Reconstruction of ca defects (nx power lite)

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Reconstruction of ca defects (nx power lite)

  1. 1. RECONSTRUCTION OF ORAL MALIGNANCY EXCISION DEFECTS - AN ANALYSIS OF 50 CASES INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. RECONSTRUCTION OF ORAL MALIGNANCY DEFECTS  6th leading malignancy  Accounts for 40% of all malignancies in India  Commonest site is buccal mucosa  80 % of patients report in advanced stage of the disease www.indiandentalacademy.com
  3. 3. RECONSTRUCTION OF ORAL MALIGNANCY DEFECTS  Excision of these tumors leaves large defects with significant functional and esthetic morbidity  Reconstructionintegral part of multidisciplinary management of oral cancer patients www.indiandentalacademy.com
  4. 4. RECONSTRUCTION OF ORAL MALIGNANCY DEFECTS  To analyze the patients who underwent oral malignancy resection and reconstruction  To evaluate the need for free tissue transfer in head and neck reconstruction  To illustrate our experience in reconstructing complex oro-facial excision defects www.indiandentalacademy.com
  5. 5. RECONSTRUCTION OF ORAL MALIGNANCY DEFECTS  50 patients treated between 2000 JAN-2003 AUG Age Range – 31- 70 years Majority in the 5th & 6th decade 17 33 Sex ratio www.indiandentalacademy.com Male Female S.D.M. DHARWAD
  6. 6. RECONSTRUCTION OF ORAL MALIGNANCY DEFECTS Tongue 24% Lower Alveolus 14% Buccal Mucosa 54% Retromolar area 8% www.indiandentalacademy.com S.D.M. DHARWAD
  7. 7. RECONSTRUCTION OF ORAL MALIGNANCY DEFECTS Tumour size Tumour type 30 V.C. 25 20 6 15 30 44 10 12 5 0 3 5 T1 T2 T3 T4 www.indiandentalacademy.com S.C.C. S.D.M. DHARWAD
  8. 8. RECONSTRUCTION OF ORAL MALIGNANCY DEFECTS Resection Procedures 30 patients had bony excisions - 14 Hemi-mandibulectomies - 10 Hemi-mandibulectomies + Maxillary Alveolus - 3 Marginal Resections - 3 Segmental Resections www.indiandentalacademy.com S.D.M. DHARWAD
  9. 9. RECONSTRUCTION OF ORAL MALIGNANCY DEFECTS Reconstruction Procedures 4 20 26 33 www.indiandentalacademy.com Local Closure Pedicled Flaps Free Flaps S.D.M. DHARWAD
  10. 10. RECONSTRUCTION OF ORAL MALIGNANCY DEFECTS Free Flap Reconstruction 10 9 8 7 6 5 4 3 2 1 0 Fibula 10 8 8 www.indiandentalacademy.com Anterolateral Thigh Radial Forearm S.D.M. DHARWAD
  11. 11. RECONSTRUCTION OF ORAL MALIGNANCY DEFECTS Pectoralis Major - Has remained a work horse for head and neck reconstruction - Reliable long pedicle - Multiple skin perforators enabling multiple paddles www.indiandentalacademy.com S.D.M. DHARWAD
  12. 12. RECONSTRUCTION OF ORAL MALIGNANCY DEFECTS www.indiandentalacademy.com S.D.M. DHARWAD
  13. 13. RECONSTRUCTION OF ORAL MALIGNANCY DEFECTS Limitations : Skin size limited Distal most part of the flapVascularity limited Mobility of the flap restricted by pedicle Can be bulky Early Lymph node detection can be hampered www.indiandentalacademy.com S.D.M. DHARWAD
  14. 14. RECONSTRUCTION OF ORAL MALIGNANCY DEFECTS Free Tissue Transfer Greater variety of donor sites Superior vascularity Technically more demanding Mobility not affected by vascular pedicle Long procedures Potential for sensate flaps Composite tissue can be harvested www.indiandentalacademy.com S.D.M. DHARWAD
  15. 15. RECONSTRUCTION OF ORAL MALIGNANCY DEFECTS Radial Forearm : Based on the ascending septo-cutaneous branches of RA Thin pliable skin with a long pedicle Very useful for reconstructing mucosal defects Potential for sensate flap www.indiandentalacademy.com S.D.M. DHARWAD
  16. 16. RECONSTRUCTION OF ORAL MALIGNANCY DEFECTS www.indiandentalacademy.com S.D.M. DHARWAD
  17. 17. RECONSTRUCTION OF ORAL MALIGNANCY DEFECTS Free Fibula Based on the Peroneal artery Long length of the bone can be harvested Good peri & endosteal supply allowing multiple osteotomies for shaping Skin and muscle paddles possible www.indiandentalacademy.com S.D.M. DHARWAD
  18. 18. RECONSTRUCTION OF ORAL MALIGNANCY DEFECTS www.indiandentalacademy.com S.D.M. DHARWAD
  19. 19. RECONSTRUCTION OF ORAL MALIGNANCY DEFECTS www.indiandentalacademy.com S.D.M. DHARWAD
  20. 20. RECONSTRUCTION OF ORAL MALIGNANCY DEFECTS Antero-Lateral Thigh Based on perforators of descending branch of Lat circumflex Femoral artery Large tissue stock Long large pedicle Tissue can be folded for through and through defects www.indiandentalacademy.com S.D.M. DHARWAD
  21. 21. RECONSTRUCTION OF ORAL MALIGNANCY DEFECTS www.indiandentalacademy.com S.D.M. DHARWAD
  22. 22. RECONSTRUCTION OF ORAL MALIGNANCY DEFECTS Protocol for Free Flaps -Tracheostomy -Two team approach -ICU monitoring for minimum 48 hours -Dextran Infusion for 72 hours to improve micro-circulation -Avoid Hypotension www.indiandentalacademy.com
  23. 23. RECONSTRUCTION OF ORAL MALIGNANCY DEFECTS Complications Pedicled Flaps - 4 Dehiscences -3Skin Sloughing - 1 Donor site morbidity Free Flaps - 3 failures - 5 Re-explorations -4 donor site morbidities www.indiandentalacademy.com
  24. 24. RECONSTRUCTION OF ORAL MALIGNANCY DEFECTS Conclusion -Recent developments in Reconstructive procedures has made large resections possible -Although pedicled flaps have limitations they still play a significant role -Free flaps have helped significantly in rehabilitating patients with large defects -Team approach is essential for successful reconstruction www.indiandentalacademy.com
  25. 25. RECONSTRUCTION OF ORAL MALIGNANCY DEFECTS www.indiandentalacademy.com

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