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"ABSTRACTAlar defects generally mandate replacement of the entire unit. The nasal alar unit is highly contoured, has a free margin, and contributes to the external nasal valve. Many methods exist to reconstruct the ala, including local nasal flaps, skin grafts, composite auricular grafts, and pedicle flaps. In most instances, however, consistent results require a cartilage subsurface framework to resist the forces of contraction and provide a stable external valve and provide a scaffold for contour Main Outcome Measures Observer's and patient's rating of the final results, patient's rating of breathing and level of self-consciousness, and medical record review of complications. Most aesthetic outcomes were excellent to good. Breathing from the reconstructed side can be returned to preoperative status in most of these patients. Staged reconstruction of the nasal ala using free cartilage grafts, interpolated cheek or forehead and mucosal flaps when necessary, result in a highly aesthetic and functional outcome in most patients. "

"ABSTRACTTotal auricular reconstruction of microtia with autogenous costal cartilage is one of the most demanding challenges in plastic and reconstructive surgery because of the complex three-dimensional shape of the auricle. An ideal result of the constructed ear depends primarily on the fabricated cartilaginous ear framework. As the cartilage framework used for reconstruction is always insufficient for the fabrication of anatomical structures, especially the tragus and the conchal bowl, individualized framework grafting based on different patient age groups and different degrees of strength and thickness of the rib cartilages have been devised accordingly. For a configuration of the concha that is definitely anatomical, we constructed the conchal bowl element in one of three patterns according to the amount of available cartilages: one block, two-pieces, or a cymba bowl element only. The patients were followed up for more than 1 year. The aesthetic results were scored by evaluating characteristics involving the stability of the crus helicis, the conchal definition, and the smoothness of the helical curve.The ears reconstructed early without a conchal bowl element and ears reconstructed later with the concha bowl element showed a definite crus helicis, deep cymba conchal space, and smooth helical curve. The construction of the conchal bowl element is simple dan not time-consuming procedure. It is suggested that the conchal bowl element must be constructed and attached to the main framework for natural configuration of the reconstructed ear. "

"Madible fracture, also known as fractures of jaws are breaks through the mandiblebone. Fractures of mandible account for 36 -70% of all maxillofacial injuries (1,2,3)the symphysis and parasymphysis account for 17%of mandible fracture (4) 75 % to85 % of mandible fracture occurs in males with majority occuring in their twenties &thirties (5,6,7). 43% of the patients had an associated injury. Of these patients, headinjuries occurred in 39% of patients, head and neck lacerations in 30%, midfacefractures in 28%, ocular injuries in 16%, nasal fractures in 12%, and cervical spinefractures in 11% - 53% of patients had unilateral fractures, 37% of the patients had2 fractures, and 9% had 3 or more fractures."

"AbstrakDespite the advancement of bone reconstruction in the past decade, large bone defect remains a challenge for orthopedic surgery. As mesenchymal stem cells (MSCs) emerges as one of the possible treatment of these defects, we evaluate the effect of its transplantation, particularly in combination with hydroxyapatite-calcium sulphate pellets. Methods: Twenty eight rabbits were randomly assigned into four different treatment groups. Each group received a different type of grafts (Autograft, hydroxyapatite-calcium sulphate [HA-CaSO4], HA-CaSO4 combined with marrow aspirate, or HA-CaSO4 combined with 2x106 MSCs). One centimeter long bone defects were created then immediately fixated with mini plate-screw and two cerclage wires. It was followed by the graft transplantation. Callus thickness was measured from the x-rays taken at 4, 8, 12 week after transplantation by two authors working independently. At the end of the study, histological staining along with osteocyte index were obtained by sacrificing the rabbits. These data were analyzed by one-way ANOVA test.Results: At the fourth week, callus thickness showed significant difference (p = 0.018). Although statistically insignificant, callus in MSCs group at the eighth week seemed to be thicker than any other groups of intervention (p = 0.546). The MSCs group also tend to have a higher osteocyte index at the follow-up weeks.Conclusion: MSC transplantation on bone defect results in faster callus formation and tends to generate a thicker callus."

"In cases of advanced alveolar bone loss frequently associated with periodontal pockets that may not be accessible by conservative therapy, corrective surgery is often indicated as osseous resective and complete debridement therapy. Transplantation of osseous fill material is often necessary, as a surgical intervention may create an alveolar bone defect. In this reported case of surgery, a cortico-cancellous bone graft taken from the mandibular symphysis was transplanted in a mixture with human mineralized bone from the Dr. Soetomo Hospital Surabaya Bone Bank, expecting for osseous regeneration to reduce the bony defect. Six months after surgery the morphology of the reconstructed alveolar process was satisfactory and showing new growth of bone"

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Introduksi: Rekonstruksi mandibula pada kasus-kasus tumor mandibula menggunakan flap fibula bebas merupakan hal penting untuk mengembalikan fungsi dan estetik pada defek pascareseksi. Penelitian ini ditujukan untuk menilai hubungan karakteristik klinis dengan fungsi menelan, fungsi bicara, fungsi makan, dan kualitas hidup pada pasien yang dilakukan rekonstruksi mandibula menggunakan flap fibula bebas pascamandibulektomi.

Metode: Dilakukan studi dengan desain potong lintang dan survei mengikutsertakan pasien yang dilakukan rekonstruksi mandibula menggunakan flap fibula bebas pascamandibulektomi di RSCM pada tahun 2014-2019. Dilakukan penilaian terhadap kelas defek mandibula, panjang defek, jumlah subunit mandibula, ekstensi defek, jumlah segmen tulang, selanjutnya dilakukan penilaian fungsi melalui wawancara menggunakan European Organization for Research and Treatment of Cancer Head and Neck Cancer Quality of Life Questionnaire (EORTC QLQ-H&N35).

Hasil: Tercatat 63 pasien dengan mandibulektomi dan dilakukan rekonstruksi. Hanya 14 dapat dinilai. Hanya panjang defek dan ekstensi defek yang memiliki hubungan bermakna dengan fungsi. Panjang defek mandibula memiliki korelasi positif dengan gangguan pada fungsi menelan (p = 0,032), fungsi bicara (p = 0,020), dan kualitas hidup (p = 0,032). Ekstensi defek intraoral dan ekstraoral menyebabkan gangguan fungsi menelan (p = 0,035).

Konklusi: Penelitian ini menunjukkan bahwa fungsi menelan, fungsi bicara, dan kualitas hidup tergantung defek pascamandibulektomi.

 

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Introduction: Mandibular reconstruction utilizing free fibula flap is essential in restoring the function, and aesthetics outcomes post mandibular tumor resection. This study looks into the association of clinical characteristics with functional outcomes such as swallowing, speaking, eating, and quality of life on patients undergoing post-mandibulectomy mandibular reconstruction using free fibula flap.

Methods: We performed a cross-sectional study that includes patients who underwent post-mandibulectomy mandibular reconstruction using free fibula flap at RSCM in 2014-2019. Mandibula defect class, defect length, the number of mandibula subunits, defect extension, and the number of osteotomy segments was evaluated. The functional outcomes were assessed using the European Organization for Research and Treatment of Cancer Head and Neck Cancer Quality of Life Questionnaire (EORTC QLQ-H&N35).

Results: 63 patients underwent mandibulectomy and reconstruction using free fibula flap. Only 14 were included in the study. Defect length and extension are significantly associated with functional outcomes. Mandibula defect length has positive correlation with problems in swallowing function (p = 0.032), speaking function (p = 0.020), and quality of life (p = 0.032). Both intraoral and extraoral defect extension causes swallowing function problem (p = 0.035).

Conclusion: This study discovered that swallowing function, speaking function, and quality of life are associated with post-mandibulectomy defect.

 

 

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