Segmental Resection of the Anterior Mandibular Arch With Fibular Microvascular Reconstruction

Dierks, Eric J.; Karakourtis, Mark H.

doi:10.1016/s1061-3315(18)30083-0

Cited by 9 publications

(3 citation statements)

References 12 publications

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“…A segmental resection is required in patients with significant mandibular invasion. Immediate reconstruction is preferable, and with the growing familiarity with composite microvasular free tissue transfer this option has become the technique of choice, particularly for the anterior defect 8. However, mandibular resection has long been associated with a poor quality of life.…”

mentioning

confidence: 99%

Longitudinal health‐related quality of life after mandibular resection for oral cancer: a comparison between rim and segment

et al. 2003

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mentioning

confidence: 99%

Longitudinal health‐related quality of life after mandibular resection for oral cancer: a comparison between rim and segment

et al. 2003

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“…autologous microvascular anastomosed pedicled flaps [10]. This technique is particularly well suited for defects of the anterior mandibular arch [11]. It is known that (a) this type of surgical intervention allows better conditions for healing than non-revascularised grafts and (b) the soft tissue part of the transplant is essential for adequate healing of bone [12,13].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic and prognostic value of 99mTc-tetrofosmin scintigraphy in maxillofacial flaps

Aigner

Schultes

Sorantin

2003

Eur J Nucl Med Mol Imaging

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In oro-maxillofacial malignancies, new therapeutic approaches are placing changing demands on the diverse diagnostic modalities. In contradistinction to mandibular reconstruction of former years, the transplants (microvascular anastomosed pedicled flaps, "flaps") now consist of one or more arteries feeding a soft tissue component attached to a piece of bone suitably fitted to fill the defect. We addressed the diagnostic value of technetium-99m tetrofosmin scintigraphy in differentiating between viability and non-viability of the soft tissue portion of flaps in the immediate postoperative assessment. A total of 60 patients who had received flaps for reconstruction of the mandible after partial resection were investigated with (99m)Tc-tetrofosmin 3-5 days after surgery. Scintigraphy consisted of (a) radionuclide angiography, (b) static planar imaging in four projections starting at 10 min post injection, and (c) single-photon emission tomography (SPET) performed immediately after the planar imaging. Normal perfusion associated with no defects throughout the soft tissue portion of the transplant was observed in 46/60 patients. This scintigraphic pattern was identical to viability and normal postoperative follow-up. Hypoperfusion and small defects on planar and SPET images indicated viability and uncomplicated postoperative healing in 6/60 patients, but non-viability/inadequate healing of the flap in 4/60 patients. Absence of perfusion combined with a large defect on static planar and SPET images definitively showed the non-viability of the flap (4/60 patients). It is concluded that (99m)Tc-tetrofosmin scintigraphy is a sensitive diagnostic tool for the immediate postoperative assessment of the viability and the adequacy of implantation of the soft tissue portion of flaps. Therefore tetrofosmin scintigraphy is an important modality in order (a) to define the optimal therapeutic regimen in the immediate postoperative period and (b) to provide better prognosis.

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“…The vascularized flaps have a better rate of success, particularly in patients treated for malignant disease, also after radiation therapy. They are useful for filling large defects, too, and generally require fewer reconstructive surgical procedures (8,10). Failing flaps complicate later reconstructive surgery and may impair late results because of scarring or loss of functionally important muscle tissue (speech, mastication).…”

Section: Discussionmentioning

confidence: 99%

18F-FDG PET: early postoperative period of oro-maxillo-facial flaps

Aigner

Schultes²,

Wolf³

et al. 2003

Nuklearmedizin

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Summary: Aim: We addressed the feasibility of FDG-PET to differentiate between viability and non-viability in the immediate postoperative assessment of flaps (autologous microvascular anastomosed pedicled flaps) in oro-maxillo-facial surgery. Methods: 3-7 days after surgery, FDG-PET was done in 38 patients who had received flaps for reconstruction of the mandible after partial resection. The studies were done on a dedicated full ring PET-scanner (ECAT EXACT HR+, Siemens/CTI). Acquisition started between 60 and 80 min post injection. The findings of the soft tissue component of the flaps were grouped using a three point scale: (I) no defect, (II) small defects, (III) one large defect. The results of PET were compared with the clinical course for at least 3 months. Results: “No defect” on the FDG-PET study identified viability of the flap and predicted normal clinical follow-up (22/38 patients). “Small defects” visualized areas of decreased perfusion and decreased glucose metabolism indicating risk of non-viability (13/38 patients); adapting the postsurgical management led to delayed but uncomplicated healing of the flaps in these patients. “One large defect” demonstrated early necrosis of the flap (3/38 patients). After removal and replacement of this necrotic portion of the flap the second FDG-PET scan of these 3 patients demonstrated the uncomplicated post-operative healing. Conclusion: FDG-PET facilitated the assessment of viability and non viability of flaps in the immediate postsurgical period, and demonstrated the usefulness of FDG-PET for postoperative care and prognosis.

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Segmental Resection of the Anterior Mandibular Arch With Fibular Microvascular Reconstruction

Cited by 9 publications

References 12 publications

Longitudinal health‐related quality of life after mandibular resection for oral cancer: a comparison between rim and segment

Longitudinal health‐related quality of life after mandibular resection for oral cancer: a comparison between rim and segment

Diagnostic and prognostic value of 99mTc-tetrofosmin scintigraphy in maxillofacial flaps

18F-FDG PET: early postoperative period of oro-maxillo-facial flaps

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