Recent advances in reconstructive oral and maxillofacial surgery

Reconstruction within the head and neck is challenging. Defects can be anatomically complex and may already be compromised by scarring, inflammation, and infection. Tissue grafts and vascularised flaps (either pedicled or free) bring healthy tissue to a compromised wound for optimal healing and are the current gold standard for the repair of such defects, but disadvantages are their limited availability, the difficulty of shaping the flap to fit the defect and, most importantly, donor site morbidity. The importance of function and aesthetics has driven advances in the accuracy of surgical techniques. We discuss current advances in reconstruction within oral and maxillofacial surgery. Developments in navigation, three-dimensional imaging, stereolithographic models, and the use of custom-made implants can aid and improve the accuracy of existing reconstructive methods. Robotic surgery, which does not modify existing techniques of reconstruction, allows access, resection of tumours, and reconstruction with conventional free flap techniques in the oropharynx without the need for mandibulotomy. Tissue engineering and distraction osteogenesis avoid the need for autologous tissue transfer and can therefore be seen as more conservative methods of reconstruction. Recently, facial allotransplantation has allowed whole anatomical facial units to be replaced with the possibility of sensory recovery and reanimation being completed in a single procedure. However, patients who have facial allotransplants are subject to life-long immunosuppression so this method of reconstruction should be limited to selected cases.     

Indications for the microvascular medial femoral condylar flap in craniomaxillofacial surgery

The medial femoral condylar flap makes it possible to reconstruct bone, cartilage, and skin, but elongation of the pedicle is usually required to bridge the distances to the vascular connections in the neck. The indications in the maxillofacial area include reconstruction of the temporomandibular joint (TMJ), pseudarthrosis of the jaws, osteonecrosis of the jaws and skull, and augmentation of bone in irradiated or otherwise compromised tissue. If small bony defects require safe and reliable osseous, osteochondral, or osteocutaneous reconstruction, the medial femoral condylar flap can be used to fill the gap between small avascular, and larger microvascular, bone transplants.     

A systematic review of patient self-completed questionnaires suitable for oral and maxillofacial surgery

Patient reported outcomes (PRO) have an established role when reporting treatment outcomes. This data is usually collected using patient self-completed questionnaires. There are numerous questionnaires available and selecting the most appropriate one can be difficult.

Aim

The aim of this article was to carry out a systematic review of the literature to identify publications using patient self-completed questionnaires suitable for oral and maxillofacial surgery. The questionnaires were collated and grouped according to sub-speciality interests.

Method

The ISI search engine with cross-reference using Pub Med and Ovid was searched for publications between 1981 and March 2009. Abstracts written in English were reviewed by two of the authors independently.

Results

A total of 511 abstracts were reviewed and the paper cites 56 studies with self-administered instruments. The number of subsite specific questionnaires identified were; cleft lip and palate (1), craniofacial surgery (2), dentoalveolar surgery (6), distraction osteogenesis (1), facial aesthetic surgery (4), facial pain (1), head and neck cancer (14), maxillofacial injury (3), oral medicine and oral mucosal disorders (2), orthognathic surgery (1), pre-prosthetic surgery and dental implants (15), skull base surgery (7), temporomandibular joint (2).

Conclusion

There is a tremendous variety of validated questionnaires available that are suitable for oral and maxillofacial surgery. This summary serves as a useful reference point when selecting a questionnaire for an audit or research projects. It also describes publications, which have used the various questionnaires, thus readily identifying papers that might be useful for comparison.     

Role of robotic surgery in oral and maxillofacial, and head and neck surgery

We review the current status of robotic surgery in the head and neck region and its role in oral and maxillofacial surgery.     

Psychological issues in oral and maxillofacial reconstructive surgery

Many psychological problems affect patients who have oral and maxillofacial operations. This article reviews these problems among patients with craniofacial conditions, facial injuries, facial cancer, and those having orthognathic surgery. Facial cosmetic surgery is not addressed. Problems such as depression, anxiety, low self-esteem, poor social relationships, and changes in body image are considered. The roles of mental health professionals is emphasised to enhance postoperative satisfaction and to provide a better quality of life for these patients.     

负压封闭引流在颌面外科术后严重颌面颈部感染的应用

目的探讨应用持续负压封闭引流技术（VSD）治疗口腔颌面外科术后经持续换药后未见明显好转、且呈持续性加重的颌面颈部感染的疗效。 方法采用VSD治疗8例口腔颌面外科术后经持续换药未见好转、且呈持续性加重的严重颌面颈部感染,在去除术后感染区坏死物质、彻底清创后,以负压封闭引流材料覆盖创口,0.9%氯化钠溶液冲洗,持续负压引流,直至引流液清亮、创缘组织无红肿、无压痛后,撤除VSD装置。 结果6例患者明确感染后,使用传统换药约7 ~ 8 d,感染呈进行性加重,遂使用VSD装置置于感染区,持续引流5 ~ 15 d后,可见引流液清亮,颌面部肿胀基本消失,创缘周围可见肉芽组织增生,伤口基本愈合;所有病例中有1例为放射性颌骨骨髓炎行腓骨肌皮瓣修复,明确感染、持续换药约20 d后,感染呈进行性加重,放置VSD 5 d后于手术室清除病灶骨,术后继续换药,伤口愈合;1例术后并发食管瘘患者使用VSD时间长,撤除VSD后,引流液清亮,颌面部肿胀较前明显减轻,创口可见肉芽组织增生,但左颈部仍可见到1个大小约1 cm × 1 cm的瘘管,邻近瘘管可见颈部膨隆明显,扪诊质硬,无波动感。左颈部磁共振成像（MRI）增强示：左颈部见3.9 cm × 2.3 cm × 5.0 cm大小的不规则占位病变,右颈部见1个大小约2.3 cm × 1.4 cm团块状病变,考虑淋巴结肿大（术后复发）。 结论VSD有利于控制感染,防止术后感染扩散,促进术后创面组织的愈合;同时肿瘤患者使用VSD存在促癌细胞转移、增殖的可能,在应用过程中应充分考虑其适应证,并密切监测创区变化,当发现可疑病变或创面延迟愈合时,应立即撤除VSD装置,根据具体情况行进一步治疗。     

Temporary tracheotomy in microvascular reconstruction in maxillofacial surgery: Benefit or threat?

Background

Temporary tracheotomies are often used in oral microvascular flap reconstruction surgery to secure postoperative airway management and avoid emergency tracheotomies. Even when planned electively, a tracheotomy can cause severe and life-threatening complications. The aim of this study was to evaluate the complications of tracheotomies performed on oral cancer patients with microvascular flap reconstructions and differentiated patterns, which could lead to postoperative complications.

Failure to diagnose pathology: an avoidable complication in oral and maxillofacial surgery

The routine submission of abnormal tissue for histopathologic diagnosis is a vital link in the appropriate management of patients. Receipt of a biopsy report brings the usual case to its full conclusion. Patients are best served when clinical impressions are verified by histopathologic examination, and this in turn will reduce the likelihood of successful malpractice litigation for failure or delay in diagnosis.     

Use of free flaps with supermicrosurgery for oncological reconstruction of the maxillofacial region

Supermicrosurgery involves the dissection and anastomosis of vessels<0.8 mm in diameter with minimal donor site morbidity. This study evaluated the feasibility and outcomes of free flaps using supermicrosurgery to repair oncological defects in the maxillofacial region. Forty-two patients were treated with supermicrosurgery to repair oncological defects in the maxillofacial region between December 2015 and February 2021. The supermicrosurgery technique was used for different types of free flap, including 24 superficial circumflex iliac artery perforator flaps, seven anterolateral thigh flaps, three peroneal artery perforator flaps, five medial femoral condyle osteo-adipofascial flaps, and three profunda artery perforator flaps. An artery-to-artery approach was used in 38 patients; venous grafts for anastomosis were used in four patients to resolve an arterial discrepancy. Forty-one flaps (97.6%) survived. Thirty-six patients (85.7%) healed without any complications; three flaps required revision surgery including one lost, one demonstrated wound dehiscence, and two demonstrated wound infection. Supermicrosurgery is a useful complement to conventional microsurgery in head and neck reconstruction.     

坚强内固定在口腔颌面外科颌骨骨折实践教学中的应用

对颌骨骨折传统实践教学方法进行改革.学生随机进行分组进行传统骨折实践教学和坚强内固定实践教学.采用项目组针对教学改革制定的评估方法,通过对学生调查问卷的形式获得相关评价.将取得的评分进行统计学分析,学生对坚强内固定用于颌骨骨折实践教学的认可度明显高于传统教学方法(P<0.01 ).坚强内固定技术引入颌骨骨折的实践教学中,是对传统实践教学的一个完善、一个革新,值得在口腔医学的教学实践中推广.     

放射性粒子组织间植入治疗口腔颌面部恶性肿瘤初探

目的 应用^125Ⅰ放射性粒子植入组织间近距离治疗口腔颌面部恶性肿瘤，观察其近期疗效及副反应。方法 对36例口腔颌面部恶性肿瘤患者实施^125Ⅰ放射性粒子定向植入治疗（分别为术中即刻植入、术后经皮穿刺植入、单纯粒子植入），治疗前分别行靶区设计，平面植入计划或立体植入计划。植入后1周内及2个月后CT验证粒子分布及靶区剂量变化。随访观察患者的疗效及副反应。结果 本组患者随访6～36个月，平均14个月。晚期恶性肿瘤单纯植入2例，肿瘤明显缩小，症状减轻；早期舌癌单纯植入1例，肿瘤完全消退；33例手术及粒子植入后随访，靶区覆盖范围均无复发及转移，有3例出现靶区外复发或转移。除8例局部皮肤充血反应外，其余患者无特殊不适主诉及外照射副反应。结论 ^125Ⅰ放射性粒子植入组织间近距离治疗口腔颌面部恶性肿瘤，对控制复发及颈部淋巴转移近期效果显著。     

圆筒形骨凿在口腔颌面外科的临床应用

目的探讨骨移植用圆筒形骨凿在口腔颌面外科的临床应用.方法随机将97名需行自体髂骨骨松质移植的患者分为2组,由同一术者分别采用圆筒形骨凿通过小切口和常规切口髂骨开窗松质骨刮取术切取自体髂骨骨松质,分别记录患者的伤口长度、伤口愈合情况、卧床时间、感觉障碍、疼痛、步态障碍等,并进行统计学处理.结果 2组患者在伤口长度、卧床时间及感觉障碍、疼痛、步态障碍的差异有非常显著性(P＜0.01).结论运用骨移植用圆筒形骨凿通过小切口切取自体髂骨骨松质,创伤小,不失为一种良好的方法.     

Recent trends in cartilage regenerative medicine and its application to oral and maxillofacial surgery

Greater progress has been made in the clinical application of cartilage regenerative medicine, compared with that of other organs. A typical example of cartilage regenerative medicine is autologous chondrocyte implantation, in which chondrocytes isolated from the patient's cartilage are cultured and injected into the cartilage defects in a liquid- or gel-form. However, the classic autologous chondrocyte implantation has been applicable to only limited diseases, including focal cartilage lesion. Therefore, we developed “implant-type” tissue-engineered cartilage that shows mechanical strength and three-dimensional shape. This type of tissue-engineered cartilage uses scaffold composed of atelocollagen hydrogel and poly-l-lactic acid porous material, which is administered with cultured autologous auricular chondrocytes. Its clinical application to nasal deformity of cleft lip and palate patients has been ongoing at present. This review presents an overview of the current situation regarding cartilage regenerative medicine, as well as introducing our research and the development of implant-type tissue-engineered cartilage for the cleft-lip nose. The discussion of the future development of regenerative medicine is also mentioned.     

Non-technical skills in oral and maxillofacial and head and neck surgery: systematic review

The importance of teams’ and individuals’ non-technical skills in reducing adverse events is well-recognised. We undertook a systematic review of the published literature to assess the research undertaken to date on non-technical skills and behaviours within oral and maxillofacial, and head and neck (OMFS-H&N) surgery. The aim was to assess the applicability of published studies to current practice, to look at how these studies could guide future research, and look for areas that could be developed further. The search terms included ‘non technical skills’, ‘nontechnical skills’, ‘NOTSS’, ‘non-technical skills for surgeons’, ‘oral surgery’, ‘oral maxillofacial surgery’, ‘OMFS’, ‘maxillofacial surgery’, ‘head and neck surgery’, ‘microsurgery’, ‘behavioural markers’, ‘behavioural assessment tool’, and ‘behavioural ratings system’. Three publications were included, involving 83 participants. Participants consistently achieved the highest scores in the ‘situational awareness’ category and showed a tendency to achieve lower mean scores in the ‘communication and teamwork’ and ‘decision-making’ categories. The majority of research into surgeons’ non-technical skills has occurred in simulated environments and not in the genuine environments in which actual surgery is being performed on patients. Research involving ‘real’ patients has been done in the field of OMFS-H&N and this places the specialty in a stronger position than many other surgical specialties.     

舌板在口腔颌面部肿瘤放射治疗中的应用

目的通过电脑模拟,研究舌板在三维适形放疗过程中对正常组织的保护作用。方法利用三维适形放疗设计系统,模拟我院15例使用三维适形放疗技术治疗口腔颌面部肿瘤的患者,通过测量佩戴舌板前后,正常组织所受到的剂量值,评价舌板在放疗中起到的作用。结果实验表明佩戴舌板后,正常组织所受剂量值明显减少,并且厚度越厚所受剂量越小。结论佩戴舌板能够达到保护正常组织,减少重要组织器官损伤的目的。     

Management in oral and maxillofacial surgery during the COVID-19 pandemic: Our experience

A novel β-coronavirus (2019-nCOV), identified in Wuhan City in late December 2019, is generating a rapid and tragic health emergency in Italy due to the need to provide assistance to an uncontrollable number of infected patients and, at the same time, treat all the non-deferrable oncological and traumatic maxillofacial conditions. This article summarises the clinical and surgical experience of Maxillofacial Surgery Unit of “Magna Graecia” University (Catanzaro -Italy) during the COVID-19 pandemic and would like to provide a number of recommendations that should facilitate the scheduling process of surgical activities during the COVID-19 pandemic and reduce the risk of infection among healthcare professionals.     

An update on the use of ultrasound imaging in oral and maxillofacial surgery

Ultrasound is a relatively inexpensive, non-invasive, and readily available technique that is well tolerated by patients. It is particularly useful in the examination of superficial structures where the use of a high frequency linear probe (7.5–12 MHz) produces high definition multi-planar images. The spatial resolution achieved is superior to other methods of cross-sectional imaging and, when combined with tissue biopsying techniques such as fine needle aspiration cytology (FNAC) or core biopsy samples, it is rendered a highly specific diagnostic tool. This article provides an overview of the use of ultrasound for common head and neck conditions, including its use in salivary gland disease, and for the assessment of cervical lymphadenopathy.