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- Surgical management of severe mandibular actinomycosis: segmental mandibulectomy and fibula free flap for optimal outcomesPublication . Leite, Paula Maria; Chaves, Carolina F; Morgado, Bruno; Zenha, Horácio; Costa, HorácioActinomycosis is a chronic, suppurative, granulomatous bacterial infection primarily associated with Actinomyces israelii. The condition can be categorized into three distinct clinical types based on the affected anatomical region: cervicofacial, pulmonary, or abdominopelvic actinomycosis. The standard treatment for actinomycosis involves antibiotic therapy, with an empiric penicillin regimen as the first-line approach. Surgical interventions comprise curettage of the affected bone, resection of necrotic tissues, excision of existing sinus tracts, and drainage of abscesses. These procedures are considered a last resort for cases of actinomycosis unresponsive to antibiotic therapy. In this context, we present a case of severely unresponsive actinomycosis that necessitated aggressive surgical resection of the infected mandibular bone, followed by immediate reconstruction using a fibula-free flap. The outcome yielded both favorable functional and aesthetic results.
- Stylomandibular false ankylosis: an unusual complication after vascularized lliac crest flap for mandibular reconstructionPublication . Morgado, Bruno; Poleri, Filipa; Gaspar, Carolina; Costa, Horácio; Zenha, HorácioStylomandibular fusion is a poorly documented and rare complication of maxillofacial surgical procedures. This case report describes a patient presenting with stylomandibular false ankylosis following mandibular reconstruction. A 59-year-old female patient underwent segmental mandibular resection and reconstruction for a defect resulting from ameloblastoma surgery using an iliac crest free flap. A styloid fracture was detected postoperatively, and the patient was managed conservatively. In the third postoperative year, the patient presented with marked limitation of oral gape. A diagnosis of stylomandibular false ankylosis was made, and the patient underwent an ostectomy of the aberrant bone, with improved mouth opening. The abnormal union between the styloid process and the mandible is a previously unreported complication in the use of iliac crest free flaps. This case report emphasizes the importance of being vigilant for stylomandibular false ankylosis, especially when there is a restriction of oral aperture postoperatively following reconstructive procedures involving bone flaps.
- Lessons learned from reconstructing advanced osteoradionecrosis with free vascularized flaps: a retrospective studyPublication . Lanzaro, Larissa; Caixeiro, Leonor; Chaves, Carolina; Morgado, Bruno; Pinto, Cristina; Zenha, Horácio; Costa, HorácioBackgroundAt present, there is no universally accepted standard of care for osteoradionecrosis (ORN), and comprehensive clinical guidelines remain absent. The primary objective of this study is to offer insights into the effectiveness and safety of microvascular reconstruction approach in patients with ORN.MethodsA retrospective analysis was conducted on all patients who underwent free flap reconstruction following a diagnosis of ORN by the senior author, from 2005 to 2022. Data regarding the patient's demographics, comorbidities, previous treatments, ORN classification, postoperative complications, and therapeutic outcome were collected.ResultsFifty-three free flaps were carried out in a cohort of 48 patients. One maxilla ORN and 42 mandible ORN were treated. The most common flap chosen was free fibula flap. The only risk factor that was statistically significant for major complications was previous neck dissection. Concerning complications after discharge, 41 patients had follow-up with an average follow-up duration of 60 months. Exposure of osteosynthesis material and fistula were the most common long-term complications that required return to the OR. Only 11.36% had recurrence of ORN.ConclusionsThe iliac crest flap represents a valuable option for mandible reconstruction. However, this preference does not extend to ORN; fibula flap remains the optimal choice. It is worth noting that flap and complication rates are notably higher in ORN. Patients with a history of neck dissection are at a heightened risk of complications. Our study demonstrates a reassuring outcome as ORN recurrence occurred approximately in only one out of eight patients.Level of evidence: Level IV, risk/prognostic.ConclusionsThe iliac crest flap represents a valuable option for mandible reconstruction. However, this preference does not extend to ORN; fibula flap remains the optimal choice. It is worth noting that flap and complication rates are notably higher in ORN. Patients with a history of neck dissection are at a heightened risk of complications. Our study demonstrates a reassuring outcome as ORN recurrence occurred approximately in only one out of eight patients.Level of evidence: Level IV, risk/prognostic.