Gianluca Colapinto

Background/Objectives: Mandibular reconstruction following ablative oral surgery is particularly challenging in elderly patients due to comorbidities and reduced physiological healing potential. While vascularized bone flaps represent the gold standard, the combination of an anterolateral thigh (ALT) flap and a bone reconstruction metallic plate may be considered as a less invasive alternative. This systematic review aimed to evaluate the effectiveness of such reconstructive techniques, in terms of success rate and complication rate, in patients aged over 55. Methods: Studies were included if the sample size consisted of at least 20 patients undergoing mandibular reconstruction with an ALT flap and plate following oral cavity resection for benign or malignant conditions. Studies were excluded if relevant outcomes were not reported and the mean age was 55 years were included. Mean hospital stay ranged from 10 to 24 days. The overall clinical success rate of the ALT flap procedure was 97% (95% confidence intervals (CIs): 92%, 99%). Flap-related complications were rare, with flap loss reported in only one patient and partial necrosis or failure affecting up to 6.6% of cases. Conversely, the overall plate-related complications rate was 28% (95% CI: 15%, 41%), with plate exposure rates ranging from 10% to 38.7% in the included studies. Wound complications, including infection and fistula formation, ranged from 20% to 38.7% of patients. Conclusions: In patients over 55, despite the not negligible rate of complications, the use of ALT flaps and reconstruction plate represents a viable alternative to vascularized bone flaps for mandibular reconstruction, particularly when comorbidities or frailty preclude more complex procedures. Further studies with a large sample size are needed to validate these findings and guide clinical decision-making.

Objectives: We aimed to evaluate the efficacy of antimicrobial photodynamic therapy (aPDT) in promoting wound healing after the surgical removal of inferior third molars. Methods: Patients in need of unilateral mandibular third molar extraction were randomly assigned to either a test or control group before surgery. During the test, a photoactive substance activated with laser light (20 mW, 660 nm) was applied to the post-extraction site for 60 s before suturing to promote healing and disinfection. The control group did not receive any laser applications after tooth removal. The probing pocket depth (PPD), bleeding on probing (BOP), plaque index (PI), gingival recession (REC), and levels of clinical attachment loss (CAL) before surgery (T0), 14 days after surgery (T1), and after 3 months after surgery (T2) were evaluated for the adjacent second molar. Post-operative swelling, pain (VAS index), the number of painkillers taken, alveolar probing, and Landry’s healing index were recorded at T1. Results: Sixty-five patients, aged between 14 and 39 years, were assigned randomly to test (n = 32) or control (n = 33) groups. Five dropouts occurred. Post-operative swelling and the VAS index were significantly lower in the test group compared to the control (p = 0.002 and p = 0.04, respectively). All periodontal indexes except recession significantly worsened at T1 in both groups. After three months, a significant improvement for PPD, CAL, and PI was recorded in the test group compared to the control (p = 0.001). Conclusions: According to the results of this study, the use of aPDT seems to have a beneficial effect on post-operative swelling and pain, as well as the plaque index, in the short-term follow-up.

Introduction: The surgical gold standard following mandibular resection is reconstruction with a vascular osteocutaneous free flap. However, not all patients are suitable candidates for this type of procedure due to local or systemic contraindications or the critical anatomy of the remaining healthy bone. This study aimed to evaluate the outcomes of reconstruction with an anterolateral thigh (ALT) free flap in combination with a reconstruction plate as an alternative in such situations.Methods: This retrospective case series included 34 oncological patients treated with ALT and reconstruction plate to restore mandibular bone defect following mandibulectomy. Seven patients who experienced serious postoperative complications received additional surgery involving the replacement of titanium plates [three with custom-made plates using computer-aided design (CAD)/computer-aided manufacturing (CAM) methods]. For evaluation, the following data were collected from the patients: gender, smoking habits, information about surgery (such as type of demolition, type of reconstruction plate used, and duration), the pathological node involvement, the application of radiotherapy (pre- or postoperative), the onset of complications (type of complication, time to complication, management strategy), and follow-up data. The follow-up period of the patients ranged from 3 months to 7 years. The follow-up assessments were based on both clinical and radiological methods, with CT scans performed at 1, 3, and 6 months.Results: Thirteen out of 34 patients developed early or late complications and were candidates for reoperation. Six of them died before undergoing additional surgery. The complications that were observed included flap failure, complications related to the plate (exposure, fracture, dislocation), development of sarco-radionecrosis, and recurrence. Seven subjects received additional surgery, including the removal and replacement of the reconstruction plates (custom-made plates in three patients).Conclusion: The surgical protocol described in this paper represents a promising option mostly suitable for geriatric patients who show relatively poor health status and advanced tumor stages.