This article report 5 cases of malunion or nonunion ofthe fractures of the jaws which were treated by functional re-duction. From the anatomical and physiological point ofview, this operation was highly versatile and reliable. The re-construction was accomplished precisely in one stage. All pa-tients had a good prognosis.
The three-dimensional (3-D) Titanium miniplate system is one of the newest internal rigid fixation for the maxillo-mandibular surgery in recent years. The geometry of the plate assures a good stability in the three-dimensions of the fracture sits. Thirty patients suffering from maxillo-mandibular fractures had been operated on using the 3-D Titanium miniplates since 1991. The group of the patient included 16 cases of mandibular fractures, 8 cases of maxillary fractures and 6 cases of maxillo-mandibular fracture. All of the patient had very good result without any complication. The follow-up was 6 months to 3 years. The 3-D Titanium miniplate as an ideal easy to use, good resistance against torque forces and, compact forms of the miniplate were the some of the advantages. Clinical examples had been provided to illustrate the actual usage of the 3-D miniplate in the field of the surgical treatment for the maxillo-mandibular fracture. It is the author’s opinion that the internal rigid fixation by 3-D Titanium miniplates is a promising method of treating fractures of the maxilla and is to be better tolerated by the patients and surgeons.
ObjectiveTo systematically review the survival rate of different vascularized bone flaps in mandibular defect repair and reconstruction by Bayesian network meta-analysis. MethodsThe PubMed, EBSCO, Scopus, Web of Science, Cochrane Library, WanFang Data and CNKI databases were electronically searched to collect clinical studies related to the objectives from inception to February 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. The Bayesian network meta-analysis was carried out applying R software. ResultsA total of 24 studies involving 1 615 patients were included. The results of meta-analysis showed that the respective survival rates of fibula free flap (FFF), deep circumferential iliac artery flap (DCIA), scapula flap, and osteocutaneous radial forearm flap (ORFF) were 95.62%, 94.09%, 98.16%, and 93.75%. Moreover, the network meta-analysis failed to show a statistically significant difference between all comparators. Conclusion Current evidence shows that different vascularized bone flaps have similar survival rates in mandibular defect repair and reconstruction. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objective To investigate the clinical effect of free forearm flap and titanium mesh in repairing maxillary defects. Methods From January 2002 to November 2002,partial maxillectomy or maxillectomy wereperformed in 3 patients with maxillary gingival carcinoma, in 1 patient with palatine mucoepicermoid carcinoma and in 1 patient with maxillary sinus carcinoma. Maxillary defects were reconstructed withfree forearm flaps ranging from 4 cm×5 cm to 6 cm×7 cm and titanium mesh.The effect was estimated by clinical examination, CT and nasopharyngoscope. Results Five cases were followed up 515 months. All the flaps were alive. Facial, alveolar process and palatal contours were restored well. Epithelium was found on the nostril surface of the titanium mesh. The functions of speech and chew were restored well. Conclusion A combination of the free forearm flap and titanium mesh is an ideal method in reconstruction of maxillary defects.
Objective To examine the mRNA expression of activin A(ACT A) and follistatin(FS) during mandibular lengthening and to elucidate the regulating pattern of during mandibular distractionosteogenesis.Methods Skeletally mature-white New Zealand rabbits were established right mandibular distraction osteogenesis models and the mandibles were lengthened 7 days after osteomy. Atthe end of latency period and the end of distraction period, 10,20, 30, 40 and60 days after fixation, the regenerating tissue of animals’ lengthened mandibles and that of the other side normal mandibles were harvested to extract RNA andto analyse ACT A, FS mRNA by RT-PCR.Results The expression of ACT A mRNA was not detectable in normal bone tissue and ACT A mRNA began to express at the end of latency period. The expression of ACT AmRNA increased gradually along with the beginning of distraction and reached the peak on the 10th and 20th days of distraction which was 5.04 and 4.98 times as much as that of the end of latency period, respectively. The trend of expression of FS mRNA during mandibular distraction osteogenesis was the same as expression of ACT A mRNA. Conclusion ACT A/FS play an important role during rabbit mandibular distraction osteogenesis.
Objective To reconstruct the maxillary defect by usingfree vascularized iliac osteomusculocutaneous flap combined with immediate zygomatic implantation for early rehabilitation of maxillary contour and masticatory function. Methods In August 2003, the patient presented with deformity ofleft middle face(Brown Ⅱ type defect) after subtotal maxillectomy. After hospitalization, a set of preoperative preparations were made, including spiral CT scanning, manufacture of nature size anatomical model and implantation protocol design. The maxillary defect was reconstructed with free vascularized iliac osteomusculocutaneous flap combined with simultaneous insertion of one Br¨nemark zygomatic implant and two general implants. Six months later the prosthesis were placed. Results The vascularized osteomusculocutaneous flap survived, the osseointegration was observed between bone and implant 6 months later. The contour of face and palate was satisfactory, the normal occluding relation was gained. The average masticatory force of operative side was 76.3% of the normal side. No tumor recurrence was noticed during the follow-up of 14 months. Conclusion It is a reliable method for functional reconstruction of maxillary defect via vascularized iliac osteomusculocutaneous flap combined with immediate zygomatic implantation.
Thirty cases of mandibular deformities undergoing sagittal splitting ramus osteotomy for their corrections were presented. The surgical precedure was carefully designed according to each individual deformity before operation, After treatment, the facial configuration and the function of occlusion were markedly improved. There was no non-union of the osteotomy and no recurrence of the deformity after correction. Complications happened in 4 cases and were all improved following treatment. The planning and techniques of the operation were discussed in detailed.
Objective To summary the clinical application of free fibular composite flaps in repair of mandibular defect. Methods Fiftyeight cases of mandibular reconstruction using free fibular flaps, from June 1999 to November 2000, were reviewed, among which there were 37 cases of male and 21 cases of female, aged from 12 to 65 years old. All of the relevant data of the operation, such as the cause of the defect, design of the flaps, the blood vessels of the recipientand the complications, were included and analyzed. Results The fibular flap was 10.9 cm (4-21 cm) averagely in length and was harvested for 2.1 times (1-4 times); the average size of the skin paddle was 5.88 cm×3.13 cm. Of 58 flaps, therewere 56 survived; the overall complication rate was 24.1%.Conclusion It’s safe and reliable to use free fibular flap to reconstruct the mandibular defect.
Objective To systematically review the efficacy of poly-L-lactide (PLLA) material treatment versus titanium plates treatment for mandibular fractures. Methods We searched the Cochrane Library, PubMed, Embase, Chinese Journal Full-text Database, VIP Database, and Wanfang Database to collect literatures about randomized or non-randomized controlled trials using PLLA treatment (the trial group) versus titanium plates treatment (the control group) for mandibular fractures in the last ten years (from January 2007 to March 2017). The quality evaluation and data extraction were carried out by 2 reviewers independently and analyzed by Review Manager 5.3 software. Results A total of 8 literatures including 453 patients with mandibular fractures were included in this Meta-analysis. There was no significant difference in total complications between the two groups [odds ratio (OR)=0.98, 95% confidence interval (CI) (0.55, 1.75), P=0.95], including dislocation healing [OR= 0.96, 95%CI (0.46, 2.01), P=0.90], occlusal disturbance [OR=1.53, 95%CI (0.61, 3.87), P=0.37], infection [OR=0.63, 95%CI (0.23, 1.74), P=0.37], and secondary operation [OR=0.46, 95%CI (0.17, 1.27), P=0.14]. Conclusion There is no significant difference between PLLA and titanium plate in the treatment of mandibular fractures.