Masticatory Efficiency of Mandibulectomy Patients after Oral Prosthetic Rehabilitation: Preliminary Results

Comparative osteoradionecrosis rates in bony reconstructions for head and neck malignancy

BackgroundStainless steel crowns (SSCs) are commonly employed to restore the posterior teeth of children and over the years, they are available with improved anatomical shapes. This study was conducted to evaluate and assess the effect of the placement of SSCs on the masticatory efficiency of children.MethodsThis pilot cross-sectional split-mouth study assessed masticatory efficiency in children aged 6–11 years. Fifteen participants, each with stainless-steel crowns placed unilaterally at least one month prior, were included. This study utilized two flavours of trident chewing gum (red and green) to measure masticatory efficiency. The child was asked to chew half a strip of red and green chewing gum placed one on top of the other using either the noncrown or crown side 15 times. Another set of chewing gum was given to the child to chew 20 times on the same side. The chewing exercise was repeated using teeth on the other side. Chewed gum samples were collected, photographed, and analysed via ImageJ software to determine the red and green areas. Masticatory efficiency was subsequently calculated with the help of a formula in which the red areas and green areas were calculated via ImageJ software. The data were analysed with paired t tests via SPSS (version 20.0).ResultsWhen the mean values of the crown side were compared with those of the noncrown side following 15 chewing cycles, the chewing efficiency on the noncrown side was greater, with a difference of 0.303, whereas the chewing efficiency following 20 chewing cycles was greater on the crown side, with a difference of 0.814. However, both differences were statistically nonsignificant, with t values of -0.07 and 0.26, respectively, and p values of 0.94 and 0.8, respectively.ConclusionThe presence of SSCs on the molars of children did not affect masticatory efficiency.

BackgroundTreatment for malocclusion can cause discomfort and pain in the teeth and periodontium, which may impair masticatory efficiency. The glucose concentration method is widely used to assess masticatory efficiency for its convenience in the clinical situation, although its validity has not been shown.ObjectivesThe aims were to determine the validity of the glucose concentration method and investigate if this method can be applicable to orthodontic patients with braces.MethodSixteen healthy individuals (7 men, 9 women, and 26 ± 5 years old) and 16 patients with malocclusions needing orthodontic treatment (5 men, 11 women, and 26 ± 4 years old) participated. Glucose concentration was measured after 5‐, 10‐, and 15‐s mastication of gummy jelly and compared to Hue values obtained from the color‐changing gum method (reference method). In addition, all participants were asked to fill out the Oral Health Impact Profile questionnaire (OHIP) to assess differences in perception related to the mouth before and after the placement of braces.ResultsGlucose concentrations were strongly correlated to measures of the two‐color chewing gum methods (R 2 = 0.965). Both the glucose extraction and chewing gum hue value were the smallest for 5 s chewing cycles and increased as the number of chewing strokes increased for the 15 s chewing cycles. (Hue: R² = 0.510, p < 0.001; glucose: R² = 0.711, p < 0.001) Masticatory efficiency assessed by both methods was significantly lower in orthodontic patients compared to controls (p < 0.05), even though it was not affected by bonding (p > 0.09). In addition, OHIP scores in physical pain dimension and psychological disability were higher in orthodontic patients than in the control group (p < 0.005).ConclusionMeasurement of glucose concentration was confirmed as a reliable and convenient method for assessing masticatory efficiency. Furthermore, it appears that this method is applicable to patients with braces whose perception in the oral cavity could change.

Surgical Management of Ameloblastoma in the Mandible: Segmental Mandibulectomy and Immediate Reconstruction With Free Fibula or Deep Circumflex Iliac Artery Flap (Evaluation of the Long-Term Esthetic and Functional Results)

The treatment of hand soft tissue defects primarily relies on flap reconstruction. However, traditional venous/arterial free flaps have several disadvantages, including damage to the donor site, blood stasis, cyanosis, blister formation, and even necrosis. These issues can significantly affect patient recovery and outcomes. Therefore, there is a need for alternative approaches that minimize these complications and improve overall patient treatment. To compare the efficacy of medial tarsal free venous flaps and traditional venous/arterial free flaps in the reconstruction of hand soft tissue defects, by evaluating various clinical outcomes and patient recovery metrics. We screened 30 suitable patients with hand soft tissue defects and randomly assigned them to three groups. Patients in each group were transplanted with either medial tarsal free venous flaps or traditional arterial/venous free flaps to achieve coverage and reconstruction of the soft tissue defects. The results were compared and analyzed using the following metrics: operation time, complication rate, pain index, postoperative infection rate, and functional evaluations of both the donor and recipient areas. There was no significant difference in operation time between the medial tarsal free venous flaps and the traditional forearm free venous flaps. The operative time of both types of flaps above was shorter than that of the traditional fibular-side arterial flap of the hallux. The complication rate of the medial tarsal free venous flaps was comparable to that of the fibular-side arterial flaps from the great toes and significantly lower than that of the traditional forearm free venous flaps. In terms of pain, the pain index for the medial tarsal free venous flaps was significantly lower than that of the fibular-side arterial flap from the hallux and comparable to that of the forearm free venous flaps. Regarding postoperative infection rates, the forearm free venous flaps had the highest rate, while there was no significant difference between the medial tarsal free venous flaps and the fibular-side arterial flaps from the great toes. The functional recovery of the medial tarsal free venous flaps was outstanding in both the donor and recipient areas. There was no poor functional performance in the donor areas of the forearm free venous flaps or the recipient areas of the fibular-side arterial flaps of the halluces. The medial tarsal free venous flaps effectively avoid the disadvantages of traditional venous and arterial free flaps, combining their advantages. This kind of flaps offer shorter operative times, and lower pain indices. They also provide excellent functional recovery in both donor and recipient areas. Thus, medial tarsal free venous flaps represent an ideal solution for reconstructing hand soft tissue defects.

Through and through complex oro-mandibular defect usually involves buccal mucosa, mandibular segment, lip, and outer cheek skin. Reconstruction of such extensive three-dimensional defects pose a great challenge to reconstructive surgeons which requires use of two flaps. There are diverse options for such types of defects like use two pedicled flaps, one free flap, one pedicled flap or use of two free flaps. Amongst them the use of dual free flaps is ideal for the reconstruction. Commonly used dual free flaps are free fibula osteocutaneous flap for mandible, buccal mucosal defect and free radial artery flap or antero-lateral flap for cheek defect. The major disadvantages of using these two free flaps include two different sites for flap harvest, more time for harvesting and increased overall surgery time. We present our experience of reconstruction of large oro-mandibular defect using free osteo-cutaneous fibula flap and lateral sural artery free flap from single limb in six patients between January 2019 and December 2020. Minimum follow up was 6 months.

A special, hard chewing gum was used to study the effects of chewing training on masticatory efficiency. An experimental group of 17 individuals used this chewing gum 1 h daily for 28 days, while a control group of 8 individuals performed no chewing-gum training. The percentage of masticatory efficiency was measured with a special sieve system, and the time for 10 chewing cycles was taken from EMG recordings. These measurements were made in trained and untrained condition before and after 30 min of intense chewing. The results indicate that intense chewing for 30 min decreased the masticatory efficiency and increased the frequency of the chewing cycles significantly in both trained and untrained individuals, possibly due to fatigue of the masticatory muscles. However, chewing training for 28 days did not influence these factors significantly.

The aim of this split-mouth study was to evaluate the masticatory efficiency in patients with segmentally reconstructed mandibles using free fibula flaps, with and without stabilizing osteosynthesis material in-situ during implant placement for rehabilitation with implant-supported removable partial dental prostheses (ISRPDPs). Ten participants (n=10; ♀=2, ♂=8; mean age=38.1years) consented to participate in this study. The participants' normal side (Side N) of the mandible served as the control side, for comparing the masticatory efficiency of the segmentally reconstructed and rehabilitated side (Side R). Masticatory efficiency was evaluated using the two-colored chewing gum test, measured as subjective assessment (SA) and electronically evaluated variance of hue (VOH). Data were checked for normal distribution and statistically analyzed with the level of significance set to p<0.05. Thirty-four tissue-level implants were placed in reconstructed mandibles of 10 participants. There was no significant difference observed in the masticatory efficiencies between Side N and Side R, in both subjective and electronic assessments. No implant loss was observed after a post-rehabilitated mean follow-up period of 42.7months, revealing an implant survival rate of 100%. In patients with surgically reconstructed mandibles, a normal masticatory function can be successfully achieved with a rehabilitation of the reconstructed side with implant-supported removable partial dental prostheses. Implant-supported prostheses should be actively advocated in patients with reconstructive surgeries to restore their masticatory function, extend their food choices, and improve their overall oral health-related quality of life.

In free osteofasciocutaneous fibula flaps, secondary donor sites are avoided using one of three local closure methods: full-thickness skin grafts (FTSGs), split-thickness skin grafts (STSGs), or flaps. This systemic review aimed to evaluate the differences in outcomes among the three groups of closure methods used for free fibula flap defects. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, we systematically searched the PubMed and Web of Science medical databases from inception to January 2021 for articles focused on closure of the free fibula flap donor site using the lower leg area-local skin graft or flap-that mentioned the free fibula flap defect size, and/or complications of the donor site. Study characteristics, free fibula flap size, and short-term complication rates were extracted for analysis. The pooled complication rates and confidence intervals were calculated based on the random-effects model. Eleven studies were included in the qualitative synthesis, and ten studies were included in the quantitative synthesis (meta-analysis). The FTSG (n=79, 52.3%) was the most widely used method, while both STSG (n=36, 23.8%) and flap (n=36, 23.8%) were the least commonly used methods. The mean free fibula flap length and width were largest for the flap method (11.5 ± 2.5cm and 6.0 ± 1.8cm), and all closure methods were used for free fibula flap widths ≥3cm. Rates of partial and complete necrosis were highest for the FTSG method (20.3%, p=.95, I2 =0%) and lowest for the flap method (12.7%, p=.95, I2 =0%). This systemic review indicated that any closure method could be adapted for a free fibula flap width ranging from 3 to 9cm, and the flap method was associated with the lowest rate of short-term complications.

Most of the tools and diagnosis models of Masticatory Efficiency (ME) are not well documented or severely limited to simple image processing approaches. This study presents a novel expert system for ME assessment based on automatic recognition of mixture patterns of masticated two-coloured chewing gums using a combination of computational intelligence and image processing techniques. The hypotheses tested were that the proposed system could accurately relate specimens to the number of chewing cycles, and that it could identify differences between the mixture patterns of edentulous individuals prior and after complete denture treatment. This study enrolled 80 fully-dentate adults (41 females and 39 males, 25 ± 5 years of age) as the reference population; and 40 edentulous adults (21 females and 19 males, 72 ± 8.9 years of age) for the testing group. The system was calibrated using the features extracted from 400 samples covering 0, 10, 15, and 20 chewing cycles. The calibrated system was used to automatically analyse and classify a set of 160 specimens retrieved from individuals in the testing group in two appointments. The ME was then computed as the predicted number of chewing strokes that a healthy reference individual would need to achieve a similar degree of mixture measured against the real number of cycles applied to the specimen. The trained classifier obtained a Mathews Correlation Coefficient score of 0.97. ME measurements showed almost perfect agreement considering pre- and post-treatment appointments separately (κ ≥ 0.95). Wilcoxon signed-rank test showed that a complete denture treatment for edentulous patients elicited a statistically significant increase in the ME measurements (Z = -2.31, p < 0.01). We conclude that the proposed expert system proved able and reliable to accurately identify patterns in mixture and provided useful ME measurements.

&#x0D; &#x0D; &#x0D; &#x0D; Background: Head and neck reconstruction following cancer resection remains a challenge for surgeons. Microsurgical free tissue transfer is the technique of choice to close the defect. Extensive complex defects resulted from radical excision often require two free flaps to provide adequate bony structure and soft tissue coverage.&#x0D; Method: Three cases following head and neck cancer resection that require reconstruction with two combined free flaps were reported. The combination of two free flaps between vastus lateral free flap, radial forearm free flap, and free fibular flap was reviewed in this study. The patients were then followed up for 1-2 months.&#x0D; Result: Two of the patients had a flow through chimeric free flap between radial forearm free flap and free fibular flap to reconstruct the maxillary, palatal and mandibular defect. One patient had a combination of free fibular flap and vastus lateral free flap to reconstruct the mandibular defect. No complications were observed in all patients. All the flaps were vital without donor site morbidity. However, two patients needed secondary procedures for further reconstructions.&#x0D; Conclusion: Combined free flaps are reliable for closing the complex defect after wide resection of head and neck cancer. They can provide adequate tissues, reduce recipient site morbidity, permit simultaneous reconstruction with two-team approach. Therefore, provide a practical method of defect coverage for these patients.&#x0D; &#x0D; &#x0D; &#x0D;

To assess the successful rehabilitation outcome of dental implants placed in free fibula flap and iliac crest free flap after maxillary or mandibular resection. This systematic review was done using Preferred Reporting Items for Systematic Review guidelines published from 2000 to February 2023. Sixteen publications consisting of rehabilitation outcome of dental implants placed in free fibula or iliac crest free flap after surgical resection were included in our analysis. The mean age of the included participants was 51years. A total of 643 individuals were included. A total of 927 implants were placed in free fibula flap and 230 implants were placed in iliac crest free flap in the studies included in our review. The success rate of implants ranged between 92 and 100% in accordance to Albrektsson criteria. The follow-up ranged between 1 and 15year. Bias due to selection showed some concern between 80 and 100%. Bias in the classification of intervention was seen in 90-100%. The overall weight was low showing 100% low bias. The present systematic review found no significant differences in implant survival rates between the free fibula flap and the iliac crest free flap. As such, clinical decisions for the use of implants should be made based on patient and deficit factors.

Poster 12: Venous Anastomoses Coupler With Implantable Doppler in Head and Neck Microvascular Reconstruction: A Preliminary Cohort

Roux-en-Y gastric bypass (RYGB) is among the most performed bariatric surgery techniques. One known complication of RYGB surgery is food intolerance, which may limit the intake of protein. To investigate the relationship of food intolerance after RYGB surgery with masticatory efficiency, chewing time and cycles, and consumption of protein and red meat. A case-control study in subjects with and without food intolerance (regurgitation and/or vomiting more than once a week) aged over 18years old who had undergone RYGB more than 2years prior, with an absence of no more than 2 dental units and normal oral motor system evaluation. Masticatory efficiency was evaluated by the granulometry of red meat chewed by the study subject according to a predefined protocol using a sieving technique and classified from very poor to excellent. Protein and red meat consumption were evaluated by usual food recall and a 3-day dietary diary. The study population consisted of 24 cases (37.7 ± 7.57years old, 79.2% females) and 68 controls (38.0 ± 8.75years old, 61.8% females). There was a statistically significant association (p = 0.001 by the ranksum test) between food intolerance and masticatory efficiency, with 58.3% of cases and 23.5% of controls showing very poor masticatory efficiency. No evidence was found of an association of food intolerance with chewing time, chewing cycles, low protein or red meat consumption. Masticatory inefficiency is a contributing factor to food intolerance after RYGB, regardless of time and chewing cycles. No relationship was found between food intolerance and consumption of red meat and protein.

Comparison of microsurgical reconstructive options after mandible resection is limited in the literature. Fibula free flaps (FFFs) can be costly and have timing limitations, but dental restoration can be performed, with varied reported rates of completion. The radial forearm free flap (RFFF) with mandible plating may be an alternative in select populations. The purpose of this study was to determine if the RFFF has similar outcomes to the FFF for mandible reconstruction in a rural population. A retrospective review of patients who underwent mandibulectomy from 2017 to 2021 at a single tertiary-care academic institution was performed. Those with FFF or RFFF reconstruction were included. Mandible defects were classified using the Jewer-Boyd H-C-L system. Sixty-eight patients were included with 53 undergoing FFF and 15 undergoing RFFF. Immediate reconstruction was significantly more common with RFFF than FFF (100% versus 64.2%; P =0.01). Lateral mandible defects were most common among both groups (52.9% FFF versus 73.3% RFFF; P =0.04). Osseous defect length was similar (9.5cm FFF versus 7.7cm RFFF; P =0.07), but soft tissue defect size was significantly larger in the RFFF group (28.6cm 2 versus 15.3cm 2 ; P =0.01). Complication rates (47.1% FFF versus 46.7% RFFF; P =0.98) and disease-free status at last follow-up (96.2% FFF versus 80.0% RFFF; P =0.06) were similar. Dental restoration occurred in 21.3% of patients undergoing FFF. Patients undergoing RFFF or FFF reconstruction after mandibulectomy had similar surgical and disease outcomes, with a low rate of completed dental restoration after FFF. Our findings suggest RFFF is a reasonable alternative to FFF for mandible reconstruction in select patients.