This document summarizes reconstruction options for various parts of the oral cavity following defects from surgery or trauma. It discusses the anatomy and functions of different structures like the floor of mouth, tongue, and mandible. For each region, it outlines considerations for reconstruction like tissue types needed and options ranging from local flaps to free flaps that can restore form and function. Patient factors like medical comorbidities and expectations also influence the selection of appropriate reconstructive procedures.
A flap is a unit of tissue that is transferred from one site (donor site) to another (recipient site) while maintaining its own blood supply or from a anastomised vessel.
Flaps come in many different shapes and forms. They range from simple advancements of skin to composites of many different types of tissue
A flap is a unit of tissue that is transferred from one site (donor site) to another (recipient site) while maintaining its own blood supply or from a anastomised vessel.
Flaps come in many different shapes and forms. They range from simple advancements of skin to composites of many different types of tissue
The Middle Third Of The Facial Skeleton Is Defined As An Area Bounded,
Superiorly –Line Drawn Across The skull from the Zygomatico frontal Suture across the Frontonasal & Frontomaxillary sutures to the Zygomaticofrontal suture on the opposite side
Inferiorly –by the occlusal plane of the upper teeth./upper alveolar ridge.
Posteriorly-The region is demarcated by the sphenoethmoidal junction but includes the free margin of the pterygoid laminae of the sphenoid bone inferiorly.
Inferiorly –by the occlusal plane of the upper teeth./upper alveolar ridge.
Posteriorly-The region is demarcated by the sphenoethmoidal junction but includes the free margin of the pterygoid laminae of the sphenoid bone inferiorly.
It is made up of the following bones:
1. Two maxillae
2. Tw o palatine bones
3. Two zygomatic bones and their temporal processes
4. Two zygomatic processes of the temporal bone
5. Two nasal bones
this presentation describes about each bone individually and its applied anatomy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Middle Third Of The Facial Skeleton Is Defined As An Area Bounded,
Superiorly –Line Drawn Across The skull from the Zygomatico frontal Suture across the Frontonasal & Frontomaxillary sutures to the Zygomaticofrontal suture on the opposite side
Inferiorly –by the occlusal plane of the upper teeth./upper alveolar ridge.
Posteriorly-The region is demarcated by the sphenoethmoidal junction but includes the free margin of the pterygoid laminae of the sphenoid bone inferiorly.
Inferiorly –by the occlusal plane of the upper teeth./upper alveolar ridge.
Posteriorly-The region is demarcated by the sphenoethmoidal junction but includes the free margin of the pterygoid laminae of the sphenoid bone inferiorly.
It is made up of the following bones:
1. Two maxillae
2. Tw o palatine bones
3. Two zygomatic bones and their temporal processes
4. Two zygomatic processes of the temporal bone
5. Two nasal bones
this presentation describes about each bone individually and its applied anatomy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Management of mandibulectomy / /certified fixed orthodontic courses by Indian...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
Prosthodontic management /certified fixed orthodontic courses by Indian denta...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The anatomy of the edentulous ridge in the maxilla and mandible is very important for the design of a complete denture. Objective in fabrication of a complete denture is to provide a prosthesis that restores lost teeth and associated structures functionally, anatomically and aesthetically as much as possible with preservation of underlying structures and the knowledge landmarks help us in achieving our objective.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Anatomy and clinical significance of denture bearing areasOgundiran Temidayo
A presentation on the anatomy and clinical significance of the denture bearing areas by Ogundiran Temidayo who is a dental student at OBAFEMI AWOLOWO UNIVERSITY ILE-IFE
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
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This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
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2. Introduction
! Difficult challenge
! Complex anatomy and function
! Goals
! Restore preoperative function
! Cosmesis
! Patient status is important consideration
! Variety of reconstruction options
3. Anatomy
! Vermilion to junction of
hard and soft palate
superiorly
! Inferiorly to circumvallate
papillae
! Structures: lips, alveolar
ridges, buccal mucosa,
retromolar trigone, hard
palate, floor of mouth,
mobile tongue
! Functions: speech,
mastication, bolus
preparation and initiation
of deglutition
4. Functional Considerations
! Oral sphincter
! Speech, mastication and deglutition
! Provides a watertight closure for bolus
preparation
! Prevents escape of saliva
5. Functional Considerations
! Alveolar Ridges
! Covered with thin, adherent mucosa
! Elevated above floor of mouth
! Lingual and buccal sulci direct the flow of food
and saliva during bolus processing
6. Functional Considerations
! Floor of the mouth
! Allows unrestricted mobility of the oral tongue
! Collects food and saliva (bolus preparation)
7. Functional Considerations
! Oral (mobile) tongue
! Speech and deglutition
! Mobility allows for:
! Articulation of speech
! Bolus manipulation in preparation for deglutition
! Sensory functions: proprioception, pain, taste
! Assists in mastication and bolus processing
9. Functional Considerations
! Buccal Mucosa
! Lines the cheek
! Functions in mastication and deglutition
! Allows expansion for mastication
! Thin to avoid restriction of dental closure
10. Functional Considerations
! Base of tongue
! Often involved with oral cavity defects
! Participates in taste, deglutition and speech
! Must occlude oropharynx during deglutition
! Some consonants require BOT to touch hard
palate
11. Patient Factors
! Individualize options
! Type of tissue
! Anticipated functional gain
! Anticipated donor morbidity
! Need for innervation
! Success rate
! Intraoperative positioning
! Operative time
! Dental restoration
! Overall medical status
12. Patient Factors
! Preoperative counseling
! Complete medical history
! Diabetes, atherosclerosis, previous radiation
! Cardiopulmonary status (operating time,
aspiration risk)
! Smoking history
! Patient expectations and motivation are
very important
13. Floor of Mouth Reconstruction
! Requires soft and mobile tissue
! Allow mobility of oral tongue
! Avoid scar contracture (i.e., secondary
intention)
! Avoid bulk (glossoptosis, obliteration of
lower lip sulcus)
14. Floor of Mouth Reconstruction
! Smaller defects
! Split thickness skin graft
! Harvest from lateral thigh at 0.017 in
! Provides water-tight closure, no hair
! Stabilize with bolster
! Survives over muscle and cancellous bone (via
imbibition and neovascularization)
! Also good for lateral FOM and retromolar trigone
16. Floor of Mouth Reconstruction
! Moderate defects involving a larger
portion of mylohyoid
! Nasolabial flap
! Based on angular artery
! Better for older patients with lax skin
! Requires two stages and temporary fistula
! Bite block necessary
22. Floor of Mouth Reconstruction
! FAMM flap
! Branch of facial artery
! Contains mucosa, buccinator muscle, and fat
! 2 x 8 cm flap without injury to facial nerve
24. Floor of Mouth Reconstruction
! Deltopectoral Flap
! Axial distant flap
! First four perforators
of internal mammary
! Deltoid portion is
random
! Preliminary delay
procedure
! Creates dependent
orocutaneous fistula
25. Floor of Mouth Reconstruction
! Fasciocutaneous free flaps
! Thin nature and pliability
! Radial forearm has low incidence of failure to
this site
! Provides tongue mobility and free movement
of food during deglutition
26. Floor of Mouth Reconstruction
! Radial forearm free flap
! Based on radial artery
! Outflow: two venae comitantes, basilic vein, cephalic
vein
! Long vascular pedicle with dependable supply
! Potential sensation (posterior cutaneous nerve
anastomosed to lingual)
! Disadvantage: donor site morbidity (STSG, potential
loss of thumb and index finger, potential decreased
forearm function)
28. Anterior Tongue Reconstruction
! Very difficult to reconstruct
! Complex intrinsic musculature and
function
! Redundancy is advantageous
! Near hemiglossectomy does not significantly
alter function
29. Anterior Tongue Reconstruction
! Defects <50% can be closed primarily +/-
STSG
! Larger or composite defects require more
bulk (i.e, fasciocutaneous free flap)
! Lateral arm free flap is good for defects
including posterior aspect of tongue/FOM
40. Mandibular Reconstruction
! Scapular free flap for anterior defects with
massive soft tissue loss (i.e., total glossectomy)
! Circumflex scapular artery and vein
! 14 cm of bone available (lateral aspect)
! Allows osseointegrated implants
! Long pedicle to axillary artery
! Multiple fasciocutaneous/musculocutaneous flaps
available (scapular, parascapular, latissimus dorsi,
serratus anterior)
! Major drawback: patient positioning
47. Special Considerations
! Total Glossectomy Defects
! Often accompany oral cavity defects with
extensive disease
! Require bulk for reconstruction
! Goals
! Direct secretions laterally
! Provide contact of neo-tongue with palate
! Use flaps which will not atrophy over time
! Palatal drop prosthesis
48. Special Considerations
! Total Glossectomy Defects
! Rectus abdominis free flap
! Inferior and superior epigastric arteries
! Motor nerve (intercostal) anastomosis retains bulk
! Latissimus dorsi myocutaneous free flap
! Thoracodorsal artery
! Motor nerve (thoracodorsal)
! Pedicled flaps (PMMF, latissimus dorsi)
49. Special Considerations
! Total glossectomy with laryngeal
preservation
! Select patients
! Good health without cardiopulmonary disease
! Can tolerate aspiration
! Disease does not involve valleculae or
preepiglottic space
! Must maintain intact superior laryngeal nerve
! Laryngeal suspension lessens aspiration
50. Decision Making in Oral Cavity Reconstruction
Defect Type
Soft Tissue Bone
Floor of Mouth Buccal Mucosa Tongue
Superficial
Anterior Defect Lateral Defect
Primary Closure
Skin/Mucosal Grafts
Full Thickness
Regional Flaps Osseocutaneous free flaps
Fasciocutaneous Free Flaps
Large Full Thickness
Fasciocutaneous Free Flaps
Pedicled musculocutaneous flaps Regional/Distant Flap
Small <50% Loss and Mandibular Swing
STSG Primary Closure Reconstruction Plate and
Moderate Skin Graft Regional/Distant Flaps
Regional Flaps Combined Defects Osseocutaneous Free Flaps
Fasciocutaneous Free Flaps Fasciocutaneous free flaps
Large Total Glossectomy
Pedicled Fasciocutaneous flap Myocutaneous free flaps
Fasciocutaneous free flaps Pedicled musculocutaneous flaps
51. Conclusion
! Multitude of reconstructive options
! Remember functional characteristics of
tissue involved
! Various patient factors to consider
! Preoperative counseling essential
! High success rates possible with proper
patient selection
52. References
! Fong BP, Funk GF. Osseous free tissue transfer in head and neck reconstruction. Facial Plast Surg. 1999; 15(1): 45-59
Surg. 45-
!
! Liu R, Gullane P, Brown D, Irish J. Pectoralis major myocutaneous pedicled flap in head and neck reconstruction: retrospective review
of indications and results in 244 consecutive cases at the Toronto General Hospital. J Otolaryngol. 2001 Feb; 30(1): 34-40
Toronto Otolaryngol. 34-
!
! Abemayor E, Blackwell KE. Reconstruction of soft tissue defects in the oral cavity and oropharynx. Arch Otolaryngol Head Neck Surg.
oropharynx. Surg.
2000 Jul; 126(7): 909-12
909-
!
! Berenholz L, Kessler A, Segal S. Platysma myocutaneous flap for intraoral reconstruction: an option in the compromised patient. Int J
Oral Maxillofac Surg. 1999 Aug; 28(4): 285-7
Surg. 285-
!
! Burkey BB, Coleman JR Jr. Current concepts in oromandibular reconstruction. Otolaryngol Clin North Am. 1997 Aug; 30(4): 607-30
Jr. 607-
!
! Wells MD, Edwards AL, Luce EA. Intraoral reconstructive techniques. Clin Plast Surg. 1995 Jan; 22(1): 91-108
Surg. 91-
!
! Hausamen JE, Neukam FW. Resection of tumors in tongue, floor of the mouth, and mandible: possibilities of primary reconstruction.
Recent Results Cancer Res. 1994; 134:25-35
134:25-
!
! Boyd JB. Use of reconstruction plates in conjunction with soft-tissue free flaps for oromandibular reconstruction. Clin Plast Surg. 1994
soft- Surg.
Jan; 21(1): 69-77
69-
!
! Yousif NJ, Matloub HS, Sanger JR, Campbell B. Soft-tissue reconstruction of the oral cavity. Clin Plast Surg. 1994 Jan; 21(1): 15-23
Soft- Surg. 15-