• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.30 no.4
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• pp.301-307
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• 2004

The flap considered at first for the reconstruction of large maxillary defect, especially mid-face defect, is scapular free flap, because it provides ample composite tissue which can be designed 3-dimensionally for orbital, facial and oral reconstruction. In case of maxillary defect involving hard palate, however, this flap has some limitations. First, its bulk prevents oral function and physio-anatomic reconstruction of nasal and oral cavity. Second, mobility and thickness of cutaneous paddle covering the alveolar area reduce retention of tissue-supported denture and give rise to peri-implantitis when implant is installed. Third, lateral border of scapula that is to reconstruct maxillary arch and hold implants is straight, not U-shaped maxillary arch form. To overcome these problems, new concept of step prefabrication technique was provided to a 27-year-old male patient who had been suffering from a complete hard palate and maxillary alveolar ridge defect. In the first stage, scapular osteomuscular flap was elevated, tailored to fit the maxillary defect, particulated autologous bone was placed subperiosteally to simulate U-shaped alveolar process, and then wrapped up with split thickness skin graft(STSG, 0.3mm thickness). Two months later, thus prefabricated new flap was elevated and microtransferred to the palato-maxillary defect. After 6 months, 10 implant fixtures were installed along the reconstructed maxillary alveolus, with following final prosthetic rehabilitation. The procedure was very successful and patient is enjoying normal rigid diet and speech.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.27 no.2
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• pp.189-191
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• 2001

Objective : The objective of this study was to determine which forms of iliac cancellous bone grafts better restore alveolar clefts. Study design : Forty consecutive patients who required a unilateral alveolar cleft graft were studied. Group I (20 patients) had reconstruction with iliac cancellous particulate bone grafts and group II (20 patients) had reconstruction with iliac cancellous block bone grafts. The two groups were evaluated radiographically and clinically. Results : The group with the block bone grafts showed less postoperative problems and better incorporation of the bone graft than the group with the particulate grafts. Conclusion : Surgical reconstruction of alveolar process defects in patients with alveolar cleft using iliac cancellous block bone is a more reliable method than particulate bone grafts both for closing the oronasal fistula and for building interalveolar septal height.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.16 no.4
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• pp.359-370
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• 1994

The reconstruction of major head and neck defects must be an integral part of the overall cancer treatment plan. The priorities of surgical treatment of head and neck tumor are 1) local tumor control, 2) relief of pain, 3) avoidance of difficult dressing, 4) provision of oral continence, and 5) ability to swallow and manage saliva. The recent advances in reconstructive surgery including the development of musculocutaneous flaps and microvascular free tissue transfer have allowed the surgical restoration of head and neck tumor defects that previously were not possible. These techniques have provided the opportunity to undertake larger, more aggressive resection while at the same time permitting functional rehabilitation. The timing of reconstruction demands on the nature of the resection, the ability of the ablative and reconstructive teams to coordinate efforts, the overall health of the patients, the patient's needs and wishes. So, we report to emphasize current methods for restoring major head and neck tumor defects after tumor ablation, reviewing for the reconstructive operations, postoperative complications, and postoperative sequelae etc, of patients from Jan, 1990 to Dec, 1993.

• Archives of Plastic Surgery
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• v.46 no.5
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• pp.480-483
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• 2019

Repairing surgical defects of the nose is still challenging due to its tridimensional shape and its aesthetic concern. Difficulty in reconstructing nasal subunits lies in their contour, skin texture and limited availability of adjacent skin. For lower nasal dorsum and supra-tip regions, we design a new combined local flap as existing local flaps may give disappointing results. This combination flap was performed on two patients for reconstruction of the lower nasal dorsum area after basal cell carcinoma excision. Size of the excision ranged from 20 to 25 mm diameter and safe margins were obtained. The defects were reconstructed with a local flap that combined a rotation nasal flank flap and a V-Y advancement nasolabial flap. Excision and reconstruction were performed in a one-stage surgery under intravenous sedation and local anesthesia. There were no postoperative complications and no flap loss occurred. Aesthetic and functional results after 6 months postoperatively were satisfying without modification of nasal shape. This flap is reliable and offers interesting functional and aesthetic outcomes. It can be considered as a new reconstruction alternative for supra-tip and lower nasal dorsum skin defects performed in a one-stage procedure under local anesthesia.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.40
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• pp.35.1-35.7
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• 2018

Background: After the resection at the mandibular site involving oral cancer, free vascularized fibular graft, a type of vascularized autograft, is often used for the mandibular reconstruction. Titanium mesh (T-mesh) and particulate cancellous bone and marrow (PCBM), however, a type of non-vascularized autograft, can also be used for the reconstruction. With the T-mesh applied even in the chin and angle areas, an aesthetic contour with adequate strength and stable fixation can be achieved, and the pores of the mesh will allow the rapid revascularization of the bone graft site. Especially, this technique does not require microvascular training; as such, the surgery time can be shortened. This advantage allows older patients to undergo the reconstructive surgery. Case presentation: Reported in this article are two cases of mandibular reconstruction using the ready-made type and custom-made type T-mesh, respectively, after mandibular resection. We had operated double blind peer-review process. A 79-year-old female patient visited the authors' clinic with gingival swelling and pain on the left mandibular region. After wide excision and segmental mandibulectomy, a pectoralis major myocutaneous flap was used to cover the intraoral defect. Fourteen months postoperatively, reconstruction using a ready-made type T-mesh (Striker-Leibinger, Freibrug, Germany) and iliac PCBM was done to repair the mandible left body defect. Another 62-year-old female patient visited the authors' clinic with pain on the right mandibular region. After wide excision and segmental mandibulectomy on the mandibular squamous cell carcinoma (SCC), reconstruction was done with a reconstruction plate and a right fibula free flap. Sixteen months postoperatively, reconstruction using a custom-made type T-mesh and iliac PCBM was done to repair the mandibular defect after the failure of the fibula free flap. The CAD-CAM T-mesh was made prior to the operation. Conclusions: In both cases, sufficient new-bone formation was observed in terms of volume and strength. In the CAD-CAM custom-made type T-mesh case, especially, it was much easier to fix screws onto the adjacent mandible, and after the removal of the mesh, the appearance of both patients improved, and the neo-mandibular body showed adequate bony volume for implant or prosthetic restoration.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.18 no.3
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• pp.378-387
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• 1996

We performed costochondral grafting in mmandibular reconstruction including condyle replacement in 5 patients which have 4 cases of ameloblastoma, 1 case of resorption of left condyle due to osteomyelitis. We harvested the 6 th costochondral cartilage of unaffected side. No specific complications were appeared with unexpected fracture of costochondral junction and infection of operation site, These patients show 30-45mm at month opening, near normal of affected side, near normal or normal of unaffected side at lateral excursion. Postoperative coureses was uneventful with improved cosmetic and functional results. Our report is indicated that the costochondral graft is satisfactory to reconstruct mandibular defect including condyle replacement, especially in growing patients.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.41
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• pp.55.1-55.7
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• 2019

Background: Transverse facial clefts are Tessier's number 7 facial cleft among numbers 1-15 in Tessier's classification of craniofacial malformations, which varies from a simple widening oral commissure to a complete fissure extending towards the external ear. Case presentation: In a patient with a transverse facial cleft, to functionally arrange the orbicularis oris muscle and form the oral commissure naturally, we performed a surgical procedure including orbicularis oris muscle reconstruction and cheiloplasty with Z-plasty. Conclusion: We achieved good results functionally and esthetically by orbicularis oris muscle reconstruction and cheiloplasty with Z-plasty. The surgical modality of our anatomical repair and 3 months follow-up results are presented.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.47 no.3
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• pp.151-152
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• 2021

• Maxillofacial Plastic and Reconstructive Surgery
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• v.34 no.5
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• pp.337-342
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• 2012

The osseous or osteocutaneous free fibula flap has become the gold standard for most mandibular reconstructions because of its favorable osseous characteristics. However, disadvantages, such as the time-consuming reconstructive step, difficulty in performing the osteotomies to precisely recreate the shape of the missing segment of mandible and poor bone-to-bone contact play a role in making the surgeons look for alternative flaps. With the advent of computerized design software, which accurately plans complex 3-dimensional reconstructions, has become a process that is more efficient and precise. However, the ability to transfer the computerized plan into the surgical field with stereolithographic models and guides has been a significant development in advancing reconstruction in the maxillofacial regions. The ability to "pre-plan" the case, mirror and superimpose natural structures into diseased and deformed areas, as well as the ability to reproduce these plans with good surgical precision has decreased overall operative time, and has helped facilitate functional and esthetic reconstruction. We describe a complex case treated with this technique, showing the power and elegance of computer assisted maxillofacial reconstruction from the University of Michigan, Oral and Maxillofacial Surgery.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.38 no.2
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• pp.116-120
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• 2012

The buccal fat pad is specialized fat tissue located anterior to the masseter muscle and deep to the buccinator muscle. Possessing a central body and four processes it provides separation allowing gliding motion between muscles, protects the neurovascular bundles from injuries, and maintains facial convexity. Because of its many advantageous functions, the use of the buccal fat pad during oral and maxillofacial procedures is promoted for the reconstruction of defects secondary to tumor resection, and those defects resulting from oroantral fistula caused by dento-alveolar surgery or trauma. We used the pedicled buccal fat pad in the reconstruction of intraoral defects such as oroantral fistula, maxillary posterior bone loss, or defects resulting from tumor resection. Epithelization of the fat tissue began 1 week after the surgery and demonstrated stable healing without complications over a long-term period. Thus, we highly recommend the use of this procedure.