Chirurgia maxillofacialis & plastica最新文献

In the Department of Surgery, Clinical Hospital Center Rijeka in cooperation with ENT Department and the Department of Maxillofacial Surgery, fifty patients with the mouth and the throat tumor were operated since 1985. The defects were covered with free radial forearm flaps. In seven cases flap did not survived due to thrombosis of the anastomosis. The arterial anastomosis were usually made on the external carotid artery branches. Seven anastomosis were made on the opposite side of the neck because homolateral carotid artery was ligated. In three cases terminolateral anastomosis with common carotid artery was made. In eight patients the bone defect of the lower jaw was reconstructed with vascularized radial bone graft. Irradiation and/or cytostatic therapy was mostly applied two weeks after surgery. The donor site defect has no functional nor aesthetic implications.

Nine endosteal implants of Linkow, Sandhaus and Vitradent type and one transdental implant have been used in six patients for the retention of resection prostheses. The intention was to find out the efficiency of endosteal implants in prosthetic rehabilitation of patients with oncologic defects of jaws. Most implants were removed because of loosing and mucosa inflammation after the period of 46 to 139 days. The earliest extraction was performed in one case after eight days and the latest in the another case after two years. The results showed that there are no medical indications for endosteal implantation of such implants in resection prostheses retention.

In five year period (1977-1982) 38 patients were treated for the epipharyngeal cancer in Department for oncology and radiotherapy and Department of otolaryngology of Medical Faculty in Zagreb. Most of the patients were male (76%), between 40 and 70 years of age. In 23 (60%) the cancer was poorly differentiated, in 15 (40%) well differentiated. Most of the patients were in advanced stage (III and IV - 37 patients, only one in I stage). All patients were primary treated by radiotherapy (telecobalt). The applied dose was 60 Gy in 50% of the patients. The other received lower doses (ten of them less than 55 Gy), only one received 70 Gy by classic fractions. Surgery was performed for residual neck nodes (radical neck dissection). Adjuvant chemotherapy was administrated as a rule in cases of poorly differentiated squamous carcinoma, as well as in all cases with local recurrence and/or distant metastases. Two years survival was 45%, three years 42% and five years 21%. The other radiotherapy techniques are discussed concerning the treatment improvement and diminishment of irradiation sequalae.

As a result of new knowledge on the proteolytic activity of the damaged sinus mucosa discharge, the multiple puncture and irrigation for acute or exacerbated chronic maxillary sinusitis is recently much more recommended. The author used a polytene tube, inserting it through a standard puncture needle into the maxillary sinus in 81 patients. Further irrigations and direct applications of the appropriate drugs into the sinus were possible without repeated puncture procedures. The method, thus, is very suitable causing no discomfort to the patient, as the tube is invisible and biologically inert in relation to the nose and sinus mucosa. This method avoids the repetition of further punctures. No significant complications were observed.

In the anatomical investigation the authors dissected 20 fresh cadaveric forearms to study septofascial layers. It's vascularization was based on radial artery and concomitant veins. We perfused those flaps with methylene blue in the proximal part of radial artery. In 10 cases we found fine vascular network colored in blue. In the second group we isolated free septofascial tissue which was perfused with radiopaque contrast Hexabrix. Five flaps were perfused in the proximal part of vascular pedicle and five in the distal part. Afterwards the radiographs confirmed good vascular network, independent of flow direction. Fascia dimension in the proximal part of the forearm varied from 7-15 cm and in the distal part from 6-10 cm, depending on the forearm size. Fascia length varied from 21-27 cm. The authors found thicker and stronger fascia in the ulnar part of the forearm. The length of vascular pedicle was reversely proportional with the flap dimension. This anatomical investigation may find it's greatest application in plastic and reconstructive surgery.

A case report of a mutilating injury of the hand is presented illustrating the use of a composite tendo-aponeuro-capsular autograft during primary reconstruction, with the aim to preserve the functional ability of the injured MCP joint. Some conditions necessary for such reconstruction are also mentioned.