The functional disability and cosmetic deformity after jaw and neck dissection can be very severe due to soft tissue and mandibular loss. Reconstruction of the mandible alone without soft tissue coverage can be complicated with prosthetic exposure, infection and, finally, rejection. We attempted to reconstruct the mandible at the time of tumor resection in a group of patients, using titanium mesh with marrow, rib, scapular spine, and clavicle. We used myocutaneous flaps in order to obtain intraoral coverage of the mandibular grafts. In a second group of patients, delayed reconstruction of the jaw was performed 6 months to 2 years after tumor resection. Titanium mesh prostheses were used for reconstruction of the mandible in conjunction with myocutaneous flaps for soft tissue augmentation. Osteomyocutaneous flaps were also used. The results and complications in 54 patients are presented.
The Cavitron Ultrasonic Surgical Aspirator (CUSA System) has been used at our institution in the resection of carcinoma of the tongue in 10 patients. This device is an ultrasonically powered aspirator that selectively fragments and aspirates tissue within a 1- to 2-mm radius of its tip. The technique used in our unit in tongue surgery was to incise the touch mucosal capsule of the tongue with electrocautery, and then to divide muscle and skeletonize blood vessels using the CUSA System. Smaller vessels, up to 2 mm in size, were cauterized directly by the friction created at the tip of the instrument. In this way, excellent control was available at all times and blood loss was consequently minimal. As our experience in the use of the CUSA System increased, blood loss was virtually eliminated, anatomic landmarks were more easily defined, and at no stage did any tongue necrosis occur in any of the patients of the series.
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