ObjectiveTo investigate the effectiveness of medial sural artery perforator free flap (MSAP) for repairing defect after tongue cancer ablation. MethodsBetween March 2013 and April 2014, the defects after tongue carcinoma resection were repaired with MSAP in 12 patients, including 8 cases of high or medium differentiated squamous cell carcinoma (SCC) and 4 cases of moderately-poor differentiated SCC. There were 7 males and 5 females with a median age of 55 years (range, 45-68 years). The disease duration ranged from 2.0 to 8.5 months (mean, 4.3 months). The tumor located at the tongue edge in 8 cases and at the tongue abdomen in 4 cases (mouth floor infiltration in 1 case). According to TNM stage, 7 cases were rated as T2N0M0, 2 cases as T2N1M0, 2 cases as T3N1M0, and 1 case as T4N1M0. The size of tumor ranged from 3.0 cm×2.0 cm to 4.5 cm×3.0 cm. The size of MSAP varied from 4.0 cm×3.5 cm to 6.5 cm×6.0 cm. ResultsThe time of total operation ranged from 5.5 to 8.3 hours (mean, 6.8 hours), and flap harvesting time ranged from 54 to 85 minutes (mean, 65.6 minutes). The other flaps survived except 1 case of vein crisis. All the patients were followed up 6-18 months (mean, 13.7 months). With time passing, the pronunciation got better, and the skin showed mucosa-like change; the patients were capable of normal language exchange at 6 months after operation. No obvious scar on the leg or limitation of limb motion was observed. ConclusionThe MSAP is reliable for repair of defect after tongue cancer ablation, with the advantages of satisfactory recovery of tongue appearance, language function, and less donor site morbidity.
ObjectiveTo explore the application of three-dimensional (3-D) printing technique in repair and reconstruction of maxillofacial bone defect. MethodsThe related literature on the recent advance in the application of 3-D printing technique for repair and reconstructing maxillofacial bone defect was reviewed and summarized in the following aspects:3-D models for teaching, preoperative planning, and practicing; surgical templates for accurate positioning during operation; individual implantable prosthetics for repair and reconstructing the maxillofacial bone defect. Results3-D printing technique is profoundly affecting the treatment level in repair and reconstruction of maxillofacial bone defect. Conclusion3-D printing technique will promote the development of the repair and reconstructing maxillofacial bone defect toward more accurate, personalized, and safer surgery.
ObjectiveTo evaluate the value of computer assisted navigation system (CANS) in the reconstruction of mandibular defects. MethodsBetween April 2012 and September 2014, 8 patients with mandibular defects were included in this study. There were 5 males and 3 females with an age range of 22-50 years (mean, 34.5 years), including 4 cases of ameloblastoma, 3 cases of odontogenic keratocyst, and 1 case of condylar osteoma. According to the CRABS (condyle, ramus, angle, body, symphysis) classification criteria based on the location of mandibular defect, there were 1 case of right CRAB type, 1 case of left RABS type, 1 case of left CR type, 1 case of right RAB type, 1 case of left C type, 1 case of right RABS+left S type, and 2 cases of right AB type. With the biteplate fixing mandible, maxillofacial CT and the donor site CT scan were done. Computer assisted design was made by using Surgicase CMF5.0 software and BrainLab Iplan software, included delineating the osteotomy lines for resection, ascertaining the normal anatomic structures for defect reconstruction, and determining the reconstructive morphology. With guide plates and the guidance of BrainLab navigation system, an en bloc tumor resection and simultaneous defect reconstruction were performed under the precise localization of mandibular angle and condyle. Preoperative and postoperative CT images were superimposed in Geomagic studio12.0 software system, and both were compared by three-dimensional (3D) objects and 2D slices. The complications and signs of recurrence were observed. ResultsUnder the guidance of navigation, preoperative facial symmetry design, surgery simulation, and simultaneous navigation operation were performed successfully. The postoperative CT and postoperative 3D error analysis showed osteotomy lines and reconstruction contour had good matching with the preoperative planning. The error of important corresponding points (mandibular angle and external pole of condyle) in the reconstruction of mandibular defects were (1.83±0.19) mm and (1.61±0.24) mm. The patients were followed up 2-6 months (mean, 3.5 months). No complication was observed in the other patients except the patients undergoing rib transplantation who had mild limitation of mouth opening. Good facial symmetry was obtained, and no tumor recurrence was found. ConclusionCANS can effectively increase the surgical precision in the reconstruction of mandibular defects and reduce complications, and recover facial symmetry. It is regarded as a valuable technique in this potentially complicated procedure.