21st ICOMS 2013—Abstracts: Oral Papers 1249

traction protocol design and follow osteotomies simulation. Thepostoperative result was asses by clinical and cephalometry inves-tigation as well as postoperative CT scan.

Results: No significant complications occurred and satis-factory functional and aesthetic results achieved. The adequateelongation of hard and soft tissue component of the hemifacialasymmetry was noted. Postoperative CT scan showed reasonablepositioning of the chondral part of rib transplant within glenoidfossa and adequate elongation of graft and the mandibular body.

Conclusions: We found that the method could be perspectivefor adequate length restoration in case of hemifacial asymmetryand compromised TMJ function and anatomy.Key words: virtualplanning; costachondral graft; distraction osteogenesis

http://dx.doi.org/10.1016/j.ijom.2013.07.266

T12.OR011

Clinical and radiographic evaluation of Platelet Rich Plasma(PRP) and iliac crest graft in mandibular reconstruction

M. Elsholkamy 1,∗, A. Abdelmabood 1, M.S. Hammed 1, O.A.Adly 2, A. Ahmed 3, A.H. Abbas 2, A.M. Moghazy 2

1 Department of Oral & Maxillofacial Surgery, Faculty of Den-tistry, Suez Canal University, Egypt2 Department of Plastic Surgery, Faculty of Medicine, Suez CanalUniversity, Egypt3 Department of Clinical Pathology, Faculty of Medicine, SuezCanal University, Egypt

Objective: This clinical and radiographic prospective studyinvestigated the effect of Platelet Rich Plasma (PRP) on iliac crestgraft as a method of mandibular reconstruction.

Patients and methods: This was a prospective comparativestudy carried out on 17 patients. Nine of them were submittedto mandibular reconstruction by iliac crest graft with PlateletRich Plasma (PRP) and the remaining eight patients underwentmandibular reconstruction by iliac crest graft without Platelet RichPlasma (PRP). This was carried out at Plastic Surgery Unit in theDepartment of Surgery, Suez Canal University Hospital along theperiod of two years (from October 2009 to October 2011). Patientswere assessed clinically and using dental CT.

Results: There was no effect of Platelet Rich Plasma (PRP) onthe final outcome of the bone density of the grafted area at the endof follow up, and the only effect of PRP was detected at the earlystage of the graft osteogenesis.

Conclusion: The effect of PRP was restricted to decrease painlevel and accelerate the healing response post-operatively. Theextent of the mandibular defect represented the only significantfactor associated with the occurrence of postoperative complica-tions.

http://dx.doi.org/10.1016/j.ijom.2013.07.267

T12.OR012

The forgotten flap? Platysma flap: a case series and review ofthe literature

E. Gruber ∗, S. Bhatia, G. Mihalache

Shrewsbury and Telford NHS Trust, United Kingdom

Background: The platysma myocutaneous pedicled flap is notcommonly used in head and neck reconstruction, but should beconsidered for reconstruction of small and medium-sized defects

in the oral cavity. The advantages of the platysma flap is that it is ofappropriate thickness, has minimal donor site complications, lit-tle post-operative scarring and ideal colour match. Rotation of theplatysma muscle means that it can be used to reconstruct a numberof different sites, including the lower lip, floor of mouth, ventraltongue and lower third of the face. Contraindications include pre-vious radiotherapy and surgery to the head and neck, neoadjuvantchemotherapy, nodal disease and large defects.

Case series: We present six cases, illustrated with clinicalphotographs, demonstrating the use of the platysma flap in thereconstruction of various intraoral defects. No post-operative com-plications occurred, except for one case in which the skin was lost,however the underlying muscle remained viable and the area hashealed with a good result. There were no donor site complica-tions. No further surgery was required in any of the cases due toflap failure.

Literature review: Several retrospective, multicentre studieshave shown platysma flaps to be effective. Complications havebeen described, which makes patient selection imperative.

Conclusions: Further studies on the long term success ofplatysma flaps are required, however, good results have beenachieved to date. We propose that due to the versatility and reportedsuccess of this technique it should be used more frequently and incases where free flap reconstruction may be less suitable.

Key words: pedicled flap; platysma flap; reconstruction

http://dx.doi.org/10.1016/j.ijom.2013.07.268

T12.OR013

Fourteen years experience of flap prefabrication for complexfunctional maxillofacial reconstruction

R. Guijarro-Martínez ∗, D. Rohner, P. Bucher, B. Hammer

Craniofacial Center (CFC), Hirslanden Klinik Aarau,Switzerland

Background and objectives: Conventional maxillofacialreconstruction often leads to suboptimal results due to inaccurateplanning or surgical difficulties in adjusting a free flap into a three-dimensional defect. Conversely, flap prefabrication together withprecise preoperative planning enables an optimal flap design suchthat a prosthetically ideal implant-supported rehabilitation is pos-sible. The aim of this abstract is to present our 14-year experiencewith prefabrication and to justify this treatment concept.

Patients and methods: A retrospective analysis of all patientswho underwent a prefabrication protocol for maxillofacial recon-struction was performed. This protocol involves an initial surgicalstage, namely “flap prefabrication”, where dental implants areinserted at the donor site and the future mucosa is created with asplit-thickness skin graft. After 6–8 weeks, the graft is harvested,the donor bone is osteotomized and adjusted to a preprepared pro-visional prosthesis, and the flap-prosthesis complex is transferredto the defect.

Results: Since 1999, a total of 54 flaps have been transferredfollowing our prefabrication concept. In 51 cases, the fibula wasthe preferred donor site. In the remaining 3, other donor sites wereused (2 iliac crest, 1 scapula). In 30 patients a maxillary recon-struction was performed, whereas in the other 24 a mandibularreconstruction was executed. Four flaps were lost partially and 3were lost completely. A total of 208 implants were placed. Ofthese, 14 were lost at an early stage, and 12 showed delayedfailure. Patients regained full function and aesthetics within6–10 weeks.

1250 21st ICOMS 2013—Abstracts: Oral Papers

Conclusions: Compared to conventional planning, prefab-rication ensures an optimal position of the flap that enablesprosthetically ideal implant placement. The future gingiva is pre-fabricated and incorporated into the flap, thus sparing the patientfrom secondary multistage soft tissue procedures prior to pros-thetic rehabilitation. In addition, operating room time, ischemiatime and handling trauma to the graft are reduced.

http://dx.doi.org/10.1016/j.ijom.2013.07.269

T12.OR014

Reconstruction of mandibular defect by transport distractionosteogenesis: case report

A. Maciel ∗, A. Cerqueira, L. Cincura, W. Cavalcante

Saint Antony Hospital, United States

Several lesions occurring at the mandible require as the treat-ment of choice to minimize recurrence, an extensive resection withsecurity margin. The rehabilitation of those patients promotes agreat challenge for the surgeon, especially when the symphysealarea is involved. Traditionally, bone graft, harvested from a sec-ondary donor site, with the use of microvascular reconstructiontechniques or osseous free flaps are the procedures used to pro-mote the reconstruction of the mandible, however, the weaknessesof bone graft still exist, and complications associated with thedonor site are frequent. The distraction osteogenesis is a biolog-ical process of generating new bone by gradual traction of thedivided bone segments. The technique of distraction osteogenesiswas applied first in orthopaedic surgery for long-bone lengthen-ing and was subsequently utilized in the treatment of cranio-facialmicrosomia and bone defect. The most significant advantage is thatthis technique can obviate any bone grafts and hence avoids donorsite morbidity, also it allows the growth of soft tissue, minimizingdehiscence and bone exposure. This paper has the aim of pre-senting a case report of mandible reconstruction through the use oftransport distraction osteogenesis and rehabilitation with osseoin-tegrated implants and prosthetics in order to reconstruct a bonedefect ranging from symphysis to temporomandibular joint in apatient who underwent mandibular resection due to odontogeniclesion, allowing the recovery of both function and aesthetics.

http://dx.doi.org/10.1016/j.ijom.2013.07.270

T12.OR015

Upper maxillary reconstruction of oncological defects a clini-cal series of 31 patients

M. Moreno Sánchez ∗, R. González García, L. Ruiz Laza, D.Manzano Solo de Zaldívar, J. Mateo Arias, C. Moreno García, O.Maestre Rodríguez, L. Villanueva Alcojol, D. González Ballester,F. Monje Gil

Infanta Cristina Hospital, Spain

Background: Upper maxillary reconstruction of oncologicaldefects remains a challenge for both aesthetic and functional rea-sons.

Objective: Assess the results after using different reconstruc-tive techniques.

Methods: A retrospective study of 31 patients who underwentsurgery due to upper maxilla cancer was carried out. The maxillarydefects were reconstructed with different flaps and were definedaccording to Brown & Shaw classification.

Results: Used flaps were: (1) temporalis muscle flap (38%);(2) microvascular fibular free flap (26%); (3) microvascular radialforearm free flap (12%); (4) buccinators myomucosal flap (15%);(5) Bichat’s buccal fat pad or direct closure (8%). According toBrown & Shaw classification, the most common defect after resec-tive surgery was type IIb. In most cases, the relationship betweentype of defect and used flap was: (1) microvascular fibular free flap:type II defects; (2) temporalis muscle flap: type Ib; (3) microvas-cular radial forearm free flap: types Ib and IIb; (4) buccinatorsmyomucosal flap and direct closure: type I defects

Conclusions: Microvascular fibular free flap would be spe-cially recommended for type II defects (b, c and d), temporalismuscle flap for type Ib and buccinators myomucosal flap for typeI defects (a, b and c).Key words: oncological defects; maxillaryreconstruction

http://dx.doi.org/10.1016/j.ijom.2013.07.271

T12.OR016

Costochondral reconstruction of the mandibular condyle afterhemimandibulectomy due to ameloblastoma

I. Mulyawan 1,2,∗, N.D. Ismawati 2

1 Faculty of Dentistry, Airlangga University, Surabaya, Indonesia2 Dr. Soetomo General and Teaching Hospital, Surabaya,Indonesia

Costochondral grafts have gained increasing popularity amongoral surgeons in reconstructing the mandibular condyle in cases,such as ameloblastoma. Seven patients with mandible ameloblas-toma were treated with resection and immediate reconstructionby mean of autogenous non-vascularized costochondral at theDepartment of Oral and Maxillofacial Surgery, Stomatology Insta-lation, Dr. Soetomo General and Teaching Hospital. Analysis ofthe results was gained as a result of a retrospective study of patientswhen they attended appointments for 1 year post op follow up.Clinical and radiological evaluations obtained during the followup showed significant anatomical and functional rehabilitation ofthe mandible as a result of the costochondral graft. The conclu-sion of this study is that free costochondral grafting is a successfultechnique for reconstruction of portions of the mandible and itstemporal articulation The purpose of this study is to evaluate cos-tochondral graft reconstruction of the mandibular condyle afterhemimandibulectomy.Key words: costochondral grafts; mandiblereconstruction

http://dx.doi.org/10.1016/j.ijom.2013.07.272

T12.OR017

Pedicled submandibular gland flap for reconstruction oforopharyngeal defects

L. Pingarrón Martín 1,∗, S. Zhou 2, W. Yang 1,2, C. Zhang 1,2

1 Fundación Jiménez Díaz Avda, Reyes Católicos, 2 – 28040Madrid, Spain2 9th People’s Hospital School of Medicine, Shanghai Jiao TongUniversity 639 Zhizaoju Road, Shanghai 200011, China

Background and objectives: The pedicled submandibulargland flap is an arterialized local flap in the head and neck regionwith an axial blood supply provided by the facial artery. As far asthe authors know, the SGF has been used as modality of preventivecare for xerostomia in patients undergoing radiation therapy of the