Oral and Maxillofacial Surgery Clinics of North America最新文献

Successful dental implant therapy relies on a bone-implant interface that is mechanically strong and capable of dynamic remodeling in response to functional loads. There are a number of medical conditions or therapies that can affect either bone metabolism or the resistance of bone to infection. However, their effects are often mitigated by local factors or individual responses so the impact of these conditions is not clear-cut. This article will review a number of these conditions and therapies and describe existing studies that have studied these conditions to guide practitioners in their implant practice.

The surgical ablation of head and neck cancer followed by radiotherapy often leads to unfavorable functional and aesthetic outcomes. Studies have demonstrated that these outcomes can significantly impact quality of life. Dental implants play a crucial role in rehabilitation by facilitating the use of suprastructures and obturators. However, the long-term survival of dental implants in patients who have undergone radiotherapy remains uncertain, raising several questions. These include determining the optimal timing for dental implantation (before or after radiotherapy), identifying the radiotherapy threshold for implant loss, and considering the role of hyperbaric oxygen therapy. These and other related concerns will be addressed in the following article.

The success of implants depends on the biological and mechanical factors of the implant, as well as on the chosen prosthesis, which has different characteristics that can affect the survival of the implant and its marginal bone levels. Therefore, when choosing the type of prosthesis, it is necessary to understand and consider each of these variables and tailor them to the relevant clinical situation. In this narrative review, we will assess the types of prostheses, their different characteristics, timing, and their impact on implant survival and marginal bone levels, as accepted in today's literature.

Zygoma implants are an alternative for rehabilitating severe maxillary atrophy. Since 2004, when Prof. Branemark first reported the long-term findings on zygomatic implants using the original intra-sinus approach, various surgical techniques have been introduced. In 2006, an anatomy-guided approach was developed, applying different implant trajectories based on alveolar atrophy levels and sinus concavity. The purpose of this review is to clarify the existing techniques and long-term outcomes of ZI rehabilitation over the past 20 years. Additionally, it aims to enhance the quality of current practices and identify gaps in the understanding of ZI treatment for future studies.

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.

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.

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.

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.

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.

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.