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Introduction: We report a case of donor site morbidity late after harvesting a free fibular flap for reconstruction of the mandibular symphsis., Case Report: An 8-year-old boy presented a valgus deformity of the ankle 4 years harvesting of a vascularized fibular graft for mandibular reconstruction. The deformation was repaired with a tibial bone slit and pin fixation. The biomechanical result was very satisfactory, allowing normal gait., Discussion: We recall the rules for fibular flap harvesting needed to prevent deformation of the donor site in children aged less than 9 years.

Background: Mandibular reconstruction with fibula free flap is a challenge in pediatric patients because of the size of the bone and absence of growth without epiphyseal transplantation., Case Report: We report 2 cases of free fibula flap in children for mandibular reconstruction. The 2 patients presented with growth insufficiency of the bone graft after few years of evolution., Discussion: Growth insufficiency was treated with different surgical procedures which were discussed We review the consequences on growth after fibula free flap and the specific indications to achieve epiphyseal fibular growth in children.

Introduction: The reconstruction of mandibular continuity destroyed by osteoradionecrosis can be a difficult task. The aim of this study was to evaluate the reliability and contribution of vascular osseous flaps for mandibular reconstruction after osteoradionecrosis., Material and Method: A retrospective study of patients undergoing mandibular reconstruction after osteoradionecrosis between 1989 and 2002 was performed. Twenty-five mandibular reconstructions were performed in 23 patients: 16 fibular free flaps, 5 osteomuscular serrato-costal free flaps, 1 osteocutaneous external brachial free flap, 1 medial femoral condylar free flap and 2 armed pectoralis major pediculed flaps., Results: We observed two major complications (8%): loss of one fibular flap and one medial femoral condylar free flap. We observed 42% minor complications. Overall quality of life was constantly enhanced., Discussion: Fibular flap is definitely a good method for immediate or secondary mandibular reconstruction. A serratocostal flap must be considered as an alternative flap when the fibular flap is unavailable.

When a patient must undergo resection of part of the upper lip for the treatment of a cancer or following a traumatic defect of the upper hemilip, the surgeon is faced with the problem of reconstruction of a lip whose appearance and function must be as close as possible to the normal lip. The limits of the normal lip must be restored: the symmetry, equilibrium of the lips and position of the commissures must be maintained. The upper lip esthetic unit can be divided into subunits, as described by Burget and Menick. If a large part of a subunit is removed, replacement of the entire subunit rather than simple reconstruction of the defect often gives a better esthetic result (Burget). The best tissue for esthetic reconstruction of a full thickness defect of the upper lip is the lower lip. We apply Burget's principles to raise an Abbé flap, which is transferred in two stages. This approach is illustrated by 5 patients operated by this technique. Finally, this technique is compared to other techniques allowing reconstruction of the upper hemilip.

The Abbe-Estlander flap is a full-thickness lip-switch flap rotated from mid lower lip to fill defects of the upper lip. In 1872, Estlander emphasized the importance of this flap. Abbe, in 1898, was the first to switch a lower lip flap into the upper lip for a cleft deformity. The lip-switch flap is an arterialized flap, based on the constant inferior labial artery. This flap is widely used to repair the defects from cancer and traumatism or in repair of the cleft lip deformities.

The gastro-omental flap consists of a patch taken from the greater curvature of the stomach and the bordering omentum. It is based on the right gastro epiploic vessels and is used as a free flap for intraoral reconstruction after resection of oral carcinoma. Twenty patients underwent gastro-omental flap. The operative technique is described. The evaluation consisted in questioning, chemism on the salivary flow and biopsies. There is no morbidity related with the donor site. The gastro-omental flap avoids post irradiation xerostomia. Oral irritation and bleeding of the flap may occur.

The serrato-costal free flap provides a large costal flap vascularized by a digitation of the serratus anterior muscle supplied by the dorsal thoracic artery. The flap is easy and rapid to raise with low morbidity. The repair obtained is functionally very satisfactory, but does not allow insertion of an implant. Six cases are reported. The indications of this technique of mandibular reconstruction are discussed.

The gastro-omental flap is centered around the midportion of the greater curve of the stomach, with the attached omentum. The flap is based on the right gastro-epiploïc pedicle. The size of the mucosal patch is adaptable. This flap offers several practical advantages: great plasticity (including the omentum), large length and size of the pedicle, mucus secretion which may improve xerostomia, and less morbidity. Disadvantages include the propensity for excessive mucus production (needing tracheotomy), the requirement for an abdominal operation, and the possibility of peptic ulceration (no case reported in the literature). Seven patients have been treated, with a good result. This flap is suitable for repair of complex soft-tissue defects after extensive cancer surgery.

Two edentulous elderly women presented with benign but extensive tumors of middle third of face. The excision necessary for reasons of comfort and hygiene could not be envisaged unless the ineluctable vast palatine breach opened could be immediately repaired by surgery, any prosthetic solution being excluded. The use of a total temporal muscle flap, without zygoma section, provided an effective and comfortable solution to this both delicate and unusual problem. These cases illustrate the interest in the use of temporal muscle flaps in maxillofacial surgery, and their management for the repair of large palatine breaches.

Washio's temporo-retro-auricular flap was used to repair point of nose in three children and one ala nasi amputated by dog bites. Details of the technique are presented and long-term results discussed. Despite two inconveniences--dyschromia and relative stenosis of nares--this method compares favorably with other surgical procedures and over the time has proved to be one worth recommending.

The authors report 3 cases (including 2 recurrences) of congenital median cervical clefts (fold and fistula). Based on a review of the literature, they recall the principal clinical features of these lesions. The modalities and results of surgical treatment are discussed: Z-plasty, musculocutaneous flaps, tissue expansion. The possibility of recurrence after Z-plasty during the first months of life emphasises the importance of regional hypoplasia in certain cases and requires tissue supplementation. The disturbance of mandibular growth may require genioplasty in adolescents.

Copyright of Revue de Stomatologie & de Chirurgie Maxillo-Faciale is the property of Masson SPA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revue de Stomatologie & de Chirurgie Maxillo-Faciale is the property of Masson SPA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)