Oral Maxillofac Surg Clin North Am
· 2025 Feb · PMID 39244494
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This article provides clinicians with 3 main factors that relate to long-term success. Long term in this article represents the lifespan of the patient, often requiring more than 40 years of function on the implant resto...This article provides clinicians with 3 main factors that relate to long-term success. Long term in this article represents the lifespan of the patient, often requiring more than 40 years of function on the implant restoration. Literature is reviewed and used to provide evidence for these recommendations. Cases are presented to demonstrate these critical factors.
Oral Maxillofac Surg Clin North Am
· 2024 Nov · PMID 39217091
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Preoperative computed tomography angiography (CTA) for perforator free flaps is accurate, precise, and reliable in mapping perforator anatomy that can be used in the intraoperative domain. CTA holds important clinical va...Preoperative computed tomography angiography (CTA) for perforator free flaps is accurate, precise, and reliable in mapping perforator anatomy that can be used in the intraoperative domain. CTA holds important clinical value as a tool in surgical decision making and surgical innovation, enabling reconstructive surgeons to tailor complex flap designs for extensive defects. Integration into existing infrastructure for virtual surgical planning is feasible, and future efforts to characterize the association of preoperative CTA with postoperative outcomes and cost-analyses for perforator flaps are warranted.
Scaglioni MF, Meroni M, Meschino A
… +1 more, Rajan GP
Oral Maxillofac Surg Clin North Am
· 2024 Nov · PMID 39217090
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Head and neck defects present a unique challenge in reconstructive surgery due to the complex anatomy of this area. Different defects often require a variety of reconstructive techniques. The superficial circumflex iliac...Head and neck defects present a unique challenge in reconstructive surgery due to the complex anatomy of this area. Different defects often require a variety of reconstructive techniques. The superficial circumflex iliac artery perforator (SCIP) flap is particularly notable for its versatility in this context. It provides a thin, pliable skin island that can be integrated with bone, muscle, fascia, and other structures. Additionally, the morbidity associated with the donor site of the SCIP flap is generally low and well tolerated. This article offers a comprehensive overview of the evolution of this technique.
Bianchi A, Hayashi A, Salgarello M
… +2 more, Gentileschi S, Visconti G
Oral Maxillofac Surg Clin North Am
· 2024 Nov · PMID 39217089
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Microsurgeons have today the freedom of the "chosen flap," as opposed to the "flap of choice," but the preoperative knowledge of the microanatomy of each patient is mandatory. The need for preoperative evaluation of the...Microsurgeons have today the freedom of the "chosen flap," as opposed to the "flap of choice," but the preoperative knowledge of the microanatomy of each patient is mandatory. The need for preoperative evaluation of the perforators, not only in terms of position, but also for dimensions, flow, and relationship with the surrounding structures became essential and allows more personalized reconstruction, less invasiveness, more safety and finally increase microsurgeon creativity.
Oral Maxillofac Surg Clin North Am
· 2024 Nov · PMID 39217088
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This article explores advancements in functional tongue reconstruction after cancer ablation, focusing on the importance of flap selection, positioning, and volume adjustment to restore speech and swallowing function. It...This article explores advancements in functional tongue reconstruction after cancer ablation, focusing on the importance of flap selection, positioning, and volume adjustment to restore speech and swallowing function. It highlights advancements such as the perforator flap concept for customized reconstructions and the transition to dynamic techniques with motor-innervated free flaps, aiming to accurately replicate the tongue's inherent functions. The effectiveness of dynamic techniques in improving swallowing efficiency and speech clarity underscores their significant potential in enhancing postoperative rehabilitation, representing a significant progress in the realm of functional tongue reconstruction.
Oral Maxillofac Surg Clin North Am
· 2024 Nov · PMID 39217087
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In this study, the authors shed light on the underappreciated realm of head and neck lymphedema (HNL) amid the backdrop of significant advancements in extremity lymphedema management. Despite its prevalence and impact, H...In this study, the authors shed light on the underappreciated realm of head and neck lymphedema (HNL) amid the backdrop of significant advancements in extremity lymphedema management. Despite its prevalence and impact, HNL has long been overlooked, attributed to its subtle symptom presentation and lack of awareness among primary care providers. The study delves into the unique challenges associated with diagnosing and treating HNL, emphasizing the predominance of internal swelling over external manifestations. The authors advocate for the refinement and standardization of outcome measures and the integration of innovative techniques such as indocyanine green lymphography and patient-reported outcomes.
Oral Maxillofac Surg Clin North Am
· 2024 Nov · PMID 39198073
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The authors aim to provide a comprehensive overview of the advancements in head and neck reconstructive surgery using thinned perforator flaps. The article categorizes these flaps based on thickness and discusses the imp...The authors aim to provide a comprehensive overview of the advancements in head and neck reconstructive surgery using thinned perforator flaps. The article categorizes these flaps based on thickness and discusses the importance of standardized terminology. Critical aspects like flap vascularity, pre-operative planning, and imaging technologies for perforator mapping are examined with practical considerations. The article then delves into various thinning techniques and their applications in head and neck reconstructions, highlighting challenges and concerns. In conclusion, significant progress in reconstructive surgery using thinned perforator flaps has brought advancements in improving surgical precision and patient outcomes in head and neck reconstructions.
Oral Maxillofac Surg Clin North Am
· 2024 Nov · PMID 39198072
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Head and neck reconstruction has evolved to a more accurate replacement of the missing tissues for aesthetic and functional benefits, besides a concern with the morbidity caused in the donor site. This has led us to the...Head and neck reconstruction has evolved to a more accurate replacement of the missing tissues for aesthetic and functional benefits, besides a concern with the morbidity caused in the donor site. This has led us to the use of perforator flaps. Deep inferior epigastric perforator flap allows the harvest of a large well-vascularized skin paddle with adequate bulk for large and voluminous defects reconstruction. Its main uses described in the literature are: tongue reconstruction, orbitomaxillary reconstruction, and scalp reconstruction. Thoracodorsal artery perforator flap is derived from the subscapular system and allows the harvest of a large array of chimeric flaps.
Heredero S, Falguera MI, Gómez V
… +1 more, Sanjuan-Sanjuan A
Oral Maxillofac Surg Clin North Am
· 2024 Nov · PMID 39155167
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The integration of imaging technologies such as computed tomography angiography and color Doppler ultrasonography are transforming soft tissue free flap reconstruction. The search for thinner and more refined flaps has e...The integration of imaging technologies such as computed tomography angiography and color Doppler ultrasonography are transforming soft tissue free flap reconstruction. The search for thinner and more refined flaps has expanded indications for flaps harvested from donor sites that were not commonly used in head and neck reconstruction. This article explores how these tools and techniques facilitate precise flap selection, thickness, and design customization based on detailed patient preoperative perforator anatomy and vascular configuration mapping. Optimizing outcomes with tailored flap designs improves surgical accuracy and patient-specific results in soft tissue reconstruction.
Oral Maxillofac Surg Clin North Am
· 2024 Nov · PMID 39142950
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Head and neck cancer (HNC) is the sixth most common cancer across the world. Despite a general reduction in tobacco consumption and therefore reduction in risk exposure there has been an increasing incidence of oropharyn...Head and neck cancer (HNC) is the sixth most common cancer across the world. Despite a general reduction in tobacco consumption and therefore reduction in risk exposure there has been an increasing incidence of oropharyngeal squamous cell carcinoma. Progress made in the past decades in free tissue transfer reconstruction and robotic surgery have merged into transoral robotic reconstruction with free perforator flaps for head and neck. We reviewed and discussed indications and contraindications for this type of procedure, as well as potential limits refinements.
Oral Maxillofac Surg Clin North Am
· 2024 Nov · PMID 39142949
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The anterolateral thigh (ALT) free flap has become a workhorse for head and neck reconstruction. This paper offers a thorough introduction to the ALT flap, covering its anatomy, surgical technique, adaptable designs, and...The anterolateral thigh (ALT) free flap has become a workhorse for head and neck reconstruction. This paper offers a thorough introduction to the ALT flap, covering its anatomy, surgical technique, adaptable designs, and use in a range of clinical settings along with case studies. With its long vascular pedicle and tissue versatility, the ALT flap is well-suited for matching varied defects. Still, understanding possible anatomic variances and managing complications are critical to its success. With this paper as a comprehensive guidance, surgeons can apply the ALT flap for difficult head and neck reconstructions and achieve the best possible results.
Oral Maxillofac Surg Clin North Am
· 2024 Nov · PMID 39142948
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A perforator is a vessel that travels through muscle and perfuses the skin. Perforator flaps require intramuscular dissection and can be used as pedicled or free flap. With improved understanding of microvasculature, the...A perforator is a vessel that travels through muscle and perfuses the skin. Perforator flaps require intramuscular dissection and can be used as pedicled or free flap. With improved understanding of microvasculature, they can be tailored to have multiple skin paddles, multiple components, or shaped to conform to any defect. Reliable perforator flap-based reconstruction is a meticulous microvascular technique, ultimately allowing the surgeon to harvest any flap in a freestyle fashion and transplant to any recipient vessel. New technologies improve the safety and reproducibility of this type of reconstruction.
Oral Maxillofac Surg Clin North Am
· 2024 Nov · PMID 39142947
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This article illustrates the use of locoregional perforator and pedicled flaps from the 2 main vascular systems of the head and neck area. The 2 authors combine their experiences and research findings to highlight clinic...This article illustrates the use of locoregional perforator and pedicled flaps from the 2 main vascular systems of the head and neck area. The 2 authors combine their experiences and research findings to highlight clinical scenarios for these useful refined reconstructions and discuss their pros and cons.
Oral Maxillofac Surg Clin North Am
· 2024 Aug · PMID 38782678
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A wide variety of diagnoses can be approached with a common framework for diagnosis, extirpation, and reconstruction of pediatric cranial vault pathologies. Durability of reconstruction is critical for the range of pedia...A wide variety of diagnoses can be approached with a common framework for diagnosis, extirpation, and reconstruction of pediatric cranial vault pathologies. Durability of reconstruction is critical for the range of pediatric patients from infancy to adolescence. Rigid reconstruction, preferably with autologous tissue when possible, promotes brain protection and satisfactory aesthetic outcome. Careful planning can allow for immediate definitive reconstruction of defects without need for further surgical intervention.
Oral Maxillofac Surg Clin North Am
· 2024 Aug · PMID 38777729
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Odontogenic infections are a broad group of head and neck conditions that arise from the teeth and surrounding periodontium. These largely preventable infections disproportionately affect members of ethnic and racial min...Odontogenic infections are a broad group of head and neck conditions that arise from the teeth and surrounding periodontium. These largely preventable infections disproportionately affect members of ethnic and racial minorities and low-income/uninsured groups, and result in significant costs to our health care system. Left untreated, odontogenic infections can spread to deep spaces of the head and neck and can result in life-threatening complications. The mainstay of treatment includes timely treatment of the affected teeth. These infections are a global public health concern that could be diminished with improved access to routine dental care.
Oral Maxillofac Surg Clin North Am
· 2024 Aug · PMID 38777728
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Since 2000, the incidence of head and neck cancer has dramatically increased. At this time, future studies are needed to further elucidate the factors contributing to rising incidence of head and neck cancer in children....Since 2000, the incidence of head and neck cancer has dramatically increased. At this time, future studies are needed to further elucidate the factors contributing to rising incidence of head and neck cancer in children. This article provides a treatment framework for the pediatric surgical oncologist who manages cancer in children.
Beck CM, Onyekweli T, Ettinger RE
… +1 more, Boos MD
Oral Maxillofac Surg Clin North Am
· 2024 Aug · PMID 38724424
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Facial soft tissue lesions in children are often classified based on their structure or cellular origin and can be benign or malignant. This review focuses on common facial soft tissue lesions in children, their clinical...Facial soft tissue lesions in children are often classified based on their structure or cellular origin and can be benign or malignant. This review focuses on common facial soft tissue lesions in children, their clinical morphology, natural history, and medical and surgical management, with an emphasis on those considerations unique to soft tissue lesions present at this anatomic site.
Oral Maxillofac Surg Clin North Am
· 2024 Aug · PMID 38724423
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Facial nerve pathology in children has devastating functional and psychosocial consequences. Facial palsy occurs less commonly in children than adults with a greater proportion caused by congenital causes. Most pediatric...Facial nerve pathology in children has devastating functional and psychosocial consequences. Facial palsy occurs less commonly in children than adults with a greater proportion caused by congenital causes. Most pediatric patients have normal life expectancy and few comorbidities and dynamic restoration of facial expression is prioritized. This article will focus on the unique aspects of care for facial palsy in the pediatric population.