Oral Reconstruction Research Articles

Functional Results of Oral Cavity Organs Reconstruction By Innervated Free Flaps in Oncological Patients

Functional Results of Oral Cavity Organs Reconstruction By Innervated Free Flaps in Oncological Patients

Environmental Reconstructions in the Upper Tana region, Kenya

This article sets out to unravel aspects of environmental changes in the Upper Tana during the second millennium AD. This aspect has not been adequately addressed in the Upper Tana. This makes it clear that a lacuna exists in the study of communities of the Upper Tana and the way they interact with their environment in the past and present times. The objective of this article is to evaluate the relationship between human activities and environmental change in the Upper Tana from AD 1000 to 1950. It is hypothesized that the advent of iron technology and its attendant economic activities led to the depletion of indigenous forests and the general environmental degradation. The article has employed archaeological, ethnographic, oral and historical methodologies to gather data on vegetation change in the Upper Tana and other related regions. The article, argues that livestock grazing, iron smelting, slush and burn agriculture, and the clearing of forests for housing are key contributors to vegetation change in the Upper Tana. Results from oral reconstruction of the past vegetation of the area, and using the plant succession theory, shows that the lowland area of the Upper Tana is actually savanna with scattered trees probably inhabited by grazers. It is posited that the above factors, together with persistent droughts have altered the vegetation cover of the area. What we have today is colonization of less desirable stunted growth. The theory advanced here is that the vegetation change has been a result of human activities. Overwhelmingly, results the study that the researcher carried out, showed that the causes of these changes have been socio-economically associated with the expansion of agricultural communities into the area; rather than through climatic factors. Colonisation and other forces of modernistion have also contributed to the underlying problem. The article concludes that anthropogenetic factors have greatly contributed to environmental change in the upper Tana. Certainly, environmental change is a global phenomenon that has elicited research interests due to its negative impacts on human population. It is recommended that knowledge of environmental change in the past should be used to extrapolate modern environmental challenges affecting African ecosystems.

Our Experience in Oral Commissure Reconstruction After Surgical Excision of Stage 3 and Stage 4 Oral Cavity Malignancy

The upper and lower lips represent the most important functional and aesthetic anatomical structures of the lower segment of the face. The reconstructive aims are to restore the oral lining, oral competence and function (i.e. articulation, speech and mastication). Functional and aesthetic restoration of lip and oral commissure defects can be achieved using the composite radial free forearm flap (RFFF) with Palmaris longus tendon. To present the technique, we have used our experience with this form of reconstruction in 30 consecutive patients with lip and oral commissure defects who were surgically treated between 2012 and 2018. Reconstruction of the lip defect was done with RFFF with Palmaris longus tendon. The ends of the Palmaris longus tendon were passed intraorally and anchored to the remnant orbicularis oris muscle of the upper lip to provide adequate tension so that oral competency could be achieved and sagging of the commissure could be prevented, and in cases, where adequate orbicularis oris was not present, the tendon was sutured to the zygomatic prominence. The patients were followed for 1 year. In our study of 30 cases of stage 3 and stage 4 oral cavity squamous cell carcinoma, we did RFFF with Palmaris longus and found that the graft uptake was excellent, i.e. 93.33%. Flap failure occurred in only 2 out of the total 30 cases. Re-exploration of the flap was done, and venous congestion was the cause of flap failure. Re-anastomosis of the vessels was done, but still the flap could not be salvaged. Donor site healed satisfactorily without any complications except for scarring. All patients had excellent oral competence during rest, speaking and eating. Good sphincteric function was obtained in early post-operative days. Drooling or air leakage was seen only in 6 out of 30 cases after 1 year of follow-up. The patients’ articulation was near-normal. The aesthetic results were accepted by 24 patients. All patients were able to resume regular diet. No complications were observed such as dehiscence, fistula formation or abscess formation. The mouth opening was also adequate (2–3 finger width) in 24 out of 30 patients of oral commissure reconstruction. The RFFF with Palmaris longus has excellent viability. It is a secure and reliable reconstructive option which produced satisfactory aesthetic and functional results.

Abnormal Formation of External Jugular Vein and its Repercussions.

External jugular vein is formed by joining of posterior division of retromandibular vein and posterior auricular vein and common facial vein drain into internal jugular vein.Variations are not uncommon and these are more often observed in veins than in arteries. Aim of the study is to report the prevalence of unique variation of formation of external jugular vein.Head and neck of 6 cadavers (12 sides) fixed in 10% formalin were dissected in the department of anatomy AIIMS Rishikesh for the variant formation of external jugular vein.Abnormal formation of external jugular vein was detected in 1 cadaver on left side. The mean age of the cadavers was 70 years. The retromandibular vein divided into anterior and posterior divisions 2.5 cm below the angle of mandible. The facial, after travelling for 6 cm below the mandible, along with anterior and posterior divisions abnormally joined to form the external jugular vein. This is unique and rare finding.External jugular vein is used for assessment of venous pressure in right atrium and for catheterization. The variation may give false value of pressure due to facial vein draining into it, also create difficulty in catheterization. In addition to this, these veins are also used for various other procedures like carotid endarterectomy and for oral reconstruction surgeries. Thus facial vein and external jugular vein variations are of paramount importance to head and neck surgeons, anatomists and anesthetist.

Application of chimerical ALT perforator flap with vastus lateralis muscle mass for the reconstruction of oral and submandibular defects after radical resection of tongue carcinoma: a retrospective cohort study

BackgroundPatients with tongue carcinoma who undergo combined tongue and neck radical resection often have simultaneous oral and submandibular defects. Due to its high flexibility, the anterolateral thigh (ALT) perforator flap is gradually being adopted by surgeons for oral reconstruction. However, the tissue volume of perforator flaps is insufficient for the reconstruction of both the oral and submandibular regions. In this retrospective cohort study, we compared the postoperative outcomes and complications between patients reconstructed with using the classical ALT perforator flap and patients reconstructed using the chimeric ALT perforator flap with vastus lateralis muscle mass.MethodsFrom August 2017 to August 2019, 25 patients underwent reconstructive therapy using a classical ALT perforator flap (classical group), while 26 patients were reconstructed with the chimeric ALT perforator flap (chimeric group) after radical resection of tongue cancer in Xiangya Hospital, Central South University. The flap survival rate, incidence of submandibular infection, lateral appearance, lower extremity function, and quality of life were compared between the two groups.ResultsThere were no differences in flap survival rate and postoperative lower extremity function between the two groups. The incidence of submandibular infection was 15.4 and 40% in the chimeric and classical group, respectively. The duration of recovery was 12.20 ± 2.69 and 15.67 ± 4.09 days in the chimeric and classical group, respectively. The submandibular region fullness was satisfactory in the chimeric group. The postoperative quality of life in the chimeric group was better than that in the classical group (P < 0.05).ConclusionsThe chimerical ALT perforator flap with muscle mass reconstructs both the oral and submandibular defects accurately. It maintains the profile and fullness of the submandibular region and may reduce the incidence of submandibular infection.

Island NLF or Island FAMM Flap in Reconstruction of Oral Malignancy Defects?

Free tissue transfer is the reconstructive option of choice in oral defects of onco-resections. Local flaps like nasolabial flap and FAMM flaps need to be in the armamentarium of surgeons to use when need arises. The aim of this study is to assess utility of island FAMM or nasolabial flap in oral reconstruction, in an oncological setting. Patients with oral cancers, irrespective of nodal status, were included in the study. A total of 33 patients were enrolled from Jan 2018 to Feb 2019, of which 2 were discarded intra-operatively. Fifteen had NLF and 16 had FAMM flap reconstruction. Partial flap loss was noted in 2 patients that healed with granulation, secondarily. Island FAMM and island nasolabial flaps are equally good reconstructive options even in an oncological setup, if factors like addictions, socialising capacity of patient and presence of submucosal fibrosis can be ascertained.

Research progress in exosomes delivery in the jaw regeneration

Large area defect of jaw caused by trauma, tumor resection, congenital malformation and periodontitis is a critial situation for oral and craniofacial reconstruction. Recent studies have shown that some exosomes carrying specific biological information play a role in promoting tissue regeneration. Compared to allogeneic stem-cell transplantation, exosomes have lower immunogenicity, and can facilitate storage and quantitative use, thus have great potential in tissue engineering. This article reviewed the regeneration process of jaw bone and the regulatory effect of exosomes transport on bone regeneration, as well as the research progress of exosomes in jaw bone-related diseases. Key words: Exosomes; Bone regeneration; Jaw; Bone marrow mesenchymal stem cells

Clinical and Histological Features of Intraoral Flap and a Preliminary Study of DNA Methylation of Mucosalization

Flaps have been routinely used to reconstruct intraoral defects. Flaps after reconstruction tend to develop, with time, a mucosa-like appearance during a process called “mucosalization.” Many studies have described histological changes of mucosalization, but only a few of them mention the associated clinical factors. Our aim was to determine the possible predictive factors related to mucosalization of flaps employed for oral cavity reconstruction, and to verify whether skin inflammation-specific DNA methylation occurs in mucosalized flaps. In this study, 140 patients underwent reconstruction of the oral cavity defects with flaps, of which 39 showed “mucosalization” changes. Histological changes of “mucosalization” are characterized by inflammatory infiltration, accompanied by a reduction of thickness of the horny layer and elimination of skin appendages. These changes are affected by clinical differences with sex and type and site of flaps. We also found that DNA methyltransferase 1 was highly expressed in the epithelium of mucosalized flaps, and less in unmucosalized flaps, suggesting their involvement in the inflammation-dependent DNA methylation of mucosalization. To summarize, our results demonstrated that most intraorally placed flaps maintain skin features, except in the event of heavy inflammation. Mucosalization varies in association with sex of the subject and type and site of flaps. DNA methyltransferase 1 might correlate with mucosalization, suggesting that DNA methylation may be involved in chronic inflammation in mucosalization.

The utility of the lateral forehead flap in demanding reconstructive situations: our experience in a tertiary care center

The current century is an era of microsurgical reconstruction. However, there are situations when free tissue reconstruction is not possible due to extremes of age, their associated co morbidities and dearth of microsurgical expertise and equipment. The significance of local and regional flaps in such reconstructive scenario is paramount. These flaps are well vascularised, easy to master, quick to perform and can be used in both primary as well as salvage reconstruction. The Lateral forehead flap (LFF) is one such useful option. The LFF is an axial myocutaneous flap spanning the entire forehead aesthetic subunit. Herein we describe the operative technique of LFF elevation, advantages and disadvantages of the use of this flap in the reconstruction of facial and intra oral defects reconstruction, both in primary and salvage settings. We describe our experience in the use of this handy flap for various facial reconstructions in our institute. This versatile “forgotten” flap which is easy to master can be handy to all general plastic surgeons who indulge in such reconstructions.

Free-flap reconstruction for full-thickness oral defects involving the oral commissure combined with oral modiolus reconstruction using a fascial sling.

Oral modiolus reconstruction is important in unilateral oral commissure removal including the modiolus. However, the proper procedure is not yet established. We performed free-flap reconstruction for full-thickness oral defects involving the oral commissure combined with oral modiolus reconstruction using a fascial sling. From 2008 to 2018, six oral carcinoma patients, aged 65 to 86 years, underwent free-flap modiolus reconstruction after tumor resection. The resulting lip defects of 10% to 80% were labial (two patients), buccal (two patients), and mixed (two patients). Five anterolateral thigh flaps including one perforator and one radial forearm flap were performed. The oral defects were covered with folded flaps (size, 11 × 6-18 × 7.5 cm2 ). The orbicularis oris stumps were connected to the masseter with a fascia lata or palmaris longus tendon (length, 15-20 cm), arranged in a Y-shape in four patients and a V-shape in two patients. All the flaps survived without complications. Almost all the patients achieved good oral static effects (lip deviation and drooping) and dynamic effects (mouth opening, oral commissure narrowing, and diet) in the 6 to 65 months' follow-up. Free-flap reconstruction combined with oral modiolus reconstruction using a fascial sling achieves good oral static and dynamic effects for full-thickness oral reconstruction involving the oral commissure.

Long-Term Patient-Reported Outcomes of Radial Forearm Free Flap Donor Site in the Context of Head and Neck Cancer Reconstruction.

Radial forearm free flap (RAFF) is the workhorse flap for oral cavity reconstruction. In the context of oncological reconstruction with radial forearm flap, the patient-reported outcomes of donor site morbidity amongst Indian patients have not been reported previously. Cultural and racial differences prevent extrapolation of morbidity data from Western literature. We aimed to evaluate subjectively the subjective long-term functional and aesthetic outcomes of the RAFF donor site. Patients who underwent RAFF reconstruction for intra-oral defects between 2014 and 2016 were included. Two questionnaires (Cosmesis and Sensibility and Forearm Disability) were administered. Fifty-two patients who completed a 2-year follow-up were identified. Thirty-five patients (67%) had complaints regarding the donor site. With regard to cosmesis and sensibility, hand numbness was seen in 21 (40.4%) patients. With regard to forearm disability, a problem in lifting heavy weights was seen in 22 (42.3%) patients. Only three patients in the entire cohort had complaints regarding the cosmesis of the forearm scar. Overall disability score was low (7.83). With regard to donor site morbidity, numbness and difficulty in lifting weights was the most common complaint. There is good acceptance of the donor site and scar with minimum morbidity. These findings are useful for the preoperative counselling of the patients. This is the first Indian study evaluating the long-term subjective outcomes of the radial forearm donor site. We believe the RAFF is still the most preferred flap for oral reconstruction.

The Second World War, Taxation and the failure of Community in Colonial Ilesa Metropolis, Western Nigeria

This research explores the nexus between the Second World War (World War II) and the episode of communal riots that broke out in Ilesa, Western Nigeria in 1941. Ilesa a town populated by the Ijesa, a sub-group of the Yoruba was an extremely vibrant town during the colonial period. It provided opportunities in commerce and industry for both local inhabitants and settlers. However, in 1941, in the face of dwindling resources and acute competition occasioned by the World War II, the Ijesa people descended on the visitors and settlers in their midst. This work, using undocumented oral reconstruction of popular memory in Ilesa and other parts of Western Nigeria, private papers, newspaper accounts and colonial official reports in the National Archives at Ibadan, National Archives in London and secondary sources provides extensive interpretation of the consequences of World War II on identity and inter- group relations in an urban milieu in colonial Nigeria.

Dental Prosthesis: Postmortem Treatment of Oral Reconstruction during the Mummification Process

During excavations carried out in 2014 at Tell Tebilla, Egypt, three tombs were discovered inside a mud-brick mastaba, each one with an individual interment. The occupant of the second tomb was of great interest. It was a partially mummified man about 60 years old, named Wah ib Ra, a priest of Sekhmet. The detailed study of his skull and jaw revealed that this man had lost most of his teeth in life, long before his death. However, we discovered that new false teeth were carefully embedded during the mummification process in the gaps caused by antemortem teeth loss. To perform this maneuver, a white material was used as glue. Chemical analysis performed on this white material confirmed that it was anhydrite (CaSO4), which is the dehydrated form of plaster. Although the final result was successful, the embalmers made several errors in both the placement and the type of new teeth used. This performance of the embalmers can be framed within the actions already described as “prosthesis for the afterlife,” in which mummification would not only be a process to avoid putrefaction but also a moment in which the embalmers would try to rebuild, or improve the body in order for the individual to enjoy an eternal life without the problems or illnesses suffered in earthly life.

Submental island flap for oropharyngeal reconstruction: UK experience of 25 cases.

Since the first description of the submental island flap 24 years ago, advances in techniques have expanded the indications for its use and improved its characteristics to make it a favourable reconstructive option for orofacial oncological defects. We describe our experience (particularly perioperatively) of its use, the complications, and the precautions adopted. We retrospectively reviewed the cases of 25 patients and focused on the operating time, use of tracheostomy, duration of postoperative inpatient stay, oropharyngeal function, and associated morbidities. Eighteen patients had defects of the tongue. Other defects were retromolar (n=2), buccal (n=1), mandibular (n=2), and maxillary (n=2). The mean (range) operating time was 250 (152-370) minutes and the mean (range) postoperative stay was 11 (4-16) days. Only four patients required a tracheostomy, and four required postoperative monitoring in the intensive care unit (ICU). The complications were partial flap loss (n=6), sialocele (n=1), and seroma (n=1). The flap has shown its merit as an option for oral reconstruction because of its reliability, versatility, and relative ease of application. To our knowledge, our case series is the largest in the United Kingdom, and we hope that in future, this humble flap will be a standard reconstructive option for small to medium oral resection defects.

Anesthesia-Related Risk Factors for Anterolateral Thigh Free Flap Complications in 161 Elderly Chinese Patients Who Received Oral and Maxillofacial Reconstruction

The authors designed and implemented a retrospective study which enrolled patients at over 65-years-old who underwent resection of oral and maxillofacial tumors and ATFF reconstruction from January 2011 to March 2019. Predictor variables were divided into: 1) Demographic variables (gender; age; weight; comorbidities; smoking status); 2) Anesthetic (American Society of Anesthesiologists (ASA) classification.

Experiments with Truth: Narrative Nonfiction in South Africa

In this reflection on his recently published book, Hedley Twidle explores historical and theoretical approaches to the question of non-fiction in South African literature. Experiments with Truth reads the country's transition as refracted through an array of documentary modes that are simultaneously refashioned and blurred into each other: long-form analytic journalism and reportage; experiments in oral history, microhistory and archival reconstruction; life-writing, memoir and the personal essay. Its case studies trace the strange and ethically complex process by which actual people, places and events are shuffled, patterned and plotted in long-form prose narrative. While holding in mind the imperatives of testimony and witness so important to the struggle for liberation and the Truth and Reconciliation Commission, the book is increasingly drawn to a post-TRC aesthetic: to works that engage with difficult, inappropriate or unusable elements of the past, and with the unfinished project of social reconstruction in South Africa. It places southern African materials in a global context, and in dialogue with other important nonfictional traditions that have emerged at moments of social rupture and transition.

Dealing with vascular anomalies during radial forearm free flap harvest: report of two cases and review of the literature

Radial forearm free flap reconstruction for head and neck cancer is very common, and it is widely considered a workhorse flap. Although this flap has a relatively reliable anatomy, surgeons need to be aware of possible anatomical variations and how to deal with them. This paper presents the cases of two patients who underwent oral reconstruction, in whom anomalies of the radial artery were identified while raising a radial forearm free flap. Case 1 demonstrates the dominant branch of the radial artery joining the common interosseous artery approximately 9 cm from the first wrist crease. Case 2 demonstrates abnormal distal branching of the radial artery approximately 4 cm from the first wrist crease. Reconstruction with the flap was successful in both cases. A literature review of reported anomalies of the radial artery is presented, and how to deal with such vascular anomalies is discussed.

Oro-facial rehabilitation of cancer patients: 'Zygomatic 2019'-1-2 March 2019, London, UK.

This first truly global conference on the use of zygomatic implants for the oral reconstruction of patients with compromised or deficient maxillae was held at the Museum of London from 1 to 2 March 2019. It attracted over 200 clinicians and academics from 24 nations and reviewed over 25 years’ experience and research in this field. This conference presented concepts heralding new opportunities for the oro-facial rehabilitation of doctor-induced osteonecrosis of the jaw (ONJ), both osteonecrosis radiation-induced (ORN) and medication-induced ONJ (MRONJ) in oncology patients.

Investigation on masticatory muscular functionality following oral reconstruction – An inverse identification approach

The human masticatory system has received significant attention in the areas of biomechanics due to its sophisticated co-activation of a group of masticatory muscles which contribute to the fundamental oral functions. However, determination of each muscular force remains fairly challenging in vivo; the conventional data available may be inapplicable to patients who experience major oral interventions such as maxillofacial reconstruction, in which the resultant unsymmetrical anatomical structure invokes a more complex stomatognathic functioning system. Therefore, this study aimed to (1) establish an inverse identification procedure by incorporating the sequential Kriging optimization (SKO) algorithm, coupled with the patient-specific finite element analysis (FEA) in silico and occlusal force measurements at different time points over a course of rehabilitation in vivo; and (2) evaluate muscular functionality for a patient with mandibular reconstruction using a fibula free flap (FFF) procedure. The results from this study proved the hypothesis that the proposed method is of certain statistical advantage of utilizing occlusal force measurements, compared to the traditionally adopted optimality criteria approaches that are basically driven by minimizing the energy consumption of muscle systems engaged. Therefore, it is speculated that mastication may not be optimally controlled, in particular for maxillofacially reconstructed patients. For the abnormal muscular system in the patient with orofacial reconstruction, the study shows that in general, the magnitude of muscle forces fluctuates over the 28-month rehabilitation period regardless of the decreasing trend of the maximum muscular capacity. Such finding implies that the reduction of the masticatory muscle activities on the resection side might lead to non-physiological oral biomechanical responses, which can change the muscular activities for stabilizing the reconstructed mandible.

Biomimetic Enhancement of Bone Graft Reconstruction.

With aging populations and increasing oral rehabilitation, use of dental implants for oral reconstruction is increasing. Adequate hard/soft tissue are required to support use of titanium implants. Bone augmentation is sometimes a necessary procedure to supplement existing alveolar bone. With a wide variety of biomaterials available for clinical use, we focus on the enhancement of bone graft materials, targeting new technologies with potential clinical use. Clinical indications supported by research studies are provided for platelet-rich fibrin, various growth factors, and newly emerging scaffolds. Interestingly, modified biomaterials are being developed and have potential clinical use as more data become available.