• Maxillofacial Plastic and Reconstructive Surgery
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• v.38
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• pp.46.1-46.7
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• 2016

Background: Osteoradionecrosis is the most dreadful complication after head and neck irradiation. Orocutaneous fistula makes patients difficult to eat food. Fibular free flap is the choice of the flap for mandibular reconstruction. Osteocutaneous flap can reconstruct both hard and soft tissues simultaneously. This study was to investigate the success rate and results of the free fibular flap for osteoradionecrosis of the mandible and which side of the flap should be harvested for better reconstruction. Methods: A total of eight consecutive patients who underwent fibula reconstruction due to jaw necrosis from March 2008 to December 2015 were included in this study. Patients were classified according to stages, primary sites, radiation dose, survival, and quality of life. Results: Five male and three female patients underwent operation. The mean age of the patients was 60.1 years old. Two male patients died of recurred disease of oral squamous cell carcinoma. The mean dose of radiation was 70.5 Gy. All fibular free flaps were survived. Five patients could eat normal diet after operation; however, three patients could eat only soft diet due to loss of teeth. Five patients reported no change of speech after operation, two reported worse speech ability, and one patient reported improved speech after operation. The ipsilateral side of the fibular flap was used when intraoral soft tissue defect with proximal side of the vascular pedicle is required. The contralateral side of the fibular flap was used when extraoral skin defect with proximal side of the vascular pedicle is required. Conclusions: Osteonecrosis of the jaw is hard to treat because of poor healing process and lack of vascularity. Free fibular flap is the choice of the surgery for jaw bone reconstruction and soft tissue fistula repair. The design and selection of the right or left fibular is dependent on the available vascular pedicle and soft tissue defect sites.

• The Journal of the Korean dental association
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• v.54 no.4
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• pp.274-283
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• 2016

Bisphosphonates are widely used mainly for the treatment of osteoporosis and bone metastasis of malignancy. Since the first report of MRONJ, there have been many studies associated, however the pathogenesis of MRONJ is not yet clear. Medication-related osteonecrosis of the jaws (MRONJ) is a serious complication associated with long-term medication therapy. It is characterized by exposed necrotic bonein the jaw, which has persisted for more than 8weeks despite continuous treatment by dentist. The mechanism of development of MRONJ is still unclear and there is no definitive standard treatment for MRONJ. The purpose of this study is to investigate the jaw bone destruction mechanism of accumulated bisphosphonates, so that we can develop therapeutic method to repair the defect and stop the destruction process. The authors performed simultaneous application of PRF(Platelet rich fibrin) and BMP-2(Bone morphogenetic protein-2) to stimulate not only soft tissue healing but also osseous regeneration. Our case series demonstrate that simultaneous application of platelet rich fibrin and bone morphogenetic protein-2 can be a treatment of choice for MRONJ.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.39
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• pp.5.1-5.9
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• 2017

Many congenital and acquired defects occur in the maxillofacial area. The buccal fat pad flap (BFP) is a simple and reliable flap for the treatment of many of these defects because of its rich blood supply and location, which is close to the location of various intraoral defects. In this article, we have reviewed BFP and the associated anatomical background, surgical techniques, and clinical applications. The surgical procedure is simple and has shown a high success rate in various clinical applications (approximately 90%), including the closure of oroantral fistula, correction of congenital defect, treatment of jaw bone necrosis, and reconstruction of tumor defects. The control of etiologic factors, size of defect, anatomical location of defect, and general condition of patient could influence the prognosis after grafting. In conclusion, BFP is a reliable flap that can be applied to various clinical situations.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.46 no.3
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• pp.191-196
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• 2020

Objectives: Beyond the original application approved by the U.S. Food and Drug Administration, recombinant human bone morphogenetic protein-2 (rhBMP-2) is used for medication-related osteonecrosis of the jaw (MRONJ) treatment because of its bone remodeling enhancement properties. The purpose of the study was to investigate the bone formation effect of rhBMP-2/absorbable collagen sponge (ACS) in patients with MRONJ. Materials and Methods: In this retrospective cohort study, 26 female patients diagnosed with MRONJ and who underwent mandibular sequestrectomy at Ajou University Dental Hospital from 2010 to 2018 were included. The experimental group was composed of 18 patients who received rhBMP-2/ACS after sequestrectomy, while the control group was composed of 8 patients who did not receive rhBMP-2/ACS after sequestrectomy. A total dose of 0.5 mg of rhBMP-2 was used in the experimental group at a concentration of 0.5 mg/mL. Follow-up panoramic X-rays were taken immediately after the surgery and more than 6 months after the surgery. Using those X-rays, a radiographic index of bone defect area was calculated using the modified Ihan Hren method, which measures radiographic density of the normal bone and the defect site. Results: This study suggests that rhBMP-2 contributes to new bone formation. The mean radiographic index immediately after surgery and more than 6 months after the surgery for the experimental group was 68.4% and 79.8%, respectively. The mean radiographic index immediately after surgery and more than 6 months after the surgery for the control group was 73.4% and 76.7%, respectively (Wilcoxon signed rank test, P>0.05). The mean radiographic index increased 11.4% in the experimental group and 3.27% in the control group (Mann-Whitney U-test, P<0.05). Conclusion: Based on the results, use of rhBMP-2/ACS on bone defect sites after sequestrectomy could be a successful strategy for treatment of MRONJ patients.

• Journal of the Korean Society of Manufacturing Technology Engineers
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• v.18 no.6
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• pp.604-613
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• 2009

Recently, researches to develop phased array ultrasonic examination techniques are proceeded to diagnose dental caries and the status of surgical operation of dental implant. Sound field analysis of phased array ultrasonic transducers were carried out in order to characterizing the ultrasonic phased array beams. The sound field of ultrasonic radiation was calculated for the sample called "gypsum-improved stone" with the similar characteristics of dental materials. Industrial phased array ultrasonic devices were utilized for the insptriion of the artificial flaws machined in the gypsum-improved stone. Dental implants were made at the pig jaw bone and defect images were confirmed for the dental implants.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.36 no.2
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• pp.100-107
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• 2010

Introduction: A cyst is a closed pathologic sac containing fluid or semi-solid material in central region. The most common conventional treatment for a cyst is enucleation. It was reported that spontaneous bone healing could be accomplished without bone grafting. We are trying to evaluate bone reconstruction ability by analyzing panorama radiograph and computed tomography (CT) scan with retrograde studying after cyst enucleation. In this way we are estimating critical size defect for spontaneous healing without bone graft. Materials and Methods: The study comprised of 45 patients who were diagnosed as cysts and implemented enucleation treatment without bone graft. After radiograph photo taking ante and post surgery for 6, 12, 18, 24 months, the healing surface and volumetric changes were calculated. Results: 1. Spontaneous bone healing was accomplished clinically satisfying 12 months later after surgery. But analyzing CT scan, defect volume changes indicate 79.24% which imply incomplete bone healing of defect area. 2. Comparing volume changes of defect area of CT scan, there are statistical significance between under $5,000mm^{3}$ and over $5,000mm^{3}$. The defect volume of $5,000mm^{3}$ shows $2.79{\times}1.91$cm in panoramic view. Conclusion: Bone defects, which are determined by a healed section using a panoramic view, compared to CT scans which do not show up. Also we can estimate the critical size of defects for complete healing.

• Archives of Plastic Surgery
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• v.49 no.5
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• pp.652-655
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• 2022

Patients with advanced malignant tumors, including both jaws, is a challenging task for a head and neck surgeon. Current treatment landscape demonstrates good functional, anatomical, and aesthetic results in patients who could previously receive only palliative care. The extensive tissue defects resulting from oncological resections in the head and neck region require immediate reconstruction due to the exposure of vital structures and their contact with the external environment. A patient was operated using a three-team multidisciplinary approach involving simultaneous work of three specialized teams of maxillofacial and reconstructive microsurgeons, as well as an implantologist and a prosthodontist. This approach allowed simultaneous tumor resection with subsequent reconstruction of the intraoperative defect involving bilateral harvesting of two revascularized free fibular osteomusculocutaneous flaps with dental implantation and simultaneous rehabilitation of dentition with crowns.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.42
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• pp.34.1-34.7
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• 2020

Purpose: The purpose of this study was to evaluate the influence of biodegradable polycaprolactone membrane on new bone formation and the biodegradation of biphasic alloplastic bone substitutes using animal models. Materials and methods: In this study, bony defect was formed at the canine mandible of 8 mm in diameter, and the defects were filled with Osteon II. The experimental groups were covered with Osteoguide as barrier membrane, and the control groups were closed without membrane coverage. The proportion of new bone and residual bone graft material was measured histologically and histomorphometrically at postoperative 4 and 8 weeks. Results: At 4 weeks, the new bone proportion was similar between the groups. The proportion of remaining graft volume was 27.58 ± 6.26 and 20.01 ± 4.68% on control and experimental groups, respectively (P < 0.05). There was no significant difference between the two groups in new bone formation and the amount of residual bone graft material at 8 weeks. Conclusion: The biopolymer membrane contributes to early biodegradation of biphasic bone substitutes in the jaw defect but it does not affect the bone formation capacity of the bone graft.

• Journal of Korean Dental Science
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• v.7 no.1
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• pp.38-42
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• 2014

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is defined as exposed necrotic bone without evidence of healing for at least 8 weeks in the maxillofacial area in a patient with history of bisphosphonate use. Obtaining complete coverage of the hard tissue by soft tissue in BRONJ patients is especially important. Therefore, managing the mucosa is one of the key factors in a successful outcome, but this is especially hard to achieve in BRONJ patients. Various applications of buccal fat pad in oral reconstruction-including the closure of surgical defects following tumor excision, repair of surgical defects following the excision of leukoplakia and submucous fibrosis, closure of primary and secondary palatal clefts, coverage of maxillary and mandibular bone grafts, and lining of sinus surface of maxillary sinus bone graft in sinus lift procedures for maxillary augmentation-have been studied. Eliminating all potential sites of infection and post-operative infection control is crucial in BRONJ. We present a case using the buccal fat pad pedicle for a stage 3 BRONJ defect. Uneventful total epithelialization of the buccal fat pad regardless of size was noted. In summary, the buccal fat pad has versatile application and various recipient sites for surgical utilization. It is an easy technique, with promising overall success rates. With careful selection and handling, buccal fat graft can resolve problems with soft tissue coverage in stage 2 or 3 BRONJ patients.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.36 no.1
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• pp.25-29
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• 2014

The purpose of this study is to report on five cases treated with bone graft using recombinant human bone morphogenetic protein-2 (rhBMP-2) on jaw defects after cyst enucleation. We performed bone graft with BMP (rhBMP-2+${\beta}$-tricalcium phosphate/hydroxyapatite) wrapped with a collagen sponge on jaw defects after cyst enucleation. Postoperative panoramic radiographs were taken periodically. After 1 to 12 months, bone remodeling was observed in the jaw defect area. In our cases, there were few signs or symptoms of recurrence of the cyst during the follow-up period.