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Various conditions are responsible for the development of acquired temporomandibular joint (TMJ) defects, the reconstruction of which represents a unique challenge, as the TMJ plays an important role in the functioning of the jaw including mastication, deglutition, and phonation. Autogenous reconstructions such as costochondral or sternoclavicular joint graft continue to be the best option in children, owing to their ability to transfer a growth center. In adults, alloplastic reconstructions are a safe and predictable option. Vascularized tissue transfers have also become a popular and reliable way to restore these defects., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Free vascularized fibular flap is considered the treatment of choice in mandibular reconstruction for extensive bone defects (over 6 centimeters) resulting from trauma, infections or tumor resections. But, when the reconstruction involves a dentate mandible, the fibula has the limit as it does not offer sufficient bone height to restore the alveolar arch up to the occlusal plane. Therefore, the deficiency in bone height makes implant placement impractical. We report a case of vertical distraction osteogenesis of a free vascularized fibula flap used to reconstruct a hemimandible after resection of an odontogenic myxoma, for optimization of the implant prosthetic rehabilitation. The distraction device was applied intraorally. After 10 days of latency period, distraction protocol was performed at a distraction rate of 0.5 mm per day. A consolidation period of 3 months followed. Afterwards the distraction device was removed and 3 osseointegrated dental implants were placed in the distracted area. As a result, the vertical discrepancy between the fibula and the native hemimandible was corrected. The amount of vertical height achieved after distraction was 17 milimeters. The increase of vertical bone height was stable and enabled placement of dental implants without any complications. In conclusion, we consider that vertical distraction osteogenesis of free vascularized flaps is a reliable technique that optimizes implant positioning for ideal prosthetic rehabilitation, after mandibular reconstruction following tumor surgery.

Calvarial defects are common problems in craniofacial surgery. They may be explained by surgical interventions, infectious processes, cranial trauma or congenital anomalies. Calvarial defects are particularly challenging because they do not heal spontaneously in humans older than 24 months. The feasibility of using bifocal transport distraction osteogenesis to repair calvarial defects has been successfully evaluated in numerous experimental models. To our knowledge, it has not been used for the reconstruction of human skull defects. We report the first case of human calvarial defect healed by transport distraction osteogenesis., (Copyright 2009 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Purpose: Since the advent of the modern microvascular techniques, the radial forearm free flap (RFFF) and the vascularized fibular free flap (VFFF) have become reliable methods for reconstructing oromandibular defects. The purpose of this study is to evaluate our experience with the use of both free flaps in the reconstruction of oral cavity defects after tumoral ablation., Patients and Methods: Over a 9-year period, 103 consecutive patients were treated in our department for the reconstruction of oral defects after tumor ablation by means of microvascularized free flaps. A total of 55 patients underwent reconstruction using RFFFs; 42 patients underwent reconstruction using VFFFs with or without skin paddles. Patients were treated for benign (n = 15) and malignant (n = 82) entities. All but 7 patients received donor site covering with abdominal full-thickness skin grafts., Results: Of the 55 patients who received RFFFs, 5 (9.09%) developed necrosis at the end of the postsurgical period, and 7 patients developed complications of the donor site. Of the 42 patients who received VFFFs, an overall flap survival rate of 92.85% was achieved, and complications at the donor site occurred in 5 patients. For both free flaps, anesthesia time lasted from 6 to 15 hours (mean, 9.57 hours), whereas the mean flap ischemic time was 82.86 minutes., Conclusions: Our results reveal that the RFFF is a reliable method for reconstructing a wide range of oral cavity defects with an acceptably low morbidity rate. It provides adequate bulk and pliability, enabling the reconstruction of a wide variety of locations within the oral cavity. The VFFF allows good reconstruction of composite mandibular defects and provides adequate support for dental implants.

Objective: Since the advent of modern microvascular techniques, the fibula has become a reliable method for the reconstruction of partial or total mandibular defects. The purpose of this study is to evaluate our experience with the use of the vascularized free fibular flap for the reconstruction of mandibular defects following surgical resection., Patients and Methods: During a 5-year period, 102 consecutive patients were treated in our department for reconstruction of oral and maxillofacial defects, using microvascularized free flaps. Forty-two patients were reconstructed by means of the free vascularized fibular flap with or without a skin paddle. Patients underwent resection for benign (n = 15) and malignant (n = 27) entities. Fourteen patients received preoperative radiotherapy and only 1 patient received preoperative chemotherapy. The donor site was closed primarily in 7 cases, whereas an abdominal full-thickness skin graft was used in 35 cases., Results: Thirty-eight patients were treated by means of an osteocutaneous flap, whereas only 4 developed an osseous flap. Five patients developed complications related to the vascular anastomosis and needed a second surgical look. One patient died in the immediate postoperative period. The skin island flap was completely viable in 37 cases (88%). Considering bone survival as the main objective, an overall flap survival rate of 92.85% was achieved in the whole series. Endosseous dental implants were placed in 11 patients with adequate outcome. In 5 of these cases the double-barrel technique was performed., Conclusion: Our results reveal that the vascularized free fibular flap is a reliable method for reconstructing mandibular defects with an acceptable low morbidity rate. The use of the osteocutaneous flap provides good reconstruction of composite mandibular defects. It constitutes an adequate support for dental implants.

Objective: Since the advent of modern microvascular techniques, the radial forearm free flap (RFFF) has become a reliable method for reconstruction of defects within the oral cavity. The purpose of the present study was to evaluate our experience with the use of the RFFF for the reconstruction of oral cavity defects after tumor resection., Study Design: During a 9-year period, 103 consecutive patients were treated in our department for the reconstruction of oral defects after tumoral ablation by means of microvascularized free flaps. Fifty-five patients were reconstructed by means of the RFFF. Patients were treated for benign (n = 1) and malignant (n = 54) entities. All the patients underwent an abdominal split-thickness skin graft for the closure of the donor site., Results: Fifty-five patients underwent reconstruction by means of the RFFF after resection of the oral cavity. Squamous cell carcinoma was present in 54 patients. A mean age of 55.5 years was observed (range 16-78). Thirty-nine patients (70.9%) were men and 16 (29.1%) women. Primary reconstruction was achieved in 52 patients (96.3%). A fasciocutaneous graft was used in all of the cases, with a mean size of 7.39 x 5.17 cm. The mean flap ischemic time was 56.02 minutes. During the immediate follow-up period, revision of the vascular anastomosis was necessary in 18.9% of the cases owing to flap ischemia., Conclusion: Our results revealed that the RFFF is a reliable method for reconstructing a wide range of oral cavity defects with an acceptable low morbidity rate. It provides adequate bulkiness and pliability, resulting in adequate reconstruction of a wide variety of defects within the oral cavity.

Distraction osteogenesis is useful in the reconstruction of mandibular segmental defects. The effects of radiotherapy on distracted bone after resection of squamous cell carcinoma of the oral cavity are still unknown. We report the outcome in six patients who had distraction osteogenesis after postoperative radiotherapy. Distraction was by a unidirectional semi-buried device and panoramic radiographs were taken monthly during the distraction and consolidation periods to monitor the progress of the distraction. Follow-up ranged from 15 to 45 months (mean 33). The dose of radiation ranged from 60 to 70Gy. In one patient the bone was completely exposed and all the screws were loosened. There was no calcification and the gap remained radiolucent in the panoramic radiographs. The other five patients had excellent or good quality of bone. We conclude that radiotherapy may not interfere substantially with distraction osteogenesis although larger series the necessary.