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A 28-year-old African American female with end-stage renal disease on dialysis secondary to preeclampsia presented to the office as a referral for large multifocal tumors of maxilla and mandible. Surgical pathology and laboratory findings were supportive of secondary hyperparathyroidism leading to multifocal brown tumors. She underwent osteoplasty after using virtual surgical planning to create stereolithic models to visualize the tumor and fabricate cutting guides to minimize the risk of injury to adjacent nerves and teeth. Brown tumors can be resistant to medical management with unreliable regression in size. With the advent of customized surgical guides, more precise and judicious surgery can be performed on these types of tumors safely.

Functional reconstruction of the temporomandibular joint (TMJ) is a controversial topic among oral and maxillofacial surgeons; this controversy becomes more complicated when one dives into the dilemma of the ideal reconstructive modality. TMJ defects might result from various etiologies, such as blunt or penetrating traumatic injuries, advanced degenerative joint disease, or various pathologic conditions, including benign and malignant conditions, that might arise from the TMJ or adjacent tissues. Reconstruction of the TMJ is vital because of its essential function in mastication, articulation, speech, and facial esthetics and symmetry. In the pediatric population, the TMJ acts as a growth center. TMJ reconstructive surgery might be influenced by various factors that can steer the surgeon toward adopting a specific reconstructive modality. These factors can be classified into preoperative factors that include the overall general health of the patient, expectations, and socioeconomic status that might be an obstacle in using custom-made solutions. The surgeon's experience, level of comfort, and training are crucial influencing factors. TMJ reconstructive options consist of autogenous grafts or alloplastic options. Autogenous grafts encompass 2 broad subcategories. The first is the vascularized option, and a good example is the vascularized fibula free flap. The second subcategory includes nonvascularized grafts, such as costochondral grafts and sternoclavicular grafts. Alloplastic grafts include various TMJ stock joints or custom-made patient-specific prostheses and stock condylar prostheses. The goals of TMJ reconstruction are to establish a pain-free normal range of mouth opening, stable occlusion, and absence of facial deformity. Complication rates in TMJ surgery are low and include surgical infection, nerve injury, failure or fracture of the prosthesis, or injury to adjacent structures. This report presents a case of a stock condylar prosthesis displaced into the middle cranial fossa, which was managed with a 2-stage approach of removing the displaced prosthesis and then reconstruction with a fibula vascularized free flap and a simultaneous contralateral sagittal split osteotomy., (Copyright © 2018 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Oncologic and traumatic defects of the maxilla can pose a challenge to patients, reconstructive surgeons, and maxillofacial prosthodontists in an attempt to provide satisfactory treatment. Oral-nasal and oral-antral fistulas are frequently treated with soft tissue flaps, osteocutaneous flaps, or a maxillofacial obturator. The free fibula microvascular osteocutaneous flap has proved the workhorse of these maxillary and mandibular reconstructions. The success of microvascular reconstruction often hinges on flap viability in the immediate postoperative period. With most flap failures attributed to vascular compromise resulting from clot formation and venous congestion, uncompressed, and nontortuous pedicle positioning demands surgical attention. Although the use of the free fibula flap in maxillary reconstruction is a well-described and predictable procedure, the specifics of the flap inset with respect to pedicle positioning and technique within the maxilla and neck have not been clearly detailed in the available studies. In the present technique note, we have provided our surgical description for pedicle positioning and anatomic alterations in an attempt to improve microvascular anastomosis flap success., (Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Correction of orbito-frontal defects involves a multitude of surgical challenges, and requires careful and detailed planning. In the trauma setting, one must be prepared to deal with injuries to adjacent structures and be able to incorporate their repair into the surgical plan to maximize the functional and esthetic reconstruction for the benefit of the patient. Victims who have sustained trauma of the cranial complex in combination with mid-facial trauma, particularly involving the orbit, present a difficult scenario, especially when future ocular prosthetic rehabilitation is a concern. The authors present a patient of virtual surgical planning-guided planning of mid-facial osteotomies and custom implant creation for the secondary reconstruction of a patient who sustained extensive orbito-frontal trauma, requiring not only cranial vault recontouring, but also reconstruction of the mid-facial and orbital complex to accommodate an ocular prosthesis that would demonstrate proper anatomical relationships to maximize esthetics and function.

This article provides an overview of basic tissue engineering principles as they are applied to vertical ridge defects and reconstructive techniques for these types of deficiencies. Presented are multiple clinical cases ranging from office-based dentoalveolar procedures to the more complex reconstruction of postresection mandibular defects. Several different types of regenerative tissue constructs are presented; either used alone or in combination with traditional reconstructive techniques and procedures, such as maxillary sinus augmentation, Le Fort I osteotomy, and microvascular free tissue transfer. The goal is to also familiarize the reconstructive surgeon to potential future strategies in vertical alveolar ridge augmentation., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Purpose: The purpose was to analyze mandibular angle fractures by examining epidemiologic trends and mechanisms of injury and to determine whether a statistically meaningful relation existed between certain treatment modalities and patient outcomes., Materials and Methods: A retrospective chart analysis was performed, and data were limited to 1 operator. Treatment variables were methods of fixation, postoperative intermaxillary fixation (IMF), and retention versus extraction of teeth in the line of fracture. Outcomes were rates of postoperative infection, fracture healing, and overall patient comfort. Analysis was performed using the Fisher exact test, Wald test, and χ(2) test, with a P value less than .05 considered significant., Results: One hundred three patients were included in this study. The mean age was 30.4 years, most patients were men, and most injuries occurred during physical altercations and on the left side of the face. The most common concomitant fracture was of the contralateral parasymphysis. A statistically meaningful relation was noted between methods of fixation and healing and overall patient comfort, with the Champy technique and reconstruction plate being associated with the highest rates of bony union and patient comfort. No statistically relevant correlation was found between methods of fixation and rates of infection. There was no statistically relevant link for extraction versus retention of healthy teeth in the line of fracture or use of IMF with patient comfort, postoperative infection, or fracture healing., Conclusion: Although the Champy technique and reconstruction plates were associated with better postoperative outcomes, such as patient comfort and fracture healing, these should not be used interchangeably. IMF and extraction versus retention of teeth in the line of fracture did not influence any of the outcomes., (Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

The pectoralis major myocutaneous flap (PMMF), once considered a workhorse flap for head and neck reconstruction, is still used for a wide range of head and neck reconstruction in the era of microvascular free tissue transfer flap (MFTF) for many reasons including low donor site morbidity. Numerous studies have reported the flap-related complications of PMMF in depth but have seldom discussed the donor site complications in detail. This article reports 2 unusual donor site complications and reviews the published data on general donor site complications resulting from PMMF use., (Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)