including 8 with far advanced intraoral carcinoma and 2 with posttraumatic facial and mandibular defects. Eight patients presented with compromised defects as a result of radiation injury, infection, and scarring. Nine patients experienced primary bony union with complete functional and esthetic reconstruction of the mandible, and two patients eventually received dentures. This technique has resulted in a more effective, more reliable, and earlier reconstruction compared with conventional methods.     

口内与耳后联合切口的下颌角截骨术26例临床报告

目的 提供一种具有独特优势的下颌角截骨术式,以及经测量选择适合病例的客观方法.方法 术前经X线头颅定位片测量,选择符合下颌升支过长特征的患者.采用口内与耳后联合切口.由耳后切口置入电锯截骨并引流,行口内切口辅助完成剥离,按术前测量结果确定截骨线位置、取骨等操作.自2006年9月至2010年4月,对26例女性患者行下颌角截骨术.结果 所有患者的术中及术后均无较严重的并发症出现;术后随访患者5～12个月,除3例患者对效果不满意外,余者均满意.结论 口内与耳后联合切口的下颌角截骨术主要适用于下颌升支过长的患者,与单纯采用口内或耳后切口的术式相比具有独特的优势,对于经验尚未丰富的临床医师尤为安全并易于掌握;采用X线头颅定位片测量法,对术前客观选择病例及术中截骨线定位具有指导意义.     

Atrophic femoral nonunion with bone loss: treatment with monorail transport: a case report

Nonunions are an uncommon outcome of femoral fractures. Atrophic nonunions with a leg length discrepancy secondary to bone loss are often the most difficult to treat, and the treatment options are limited. We present a case that uses concomitant monolateral external fixation and intramedullary nailing to heal a nonunion and perform a simultaneous 7-cm lengthening procedure in a 33-year-old female.     

Mandibular reconstruction with local live vascularised bone transfer

There are different methods to provide a skeletal support for mandibular reconstruction following the trauma or ablation for tumor in head and neck region. These methods vary from complicated techniques like vascularised free bone grafts to methods like free bone grafts, local vascularised bone grafts, cadaveric irradiated bone grafts and alloplastic material spacers including silastic rubber, polyvinyl plastics, ceramics, hydroxylapatite or metal. The technique employed solely depends upon many factors like expertise available, existing infrastructure, the available time factor and complexity of the defects including the type and extent of tissue loss in the particular patient. The sliding mandibulectomy is a simple method of mandibular reconstruction. This surgical technique is indicated for repairing short mandibular defects up to 9 cm in overall length including the mandibular arch for which extra vertical osteotomies are needed to bend the segment. More so it has its value in patients with poor prognosis and poor general conditions in whom longer and complicated mandibular reconstruction procedures with free vascularised bone flaps are not advisable. This article describes different types of sliding osteotomies used to harvest live bone flaps for rebuilding the mandibular defects including the arch of the mandible for patients who have undergone malignant tumor ablation. Primary reconstruction for the mandibular skeletal support was obtained in 18 cases with vascularised live-bone graft through various sliding osteotomies in different combinations. Complications, failures and success rate of sliding mandibulectomies and osteotomies have been analyzed and discussed in detail.     

Pulp thumb defect reconstruction using a twin neurovascular island flaps: a case report

In this report, we present the functional and cosmetic results of a case with complete loss of the thumb pulp for which the Chen and Noordhoof techniques has been chosen for reconstruction. A 33-year-old man, artisan, had his right thumb caught in a machine during the work, resulting in a degloving injury in the entire pulp of the distal phalanx of the thumb with all other digits of the right hand intact. The patient was a young man, in good health and non-smoker. He was involved in a heavy manual work for which an appropriate soft coverage of the distal thumb was desirable. A reconstruction of the thumb pulp with a twin neurovascular island flaps as described by Chen and Noordhoff was planned and performed the day after his admission to the hospital. The patient turned up to work at 10 weeks after surgery. After 2 years, we obtained a good aesthetic result, a sensitivity in the thumb and at the donor site comparable to the other hand and a complete recovery of normal function of the hand. In focal pulp loss of the thumb, the twin neurovascular island flaps suggested by Chen and Noordhoff could be an easy and efficient method to reconstruct soft tissue coverage and sensibility when microsurgical setting and abilities are not available.