Cavity Defects Research Articles

Multi-dimensional analysis of oral cavity and oropharyngeal defects following cancer extirpation surgery, a cadaveric study

BackgroundDefects following resection of tumors in the head and neck region are complex; more detailed and defect-specific reconstruction would likely result in better functional and cosmetic outcomes. The objectives of our study were: 1) to improve the understanding of the two- and three-dimensional nature of oral cavity and oropharyngeal defects following oncological resection and 2) to assess the geometric dimensions and the shapes of fasciocutaneous free flaps and locoregional tissue flaps required for reconstruction of these defects.MethodsThis study was an anatomic cadaveric study which involved creating defects in the oral cavity and oropharynx in two cadaveric specimens. Specifically, partial and total glossectomies, floor of mouth excisions, and base of tongue excisions were carried out. These subsites were subsequently geometrically analyzed and their volumes measured. The two-dimensional (2D) assessment of these three-dimensional (3D) structures included measures of surface area and assessment of tissue contours and shapes.ResultsThe resected specimens all demonstrated unique dimensional geometry for the various anatomic sites. Using 2D analysis, hemiglossectomy defects revealed right triangle geometry, whereas total glossectomy geometry was a square. Finally, the base of tongue defects exhibited a trapezoid shape.ConclusionsCustomizing the geometry and dimensions of fasciocutaneous free flaps so that they are specific to the confronted head and neck defects will likely result in better functional and cosmetic outcomes.

Effect of Iron-Containing Intermetallic Particles on Film Structure and Corrosion Resistance of Anodized AA2099 Alloy

The anodizing behavior of iron-containing intermetallic particles in AA2099 aluminum-lithium alloy and their effect on structure and corrosion resistance of the anodic film were investigated using electrochemical measurements and scanning electron microscopy. High-copper-containing Al-Fe-Mn-Cu particles (HCCPs) dissolved preferentially through dealloying at ∼ 0 V (vs. saturated calomel electrode) in a tartaric-sulfuric acid solution, at 22, 37 and 42°C, leading to formation of copper-rich nanoparticle of 50–200 nm diameters. They dissolved completely under normal anodizing conditions, resulting in cavity defects of micrometer dimensions in the anodic film and sunken regions in the alloy substrate immediately beneath the dissolved HCCPs. Immersion testing of the anodized alloy in 3.5% NaCl solution for 24 h indicated that localized corrosion of the anodized alloy predominantly developed at the site containing dissolved HCCPs at the film/alloy interface. It is suggested that HCCPs play a critical role in controlling the corrosion resistance of the anodic film formed on AA2099 aluminum-lithium alloy.

Versatility of Modified Nasolabial Flap in Oral and Maxillofacial Surgery.

BackgroundTo evaluate the versatility and reach of modified nasolabial flap used in reconstruction of defects created in and around the oral cavity.MethodsA total number of 20 cases were selected. Out of which 13 were males and 7 females. The age of these patients ranged from 24–63 years. 29 modified nasolabial flaps were raised in twenty patients. Based on clinical and histopathological examination, out of 20 patients, 14 patients were diagnosed with oral submucous fibrosis, 3 with verrucous carcinoma, 1 with squamous papilloma, 1 with oro-antral fistula and 1 with traumatic loss of lower lip.ResultsMinimum preoperative interincisal distance (IID) was 0 mm and maximum was 15 mm with mean of 6.00±4.76 mm in patients with oral submucous fibrosis and 12 months postoperatively minimum IID was 16 mm and maximum was 41 mm with mean of 28.00±8.96 mm. In one case, dehiscence (3.4%) was noted on the anterior tip for which tip revision was done. Bulky appearance of the flap intraorally was observed in 2 cases (6.9%). Five (17.2%) among the 29 flaps had visible scar at the donor site postoperatively up to 3 months.ConclusionNumerous reconstructive techniques have been employed in the reconstruction of small to intermediate sized defects of oral cavity. Modified nasolabial flap is a versatile flap which has robust vascularity and can be successfully used with minimal complications. It can be rotated intraorally to extend from the soft palate to the lip. Thus, it can be used efficiently to treat the small defects of the oral cavity as well as recreating lost lip structure.

Dentin-like versus rigid endodontic post: 11-year randomized controlled pilot trial on no wall to 2-wall cavity defects

Dentin-like versus rigid endodontic post: 11-year randomized controlled pilot trial on no wall to 2-wall cavity defects

Supraclavicular flap repair in the free flap era.

Supraclavicular flap (SCF) repair is widely reported in head and neck surgery in select patients and defects. The authors' objective is to present our series of 30 patients who underwent SCF repair for varying defects and to review the scope and outcome of SCF repair in the literature. The authors contributed primary evidence of 30 cases of SCF repair. Our outcomes are compared with those reported in the last 5 years' literature; 33 articles published between January 2012 and January 2017 that present original clinical experience of 528 SCFs. SCF is suitable for a wide variety of oral cavity, pharyngeal, skull base and cutaneous defects. Consistent with our experience, SCF is highly reliable even in previously irradiated or dissected necks, so long as the supraclavicular artery is intact. Our case series shows minor complications in 3/30 (10%) and flap loss in 1/30 (3.3%) cases. The literature reports a similar rate of complete flap failure of 3.4% and a slightly higher average minor complication rate of 24.6%. We add our experience of 30 cases of SCF repair to the international literature. We experienced a complication rate lower than the reported average, and maintain that the SCF is an excellent reconstructive option in patients with previously irradiated necks or comorbidities that affect microvasculature and anaesthetic resilience.

CONGENITAL ANOMALIES OF ORAL CAVITY AND PHARYNX (REVIEW OF LITERATURE)

The article describes the most common basic congenital anomalies of the oral cavity and pharynx. There are real cases of in the fetal development defects and methods of their prevention, diagnosis and treatment. We described the aspects of developing such anomalies as cleft of hard and soft palate and upper lip, agglossia, ankyloglossia and Zenker`s diverticulum. This work highlights the importance of studying the basic structure by morphologists of oral and maxillofacial regions and prerequisites for the formation of defects of the oral cavity and pharynx. In turn, doctors should make efforts to identify congenital defects in the early stages of their development.

Bony Bankart lesions and glenoid defects : From refixation techniques to bony augmentation

Rim defects of the anterior glenoid cavity are amain reason for residual shoulder instability after traumatic dislocation of the shoulder. These defects can be the result of aglenoid rim fracture or chronic glenoid erosion after repeated shoulder dislocations. Treatment concepts for these entities are entirely different. While in the acute fracture situation glenoid rim fractures can be treated operatively or non-operatively, augmentation of the anterior glenoid for stabilization of the shoulder should be considered if the defect exceeds 15-25% of the anterior glenoid. The purpose of this article is to summarize the diagnostics and indications for treatment of glenoid rim fractures. Radiological assessment and options for augmentation are reviewed for both acute fractures as well as chronic instability following an anterior glenoid rim defect.

Diagnostics and treatment of posterior shoulder instability

Posterior shoulder instability has amarkedly lower incidence than anterior shoulder instability. It has awide spectrum of clinical symptom manifestations and the overwhelming number of patients lack atraumatic primary dislocation. In addition to a detailed medical history, aspecific clinical examination with the help of standardized provocation tests is essential for the diagnostics. For the detection of structural posterior capsule and labral lesions in cases of chronic courses, magnetic resonance imaging (MRI) should be used with an intra-articular contrast agent. Relevant bony defects of the humeral head (reverse Sachs-Hill lesion) are frequent, whereas critical posterior defects of glenoid cavity are relatively rare. Both lesions should be quantified using 3D computed tomography. The choice of therapeutic procedure should be based on the underlying pathology of the defect. Conservative therapy is useful in patients with scapular dyskinesis, voluntary dislocation and pathological muscle patterning. In isolated soft tissue pathologies, arthroscopic labrum fixation and capsule plication are the standard treatment. In the case of insufficient soft tissue relations or critical posterior glenoid defects, bony stabilization of the glenoid using an iliac crest bone graft is the recommended therapy.

Use of Implants Constructed Using Three-dimensional Titanium Nickelide Mesh to Fill Cavity Defects in the Femur

Acute spherical cavity defects in the distal metaphysis of the femur were created and filled with a mesh implant made of titanium nickelide wire in 15 mature adult male Wistar rats. Analogous defects were created in animals of the control group (n = 15) but were not filled. Filling of the defect in rats of the experimental group was noted 90 days after implantation, but did not occur in rats of the control group. No differences were seen in the clinical picture or pathomorphological or biochemical investigation results between animals of the experimental groups.

Cervicofacial-facial artery myocutaneous flap (C-FAM flap): A novel flap in oral cavity reconstruction.

Reconstruction is an integral part of the surgical management of oral cancer. Local flaps are one of the options in reconstruction of small to moderate sized defects of oral cavity. Reconstruction is an integral part of the surgical management of oral cancer. Every defect needs to be assessed individually to tailor made the reconstruction because of its multidimensionality and complexity. Varieties of autologous tissues are being used in reconstruction like local, regional, or free flaps which can be simple or complex tissues. There is always a trend to identify the newer flaps/technique to personalize reconstruction. Local flaps are also one of the options in reconstruction of small to moderate sized defects of oral cavity. Local tissue if it is available is in the primary surgeon's purview and the flap can be raised without much technical difficulty and morbidity. We used perforator based tissue from the face and neck which is richly supplied by the facial vessels and named as the Cervicofacial- Facial Artery Myocutaneous flap (C-FAM flap) for reconstruction of oral cavity. We used perforator based local tissue from the face and neck which is supplied by facial vessels and named it as the C-FAM flap for the reconstruction of oral cavity defects. Twenty-eight patients underwent C-FAM flap reconstruction in different subsites of the oral cavity with acceptable functional rehabilitation. There was no flap loss. The C-FAM flap is a robust flap, which is reliable, pliable, and rich in its vascularity. It has to be one of the armamentarium for the oral cavity reconstruction. C-FAM flap: A Novel flap in Oral cavity reconstruction.

Rational and simplified nomenclature for buccinator myomucosal flaps.

Reconstruction of moderate-sized mucosal defects of the oral cavity or oropharynx represents a surgical challenge. Buccinator myomucosal flaps seem to provide "ideal reconstruction" of oral/oropharyngeal defects because they carry a thin, mobile, well-vascularized, and sensitive tissue, like that excised or lost. Nevertheless, these flaps are not immediately popular because of confusion surrounding the complex terminology used to name them. After a retrospective study on our experience and a literature review, the authors propose a new rational and simplified nomenclature for the classification of buccinator myomucosal flaps, which clarifies the source vessel, the composition of the flap, and the type of transfer. According to this nomenclature, six types of buccinator myomucosal flaps are described. This proposed nomenclature may bring a consensus on the classification of buccinator myomucosal flaps and can help their spread.

Investigation on the Effects of Process Parameters on Defect Formation in Friction Stir Welded Samples Via Predictive Numerical Modeling and Experiments

Setting optimum process parameters is very critical in achieving a sound friction stir weld joint. Understanding the formation of defects and developing techniques to minimize them can help in improving the overall weld strength. The most common defects in friction stir welding (FSW) are tunnel defects, cavities, and excess flash formation, which are caused due to incorrect tool rotational or advancing speed. In this paper, the formation of these defects is explained with the help of an experimentally verified 3D finite element (FE) model. It was observed that the asymmetricity in temperature distribution varies for different types of defects formed during FSW. The location of the defect also changes based on the shoulder induced flow and pin induced flow during FSW. Besides formation of defects like excess flash, cavity defects, tunnel/wormhole defects, two types of groove like defects are also discussed in this paper. By studying the different types of defects formed, a methodology is proposed to recognize these defects and counter them by modifying the process parameters to achieve a sound joint for a displacement-based FSW process.

A vascularized preputial free flap for labial reconstruction in a dog.

To describe the clinical application of a vascularized preputial free flap in the reconstruction of a large facial-labial defect. Case report. An adult neutered male mongrel dog with a large left facial-labial defect. A preputial free flap was created by elevating the cranial part of the prepuce, using the ipsilateral caudal superficial epigastric vessels as a vascular pedicle. The flap was transferred to the facial-labial defect and the donor vessels anastomosed to the sublingual artery and vein, using standard microvascular technique. The free flap survived, leading to good cosmetic and functional outcomes. No major complications were encountered at either the donor or recipient sites after 2 years of follow-up. Vascularized preputial free flaps can be used to manage composite facial and oral cavity defects involving large areas of skin and mucosa.

A Retrospective Volume Matched Analysis of the Submental Artery Island Pedicled Flap as Compared to the Forearm Free Flap: Is It a Good Alternative Choice for the Reconstruction of Defects of the Oral Cavity and Oropharynx?

The submental artery island pedicled flap (SMIF) is an underused alternative for reconstruction of head and neck defects after tumor ablation. The purpose of this study was to perform a comparative evaluation of reconstructive outcomes based on surgical site and ablative defect volume in patients who underwent reconstruction with the SMIF versus the forearm free flap (FFF). A retrospective cohort study of all patients with oral cavity and oropharyngeal defects reconstructed with the SMIF and a cohort of patients with similar volume defects reconstructed with the FFF were compared for oncologic safety and viability of equivalent reconstructive outcomes. All statistical comparisons were assessed by analysis of variance and Fisher exact test. Average age was 61.8years in the SMIF group versus 57.9years in the FFF group. The most common defect was located in the tongue, with squamous cell carcinoma being the most common pathology identified. Flap volumes were similar (SMIF, 38.79cm3; FFF, 39.77cm3). Significant comparative outcomes identified with SMIF versus FFF reconstruction included shorter anesthesia times (815 vs 1,209minutes; P<.001), shorter operative times (653 vs 1,031minutes; P<.001), and less blood loss (223 vs 398mL; P=.04). Postoperative Eastern Co-operative Oncology Group performance score increased more for the FFF than for the SMIF group (+0.33 vs+1.25; P=.0019). Recipient site complication rates were lower for the FFF group (0.17 vs 0.42 per patient) but were not statistically relevant. There were equal rates of recurrence at the local surgical site and no differences in speech and swallowing function. Mean follow-up was 15.5months. This is the first study to compare the SMIF with the FFF for reconstruction of oral cavity defects based on ablative volume deficit. The SMIF is a viable surgical option compared with the FFF that can be considered oncologically safe in the N0 neck, allowing for an excellent esthetic reconstruction, with decreased operative time, hospital stay, and donor site morbidity.

Adhesive Capsulitis of the Shoulder: Evaluation With US-Arthrography Using a Sonographic Contrast Agent

Adhesive capsulitis (AC) is a painful and disabling disorder, which caused restricted motion and chronic pain of shoulder. Intracavitary contrast-enhanced ultrasound has been recently applied to assess obstructive bile duct diseases, tubal patency, vesicoureteric reflux and so on. The aim of this study was to detect the value of US-arthrography by injecting the contrast agent SonoVue into glenohumeral joint compared with US in diagnosing AC. Utrasound (US) and US-arthrography images of 45 patients with AC were compared with that of 45 control subjects without AC with MRI as a gold standard. Patients with AC had a significantly thickened coracohumeral ligment (CHL, 3.1 mm) and inferior capsule (3.5 mm) on US, and a decreased volume of axillary recess (1.14 ml) on US-arthrography compared with the control subjects (1.59 ml). Filling defect (91.1%) and synovitis-like abnormality (75.6%) in the joint on US-arthrography were more sensitive than that of rotator interval abnormality (71.1%), thickened CHL more than 3 mm (64.4%), thickened inferior capsule more than 3.5 mm (66.7%) on US respectively for diagnosis of AC. Consequently, US-arthrography was more effective method than US for assessment of AC. Filling defects of joint cavity and synovitis-like abnormality in the joint are characteristic US-arthrography findings for diagnosing AC.

Fabrication and Properties of Ca-P Bioceramic Spherical Granules with Interconnected Porous Structure

Spherical calcium phosphate (Ca-P) granules show advantages in filling bone cavity defects. In this study, gelatinizing technology combined with microsphere-sintering and gas-foaming methods was applied to fabricate porous spherical Ca-P bioceramic granules. The obtained three kinds of Ca-P granules (i.e., hydroxyapatite, HA-G; biphasic calcium phosphate, BCP-G; and tricalcium phosphate, TCP-G) exhibited uniformly spherical shapes and interconnected pore structures with controlled macropores (about 600 μm), and abundant minor- (10-100 μm) to microsized (<10 μm) pores. The obtained Ca-P granules contained only the HA and β-TCP phases, but their phase ratios (HA/β-TCP) had some changes in the sintering process. All of the Ca-P granules were favorable for serum protein adsorption and bonelike apatite formation, and TCP-G was superior to the other two. Cell-culturing results showed that these Ca-P granules could promote cell adhesion, proliferation, and expression of a series of osteogenic genes. These findings demonstrated that these Ca-P granules had good bioactivity and pro-osteogenic ability, especially for BCP-G and TCP-G. Therefore, the porous spherical Ca-P bioceramic granules fabricated by the novel method show great potential to serve as good candidates for bone defect filling materials.

Ulnar fasciocutaneous free flap for reconstruction of oral cavity defects: a retrospective review

Ulnar fasciocutaneous free flap for reconstruction of oral cavity defects: a retrospective review

Ventral hernia repair in patients with abdominal loss of domain: an observational study of one institution's experience.

Abdominal wall hernias are a common problem. The success of abdominal wall reconstruction decreases with increasing hernia size. This study summarizes the outcomes of one surgeon's experience using a "sandwich" technique for hernia repair in patients with loss of abdominal domain. We reviewed our ventral hernia repair (VHR) experience from 2008 to 2015 among patients with loss of domain, as defined by a hernia defect greater than 300cm2. The percent of herniation through the defect, defined by a hernia sac-to-abdominal cavity volume ratio, was measured on preoperative CT scans by four independent reviewers and averaged. Outcomes were compared among those with giant ventral hernias (hernia sac-to-abdominal cavity volume >30%) and those with smaller defect ratios. Over the study period, 21 patients underwent VHR. In 17 patients (81%), a "sandwich" technique was utilized. Ten patients had hernia sac-to-abdominal cavity defects less than 30%, and 11 had defects greater than 30%. Preoperative characteristics were similar in both groups with the exception of a higher ASA score in those with giant ventral hernias and more Ventral Hernia Working Group Grade 3 hernias in those without giant ventral hernias. Postoperative outcomes were similar in both groups. There were no mortalities. There were two recurrences (18%) in the giant VHR group and none in the smaller defect group (p=0.16). Surgical site occurrences were noted in 48% of patients and did not differ between giant and non-giant VHR groups (50 vs 45%, p=0.84). Average postoperative length of stay was significantly longer in the giant VHR group (31 vs. 17days, p=0.03). Our results suggest that the "sandwich" technique for VHR is a safe and durable method to restore abdominal wall integrity in those with LOD, even in patients with giant ventral hernias.

Calf Perforator Flaps: A Freestyle Solution for Oral Cavity Reconstruction.

Reconstruction of oral cavity defects requires a thin, pliable flap for optimal functional results. Traditional flap choices are imperfect: the anterolateral thigh flap is excessively thick, whereas the radial forearm flap has a poor donor site. The authors therefore favor calf perforator flaps such as the medial sural artery perforator flap to provide thin tissue with an acceptable donor site. This two-part study aims to demonstrate their suitability for intraoral reconstruction. In the radiologic part of the study, the authors compared thigh and calf tissue thickness by examining lower limb computed tomographic scans of 100 legs. For their clinical study, they collected data prospectively on 20 cases of oral cavity reconstruction using calf perforator flaps. The mean thickness of the calf tissue envelope was significantly less than that of the thigh (8.4 mm compared with 17 mm) based on computed tomographic analysis. In the clinical study, a medial sural artery perforator was used in the majority of cases (17 of 20). The mean pedicle length was 10.2 cm and the mean time to raise a flap was 85 minutes. There were no flap losses. One patient was returned to the operating room for management of late hematoma and wound dehiscence. Calf perforator flaps provide ideal tissue for intraoral reconstruction and are significantly thinner than anterolateral thigh flaps. In addition to medial sural artery perforator flaps, the authors raised both sural and soleal artery perforator flaps in this series. Opportunistic use of the calf donor site allows the harvest of thin tissue with minimal donor-site morbidity. Therapeutic, IV.

Adhesive Capsulitis of the Shoulder: Evaluation With US-Arthrography Using a Sonographic Contrast Agent

Adhesive capsulitis (AC) is a painful and disabling disorder, which caused restricted motion and chronic pain of shoulder. Intracavitary contrast-enhanced ultrasound has recently applied to assess obstructive bile duct diseases, tubal patency, vesicoureteric reflux and so on. The aim of this study was to detect the value of US-arthrography by injecting the contrast agent SonoVue into glenohumeral joint compared with US in diagnosing AC. Utrasound (US) and US-arthrography images of 45 patients with AC were compared with that of 45 control subjects without AC with MRI as a gold standard. Patients with AC had a significantly thickened coracohumeral ligament (CHL, 3.1mm) and inferior capsule (3.5 mm) on US, and a decreased volume of axillary recess (1.14 ml) on US-arthrography compared with the control subjects. Filling defect (91.1%) and synovitis-like abnormality (75.6%) in the joint on US-arthrography were more sensitive than that of rotator interval abnormality (71.1%), thickened CHL more than 3 mm (64.4%), thickened inferior capsule more than 3.5 mm (66.7%) on US respectively for diagnosis of AC. Consequently, US-arthrography was more effective method than US for assessment of AC. Filling defects of joint cavity and synovitis-like abnormality in the joint are characteristic US-arthrography findings for diagnosing AC.