During the late years of the Galactic Republic, Orn Free Taa represented his homeworld Ryloth in the Galactic Senate. He was a gregarious Twi’lek who was well known for his greed and cowardice.
Over time, he was relegated to the back of Coruscant politics, where he was more helpful to the Empire’s cause than to the people of Ryloth.
Reconstruction of mandibular ORN with free fibula flap
Patients who have undergone mandibulectomy to remove a tumor of the jaw (mandible) may need to undergo reconstructive surgery after the operation. Surgical treatment of the jaw bone (mandibular reconstruction) is important to restore the proper alignment of the teeth and jaw. It also improves the quality of life of these patients.
Free tissue transfer is a surgical procedure in which a flap of tissue from the body is transferred to the site of the defect, with its own vascular pedicle. It is the most appropriate procedure for reconstruction of segmental defects of the mandible due to traumatic or resective injury, and can be used for composite reconstruction of mandibular oromandibular defects. Among all grafts available for such reconstruction, the fibula is most commonly chosen.
However, there are limitations to this technique. For example, fibula grafts do not heal well in heavily irradiated areas. They are more prone to mucosal breakdown, plate exposure and graft loss, whereas vascularized iliac bone grafts are better suited for this situation.
This study investigates the use of patient-specific 3D-printed miniplates for reconstructive surgery in combination with a free fibula flap. The miniplates have been designed in collaboration with a manufacturer, and the process has been virtualized using IPS Gate software (KLS Martin Group, Muhlheim, Germany).
Eight patients who had undergone a mandibulectomy to remove a malignant or benign tumor of the jaw or osteoradionecrosis were included in this pilot study. They underwent a segmental mandibular resection and reconstruction with a mono- or dual-segmental fibula free flap and patient-specific 3D-printed miniplates between July and November 2019.
This is the first pilot study on patient-specific 3D-printed miniplates in reconstruction of the mandible with a free fibula flap. It shows that patient-specific 3D-printed miniplates are technically feasible, can be used with high accuracy, and are associated with minimal plate-related complication rates and a good chance of bone healing in the osteotomy gaps. Therefore, it is recommended that patient-specific 3D-printed miniplates be introduced into clinical practice for re-osteosynthesis and reconstruction of the mandible with free fibula flaps in order to increase patient safety and improve outcomes.
Long-term follow-up of mandibular ORN after free fibula flap reconstruction
One of the most common complications following radiation treatment for head and neck cancers is osteoradionecrosis (ORN). Symptomatic ORN has a devastating impact on quality of life, leaving patients with disabling pain and chronic wounds. In symptomatic cases, free flap reconstruction is an integral part of definitive management.
Free flap reconstruction is a minimally invasive surgical technique that aims to reconstruct tissue, especially in the skeletal system, after tumor removal. In recent years, the use of free flaps for reconstruction has become a widely accepted method. These flaps can be made of skin, bone, or other tissues.
Traditionally, fibula free flap reconstruction has been the most popular donor site for this type of reconstruction. This flap offers several advantages such as a long segment of bone stock (22-25 cm), adequate pedicle length, and low donor site morbidity. Additionally, it has a high cortical thickness and is bicortical, allowing for dental implantation.
This procedure can be a challenging operation, however, as it requires a skilled surgeon. To ensure optimal outcomes, a thorough history and physical examination must be performed before the surgery. In addition, it is important to consider the patient’s medical status and current medications before surgery.
Although recurrences of ORN after reconstruction have been reported, the exact etiology of these complications is unknown. Some studies suggest that poor wound healing and failure of osseointegration postoperatively may increase the likelihood of ORN recurrence. In contrast, other studies found that the donor site selected for reconstruction did not significantly impact ORN recurrence.
A large number of factors may influence the occurrence of late complications after free flap reconstruction. This study aimed to evaluate the occurrence and treatment outcome of late complications after reconstructive surgery for advanced mandibular ORN.
The study included 15 consecutive patients who underwent free fibula reconstruction for advanced mandibular ORN during 2013-2017 with two or more years of follow-up. All patients were followed up with routine panoramic radiographs and CT imaging.
In the present study, recurrences of ORN were not seen in any of the 15 patients. However, two patients developed infections (local and distant) and plate exposure after reconstructive surgery for advanced ORN. The occurrence of these complications was not affected by the perioperative antibiotic administration duration.
Long-term follow-up of mandibular ORN after mandibulectomy
Osteoradionecrosis (ORN) and mandibular recurrent osteomyelitis (MRONJ) are associated with reduced quality of life and can be a significant complication after head and neck cancer treatment. Radiotherapy (RT) is associated with a decreased risk of ORN. Patients with head and neck cancer have a higher risk of developing ORN than the general population. This complication can lead to a decrease in quality of life and can be treated with prophylactic surgery or RT, which is aimed at reversing the bone and soft tissue damage.
The occurrence of ORN and MRONJ is often due to dental extractions and trauma to the jawbone during radiotherapy. The first treatment is decortication of superficial bone structures and the removal of small sequestra. If this treatment does not provide relief, mandibulectomy is performed. If mandibular defects persist after a mandibulectomy, reconstruction may be needed.
Various techniques are used to reconstruct mandibular defects after mandibulectomy, such as the use of fibula free flap (FFF) and the skin-muscle flap. These flaps are well-established and have been found to be effective in rehabilitating the defect area, especially after surgery for ORN or MRONJ.
A large cohort of patients with mandibular ORN following surgery was evaluated for a long-term follow-up. The data were gathered from hospital records and the national Danish head and neck cancer database. In a nested case-control study, ORN cases and controls were matched for demographic and treatment factors including pre-RT dental procedures.
In a multivariable Cox regression analysis, Dmean was chosen as a dosimetric covariate to investigate its relationship with ORN. Dmean is a general damaging mechanism in parallel organs such as the mandible, which may explain the association of this dose-volume parameter with ORN.
The average Dmean was significantly higher in ORN cases than in control groups, and it retained its predictive effect in the multivariable model. Therefore, this parameter is a relevant factor to consider when planning the maximum mandibular dose. Doses should be kept as low as possible to reduce the risk of ORN.
Conclusions
One of the most recognizable names in Twi’lek politics, Orn Free Taa was a corpulent power player who enjoyed enriching himself on Coruscant while enmeshing himself in the galaxy’s largest legislature. In the eyes of the reformers, he was the most corrupt of all Senators, but he remained a key player in the Galactic Empire.
A review of the most prestigious awards and accolades in Star Wars revealed that Free Taa’s name was attached to some of the most noteworthy accolades in recent memory, including an award for best Senate performance and an honorary rank as a member of the Empire’s top brass. The big wigs also had their fair share of missteps. For example, when he was tapped for the position of Supreme Chancellor, he displayed no interest in the task at hand. Orn Free Taa was more concerned with the monetary value of his regal status, than in the responsibilities of the position. In the end, his legacy was a mixed bag, as he was unable to live up to his billing as an Imperial leader.