Mandibular reconstruction in Goldenhar syndrome using temporalis muscle osteofascial flap. 2008

Halil Ibrahim Canter, and Aycan Kayikcioglu, and Banu Saglam-Aydinatay, and Pinar Ozgen Kiratli, and Kemal Benli, and Tulin Taner, and Yucel Erk
Faculty of Medicine, Department of Plastic and Reconstructive Surgery, Hacettepe University, Ankara, Turkey.

Goldenhar syndrome is a well-known developmental anomaly of the maxillofacial skeleton and hemifacial soft tissue. Maxillofacial anomalies of that syndrome can be managed by a variety of means such as inlay- or onlay-applied nonvascularized bone grafts, vascularized osteocutaneous/osseous flaps, or distraction osteogenesis. Vascularized full-thickness calvarial bone grafting is an important option for mandibular reconstruction for cases in which, for one reason or another, other techniques are not available, not applicable, or have failed. A mandibular defect of a 6-year-old boy presenting with bilateral preauricular skin tags, right microtia, right mandibular hypoplasia (with missing right condylar head and ascending ramus of the mandible) was reconstructed with right vascularized full-thickness calvarial bone grafting. Preoperative three-dimensional computed tomographic scans were used to acquire the stereolithographic biomodeling of the patient for assessing the amount of bone defect and precise planning of the surgery. Panoramic, anteroposterior, and lateral cephalograms and three-dimensional computed tomographic scans were obtained before and after the surgery and in the follow-up period for the evaluation of amount of relapse in the follow-up period. Clinical follow up and bone scintigraphy were used to assess the viability of transferred vascularized calvarial bone graft in the postoperative period. Plain radiographic evaluation with anteroposterior radiographs showed that mandibular symmetry increased and normooclusive closure of incisive teeth was achieved after surgery and retained in the postoperative period. Radiographs taken 1 year after surgery demonstrated that there was a slight relapse (1 mm) to the right side in the mandible when the results were compared with early postoperative ones. Postoperative three-dimensional computed tomographic evaluation of bony structures 3 months after operation showed that the transferred bone retained its volume. Sequential bone scintigraphies, performed to assess the vascularity of the grafts 1 week, 1 month, and 1 year after the operation, demonstrated the viability of transferred vascularized bone graft. The temporalis muscle osteofascial flap is a reliable method for mandibular reconstruction. It lessens the operative time, lessens surgical team labor, minimizes postoperative morbidity and discomfort, minimizes the hospital stay period, and minimizes financial expenses without renouncing the bone-healing capacity and increases aesthetic outcome by camouflaging the donor site scar in scalp and minimizing the facial scarring.

UI MeSH Term Description Entries
D008297 Male Males
D008334 Mandible The largest and strongest bone of the FACE constituting the lower jaw. It supports the lower teeth. Mylohyoid Groove,Mylohyoid Ridge,Groove, Mylohyoid,Grooves, Mylohyoid,Mandibles,Mylohyoid Grooves,Mylohyoid Ridges,Ridge, Mylohyoid,Ridges, Mylohyoid
D008335 Mandibular Condyle The posterior process on the ramus of the mandible composed of two parts: a superior part, the articular portion, and an inferior part, the condylar neck. Condyle, Mandibular,Condyles, Mandibular,Mandibular Condyles
D010347 Patient Care Planning Usually a written medical and nursing care program designed for a particular patient. Nursing Care Plans,Goals of Care,Plans, Nursing Care,Care Goal,Care Goals,Care Plan, Nursing,Care Planning, Patient,Care Plans, Nursing,Nursing Care Plan,Plan, Nursing Care,Planning, Patient Care
D011862 Radiography, Panoramic Extraoral body-section radiography depicting an entire maxilla, or both maxilla and mandible, on a single film. Orthopantomography,Panoramic Radiography,Pantomography,Orthopantomographies,Panoramic Radiographies,Pantomographies,Radiographies, Panoramic
D011877 Radionuclide Imaging The production of an image obtained by cameras that detect the radioactive emissions of an injected radionuclide as it has distributed differentially throughout tissues in the body. The image obtained from a moving detector is called a scan, while the image obtained from a stationary camera device is called a scintiphotograph. Gamma Camera Imaging,Radioisotope Scanning,Scanning, Radioisotope,Scintigraphy,Scintiphotography,Imaging, Gamma Camera,Imaging, Radionuclide
D012008 Recurrence The return of a sign, symptom, or disease after a remission. Recrudescence,Relapse,Recrudescences,Recurrences,Relapses
D002508 Cephalometry The measurement of the dimensions of the HEAD. Craniometry
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D005205 Fascia Layers of connective tissue of variable thickness. The superficial fascia is found immediately below the skin; the deep fascia invests MUSCLES, nerves, and other organs.

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