No abstract

Long-term observation of selected noma patients showed restoration of oral function and stability of the maxilla after several years.

Ideal reconstructions of complex defects in the midface require the restitution not only of bone and soft tissue, but also of a thin and durable lining of the oral cavity. So far, split-thickness skin grafts, intestinal grafts, and in vitro cultured mucosal grafts have been used for the reconstruction of the oral lining. The use of skin as a substitute for oral mucosa is controversial because contraction, hair growth, maceration, and dysplastic changes can occur. This clinical and histologic study was performed to evaluate the suitability of dermis as a substitute for oral lining. Twelve complex defects of the midface were reconstructed with dermis-prelaminated scapula flaps. A bony flap from the lateral border of the scapula was prepared, and osseointegrated implants were placed. The bone flap was then prelaminated with dermis and covered with a Gore-Tex membrane to prevent adhesions. The composite flap was transferred to the midface 2 to 3 months later. The oral lining of the flap was evaluated clinically and histologically at 2, 4, and 6 weeks and at 3 to 41 months after the reconstruction. In all patients, the reconstructed bone was covered with a thin and lubricated surface without hair growth. None of the patients showed any signs of maceration. Histologically, these findings corresponded to a keratinized stratified squamous epithelium with highly developed connective-tissue papillae. These features closely resemble those of the normal mucosa of the hard palate and the gingiva. Thus, dermis prelamination is an effective method for reconstructing the mucosa of the alveolar ridge and the hard palate.

In the present study, 226 patients with squamous cell cancer of the head and neck, who had had undergone no antitumor therapy, were examined pretherapeutically for serum immunoglobulin levels (IgG, IgM, IgA, IgE). In cancer patients, significant elevations of mean levels of IgA and IgE were found in comparison to healthy controls (n = 100) and patients with chronic laryngitis (n = 63). IgG and IgM were in the range of the control groups. Levels above the upper limit were detected in 40.9% for IgE and 43.9% for IgA in the groups of cancer patients and in about 6% for both immunoglobulins in the control group. The group of patients with relapses in the follow-up were found to have pretherapeutically significantly higher levels of both IgE and IgA in comparison to those without evidence of disease for more than 6 months. These results point to the fact that determination of serum IgA and IgE levels in patients with head and neck cancer might be applicable as parameters for monitoring malignant disease, being additionally of some prognostic significance.

A concept for improving the precision of reconstruction of the maxilla in terms of form and function, including gnathologic, functional, and prosthetic aspects, is presented with a prefabricated combined scapula flap. In four cases, a bony flap from the lateral border of the scapula with osseointegrated titanium implants, covered with skin grafts and encapsulated with a Goretex sheet to create a stable soft-tissue coverage, was performed. Three months later, the prefabricated combined scapula flap was harvested and transferred to reconstruct a maxillary bony and soft-tissue defect in the face using microsurgical vascular anastomoses to the facial vessels. One flap was lost because of vascular thrombosis and was repeated successfully 1 year later. In each of the four cases, full dental rehabilitation and marked improvement of the facial contour was achieved in a single surgical intervention of the face. For this purpose, new radiodiagnostic methods for precise correlation between the maxillofacial defect and the donor area were use. With this new concept, an organ-specific reconstruction of soft-and bony-tissue defects of the alveolar ridge and the hard palate, with a pseudogingiva and teeth, is possible in an optimal way.