Evaluation of the pectoralis major flap for reconstructive head and neck surgery

PURPOSE: The pectoralis major myocutaneous flap (PMMF) is a commonly used flap in reconstructive head and neck surgery, but in literature, the flap is also associated with a high incidence of complications in addition to its large bulk. The purpose of the study is the evaluation of the reliability and indication of this flap in reconstructive head and neck surgery. PATIENTS AND METHODS: The records of all patients treated with a PMMF between 1998 and 2009 were systematically reviewed. Data of recipient localization, main indication, and postoperative complications were analyzed. RESULTS: The male to female ratio was 17:3, with a mean age of 60 years (45-85). Indications in 7 patients were recurrence of a squamous cell carcinoma, in one case an osteoradionecrosis and in 12 cases an untreated squamous cell carcinoma. In 6 male patients (30%), a complication appeared leading to another surgery. CONCLUSION: The PMMF is a flap for huge defects in head and neck reconstructive surgery, in particular when a bulky flap is needed in order to cover the carotid artery or reconstructive surgery, but the complication rate should not be underestimated in particular after radiotherapy

Aggressive fibromatosis of the head and neck: a new classification based on a literature review over 40 years (1968-2008)

BACKGROUND: Fibromatosis is an aggressive fibrous tumor of unknown etiology that is, in some cases, lethal. Until now, there has been no particular classification for the head and neck. Therefore, the aim of the present study was to review the current literature in order to propose a new classification for future studies. METHODS: An evidence-based literature review was conducted from the last 40 years regarding aggressive fibromatosis in the head and neck. Studies that summarized patients' data without including individual data were excluded. RESULTS: Between 1968 and 2008, 179 cases with aggressive fibromatosis of the head and neck were published. The male to female ratio was 91 to 82 with a mean age of 16.87 years, and 57.32% of the described cases that involved the head and neck were found in patients under 11 years. The most common localization was the mandible, followed by the neck. All together, 143 patients were followed up, and in 43 (30.07%), a recurrence was seen. CONCLUSION: No clear prognostic factors for recurrence (age, sex, or localization) were observed. A new classification with regard to hormone receptors and bone involvement could improve the understanding of risk factors and thereby assist in future studies

Malignancy mimicking bisphosphonate-associated osteonecrosis of the jaw: A case series and literature review

OBJECTIVE: Bisphosphonate-related osteonecrosis of the jaw (BONJ) is a common complication of bisphosphonate treatment that has been well documented over the past decade. Nevertheless, its pathogenesis is poorly understood, and treatment guidelines are based mostly on expert recommendations. Clinicians must be aware of malignancy mimicking BONJ, of which a few cases have been documented in the literature. STUDY DESIGN: Three patients undergoing long-term treatment with intravenous bisphosphonates for malignant disease demonstrated the distinct diagnostic signs of BONJ. Surgical treatment was performed by resecting the affected bone. In all cases, histologic specimens were taken for analysis. RESULTS: Histologic analysis of the bone specimen with surrounding soft tissue revealed necrotic bone with signs of inflammation, but also with cells of the underlying malignant disease. CONCLUSIONS: Clinical and radiographic diagnosis of BONJ should be confirmed by histologic analysis in patients with underlying malignant disease

Clinical reliability of radial forearm free-flap procedure in reconstructive head and neck surgery

OBJECTIVE: The purpose of the study was to evaluate the indications, reliability, and complications of the radial forearm fasciocutaneous flap (RFFF) procedure in reconstructive head and neck surgery. METHODS: The records of 81 patients who were treated with an RFFF between 1998 and 2009 were systematically reviewed. Data of recipient localization, previous T status, and postoperative complications were analyzed. RESULTS: From the 50 male and 31 female patients, 4 patients (3 men and 1 woman) experienced flap failure during the first 36 hours: in 1 patient because of arterial and in 3 patients because of venous complications. None of the 4 patients had preoperative radiotherapy. A dehiscence was observed in 2 patients without a need for further surgery. CONCLUSIONS: With a success rate of more than 95%, the RFFF is a reliable flap and a workhorse, particularly in defects where thinness is needed to substitute for the oral mucosa, such as on the floor of the mouth or the tongue

3-Dimensional imaging for lower third molars: is there an implication for surgical removal?

Three-dimensional imaging is useful for predicting the risk of postoperative IAN impairment before surgical removal of impacted lower third molars. The low IAN impairment rate seen in this study-compared with similar selected study groups in the literature of the era before 3D imaging-indicates that the availability of 3D information is actually decreasing the risk for IAN impairment after lower third molar removal

of Oral and Maxillofacial Surgeons

Purpose: Surgical removal of impacted third molars may be the most frequent procedure in oral surgery. Damage to the inferior alveolar nerve (IAN) is a typical complication of the procedure, with incidence rates reported at 1% to 22%. The aim of this study was to identify factors that lead to a higher risk of IAN impairment after surgery. Materials and Methods: In total 515 surgical third molar removals with 3-dimensional (3D) imaging before surgical removal were retrospectively evaluated for IAN impairment, in addition to 3D imaging signs that were supposed predictors for postoperative IAN disturbance. Influence of each predictor was evaluated in univariate and multivariate analyses and reported as odds ratio (OR) and 95% confidence interval (CI). Results: The overall IAN impairment rate in this study was 9.4%. Univariate analysis showed narrowing of the IAN canal (OR, 4.95; P Ͻ .0001), direct contact between the IAN and the root (OR, 5.05; P ϭ .0008), fully formed roots (OR, 4.36; P ϭ .045), an IAN lingual course with (OR, 6.64; P ϭ .0013) and without (OR, 2.72; P ϭ .007) perforation of the cortical plate, and an intraroot (OR, 9.96; P ϭ .003) position of the IAN as predictors of postoperative IAN impairment. Multivariate analysis showed narrowing of the IAN canal (adjusted OR, 3.69; 95% CI, 1.88 to 7.22; P ϭ .0001) and direct contact (adjusted OR, 3.10; 95% CI, 1.15 to 8.33; P ϭ .025) to be the strongest independent predictors. Conclusion: Three-dimensional imaging is useful for predicting the risk of postoperative IAN impairment before surgical removal of impacted lower third molars. The low IAN impairment rate seen in this study-compared with similar selected study groups in the literature of the era before 3D imagingindicates that the availability of 3D information is actually decreasing the risk for IAN impairment after lower third molar removal. © 2011 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 69:1867-1872, 2011 Surgical removal of impacted third molars is a regular, perhaps even the most frequent, procedure in oral and maxillofacial surgery. Damage to the inferior alveolar nerve (IAN) is a typical complication of the procedure. Susarla and Dodson 1 stated that nerve damage after third molar surgery occurs in 1% to 22% of surgeries. Different factors have been discussed in the literature as causes of nerve damage, eg, age of the patient, inexperience of the surgeon, or deep impaction

Registration for computer-navigated surgery in edentulous patients: A problem-based decision concept

BACKGROUND: Surgical navigation is a commonly used tool in cranio-maxillofacial surgery. Registration is the key element for precision, and a number of studies have shown different techniques to be accurate. Nonetheless, uncertainty surrounds the special situation in edentulous patients and a practical approach to what can be a challenging problem. MATERIALS AND METHODS: Four registration strategies for the Brainlab VectorVision(2) system are presented for surgical navigation of edentulous patients: three landmark-based, point-to-point techniques and one surface-based matching strategy are evaluated. RESULTS: The methods described differ in overall accuracy as well as in the region covered. In general, the more time-consuming and invasive the technique, the more precise it is. The non-invasive techniques are less precise, and they cover only small regions with sufficient accuracy. CONCLUSIONS: Taking into account which type of accuracy is clinically relevant and that the whole skull does not always need to be covered with the greatest possible accuracy, all the described techniques have their indications. The simpler and less invasive techniques can spare time, decrease costs, and harm patient. A decision tree is presented to the reader

Point-to-point registration with mandibulo-maxillary splint in open and closed jaw position. Evaluation of registration accuracy for computer-aided surgery of the mandible

INTRODUCTION: Computer navigation plays an increasingly important role in craniomaxillofacial surgery. The difficulties in computer navigation at the craniomaxillofacial site lie in the accurate transmission of the dataset to the operating room. This study investigates the accuracy of the dental-splint registration method for the skull, midface, and mandible. MATERIAL AND METHODS: A synthetic human skull model was prepared with landmarks and scanned with cone beam computer tomography (CBCT). Two registration splints fixed the mandible against the viscerocranium in two different positions (closed vs. open). The target registration error was computed in all 278 landmarks spread over the entire skull and mandible in 10 repeated measurements using the VectorVision(2) (BrainLAB Inc., Feldkirchen, Germany) navigation system. RESULTS: If registered in the closed position an average precision of 2.07mm with a standard deviation (SD) of 0.78mm was computed for all landmarks distributed over the whole skull. Registration in the open position resulted in an average precision of 1.53mm (SD=0.55mm). For single landmarks the precision decreases linearly with distance from the reference markers. The longer the three-dimensional distance between the registration points, the more precise the computer navigation is, mainly in the most posterior area of the cranium. CONCLUSION: Our findings in the cranium are comparable with those of other studies. Artificial fixation of the lower jaw via splint seems to introduce no additional error. The registration points should be as far apart from each other as possible during navigation with the splint