Condylar reconstruction in extensive ankylosis of temporomandibular joint in adults using resected segment as autograft: A new technique

A new method of condylar reconstruction after gap-arthroplasty in extensive ankylosis of the temporomandibular joint in adults is presented. An autogenous graft, consisting of the excised ankylotic mass, was contoured, reimplanted and used for condylar reconstruction. This technique has given good results and is a simple alternative to other methods of reconstruction in adults. Successful results in three cases with more than 12 months' follow up, has prompted us to use this technique routinely in adult patients.     

Simultaneous reconstruction of the area of the temporo-mandibular joint including the ramus of the mandible in a posttraumatic case. A case report.

A new technique for the simultaneous reconstruction of the glenoid fossa and the ramus of the mandible is described. By combining and adapting procedures already described, the missing bone of the zygomatic arch, temporo-mandibular joint and ramus was replaced in one operation in a post-traumatic case. The indication for this operation is discussed. It is rather limited. The technique can be used for reconstruction of skeletal defects after tumour resection and in congenital aplasias of this region.     

The temporal fasciocutaneous island flap for oncologic oral and facial reconstruction.

PURPOSE: This study reports the anatomy, operative technique, and postoperative results of the temporal fasciocutaneous island flap (TFCIF), as used for facial and intraoral reconstruction. MATERIALS AND METHODS: Retrospective study of 15 patients who underwent TFCIF reconstruction. The anatomic basis and surgical technique are described. The flap was used for mucosal reconstruction after cheek or maxillary resection. It was used for facial tissue loss in 2 cases: orbital osteoradionecrosis and exposure of a mandibular reconstruction plate. RESULTS: This technique provides a safe and rapid solution for intraoral reconstruction; however, it cannot be used for the anterior floor of the mouth. The best indication that we have found is the reconstruction of hemimaxillectomy, allowing closure of buccosinusonasal communication and prosthetic rehabilitation. The main disavantage is that hair regrowth limits its use to patients who need postoperative radiotherapy. Donor site morbidity is minimal. Only a partial failure was observed. CONCLUSION: The TFCIF is a rapid, safe, and useful flap for oral and facial reconstruction after oncologic resection. Its arc of rotation limits, however, its use to the posterior part of the oral cavity.     

Transient recycling of resected bone to facilitate mandibular reconstruction--a technical note.

BACKGROUND: Mandibular reconstruction requires considerable sculptural skills. The intriguingly complex configuration of the structure is difficult to reproduce. It is thus imperative for surgeons to seek a technique that improves the precision of the reconstruction. PATIENT: A 55-year-old male presented with a full thickness cancer (T4+) of his left cheek. Radical ablative surgery resulted in an extensive loss of bone and soft tissue mandating major reconstruction. METHOD: The resected bony specimen was thoroughly denuded, autoclaved, and then placed back into its original site so that the mandible resumed its pre-surgical configuration. A reconstruction plate was applied to maintain structural stability, then the "recycled bone" was used as a template and replaced with a free fibular graft. RESULT: The patient fared well and a follow-up panoramic radiograph demonstrated good alignment and symmetry of the reconstructed mandible. CONCLUSION: This method is a viable option for segmental mandibulectomy defect repair in selected cases. Using this technique, it is possible to restore the original bony contour expediently and accurately.     

颌面骨病变的三维CT应用（附22例报告）

三维CT成像作为一门新的放射学技术，国内在口腔颌面外科方面应用的不多。作者自1993年初始，应用西门子plus-s CT机对22例颌面部骨组织外伤及骨组织病变患者进行了三维CT成像的重建，经临床应用证明，三维CT重建对颌骨组织伤病的诊断和治疗均有积极的指导意义。     

Treatment of severe microstomia caused by swallowing of caustic soda

Treatment of severe microstomia caused by swallowing of caustic soda is presented. The oral cavity was severely constricted because of mucosal adhesions. We used a free forearm flap for reconstruction of the oral cavity and vermilion flaps at the oral commissure, with satisfactory results. A technique is presented, and the problems with respect to the reconstruction of the oral cavity are discussed.     

Reconstruction of the mandibular condyle using the microvascular lateral femoral condyle flap

The lateral femoral condyle (LFC) flap is a new flap first reported in 2015 for the treatment of osteomyelitis in hand surgery. This paper introduces a technique of osteochondral LFC flap harvest for mandibular condyle reconstruction and reports on the use of this flap in temporomandibular joint reconstruction. For condyle resection, a pre-auricular approach saving the temporal artery and vein is performed. A step osteotomy technique is used for condyle resection. LFC harvesting starts with dissection of the popliteal artery and vein. The superior genicular artery and vein are identified and followed along their periosteal branches. An osteochondral flap according to the condyle defect is harvested from the anterior pole of the knee. The flap is banded according to the defect and fixed to the mandibular neck with three miniscrews. Follow-up computed tomography scans should be performed at 1 week, 6 months, and 1 year after surgery. The case of a 58-year-old female patient with osteomyelitis of the left mandibular condyle after multiple preoperative therapies is reported. The LFC flap technique was used for left condyle reconstruction, resulting in good functional and morphological outcomes at the 6-month postoperative follow-up. In conclusion, the osteochondral LFC flap is a new and promising technique for mandibular condyle reconstruction for special indications.     

Reconstruction of a neocondyle using transport distraction osteogenesis

The process of slow bone expansion by distraction osteogenesis in conjunction with functional remodeling can also be used for the reconstruction of a neomandible and neocondyle. This is the technique of transport distraction osteogenesis. A transport disc is surgically created adjacent to the area of a discontinuity defect, and the transport disc is advanced by the process of distraction osteogenesis, using the Ilizarov principles. The mandible therefore acts as the bony template for reconstruction such that the neomandible created from the distraction process has the same size and shape as the native mandible covered by gingiva. This allows for enhanced prosthetic reconstruction. A reverse-L osteotomy of the ramus can also be performed to create a transport disc to reconstruct a neocondyle. Because the leading edge of the transport disc becomes enveloped by a fibrocartilagenous cap, the ramal transport disc can be moved superiorly to create a new articulation. Patients are encouraged to open and close their mouths during the distraction process, such that the transport disc remodels to form a neocondyle. This technique was successfully used to treat patients with degenerative joint disease, condylar resorption, and bony ankylosis.     

Reconstruction of the temporomandibular joint with cryopreserved cartilage and freeze-dried dura: a preliminary report

A technique for total reconstruction of the temporomandibular joint using cryopreserved cartilage and freeze-dried dura is described. The rationale, indications, and surgical technique are discussed. The technique has been used in nine joints in seven patients, followed between 3 and 27 months. There was one total failure of the graft, with the remainder maintaining good, asymptomatic joint function.     

An esthetic, conservative reconstruction technique for an endodontically prepared tooth.

A reconstruction technique is presented for endodontically treated teeth in which a minimally invasive procedure is desired. A resin-bonded, laboratory-fabricated, heat- and pressure-cured composite resin onlay was used to achieve tooth support as well as esthetic results.     

Use of a plate-guided distraction device for transport distraction osteogenesis of the mandible.

BACKGROUND: Transport distraction osteogenesis has been used to reconstruct continuity defects by regenerating bone and soft tissues. A challenge has been to maintain the correct vector during the distraction process. A new type of distraction device was recently developed that uses a standard reconstruction plate to "guide" the transported segment of the bone. This plate-guided distractor device (PGD) intimately follows the shape of the plate, thus allowing for 3-dimensional vector control during the distraction process. PATIENTS AND METHODS: Four patients underwent transport distraction osteogenesis for reconstruction of segmental mandibular defects ranging in size from 4 to 7 cm. The age of the patients ranged from 27 to 62 years. Two patients had been treated with radiotherapy as part of treatment for oral malignancy. A standard locking reconstruction plate was placed to bridge the continuity gap. An osteotomy was performed to create a bone transport segment. The PGD was secured to both the reconstruction plate and the transport bone. After a latency period of 7 days, the device was activated at a rate of 1 mm/d. The distraction process continued until the transport segment reached the opposing bone or sufficient bone and soft tissue were reconstructed for oral rehabilitation. RESULTS: All patients achieved hard and soft tissue formation. Two patients had premature consolidation of the distraction regenerate but had sufficient tissue for rehabilitation. CONCLUSION: A PGD can be used to regenerate missing hard and soft tissues. An advantage of this technique is that it uses a reconstruction plate that is routinely placed to bridge mandibular continuity defects. This device allows for ultimate vector control by intimately following a carefully adapted plate.     

Unilateral cleft lip-nose repair: a 33-year experience

A 33-year experience with a proven method of repair for primary unilateral cleft lip-nose is presented. The technique used by the authors has been improved by modifications that have led to better symmetry and balance with less scarring. The technique involves ignoring the abnormal skeletal base, use of perisurgical passive orthopedics, and primary surgical correction of the nose and lip. Improved results can consistently be achieved by approaching the nose laterally through an inferior turbinate incision, freeing completely the lip and nose components so they can be translocated to match the normal side. Accurate positioning and symmetry of the alar base and sill is aided by limiting the transverse incision in the lip. This results in less scarring and improved sill reconstruction. The technique for floor-of-the-nose reconstruction avoids a small nostril without discarding any tissue. It is important to leave tissue in the floor to compensate for the skeletal deficiency. The senior author has performed this procedure in more than 750 patients. Approximately 35% have or will require minor secondary reconstruction at age 5 years. An aesthetic rhinoplasty is performed on most patients after growth is complete. Self-esteem is enhanced by early nasal reconstruction and has become the authors' standard of care for rehabilitation of the unilateral cleft lip and palate. Many surgeons remain reluctant to perform primary nasal repair. With careful proper technique, any experienced cleft surgeon can learn this procedure. For the beginner, conservatism is recommended.     

Immediate temporary reconstruction of mandibular continuity defects in cancer patients.

A technique is described in detail which will produce a predictable immediate temporary reconstruction of a mandibular continuity defect. The procedure is quick, inexpensive and reliable. A review of various methods of reconstruction is presented and compared with our technique. Complications are discussed. A review of our patients is presented.     

Simultaneous obliteration and treatment of infected frontal sinus fractures: novel use of the fibula flap

We present two cases of infected frontal sinus fractures requiring simultaneous obliteration of the frontal sinus and reconstruction of the horizontal buttress. In both cases, a free fibula flap was used for obliteration and bony reconstruction in a single stage. We believe that this is a novel technique for treatment of infected frontal sinus fractures obviating the need for secondary staged procedures.     

Surgical reconstruction of interdental papilla using an interposed subepithelial connective tissue graft: a case report

The unpredictability of current surgical procedures for papilla reconstruction has been a matter of concern for both periodontists and patients. This case report presents a complete papilla reconstruction in a 20-year-old woman using an interposed subepithelial connective tissue graft. The results show that this technique can be successfully used in treating the loss of papillae and achieving long-term stability. The objective of this report is to describe the surgical technique and comment on the factors that may have influenced the final result.     

Cast gold inlay. A reliable and effective restoration

The Authors want to repropose a technique which is one of the earliest used in conservative dentistry: the fused-gold reconstruction. A method of easy application is explained by the Authors and will undoubtedly stimulate the dentists' interest towards this kind of reconstruction which still today represents one of the most efficient solutions, in conservative dentistry, of the first and second class cavities.     

Problems in the reconstruction of the inner canthus and the lacrimal duct.

The problems of reconstruction of the destructed mesial lid angle are discussed. Correct evaluation of the lesion is very important. Depending on whether primary or secondary reconstruction has to be done, different technical approaches are recommended. A personal technique of reconstruction of the lacrimal duct is described. This technique has given very satisfactory results.     

Mangement of a cheek fistula associated with false ankylosis

A 14-year-old boy presented with a Grade II left cheek fistula and inability to open the mouth following gangrenous stomatitis in early childhood. The treatment of the patient by multistaged reconstruction of the cheek defect is discussed. A large turnover flap was used for the lining, a technique which obviates the need for a second lining flap, and thus eliminates the disfigurement of a donor site. Also, it uses the healthy skin that would otherwise have been discarded in the creation of mucosal flaps.     

上颌骨复合体三维有限元模型的建立

目的 探讨利用螺旋ＣＴ建立上颌骨复合体三维有限元模型的高度数字化方法,建立一个具有生物力学特性的动态的上颌骨复合体三维有限元模型。方法 采用螺旋ＣＴ扫描及三维影像重建技术,数字影像传输与转录以及自编程序与ＡＮＳＹＳ软件相结合的方法。结果 获得形态细致逼真的颌面骨三维重建生物医学模型。建立了健康人上颌骨复合体三维有限元模型,由２６０２个单元和４５９５个节点组成,探索出一条数字化程度高,适用于活体的三     

New technique for endoscopically-assisted particulate graft reconstruction of the mandible

The reconstruction of mandibular defects using particulate grafts is a proven technique that restores the osseous anatomy effectively. Secondary osseous reconstruction can be accomplished with endoscopic assistance and reduced-access incisions if an intermediate spacer is placed during resection. Two patients required reconstruction after resection of mandibular ameloblastomas. We used a modified protocol that involved the implantation of a graft of particulate corticocancellous bone after removal of the spacer, and prepared the recipient site under endoscopic guidance with small extraoral incisions. The grafts healed uneventfully and matured into ossicles suitable for the placement of osseointegrated implants.