Second Modification Technique to Stabilize Dental Prosthesis After Resection of the Maxilla and Reconstruction
Second Modification Technique to Stabilize Dental Prosthesis After Resection of the Maxilla and Reconstruction
1:Statement of the problem
After the excision of the maxillary carcinoma, a functional improvement by means of skin-flap reconstruction and obturator denture can be conducted. However, quite a few cases show prosthesis stability difficulties due to the flap’s own weight. Therefore second modification technique is required to plan improvement of configuration. A purpose of second modification technique reduces flap, and to remove descent of flap. This reports on two new method of that took second modification technique. The first case is vestibuloplasty and defatting of the fibular osteoseptocutaneous flap from the palatal side. The second case is flap revision by skin flap lifting using mitek anchors was performed for extensive complete removal of the maxilla.
2:Materials and methods
Case1:The patient was a 73- year-old woman at the time of maxillary reconstruction. She underwent resection of the maxilla and fibular osteoseptocutaneous flap in January, 2008. However, there was no oral vestibule because the flap had been sewed up onto the upper lip. Because the dental prosthesis was unstable, we decided on vestibuloplasty.
The vestibuloplasty was performed under general anaesthesia in December, 2008.
Case2: The patient was a 56-year-old male, who underwent an extensive total maxillectomy and flap reconstruction using the rectus abdominus muscles in May 2005. Postoperatively, due to the difficulties of wearing a maxillary denture, he was transferred to our department with the chief complaint of no morphological improvement. The maxillary bone had already been removed from the midline with the rectus abdominus muscle flap sutured directly to the soft palate without oral vestibule, and the flap margin was moving together with the surrounding soft tissue. The flap size was 70×50 mm, which was sagging due to its own weight and was in contact with mandibular molars, reducing the volume of the oral cavity without a denture being worn. In Dec 2008, reduction and lifting of the flap was conducted under general anesthesia. This operation used 3 mitek anchors implanted in the zygomatic bone, and the anchor suture placed through subcutaneous tissue to the skin flap for lifting. Three years to the day since the operation, no regression of sagging of the flap and no infection of the wound can be seen.
3:Results
A purpose of second modification technique after maxillary cancer abscission is stability of prosthetic appliance. A main thing of second modification technique is vestibuloplasty. However, stability of dental prosthesis is insufficient in vestbuloplasty. Therefore, supporting methods to promote stability of dental prosthesis are required. In this case, a fibula was fixed with plates on the labial side. Then we elevated the flap from the posterior side and reduced fat tissue to make the flap thin. The oral vestibule was also formed well enough. The dental prosthesis was stable after the operation. We think this method is good in that the fibula is covered by the base of the flap and the following necrosis of the flap is reduced.
4:Conclusions
Dental prosthesis was able to be stable by using vestibuloplasty and flap loss technique and supporting means.
5:References
Yu K, Kim AJ, Tadros M, Costantino PD. Mitek anchor-augmented static facial suspension., Arch Facial Plast Surg.;12(3):159-65. 2010
Hashemi HM, Parhiz A, Ghafari S.FVestibuloplasty: allograft versus mucosal graft.Int J Oral Maxillofac Surg. 41(4):527-30. 2012
After the excision of the maxillary carcinoma, a functional improvement by means of skin-flap reconstruction and obturator denture can be conducted. However, quite a few cases show prosthesis stability difficulties due to the flap’s own weight. Therefore second modification technique is required to plan improvement of configuration. A purpose of second modification technique reduces flap, and to remove descent of flap. This reports on two new method of that took second modification technique. The first case is vestibuloplasty and defatting of the fibular osteoseptocutaneous flap from the palatal side. The second case is flap revision by skin flap lifting using mitek anchors was performed for extensive complete removal of the maxilla.
2:Materials and methods
Case1:The patient was a 73- year-old woman at the time of maxillary reconstruction. She underwent resection of the maxilla and fibular osteoseptocutaneous flap in January, 2008. However, there was no oral vestibule because the flap had been sewed up onto the upper lip. Because the dental prosthesis was unstable, we decided on vestibuloplasty.
The vestibuloplasty was performed under general anaesthesia in December, 2008.
Case2: The patient was a 56-year-old male, who underwent an extensive total maxillectomy and flap reconstruction using the rectus abdominus muscles in May 2005. Postoperatively, due to the difficulties of wearing a maxillary denture, he was transferred to our department with the chief complaint of no morphological improvement. The maxillary bone had already been removed from the midline with the rectus abdominus muscle flap sutured directly to the soft palate without oral vestibule, and the flap margin was moving together with the surrounding soft tissue. The flap size was 70×50 mm, which was sagging due to its own weight and was in contact with mandibular molars, reducing the volume of the oral cavity without a denture being worn. In Dec 2008, reduction and lifting of the flap was conducted under general anesthesia. This operation used 3 mitek anchors implanted in the zygomatic bone, and the anchor suture placed through subcutaneous tissue to the skin flap for lifting. Three years to the day since the operation, no regression of sagging of the flap and no infection of the wound can be seen.
3:Results
A purpose of second modification technique after maxillary cancer abscission is stability of prosthetic appliance. A main thing of second modification technique is vestibuloplasty. However, stability of dental prosthesis is insufficient in vestbuloplasty. Therefore, supporting methods to promote stability of dental prosthesis are required. In this case, a fibula was fixed with plates on the labial side. Then we elevated the flap from the posterior side and reduced fat tissue to make the flap thin. The oral vestibule was also formed well enough. The dental prosthesis was stable after the operation. We think this method is good in that the fibula is covered by the base of the flap and the following necrosis of the flap is reduced.
4:Conclusions
Dental prosthesis was able to be stable by using vestibuloplasty and flap loss technique and supporting means.
5:References
Yu K, Kim AJ, Tadros M, Costantino PD. Mitek anchor-augmented static facial suspension., Arch Facial Plast Surg.;12(3):159-65. 2010
Hashemi HM, Parhiz A, Ghafari S.FVestibuloplasty: allograft versus mucosal graft.Int J Oral Maxillofac Surg. 41(4):527-30. 2012