Use of deepithelialized medial sural artery perforator flap for the correction of postoncologic facial contour deformity

ABSTRACT: We report a case of young patient with a postoncologic right buccomandibular defect in which the deepithelialized medial sural artery perforator flap was used to obtain a symmetric contour of the defective side. The aim of this study was to compare treatment strategies of facial contour deformities and to give detailed information about medial sural artery flap dissection with a clinical presentation.     

A simple "fishtail flap" for surgical correction of microstomia

Treatment of microstomia, whether congenital or acquired, has long challenged the ingenuity of surgeons. In all instances, the challenge remains the ability to preserve function and provide and maintain reasonable aesthetics. The following case report presents 2 different cases of surgical correction of microstomia, resulting from flap reconstructions after perioral tumor surgery. We developed a technique that uses pericommissural mucomuscular advancement flap, "a simple fishtail flap," and used this to correct deformed oral commissures in an attempt to elongate the oral aperture in a functional and aesthetically acceptable manner without recurrence. Results have shown that, with the use of our fishtail design, we can restore the unique architecture of the oral commissure with the postoperative intercommissural distance improved by more than 10 mm and the interincisal width enlarged by approximately 5 mm. Our solution was functional and aesthetically acceptable, as well as simpler and cheaper, in comparison with the traditional surgical methods that are usually expensive, complex, and less practical. We believe that, in cases in which either the contracture is mild or a commissurotomy can be expected to increase the width and the general size of the oral aperture, this relatively conservative technique, if judiciously used, can be performed with ease and safety with good results.     

The double split flap: a surgical approach for regenerative treatment of interproximal defects

Aims and Background: Primary wound closure has been advocated to be indispensable for a successful outcome of guided tissue regeneration-procedures. Yet narrow inter-proximal spaces often lack sufficient tissue quantity in order to facilitate a tension free re-adaptation of periodontal flaps. In order to maintain an uneventful healing process, the concept of layer-wise wound closure is applied to periodontal surgery.
Material and Method: This article describes the introduction of a modified flap design, the double split flap.
Results and Conclusion: By preparation of a second, internal flap and a wound in a layer-wise fashion, it is assumed that primary healing will be more predictable to achieve.     

Esthetic buccal flap for correction of buccal fenestration defects during flapless immediate implant surgery

BACKGROUND: Clinically, it is a tremendous challenge to create natural gingival esthetics after immediate or delayed implant placement. Hence, flapless immediate implant surgery has been proposed to overcome the shortfalls of these techniques. Nonetheless, one of the major limitations for this technique is its inability to correct localized horizontal/vertical deficiency, dehiscence, or fenestration without jeopardizing esthetic outcomes. Therefore, the aim of this paper was to present a new flap design, the esthetic buccal flap (EBF), aimed at overcoming this potential problem while maintaining the optimal esthetic appearance. METHODS: Five consecutively EBF-treated patients with simultaneous implant placement were included in this pilot case study. Clinical measurements were taken at the time of prosthesis insertion and 6 and 12 months after surgery. These included soft tissue height, papillae appearance, scar appearance, and mid-buccal probing depth. RESULTS: Data obtained from this pilot case study showed that soft tissue height was preserved, and papillae appearance remained the same as at presurgery. No scar tissue was reported in any cases. Mid-buccal probing depths remained consistent throughout the study. CONCLUSION: The results indicate that EBF, together with simultaneously guided bone augmentation, allows clinicians to correct apical buccal fenestration defects while maintaining the supraosseous soft tissue during flapless immediate implant surgery.     

Closure of palatal defects without a surgical flap: an experimental study in rabbits.

PURPOSE: This study evaluated the use of resorbable calcium sulfate with and without bone grafting in palatal defects in rabbits as a guide to regeneration of the mucoperiosteal tissue and bone. METHODS AND MATERIALS: Eighteen New Zealand rabbits were used in the experiment. A 1-cm wide region of mucoperiosteum, nasal mucosa, and bone between the incisor and premolar teeth was excised from the left side of the palate to create a defect. These gaps were left open and unfilled in 6 animals as a control (group 1). Defects in a second group of 6 animals were packed with calcium sulfate (group 2). The osseous defects in a third group of 6 animals were filled with bovine demineralized xenographic bone particles, and the soft tissue gaps were covered with calcium sulfate (group 3). The various sites were evaluated clinically at 1, 3, and 4 weeks, and then at 3 months after surgery. All animals were killed at the 3 months period, and the sites were evaluated histologically. RESULTS: The calcium sulfate had resorbed and the mucoperiosteal margins of the defects in both experimental groups had regenerated and the soft tissue gaps were closed at 4 weeks. Osseous defects in group 3 showed complete bone regeneration compared with osseous defects in group 2. Defects in the control group showed persistent oronasal fistulae and fibrous healing. CONCLUSION: Open mucoperiosteal wounds in rabbits packed with calcium sulfate can heal uneventfully, and the gaps can be closed successfully.     

Coronally advanced flap: a modified surgical approach for isolated recession-type defects: three-year results

BACKGROUND: Various modifications of the coronally displaced flap have been proposed in the literature with the attempt of treating gingival recession with uneven predictable results. The goal of the present study was to evaluate the effectiveness with respect to root coverage of a modification of the coronally advanced flap procedure for the treatment of isolated recession-type defects in the upper jaw. METHODS: Forty isolated gingival recessions with at least 1 mm of keratinized tissue apical to the defects were treated with a modified approach to the coronally advanced flap. The main change in the surgical procedure consisted in the modification of flap thickness and dimension of surgical papillae during flap elevation. All recessions fall into Miller class I or II. The clinical re-evaluation was performed 1 year and 3 years after the surgery. RESULTS: At the 1-year examination, the average root coverage was 3.72+/-1.0 mm (98.6% of the pre-operative recession depth) and 3.64+/-1.1 mm (96.7%) at 3 years. The gain in probing attachment amounted to 3.65+/-1.10 mm at 1 year and to 3.70+/-1.09 mm at 3 years. The average increase of keratinized tissue between the baseline and the 3-year follow-up amounted to 1.78+/-0.90 mm. All changes of keratinized tissue (difference between baseline and 1 year, baseline and 3 years, and between 1 and 3 years) were statistically significant. CONCLUSION: The modified coronally advanced surgical technique is effective in the treatment of isolated gingival recession in the upper jaw.     

Laterally moved, coronally advanced flap: a modified surgical approach for isolated recession-type defects

BACKGROUND: Various modifications of the laterally sliding flap have been proposed to reduce the risk of gingival recession at the donor tooth site, but the reported root coverage predictability was quite low. The goal of the present study was to evaluate the effectiveness with respect to root coverage of a modified surgical approach of the laterally moved flap procedure for the treatment of an isolated type of recession defect. METHODS: One hundred and twenty (120) isolated gingival recessions (Miller Class I or II) with specific features of the keratinized tissue lateral to the defects were treated with a new approach to the laterally moved flap. The main surgical modifications consisted of the coronal advancement of the laterally moved flap and the different thickness during flap elevation. Clinical evaluation was made 1 year after the surgery. RESULTS: At the 1-year examination, 97% of the root surface was covered with soft tissue and 96 defects (80%) showed complete root coverage. A statistical and clinically significant increase of keratinized tissue was observed. These favorable results were accomplished with no change in the position of gingival margin or in the height of gingival tissue at the donor tooth/site. CONCLUSIONS: The laterally moved, coronally advanced surgical technique was very effective in treating isolated gingival recessions. It combined the esthetic and root coverage advantages of the coronally advanced flap with the increase in gingival thickness and keratinized tissue associated with the laterally moved flap. The ideal gingival conditions must be present lateral to an isolated recession defect in order to render the proposed surgical technique an highly effective and predictable root coverage surgical procedure.     

The temporal muscle flap for closure of large palatal defects in CLP patients.

Large palatal defects in 4 CLP patients were successfully closed by transposition of the anterior part of the temporal muscle. The donor side was filled by transposing the posterior part of the temporal muscle whilst the posterior area was contoured with orthopaedic bone cement.     

Utility of superiorly based platysma myocutaneous flap for reconstruction of intraoral surgical defects: our experience

Purpose

Various surgical modalities have been advocated for the soft tissue reconstruction of oral cavity with variable results. This prospective study evaluates the utility of platysma myocutaneous flap (PMF) in the reconstruction of surgical defects followed by treatment of oral submucous fibrosis (OSMF) and oral squamous cell carcinoma (OSCC) in terms of healing and functional outcomes.

Methods

In this prospective study, 47 patients with OSMF and 15 of OSCC were evaluated and selected for PMF reconstruction. OSCC was selected under T₁N₀M₀ category only. Patients were operated under general anaesthesia followed by PMF grafting. In OSCC, ipsilateral and for OSMF, bilateral PMF was used.

Results

In 47 patients treated for OSMF, 46 were male and 1 female while 15 cases of OSCC, 10 were male and 5 females aged between 18 and 44 years. Intraoperative mouth opening was achieved up to 48 mm in OSMF followed by 42.5 mm postoperatively after 2 years. However, uneventful healing and acceptable scar on cervical region was noted in all the cases including OSCC. In OSMF, three cases of dehiscence, four partial necrosis at end of flap and in OSCC one case shows skin loss at flap and two partial necrosis at tip of flap and extraoral localised abscess at ipsilateral donor site in one case was noted. An uneventful healing, anatomical form and functional results were restored with acceptable scarring at donor site without any evidence of difficulty in neck movements were observed.

Conclusion

The PMF is simple, versatile and could be valued as a reconstructive alternative, with interesting visual qualities. It is a good therapeutic alternative tool for reconstruction of the buccal mucosa, especially for small- and medium-sized defects between 2 and 4 cm² of the oral cavity.

     

The surgical correction of fronto-ethmoidal meningo-encephaloceles

One-stage correction of fronto-ethmoidal meningo-encephaloceles and related stigmata, via an orbito-cranial approach, is recommended. A bifrontal craniotomy is only required when simultaneous correction of hypertelorism is to be undertaken. A combined intra- and extracranial approach is essential. The possibility of a high relapse rate for repaired fronto-ethmoidal meningo-encephaloceles, together with the possibility of prolonged postsurgical cerebrospinal fluid leakage, meningitis and other complications is invited when either a transcranial bifrontal craniotomy surgical approach, or an extracranial approach via the facial lesion, is undertaken alone. Modification of existing craniofacial surgical approaches in order to avoid a frontal craniotomy, allowed for good repair of the encephalocele together with significant benefits in terms of simplification of the surgical procedure, operating time, blood loss, frontal lobe retraction and complications.     

The dog as an instruction model for surgical correction of mandibular prognathism.

Intraoral sagittal splitting of the mandible in dogs is an instructional exercise for correction of prognathism. The dog was selected as a surgical model for several reasons including the ability of this species to open the mouth widely. Comparative anatomical features of the mandibles of man and dog suggest that a sagittal splitting technique practiced in dogs may give expertise that would avoid complications, such as cutting vessels and nerves in humans. In addition, the dog should be carefully considered as a model for long-term study of surgical complications and of the effects of surgery on mandibular growth in young patients.     

Supraorbital artery island flap for periorbital defects

The forehead skin has the same color and texture as the periorbital region as well as the other parts of the face. The forehead is a local flap donor area for the reconstruction of full-thickness periorbital defects. This report presents eight cases in which full-thickness defects resulting from tumor resection have been repaired with supraorbital artery island flaps. Of eight patients, one was female and the rest were male with a mean age of 72.8 years (range, 64-88 years). Defects were located in the medial canthal region, lateral canthal region, glabella, and lateral part of the orbita. The flaps ranged from 2 x 3 cm to 6 x 7 cm in size. The patients were followed for 7 to 18 months. No complications occurred, except for decreased sensation on the forehead, and trapdoor deformity was seen in one case. The outcome was functionally and aesthetically satisfactory in all cases and all patients were happy with the outcome. The supraorbital artery island flap is a good alternative for the repair of defects around the orbita in that the color and texture of this flap match up with the orbital region and that it is pliable, simple, safe, and sensorial and requires only a single-session procedure.