Reconstruction of the external ear using implant-supported alloplasts-Our experience Rayan Malick, M.E. Sham, Thyagraj Jayaram Reddy, P.C. Jacob National Journal of Maxillofacial Surgery, 2023 Surgical reconstruction of the missing external ear is difficult, and the results are often far from satisfactory. An implant-retained auricular prosthesis is a suitable alternative. Microtia, malformation, deformity, and partial or complete loss of the external ear may be due to various congenital or acquired factors. A case series of three patients treated with implant-retained auricular prostheses is presented in this article. For each missing pinna, two titanium implants were placed in the temporal bone. After 6 months of osseointegration, the implants were loaded. All three cases were rehabilitated with a bar and clip retained prosthesis. There were two male and one female patient with an average age of 16.6 years. One patient had unilateral absence of external ear and two had bilateral absence. A total of 10 implants were placed, 4 on the right side and 6 on the left. The average post rehabilitation follow-up was 18 months. Peri-implant tissue reactions were observed at two sites. The implant-retained auricular prosthesis is an alternative treatment approach with good retention and patient satisfaction. Long-term follow-up is required to assess delayed sequelae.
Feasibility and reliability of microvascular reconstruction in the vessel-depleted previously operated neck Ehtaih Sham, ThyagrajJayaram Reddy, MandakuluturS Ganesh, PSuresh Menon, KarthikVishwas Gowda, Rayan Malick Annals of Maxillofacial Surgery, 2020 Background: Microvascular reconstruction of defects in the head and neck has always been a challenge in patients who have undergone previous neck dissection, owing to the prior resection of potential recipient blood vessels used for free flap perfusion. Objective: The objective of the study is to evaluate the reliability and safety of free flap reconstruction in patients who have had previous neck dissection. Materials and Methods: Twenty-four free flaps were performed in 22 patients with a previous history of neck dissection for head-and-neck squamous cell carcinoma. These included patients who underwent salvage surgery for recurrent cancer as well as patients undergoing secondary reconstruction following previous oncological resections. Flap includes 12 radial forearm free flaps, 5 fibula flaps, 1 rectus abdominis flap, and 6 anterolateral thigh flaps. Results: In cases with the previous history of selective neck dissection, recipient vessels on the ipsilateral/same side of the previously operated neck were used, while contralateral vessels were used in patients with a history of modified radical or radical neck dissection. Vein grafts were not necessary, except for one case. In our series, we did not have any flap loss or considerable increase in operative time. Conclusions: Free flap reconstruction of head-and-neck defects is highly successful in patients with a history of previous neck dissection, despite a relative scarcity of recipient blood vessels. Careful planning and relying on flaps with a long vascular pedicle obviates the need to perform a suitable vein graft. In our present series, careful planning and the right choice of a free flap with a long vascular pedicle contributes to the absence of free flap failure. In our experience, previous neck dissection should not be considered as a contraindication to microvascular reconstruction of previously operated oncologic defects.