EVALUATION OF CONFOUNDING FACTORS IN THE FUNCTIONAL AND DENTAL REHABILITATION OF RECONSTRUCTED BALLISTIC DEFECTS USING COMPOSITE ORAL AND MAXILLOFACIAL MICROVASCULAR FIBULAR FLAPS
Main Article Content
Keywords
Ballistic defects, Microvascular fibula flap, Traumatic defects, Reconstruction
Abstract
Background: Reconstruction of the oral and maxillofacial region using a microvascular free fibula flap is practical because of functional rehabilitation and mandibular and maxillary aesthetics using implant-based prostheses following trauma- or malignancy-induced resections. The present research evaluated the role of confounding factors in functional and dental rehabilitation of patients treated with microvascular composition fibula flap or fibula free flap following oral and maxillofacial defects.
Materials and methods: The present research was done as a prospective cohort on 12 eligible patients treated with composite microvascular fibula or fibula free flap following traumatic/ballistic defects of the oral and maxillofacial region. Demographic information, trauma and surgery characteristics, and characteristics associated with patient outcomes, including dysphagia, impaired respiration, mastication, speech, and diet, as well as facial symmetry aesthetic criteria, were recorded. Comparison of the quantitative variables was done using an independent t-test plus analysis of variance, along with their nonparametric equivalents (Mann-Whitney U and Kruskal Wallis test). The results of qualitative variables were evaluated using the Fisher`s exact test.
Results: Dysphagia was observed in four patients (33.33%), impaired respiration in one patient (8.33%), speech impairment in four patients (33.33%), dissatisfaction with facial symmetry in three patients (33.33%), recipient area infection in two patients (16.67%), hematoma in one patient (8.33%), and thrombosis in two patients (16.67%). Further, 10 patients (83.33%) had used implant-based prostheses with 100% success during follow-up period. The frequency of dysphagia (p=0.007), impaired respiration plus speech, and soft and mixed diet (p=0.007) was higher in the defects of mandibular lateral and anterior region. In other cases, no significant differences were found regarding the outcomes and complications of reconstruction treatments based on gender, site of defects, tobacco smoking, flap components, or lingual resection. These complications were recorded only among active smokers concerning infection, hematoma, and thrombosis in the transplant recipient area. The therapeutic success of the fibula flaps was reported to be 100%.
Conclusion: Therefore, the implantation of composite microvascular flaps or fibular-free flap grafts is associated with high success rates in the reconstruction of traumatic defects in the oral and maxillofacial regions. Nevertheless, in this context there are some considerations about the role of some variables such as smoking and failure site. Patients with lateral and anterior mandibular defects may experience swallowing and feeding problems more frequently, as well as aesthetic concerns.
References
2. Jeyaraj, P. and A. Chakranarayan, Treatment Strategies in the Management of Maxillofacial Ballistic Injuries in Low-Intensity Conflict Scenarios. J Maxillofac Oral Surg, 2018. 17(4): p. 466-481.
3. Liu, F.C., et al., A single-center review of facial fractures as the result of high-speed projectile injuries. Eplasty, 2018. 18.
4. Kaboodkhani, R., D. Mehrabani, and F. Karimi-Busheri, Achievements and Challenges in Transplantation of Mesenchymal Stem Cells in Otorhinolaryngology. Journal of Clinical Medicine, 2021. 10(13): p. 2940.
5. Gómez Roselló, E., et al., Facial fractures: classification and highlights for a useful report. Insights into imaging, 2020. 11(1): p. 1-15.
6. No Reduction in Surgical Site Infection Obtained with Post-Operative Antibiotics in Facial Fractures, Regardless of Duration or Anatomic Location: A Systematic Review and Meta-Analysis. Surgical Infections, 2020. 21(2): p. 112-121.
7. Kim, D.D. and R. Fernandes, Vascularized Reconstruction, in Peterson’s Principles of Oral and Maxillofacial Surgery. 2022, Springer. p. 1291-1312.
8. Attia, S., et al., Donor-site morbidity after fibula transplantation in head and neck tumor patients: A split-leg retrospective study with focus on leg stability and quality of life. Cancers, 2020. 12(8): p. 2217.
9. Huang, Q., et al., Pedicled Double‐Barrel Fibular Transplantation Versus Bone Transport in the Treatment of Upper Tibial Osteomyelitis with Bone Defects: A Retrospective Study. Orthopaedic Surgery, 2022. 14(11): p. 2888-2896.
10. Knitschke, M., et al., Partial and total flap failure after fibula free flap in head and neck reconstructive surgery: retrospective analysis of 180 flaps over 19 years. Cancers, 2021. 13(4): p. 865.
11. Lucattelli, E., et al., Oromandibular reconstruction with double‐skin paddle fibular free flap: A systematic review and meta‐analysis. Microsurgery, 2021. 41(7): p. 676-687.
12. Qayyum, Z., et al. Outcome assessment after reconstruction of tumor-related Mandibular defects using free vascularized fibular flap—A clinical study. in Healthcare. 2023. MDPI.
13. Margabandu, B.T., et al., Aesthetic and functional outcomes of microvascular reconstruction of large post-excisional defects of the mandible by using the chimeric double-barrel free fibula flap. European Journal of Plastic Surgery, 2023.
14. Ali, S.A., et al., Technological advancements in head and neck free tissue transfer reconstruction. Plast Aesthet Res, 2021. 8: p. 35.
15. Abdelrahman, M., et al., A constant harvest technique for chimeric anterolateral thigh flaps and patient outcomes following their use in reconstructive head and neck surgery. Journal of Plastic, Reconstructive & Aesthetic Surgery, 2021. 74(5): p. 1013-1021.
16. Vassiliou, L.V., et al., Vascularized free fibula flap oral rehabilitation using tissue engineered mucosa: Report of 3 cases. Journal of Cranio-Maxillofacial Surgery, 2022. 50(6): p. 485-492.
17. Zrnc, T.A., et al., Complex mandibular reconstruction for head and neck squamous cell carcinoma—the ongoing challenge in reconstruction and rehabilitation. Cancers, 2020. 12(11): p. 3198.
18. Zavala, A., et al., Reconstruction of mandibular defects involving the central segment with fibula osteoseptocutaneous free flap following ameloblastoma resection: Patient-reported outcomes. Journal of Plastic, Reconstructive & Aesthetic Surgery, 2021. 74(11): p. 3022-3030.
19. Antúnez-Conde, R., et al., Mandibular reconstruction with fibula flap and dental implants through virtual surgical planning and three different techniques: Double-barrel flap, implant dynamic navigation and CAD/CAM mesh with iliac crest graft. Frontiers in Oncology, 2021. 11: p. 719712.
20. Panchal, H., et al., Dental implant survival in vascularized bone flaps: a systematic review and meta-analysis. Plastic and reconstructive surgery, 2020. 146(3): p. 637-648.
21. Zhang, H.-q., et al., Combination of biomechanical evaluation and accurate placement of dental implants: a new concept of virtual surgery in maxillary and mandibular functional reconstruction. British Journal of Oral and Maxillofacial Surgery, 2020. 58(1): p. 62-68.
22. Soares, A.P., et al., Uncovering the unique characteristics of the mandible to improve clinical approaches to mandibular regeneration. Frontiers in Physiology, 2023. 14: p. 1152301.
23. Iyer, J., et al., Acquired facial, maxillofacial, and oral asymmetries—a review highlighting diagnosis and management. Symmetry, 2021. 13(9): p. 1661.
24. Liu, Y., et al., Dexmedetomidine for prevention of postoperative pulmonary complications in patients after oral and maxillofacial surgery with fibular free flap reconstruction: a prospective, double-blind, randomized, placebo-controlled trial. BMC anesthesiology, 2020. 20: p. 1-14.
25. Lodders, J.N., et al., Implant-based dental rehabilitation in head and neck cancer patients after maxillofacial reconstruction with a free vascularized fibula flap: the effect on health-related quality of life. Supportive Care in Cancer, 2022. 30(6): p. 5411-5420.
26. Goker, F., et al., Dental implant‐based oral rehabilitation in patients reconstructed with free fibula flaps: Clinical study with a follow‐up 3 to 6 years. Clinical Implant Dentistry and Related Research, 2020. 22(4): p. 514-522.
27. Goker, F., et al., Effectiveness of dental implants placed into microvascular free flaps. Oral Diseases, 2020. 26(7): p. 1532-1536.
28. Attia, S., et al., Survival of dental implants placed in vascularised fibula free flaps after jaw reconstruction. Journal of Cranio-Maxillofacial Surgery, 2018. 46(8): p. 1205-1210.
29. Jain, A.R., Clinical and functional outcomes of implant prostheses in fibula free flaps. World journal of dentistry, 2015. 8(3): p. 171-176.
30. Khadembaschi, D., et al., Systematic review and pooled analysis of survival rates, success, and outcomes of osseointegrated implants in a variety of composite free flaps. Head & Neck, 2020. 42(9): p. 2669-2686.
31. Ardisson, A., et al., Success rate of mandible implants placed in vascularized fibula bone graft: A systematic review. Journal of Oral Implantology, 2023. 49(1): p. 85-92.
32. Viblom, J. and J. Emauelsson, Mandibular Reconstruction after Head and Neck Tumor Treatment, a Systematic Review. 2014.
33. del Pino, J.G., et al., 126 Osteoblastic and microvascular capacity of free vascularized bone grafts related to epiphysial osteonecrosis.
34. Huizinga, M.P., et al., Prefabricated fibula free flaps in reconstruction of maxillofacial defects: Two cases of transplanting a fractured fibula. Head & Neck, 2023.
35. Oh, S.-L., H.J. Shiau, and M.A. Reynolds, Survival of dental implants at sites after implant failure: A systematic review. The Journal of prosthetic dentistry, 2020. 123(1): p. 54-60.
36. Gonzalez, S.R., et al., Functional outcome predictors following mandibular reconstruction with osteocutaneous fibula free flaps: correlating early postoperative videofluoroscopic swallow studies with long-term clinical results. Maxillofacial Plastic and Reconstructive Surgery, 2019. 41: p. 1-8.
37. Bodard, A.-G., et al., Assessment of functional improvement with implant-supported prosthetic rehabilitation after mandibular reconstruction with a microvascular free fibula flap: a study of 25 patients. The Journal of Prosthetic Dentistry, 2015. 113(2): p. 140-145.
38. Attia, S., et al., Functional and aesthetic treatment outcomes after immediate jaw reconstruction using a fibula flap and dental implants. Journal of Cranio-Maxillofacial Surgery, 2019. 47(5): p. 786-791.
39. Chiapasco, M., et al., Long‐term outcome of dental implants placed in revascularized fibula free flaps used for the reconstruction of maxillo‐mandibular defects due to extreme atrophy. Clinical Oral Implants Research, 2011. 22(1): p. 83-91.
40. Matsuda, Y., et al. Oral Health Management and Rehabilitation for Patients with Oral Cancer: A Narrative Review. in Healthcare. 2022. MDPI.
41. Pellegrino, G., et al., Long‐term results of osseointegrated implant‐based dental rehabilitation in oncology patients reconstructed with a fibula free flap. Clinical implant dentistry and related research, 2018. 20(5): p. 852-859.
42. Ghoreyshi ZS, George JT. Quantitative approaches for decoding the specificity of the human T cell repertoire. Frontiers in Immunology. 2023;14.
43. Anbari F, Yazdani KZ, Salemi M, Anbari F. Anxiety and temporomandibular joint disorders among law students in Iran.
44. Ashari MA, Berijani A, Anbari F, Yazdani Z, Zandian A. Comparison of the Effectiveness of Combined Diode Laser and GLUMA Bonding Therapy With Combined Diode Laser and 5% Sodium Fluoride Varnish in Patients With Dentin Hypersensitivity. Journal of Lasers in Medical Sciences. 2021;12.
45. Saghafian M, Seyedzadeh H, Moradmand A. Numerical simulation of electroosmotic flow in a rectangular microchannel with use of magnetic and electric fields. Scientia Iranica. 2023 Jun 26.
46. Rajabi M, Golshan H, Hasanzadeh RP. Non-local adaptive hysteresis despeckling approach for medical ultrasound images. Biomedical Signal Processing and Control. 2023 Aug 1;85:105042.
47. Rajabi M, Hasanzadeh RP. A Modified adaptive hysteresis smoothing approach for image denoising based on spatial domain redundancy. Sensing and Imaging. 2021 Dec;22:1-25.
48. Zhang L, Pakmehr SA, Shahhosseini R, Hariri M, Fakhrioliaei A, Karkon Shayan F, Xiang W, Karkon Shayan S. Oncolytic viruses improve cancer immunotherapy by reprogramming solid tumor microenvironment. Medical Oncology. 2023 Dec 8;41(1):8.
49. Doraghi F, Pegah Aledavoud S, Fakhrioliaei A, Larijani B, Mahdavi M. Ring‐Opening Cross‐Coupling/Cyclization Reaction of Cyclopropanols with Organic Compounds. ChemistrySelect. 2023 Aug 31;8(32):e202301438.
50. Fakhrioliaei A, Abedinifar F, Salehi Darjani P, Mohammadi-Khanaposhtani M, Larijani B, Ahangar N, Mahdavi M. Hybridization of the effective pharmacophores for treatment of epilepsy: design, synthesis, in vivo anticonvulsant activity, and in silico studies of phenoxyphenyl-1, 3, 4-oxadiazole-thio-N-phenylacetamid hybrids. BMC chemistry. 2023 Jul 17;17(1):80.
51. Mollazadeh M, Azizian H, Fakhrioliaei A, Iraji A, Avizheh L, Valizadeh Y, Zomorodian K, Elahi F, Moazzam A, Kazemzadeh H, Amanlou M. Different barbiturate derivatives linked to aryl hydrazone moieties as urease inhibitors; design, synthesis, urease inhibitory evaluations, and molecular dynamic simulations. Medicinal Chemistry Research. 2023 May;32(5):930-43.
52. Safapoor S, Halimi M, Ghomi MK, Noori M, Dastyafteh N, Javanshir S, Hosseini S, Mojtabavi S, Faramarzi MA, Nasli-Esfahani E, Larijani B. Synthesis, ADMT prediction, and in vitro and in silico α-glucosidase inhibition evaluations of new quinoline–quinazolinone–thioacetamides. RSC Advances. 2023;13(28):19243-56.
53. Ghalehbandi M, Khosravifar S, Aloosh O, Rahimi‐Golkhandan A, Abounoori M, Aloosh A, Afshar H, Khosravifar S. The association between sleep quality, health status and disability due to breathlessness in chronic obstructive pulmonary disease patients. The Clinical Respiratory Journal. 2021 Nov;15(11):1168-74.
54. Omranifard V, Abounoori M, Babakhanian M, Ebrahimi A, Akouchekian S, Shafiei K, Khosravifar S. Translation and psychometric properties of the Persian version of the Health of the Nation Outcome Scales for Elderly People (HoNOS65+). Aging Medicine. 2021 Jun;4(2):135-45.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Elahe Tahmasebi
Research Center for Prevention of Oral and Dental Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran
Reza Tabrizi
Associate Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Hamidreza Moslemi
Postgraduate Student, Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Shervin Shafiei
Postgraduate Student, Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Mohammad Khosousi Sani
Postgraduate Student, Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Samira Hajisadeghi
School of Dentistry, Baqiyatallah University of Medical Sciences, Tehran, Iran
Edris Nazarpour
Student Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
Arman Torabizadeh
Oral and Maxillofacial surgeon, Private Practice, Tehran, Iran