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Immediate loading of dental implants offers attractive advantages for patient and prosthodontist alike. Current data support immediate loading of splinted screw-shaped implants in the parasymphysis region. This report presents a case of a partially edentulous patient successfully restored with a fixed implant prosthesis following an immediate loading protocol.
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BACKGROUND: Following extensive resections of head and neck tumors, re-establishing speech and masticatory function are of crucial importance for the patient. METHODS: In 23 patients with vascularised jejunal grafts for reconstruction of the intraoral mucosa, tongue and floor of mouth, a speech intelligibility test was performed, tongue and floor of mouth mobility was investigated using a 3.5 MHz ultrasound scanner. In another 18 patients with vascularised bone grafts for reconstruction of the mandible, masticatory function was analysed using a T-scan system and a miniature pressure transducer. RESULTS: Speech results with jejunal grafts in the lateral floor of mouth/tongue region may attain 91.4%, in anterior floor of mouth reconstructions 63.4%. Patients with implant-bone dentures and vascularised bone grafts prefer the non-reconstructed side for chewing. Masticatory force is significantly diminished compared to a control group. DISCUSSION: Lack of neurosensitive feedback mechanisms may be responsible for diminished chewing pressure and also for inferior speech results despite good floor-of-mouth/tongue mobility. CONCLUSIONS: Despite complex microvascular tissue reconstructions, severe functional impairments remain and necessitate further investigations on improvement of postoperative speech, swallowing and chewing function.
Partial- or full-thickness perioral facial burns may lead to a contracture of the tissues surrounding the oral commissures that results in microstomia. The current investigators have used the microstomia prevention appliance (MPA) exclusively in the management of commissure burns at the University of Iowa Burn Center since 1972. To assess the effectiveness of the MPA, a retrospective chart review was conducted. The study population consisted of 85 patients admitted to the center between 1974 and 1986 who had incurred burns to the perioral region or to the lower two thirds of the face. The chart analysis of 83 patients revealed that, with diligent and persistent use of the MPA, only one patient required surgical repair for the development of microstomia. The MPA has proved effective in decreasing the need for reconstructive procedures and in preventing the occurrence of microstomia.
There are numerous advances that have taken place over the last several years in head and neck reconstruction. In this article, the author has outlined three exciting developments. The first is in the area of palatomaxillary reconstruction using free tissue transfer. In select cases, depending on the nature of the defect, soft tissue flaps have been highly successful. However, in more extensive defects, the author chooses to transfer vascularized bone composite flaps to achieve successful dental restoration as well as closure of the palatal defect. Sensory restoration through the use of sensate flaps has been a topic of considerable controversy. The author presents his experience with three patients who underwent a unique reconstruction of the laryngopharynx that has demonstrated conclusively that targeted sensory restoration can be achieved through neural anastomoses. By anastomosing the sensory nerve to the superior laryngeal nerve, there are implicit physiologic implications with respect to the feedback that is achieved and its role in achieving glottic closure during deglutition. Extensive laryngeal reconstruction with subglottic involvement can be a very challenging problem. The author describes a new technique using vascularized tracheal autografts with the thyroid gland as a carrier. This provides the necessary ingredients for transferring a cartilaginous infrastructure within a thin layer of vascularized mucosa to restore the framework and the lining to the laryngotracheal region. Three patients have been restored who had extensive glottic and subglottic stenoses that have since been decannulated and are successfully eating as well as speaking. In addition, the author feels that this is a very promising technique for the management of chondrosarcomas, in which a significant portion of the cricoid arch requires reconstruction.
OBJECTIVES/HYPOTHESIS: Multiple modalities exist for reconstruction of oral cavity defects following resection. Although microvascular free tissue transfer is often the first choice for complex intraoral defect reconstruction, not all patients are suitable candidates for "free flaps." The authors present their experience with the pedicled temporoparietal fascial flap (TPFF) for reconstruction of selected intraoral defects. STUDY DESIGN: Retrospective chart review. METHODS: Charts of patients who underwent a TPFF for reconstruction of intraoral defects at a tertiary academic institution between 2001 to 2003 were reviewed. Information regarding tumor, surgical procedure, complications, and results was gathered. The anatomy and surgical technique of using the TPFF for intraoral reconstruction were reviewed. RESULTS: Three patients underwent reconstruction of an intraoral defect with a TPFF. All defects were on the lateral buccal space with significant anterior or posterior extension. All patients had specific contraindications for free flaps, including compromised donor site or recipient site vascularity and medical comorbidity. The procedures were uncomplicated. There was no incidence of flap failure, and all flaps accepted a split-thickness skin graft. The average hospital stay was 7 days. An oral diet was begun on the fifth postoperative day. The cosmetic result at the donor site was excellent. Follow-up has ranged from 7 to 30 months. Mild contracture of the flap developed in two patients, limiting mandibular motion. CONCLUSION: The TPFF is a thin, vascular, durable flap that is a viable option for reconstruction of selected intraoral defects in patients who are not suitable candidates for other methods.
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Press-fit implants can be used to meet the prosthetic needs of patients who require immediate loading of their implants. This procedure may be necessary because of a patient's unwillingness and/or inability to tolerate a removable prosthesis. The implants reported in this study had a similar success rate to those immediately loaded screw-type implants previously reported by others. The lack of large numbers of long-term immediately loaded implants dictates the need for detailed informed consent when using immediately loaded cylinder implants for dental reconstruction.
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Scalp layers are widely used in reconstructive procedures. The authors used prefabricated galeal flaps based on the superficial temporal or postauricular vessels for ear, cheek, mandible, and cranium reconstructions in three cases. In case 1, synchronous beard and ear reconstructions were accomplished by using the temporoparietal and retroauricular flaps. In case 2, a buccomandibular defect was reconstructed by transposing the supra-auricular and retroauricular galea with prefabricated bone and skin. In case 3, an epidural hematoma in the left frontoparietal area was evacuated after a circular craniectomy. The harvested bone was not put back on the defect area but buried between the periosteal and galeal layers because of brain edema. These layers were raised as an osteogaleoperiosteal flap and transposed onto the defect area after 7 weeks. When used with a prefabrication method, scalp layers offer versatile options for repairing composite defects of the head region. A galeal flap based on the posterior auricular vessels is practical and reliable in reconstructive procedures. The authors suggest that this flap is an option in cases in which the temporoparietal fascia artery or the superficial temporal artery is not available. Prefabrication of the harvested cranial bone inside the adjacent tissues offers several advantages in that a viable bone is provided at the end of the procedure, intervention at a distant area is avoided, the graft is placed on osteogenic tissue (periosteum) that is also transposed onto the defect, and sophisticated procedures such as microsurgical techniques are not needed.
One hundred ninety-six patients treated for oral cancer between 1992 and 1999 self-scored their speech, chewing, and swallowing using a new self-questionnaire (Functional Intraoral Glasgow Scale) developed at Canniesburn Hospital, Glasgow, to assess the functional efficiency of patients treated for intraoral cancer. The patients were distributed into 12 homogeneous groups, according to the site and size of surgical resection, carefully mapped out on standard diagrams of the oral cavity. The functional outcome for chewing and swallowing was correlated to the site and size of resected tissue, to the reconstruction modality, and to radiotherapy and compared with the speech quality. The general trend is very similar for both chewing and swallowing; the smaller the resections, the better the functional outcome. Chewing was mostly affected by resections of the floor of the mouth, whereas swallowing was mostly affected by demolition of the base of the tongue and of the retromolar trigone. Speech showed a better postoperative recovery than chewing and swallowing. The reconstruction modality did not influence the eventual outcome for either function. Radiotherapy in combination with surgery is a negative functional prognostic factor. A correlation between site and size of excision and functional outcome is presented using color multiple-view diagrams for immediate appreciation to identify positive and negative prognostic factors.
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AIMS AND OBJECTIVES: Documentation of dental and orthodontic implications of osteoglophonic dysplasia (OGD). SETTINGS AND PARTICIPANTS: Case report describing oral and dental manifestations of a female with OGD, aged 39 years, who was first documented three decades ago. RESULTS: This rare genetic disorder manifests with gross stunting of stature, associated with severe craniofacial malformation and multiple unerupted teeth. Radiographically, multiple lucent lesions were present in the tubular bones and mandible as well as several impacted teeth. CONCLUSION: We concluded that prosthetic dental replacement in this patient would be difficult because of the distorted jaw relationship and large alveolar ridges. Equally, craniofacial reconstruction might be compromised by obstruction of the nasal airways, difficulty in intubation and postoperative respiratory problems.
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Successful treatment of the multiple endocrine neoplasia type III (MEN III) syndrome requires early diagnosis. It is highly possible that the patient's dentist may be the first practitioner with the opportunity to diagnose this potentially fatal syndrome. Additionally, patients with this syndrome having a pheochromocytoma and needing invasive dental treatment pose a life-threatening dental management risk. This article presents a review of the MEN II syndrome and a case report on the surgical management of a MEN III patient with a pheochromocytoma.
There are several dental complications associated with cocaine abuse, including adverse reactions to dental anesthetics, post-operative bleeding, and cellulitis, which can lead to necrosis of orbital, nasal, and palatal bones. Following is a report of the initial treatment rendered to a patient who had destroyed most of her hard palate over a ten-year period of cocaine abuse. There are no classic socio-economic or educational profiles for abusers of cocaine. Drug abuse victims may present as patients in any dental office. Though there are certain classic physiological and psychological symptoms of their condition, they may not display symptoms at all.