1/81. Z-plasty closure of the donor defect of the radial forearm free flap. The radial forearm is a popular free flap site for reconstruction of head and neck defects, because of its abundant, pliable, skin component and an available, extended, vascular pedicle. In addition, vascularized composite flaps, including a segment of radius, can be designed for skeletal stabilization. The donor-site defect can involve various complications, including loss of skin graft, unsatisfactory appearance, numbness, and radial fracture. Recent advances in reducing donor-site defect problems have included the use of rotation skin flaps, local muscle rotation, and soft-tissue expansion; however, each of these has its own limitations. Two cases are presented in which radial forearm donor site defects, measuring less than 4 cm x6 cm, were primarily closed successfully with z-plasties based on the longitudinal skin incision. Each patient has regained preoperative mobility, and prompt primary healing was achieved without complications. ( info) |
2/81. Reconstruction of the horizontal rami of the mandible following avulsion in childhood. A 7-year-old boy was involved in a road traffic accident in October 1971, and apparently had been dragged along face downwards with resultant avulsion of the entire horizontal mandibular rami, and most of the mandibular alveolar soft tissue and teeth. Repair by metal implants was attempted but these proved unsatisfactory, and soft tissue replacement for the missing alveolus was carried out by flap raised from arm. Rib grafting was carried out on three occasions at almost yearly intervals, but each time, probably owing to vascular insufficiency, non-union (or more correctly non-replacement) occurred in the left canine region. To "import" a new blood supply, and free some of the scar tissue, a compound muscle/bone/skin flap bearing the clavicle and sternomastoid muscle was transposed to the mandibular bed. This form of grafting was used extensively in world war i to repair facial gunshot wounds, and the transposed blood supply enabled success in the pre-antibiotic period. Bony union is now satisfactory 5 years after injuries and dentures have been recently fitted; speech is normal, the child's facial contours acceptable, and mastication has been satisfactory during this period. ( info) |
3/81. Use of the free medialis pedis flap in orofacial reconstruction: report of two cases. The medialis pedis flap is a fasciocutaneous flap based on a branch of the medial plantar artery. The authors have used this flap in the reconstruction of skin defects of the hands and fingers because its skin is very similar in texture, color, and thickness. Because of its characteristics, this flap can also be applicable for orofacial reconstruction, when small or thin skin coverage is needed. Two cases are reported in which free medialis pedis flaps were used to reconstruct the eye socket in one patient and the alveolar ridge in the other. The authors concluded that the skin of the medialis pedis flap is not flexible enough and thus less suitable than the radial forearm flap for reconstruction of defects in which flexible skin is required, such as eye-socket reconstruction. However, reduced flexibility of the medialis pedis flap may provide an advantage in reconstruction of the gingiva and palate, where thin and rigid coverage is necessary. ( info) |
4/81. Treatment of chronic mandibular dislocation. Report of a case. The procedure described in this article achieves the desired objective, but without the use of foreign bodies or any additional operation to obtain grafting material. Unlike many surgical approaches in use for treating chronic dislocation, there is no capsular violation. Six operations have been performed with this technique, and all have been successful. ( info) |
5/81. 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. ( info) |
6/81. Nine-year follow-up of successful placement of endosseous implants in a mandibular bone graft. Facial trauma injuries secondary to gunshot wounds present a unique challenge. These wounds are avulsive and typically involve the destruction of soft tissue with bone loss. A technique in bone transplantation is that of particulate cancellous bone and marrow. Initial form and stability can be provided by a titanium mesh tray or reconstruction plates while the graft undergoes maturation and consolidation. dental implants can then be placed in this grafted site to provide stabilization for a functional and comfortable prosthesis and for the support of the peri-oral soft tissues. ( info) |
7/81. Vertical distraction of a free vascularized fibula flap in a reconstructed hemimandible: case report. The authors report a case of vertical distraction osteogenesis of a free revascularized fibula flap used to reconstruct an hemimandible lost as a result of a gunshot injury. The reconstruction procedure and the distraction protocol are described; clinical and radiological results are presented. The vertical discrepancy between the fibula and the native right hemimandible was corrected. ( info) |
8/81. Dislocation of the mandible: a case report. Dislocation of the mandible is a possible complication of direct tracheal laryngoscopy. The temporomandibular joint (TMJ) is unique in that any movement of the bone always causes movement in both joints simultaneously. The entire TMJ is surrounded by a ligamentous capsule and is stabilized by 3 ligaments. Four muscles of mastication move the mandible with great power. The lateral pterygoid muscle has nearly horizontal muscular fibers and is chiefly responsible for dislocating the mandibular condyle and articular disc past the articular eminence into the infratemporal fossa, causing the patient great pain and distress. If mandibular dislocation should occur, prompt recognition and treatment of the dislocation is recommended. There are steps, used by dentists, which can be employed by the nurse anesthetist to relocate the mandible. The technique for intraoral bimanual relocation of the mandible is described. ( info) |
9/81. 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. ( info) |
10/81. Degloving injury to mental protuberance: a case report. Sporting injuries are increasing in frequency with the increase in leisure time. This report describes a case of degloving of the mental protuberance. Ideally this injury should be treated as soon as possible by repositioning the displaced tissue and closure. Immediate assistance was not sought until superimposed infection caused pain and swelling. Because the wound was infected, treatment was aimed at obtaining healing by secondary intention. ( info) |