Rehabilitation Program for Prosthetic Tracheojejunal Voice Production and Swallowing Function Following Circumferential Pharyngolaryngectomy and Neopharyngeal Reconstruction with a Jejunal Free Flap

The case of a 68-year-old woman with postoperative speech and swallowing problems following a circumferential pharyngolaryngectomy and neopharyngeal reconstruction with a jejunal free flap is presented. The primary tumor was an extended papillary thyroid carcinoma (pT4N0M0). For vocal restoration, an indwelling Provox® 1 voice prosthesis was inserted secondarily. The patient received speech and swallowing therapy, including digital maneuvers at the level of the proximal (cervical) part of the jejunal graft to improve speech and swallowing function. Pre- and/ or post-treatment data on speech and swallowing function were gathered using the following assessment methods: esophageal insufflation test, Voice Handicap Index (VHI), videofluoroscopy of phonation (VFSph), digital high-speed endoscopy of jejunal vibration during voice production, fiber-optic endoscopic evaluation of swallowing (FEES), and videofluoroscopy of swallowing (VFSs). This case clearly demonstrates that even after extensive laryngopharyngectomy with jejunal free flap reconstruction, a tailored rehabilitation program can improve both voice and swallowing function, and that these results clearly can be objectified/visualized, underlining the validity of this approach

Full 3-D digital planning of implant-supported bridges in secondary mandibular reconstruction with prefabricated fibula free flaps

Objectives In the reconstruction of maxillary or mandibular continuity defects in dentate patients, the most favourable treatment is placement of implant-retained crowns or bridges in a bone graft that reconstructs the defect. Proper implant positioning is often impaired by suboptimal placement of the bone graft. This case describes a new technique of a full digitally planned, immediate restoration, two-step surgical approach for reconstruction of a mandibular defect using a free vascularised fibula graft with implants and a bridge. Procedure A 68-year-old male developed osteoradionecrosis of the mandible. The resection, cutting and implant placement in the fibula were virtually planned. Cutting and drilling guides were 3-D printed, and the bridge was computer aided design-computer aided manufacturing (CAD-CAM) milled. During the first surgery, two implants were placed in the fibula according to the digital planning, and the position of the implants was scanned using an intra-oral optical scanner. During the second surgery, a bridge was placed on the implants, and the fibula was harvested and fixed in the mandibular defect, guided by the occlusion of the bridge. Conclusion Three-dimensional planning allowed for positioning of a fibula bone graft by means of an implant-supported bridge, which resulted in a functional position of the graft and bridge.</p

Full 3-D digital planning of implant-supported bridges in secondary mandibular reconstruction with prefabricated fibula free flaps

Objectives In the reconstruction of maxillary or mandibular continuity defects in dentate patients, the most favourable treatment is placement of implant-retained crowns or bridges in a bone graft that reconstructs the defect. Proper implant positioning is often impaired by suboptimal placement of the bone graft. This case describes a new technique of a full digitally planned, immediate restoration, two-step surgical approach for reconstruction of a mandibular defect using a free vascularised fibula graft with implants and a bridge. Procedure A 68-year-old male developed osteoradionecrosis of the mandible. The resection, cutting and implant placement in the fibula were virtually planned. Cutting and drilling guides were 3-D printed, and the bridge was computer aided design-computer aided manufacturing (CAD-CAM) milled. During the first surgery, two implants were placed in the fibula according to the digital planning, and the position of the implants was scanned using an intra-oral optical scanner. During the second surgery, a bridge was placed on the implants, and the fibula was harvested and fixed in the mandibular defect, guided by the occlusion of the bridge. Conclusion Three-dimensional planning allowed for positioning of a fibula bone graft by means of an implant-supported bridge, which resulted in a functional position of the graft and bridge.</p

Full 3-D digital planning of implant-supported bridges in secondary mandibular reconstruction with prefabricated fibula free flaps

Objectives In the reconstruction of maxillary or mandibular continuity defects in dentate patients, the most favourable treatment is placement of implant-retained crowns or bridges in a bone graft that reconstructs the defect. Proper implant positioning is often impaired by suboptimal placement of the bone graft. This case describes a new technique of a full digitally planned, immediate restoration, two-step surgical approach for reconstruction of a mandibular defect using a free vascularised fibula graft with implants and a bridge. Procedure A 68-year-old male developed osteoradionecrosis of the mandible. The resection, cutting and implant placement in the fibula were virtually planned. Cutting and drilling guides were 3-D printed, and the bridge was computer aided design-computer aided manufacturing (CAD-CAM) milled. During the first surgery, two implants were placed in the fibula according to the digital planning, and the position of the implants was scanned using an intra-oral optical scanner. During the second surgery, a bridge was placed on the implants, and the fibula was harvested and fixed in the mandibular defect, guided by the occlusion of the bridge. Conclusion Three-dimensional planning allowed for positioning of a fibula bone graft by means of an implant-supported bridge, which resulted in a functional position of the graft and bridge.</p

Full 3-D digital planning of implant-supported bridges in secondary mandibular reconstruction with prefabricated fibula free flaps

Objectives In the reconstruction of maxillary or mandibular continuity defects in dentate patients, the most favourable treatment is placement of implant-retained crowns or bridges in a bone graft that reconstructs the defect. Proper implant positioning is often impaired by suboptimal placement of the bone graft. This case describes a new technique of a full digitally planned, immediate restoration, two-step surgical approach for reconstruction of a mandibular defect using a free vascularised fibula graft with implants and a bridge. Procedure A 68-year-old male developed osteoradionecrosis of the mandible. The resection, cutting and implant placement in the fibula were virtually planned. Cutting and drilling guides were 3-D printed, and the bridge was computer aided design-computer aided manufacturing (CAD-CAM) milled. During the first surgery, two implants were placed in the fibula according to the digital planning, and the position of the implants was scanned using an intra-oral optical scanner. During the second surgery, a bridge was placed on the implants, and the fibula was harvested and fixed in the mandibular defect, guided by the occlusion of the bridge. Conclusion Three-dimensional planning allowed for positioning of a fibula bone graft by means of an implant-supported bridge, which resulted in a functional position of the graft and bridge.</p

Full 3-D digital planning of implant-supported bridges in secondary mandibular reconstruction with prefabricated fibula free flaps

Objectives In the reconstruction of maxillary or mandibular continuity defects in dentate patients, the most favourable treatment is placement of implant-retained crowns or bridges in a bone graft that reconstructs the defect. Proper implant positioning is often impaired by suboptimal placement of the bone graft. This case describes a new technique of a full digitally planned, immediate restoration, two-step surgical approach for reconstruction of a mandibular defect using a free vascularised fibula graft with implants and a bridge. Procedure A 68-year-old male developed osteoradionecrosis of the mandible. The resection, cutting and implant placement in the fibula were virtually planned. Cutting and drilling guides were 3-D printed, and the bridge was computer aided design-computer aided manufacturing (CAD-CAM) milled. During the first surgery, two implants were placed in the fibula according to the digital planning, and the position of the implants was scanned using an intra-oral optical scanner. During the second surgery, a bridge was placed on the implants, and the fibula was harvested and fixed in the mandibular defect, guided by the occlusion of the bridge. Conclusion Three-dimensional planning allowed for positioning of a fibula bone graft by means of an implant-supported bridge, which resulted in a functional position of the graft and bridge.</p

Full 3-D digital planning of implant-supported bridges in secondary mandibular reconstruction with prefabricated fibula free flaps

Objectives In the reconstruction of maxillary or mandibular continuity defects in dentate patients, the most favourable treatment is placement of implant-retained crowns or bridges in a bone graft that reconstructs the defect. Proper implant positioning is often impaired by suboptimal placement of the bone graft. This case describes a new technique of a full digitally planned, immediate restoration, two-step surgical approach for reconstruction of a mandibular defect using a free vascularised fibula graft with implants and a bridge. Procedure A 68-year-old male developed osteoradionecrosis of the mandible. The resection, cutting and implant placement in the fibula were virtually planned. Cutting and drilling guides were 3-D printed, and the bridge was computer aided design-computer aided manufacturing (CAD-CAM) milled. During the first surgery, two implants were placed in the fibula according to the digital planning, and the position of the implants was scanned using an intra-oral optical scanner. During the second surgery, a bridge was placed on the implants, and the fibula was harvested and fixed in the mandibular defect, guided by the occlusion of the bridge. Conclusion Three-dimensional planning allowed for positioning of a fibula bone graft by means of an implant-supported bridge, which resulted in a functional position of the graft and bridge.</p

A continuous-discontinuous model for crack branching

This is the peer reviewed version of the following article: Tamayo, E. [et al.]. A continuous-discontinuous model for crack branching. "International journal for numerical methods in engineering", 5 Octubre 2019, vol. 120, núm. 1, p. 86-104, which has been published in final form at https://doi.org/10.1002/nme.6125. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.A new continuous-discontinuous model for fracture that accounts for crack branching in a natural manner is presented. It combines a gradient-enhanced damage model based on nonlocal displacements to describe diffuse cracks and the extended finite element method (X-FEM) for sharp cracks. Its most distinct feature is a global crack tracking strategy based on the geometrical notion of medial axis: the sharp crack propagates following the direction dictated by the medial axis of a damage isoline. This means that, if the damage field branches, the medial axis automatically detects this bifurcation, and a branching sharp crack is thus easily obtained. In contrast to other existing models, no special crack-tip criteria are required to trigger branching. Complex crack patterns may also be described with this approach, since the X-FEM enrichment of the displacement field can be recursively applied by adding one extra term at each branching event. The proposed approach is also equipped with a crack-fluid pressure, a relevant feature in applications such as hydraulic fracturing or leakage-related events. The capabilities of the model to handle propagation and branching of cracks are illustrated by means of different two-dimensional numerical examples.Peer ReviewedPostprint (author's final draft

Treatment with soft laser. The effect on complaints after the removal of wisdom teeth in the mandible

In a placebo controlled double-blind randomized study the effect of low level laser therapy on postoperative complaints after removal of lower third molars was examined. Several parameters were investigated in two groups of patients; in one group low level laser was applied during and following third molar removal, in the other no active additional laser treatment was given. The results of this study show that therapeutic low level laser treatment could not statistically reduce the postoperative pain, swelling, trismus and function impairment after extraction of lower third molars.</p

Treatment with soft laser. The effect on complaints after the removal of wisdom teeth in the mandible

In a placebo controlled double-blind randomized study the effect of low level laser therapy on postoperative complaints after removal of lower third molars was examined. Several parameters were investigated in two groups of patients; in one group low level laser was applied during and following third molar removal, in the other no active additional laser treatment was given. The results of this study show that therapeutic low level laser treatment could not statistically reduce the postoperative pain, swelling, trismus and function impairment after extraction of lower third molars.</p