1/6. rehabilitation of a patient with severe dentoalveolar injuries: a case report with a 10-year follow-up.This clinical report describes the emotional and physical rehabilitation of a young man. The impact of the injuries sustained and repeated failure of traditional dental treatment methods had caused the patient to become quite withdrawn. A successful outcome followed surgical placement of multiple titanium plasma-sprayed cylindrical fixtures in severely damaged dental supporting tissues to serve as intermediary abutments for complex maxillary and mandibular fixed prostheses. The loss of crestal bone during the postprosthetic years is determined. The advantages only implant dentistry could bring are identified.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
2/6. Primary post-traumatic mandibular reconstruction in infancy: a 10-year follow-up.Ballistic trauma to the craniofacial skeleton combines the challenges of complex bone injury and loss with severe soft tissue injury and violation of the naso-orbital or oropharyngeal cavities. The authors report a patient who experienced a unique ballistic injury at 28 months of age that resulted in loss of the mandibular ramus and condyle. A segmental injury to the facial nerve was also identified. Primary costochondral grafting and delayed interpositional nerve grafting was undertaken. After 10 years, the patient has nearly 40 mm of opening, with only slight deviation to the injured side. Her facial nerve regeneration provides complete orbicularis oculi function, oral competence, and only slight facial asymmetry. This traumatic reconstruction differs from that of patients with hemifacial microsomia or post-traumatic/arthritic ankylosis in that the joint space itself was spared. Thus, the costochondral graft benefits from the remaining articular disk and upper disk space and is able to rotate and translate. Function and growth are adequately re-established, even in this young pediatric patient.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
3/6. Single osteotomized iliac crest free flap in anterior mandible reconstruction.While the iliac crest flap provides a natural contour for the lateral segment of the mandible, for the anterior segment en bloc, the use of the iliac graft, even harvested in a V shape, fails to yield a three-dimensional natural-shaped reconstruction. In this report, we present our experience with reconstruction of the anterior segment of the mandible using a single osteotomized free iliac crest flap in 5 patients. The study comprised 4 male patients and 1 female patient, their ages ranging between 34-82 years. In all patients, composite iliac osteomusculocutaneous flaps were harvested based on the deep circumflex iliac artery in the standard manner, and the bony segment of the flap was divided into two segments, performing a single osteotomy. The fixation of bone segments was performed in new positions, sliding the segments in different planes to provide the original shape of the resected mandible segment, and in a manner appropriate to the defect. The overall flap success rate was 100%. In no cases were wound infections or hematomas observed. x-rays showed bone healing without resorption. In conclusion, the use of a single osteotomy for an iliac crest flap in the reconstruction of the anterior segment of the mandible is a simple and safe procedure, and provides a natural and acceptable jaw appearance. The risk of devascularization is quite low when compared with the multiple osteotomy procedure, and it does not need to be fixed with complex devices such as reconstruction plates or external fixators.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
4/6. Vertical distraction of fibula transplant in a case of mandibular defect caused by shotgun injury.This case demonstrates the successful aesthetic and functional reconstruction of a complex facial gun-shot injury with extended bone defects and soft tissue destructions using a 3-step procedure. Initially, a reconstruction plate was inserted, later a fibula transplant enabled the basic reconstruction and finally was distructed in a 3rd session. The rationale behind the sequencing of surgical sessions was the extended bony defect and soft-tissue destruction. The main problem in this type of wound is hypoxia or anoxia of the receptor bed for the transplant. A microvascular anastomosized bone transplant is necessary for sufficient oxygen tension in the recipient site. The anatomical dimensional disproportion of the transplanted free fibula graft and the shape of the mandible were corrected prior to the insertion of dental implants by means of vertical distraction.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
5/6. ankylosis of the temporalis-coronoid complex of the mandible.ankylosis of the temporalis-coronoid complex is a clinical entity. The etiology is usually direct trauma to the temporalis muscle or coronoid process of the mandible. It is difficult to differentiate diagnostically from ankylosis of the adjacent temporomandibular joint, and should always be considered in the differential diagnosis of inability to open the mouth. The treatment is always surgical and the intraoral approach is favored. The cure rate with this modality of therapy has been gratifying.- - - - - - - - - - ranking = 5keywords = complex (Clic here for more details about this article) |
6/6. Lower face reconstruction using a neurosensory osteocutaneous radial forearm flap and Webster modification lip repair.An innervated bipaddled osteocutaneous radial forearm free flap was combined with a Webster modification lip repair to successfully reconstruct in one stage the lower face following a devastating shotgun injury with loss of the anterior mandible, floor of the mouth, full-thickness chin, and subtotal lower lip. In addition to a pleasing aesthetic appearance with restoration of facial contour, the patient had a sensate flap with intelligible speech and no problems with drooling or mastication. This approach to a most complex reconstructive problem is technically feasible with a satisfactory aesthetic and functional outcome.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |