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PubMed1990

Long-term fate of the vascularized iliac crest bone graft for mandibular reconstruction.

Vascularized bone grafts, such as the iliac crest, have become a major tool for mandibular reconstruction. Due to the growing trend toward immediate bone replacement followed by implant osseointegration and dental rehabilitation, further understanding of the long-term characteristics of these grafts is essential. Early postoperative bone scans demonstrate increased activity within the vascularized graft relative to surrounding bone. This study addressed the use of bone SPECT (single photon emission computed tomography) scintigraphy as a long-term method of evaluating the integrity of vascularized bone grafts.

Adolescent↗
PubMed1992

[Mandibular reconstruction by free transfer of the fibula after cancer excision].

The authors present five cases of mandibular reconstruction using a vascularised fibula free transfer in cases of mandibulectomy for cancer. After giving a short account on the anatomy, they describe the technical details of fibula preparation and its transfer at the recipient site. The clinical observations are described. This recent technique seems to be developing, taking in account the qualities of the fibula: available bone length, possibility of performing osteotomies with preservation of the vascular supply, low morbidity at the level of the donor site, and satisfactory cosmetic and functional results. Despite of one recent failure, this short series seems to confirm the great interest in this type of bone reconstruction.

Adult↗
PubMed2002

Finite element analysis of the stresses around endosseous implants in various reconstructed mandibular models.

PURPOSE: To calculate the location and intensity of the maximum stresses occurring around implants in the reconstructed mandible. MATERIAL AND METHODS: Human preserved mandibles and fibulae were used to design 3-D mandibular models on a Desktop Computer. Various 3-D simulation models representing mandibles were made. Implants (fixtures) and superstructures were then embedded in each model and occlusal pressure was applied to the cantilever portion of the superstructure. Von Mises stress, the maximum and minimum principal stress on each model were calculated using finite element structural analysis software. Finally, evaluation of the stresses around each fixture hole was performed. RESULTS: It appeared that for each fixture hole, the direction and the magnitude of the stresses were influenced by complex factors such as the thickness of the cortical bone where the fixtures were embedded, the degree of vertical displacement under load, and the relationship between adjacent fixtures. CONCLUSION: Location and intensity of the stresses occurring around fixtures differs significantly between various types of mandibular reconstruction. Published by Elsevier Science Ltd.

Bite Force↗
PubMed1998

Use of free fibula flap in patients with prior failed mandibular reconstruction.

PURPOSE: The purpose of this study was to assess the efficacy of the free fibula flap in patients who had failed prior attempts at bony reconstruction. PATIENTS AND METHODS: The records of all patients who had undergone free fibula reconstruction for segmental mandibular resections between 1993 and 1995 were retrospectively reviewed. Patients were divided into group I (14 patients who had failed previous bony reconstruction attempts) and group II (50 patients who had no previous reconstruction), and the two groups were compared. RESULTS: No statistical differences were found between group I and group II for mean age, mean hospital stay, mean intensive care unit stay, mean operating room time, mean intraoperative blood loss, mean colloid usage, or mean blood units transfused. Although group I had a statistically higher proportion of both patients with osteoradionecrosis and those receiving hyperbaric oxygen therapy (HBO), the number with a history of radiation therapy was not different in the two groups. Wound complication rates were not statistically different between groups I and II for all patients, or between those group I patients who did or did not receive HBO therapy. CONCLUSION: There was no increase in wound complications in the patients who had failed prior bony reconstructive attempts who underwent free fibula flaps. The free fibula flap is suggested as the reconstructive method of choice in this patient population.

Bone Transplantation↗
PubMed1991

The vascularized fibular flap for mandibular reconstruction.

Vascularized fibular bone grafts have advantages over other bone grafts in the restoration of the contour and function of defective mandibles. The fibular graft can be tailored to fit even major mandibular defects; in combination with preformed temporomandibular joint prostheses total mandibular reconstruction can be performed in a single procedure. The fibular transplant is considered ideal for the insertion of implants to support dental suprastructures to obtain maximal oral rehabilitation. We have used fibular grafts in eight cases for primary or secondary reconstruction of a variety of mandibular defects resulting from cancer, chronic osteomyelitis or gunshot injuries. The results have been most encouraging with respect to function and cosmetic appearance. There have been no transplant failures and minimal donor site complications.

Adolescent↗
PubMed1990

Vascularized parietal bone flaps. A new dimension in mandibular reconstruction.

The ultimate objective, when treating a mandibular defect, is to restore completely the function and cosmetic appearance of the face. The reconstruction must include bone from a similar source, good in quality and shape and living, to resist infection and the continuous stress that takes place in the mandible during mastication. Our technique for mandibular reconstruction using bone from the calvarium, of full thickness to receive implants and living because it is pedicled on the galea (from the superficial temporal artery) is reported. Our criteria for reconstruction, and the analysis of all the cases reconstructed with the technique mentioned above, is presented. Emphasis is placed on the good shape of this bone flap, its vascularization studies (compared with those in other techniques) and the high rate of success in both cosmetic and functional results.

Adult↗
PubMed1983

Mandibular reconstruction in irradiated patients utilizing myosseous-cutaneous flaps.

Myosseous-cutaneous flaps were used for mandibular reconstruction in 16 irradiated patients. Three of six sternomastoid-clavicle flaps failed (all in conjunction with a neck dissection), as did one of 10 pectoralis major-anterior-fifth rib flaps. One trapezius-scapular flap was used and it succeeded. We found the blood supply of the sternomastoid-clavicle flap too tenuous for use in conjunction with a neck dissection. The trapezius-scapular flap had too short an arc of rotation to be used for defects other than those in the horizontal ramus. In addition, this flap required a change of position and created an undesirable functional deformity. The pectoralis major-fifth rib flap, in contrast, could be used for a variety of defects, in conjunction with a neck dissection, and did not require a change of position during operation. We found it to be the most versatile and dependable of the flaps employed in this series.

Adult↗
PubMed2004

Angle-to-angle mandibular reconstruction with two free fibular flaps in a patient with two consecutive gingival cancers.

Two consecutive mandibular reconstructions with free vascularised fibular grafts in a patient with gingival cancers are presented. After resection of a gingival cancer on the left side, reconstruction was performed with a free vascularised fibular graft from the left leg. Two-and-a-half years later, a second free vascularised osteoseptocutaneous fibular graft from the right leg was used to reconstruct the right mandible and floor of the mouth after resection of a new gingival cancer. The two flaps have reconstructed the mandible from angle-to-angle. During the second reconstruction, a deviation of the left neomandible to the right side was corrected. Both postoperative courses were uneventful. Donor site morbidity was negligible, and the osteosyntheses healed well. This result further emphasises the value of the free fibular flap and the importance of adequate contouring of the fibular graft with osteotomies.

Aged↗
PubMed1985

Mandibular reconstruction with the A-O plate.

At the University of Minnesota and affiliated hospitals several methods of mandibular reconstruction have been used. From October 1978 through March 1984, 11 patients have undergone reconstruction with the A-O plate technique. These patients had both traumatic and oncologic defects. All patients treated with this technique have achieved a solid mandibular arch. Included is a discussion of the theoretical advantages, preoperative prerequisites, and the operative technique.

Follow-Up Studies↗
PubMed2002

Temporary intraoperative external fixation in mandibular reconstruction.

OBJECTIVES: To describe the use of a temporary intraoperative external fixation device to assist in the optimal bony reconstruction of the mandible in the setting of vascularized bone grafts. STUDY DESIGN: A retrospective review of six patients who underwent composite resection of the mandible and subsequent reconstruction with osteocutaneous free tissue transfer in a tertiary care center. METHODS: Six cases of mandibular reconstruction using an intraoperative external fixation system to assist the positioning of vascularized bone grafts are presented. All patients had composite resection of the mandible and subsequent reconstruction with either a scapula or fibula osteocutaneous flap. Follow-up ranged from 2 to 16 months. RESULTS: Successful reconstruction as defined by acceptable contour, occlusion, and condylar position was achieved in all cases. Complications were limited to a postoperative cerebrovascular accident requiring anticoagulation and subsequent neck hematoma. CONCLUSIONS: Use of intraoperative external fixation maintains the proper alignment of mandibular segments without the use of a bridging reconstruction plate. This technique is particularly valuable with tumors involving the outer cortex of the mandible.

Aged↗
PubMed1999

The bridging lateral mandibular reconstruction plate revisited.

BACKGROUND: Lateral oromandibular reconstruction using a soft tissue free flap with a first-generation locking mandibular reconstruction plate (MRP) was rejected in a previous series by the senior author (K.E.B.) owing to a high incidence of delayed plate extrusion through the cheek skin. OBJECTIVE: To reexamine this method of reconstruction using a second-generation, low-profile MRP. PATIENTS AND DESIGN: A prospective case series of 27 patients with segmental defects of the lateral mandible after treatment of head and neck cancer. SETTING: An academic tertiary care referral center. INTERVENTION: All patients had mandibular continuity restored using the Leibinger Locking System (Stryker Leibinger Inc, Kalamazoo, Mich) MRP. Associated soft tissue defects were repaired using radial forearm (n = 22) or rectus abdominis (n= 5) free flaps. MAIN OUTCOME MEASURE: Incidence of hardware-related complications. RESULTS: All microvascular flap transfers were successful. One patient experienced a plate fracture 9 months after reconstruction. Only 1 patient experienced external plate exposure, 6 months after undergoing reconstruction of a through-and-through defect. Reconstruction was successful in 25 (93%) of the cases after a median follow-up period of 19.5 months. CONCLUSIONS: The high incidence of external plate exposure in patients undergoing lateral oromandibular reconstruction using soft tissue free flaps and first-generation locking MRPs may have resulted from a plate geometry that was prone to result in extrusion. After a similar length of follow-up, the incidence of reconstructive failure was reduced by using a low-profile, rounded-contour MRP. Final assessment of the durability of this technique will require long-term follow-up.

Adult↗
PubMed1991

Prosthetic plate mandibular reconstruction.

The head and neck surgeon may choose one of several available methods to reconstruct the mandible following tumor ablation. This article discusses the use of metallic mandibular prostheses, the indications for alloplastic mandibular reconstruction, techniques of plate application (AO and THRP), and associated complications.

Bone Plates↗
PubMedDate not supplied

Dual free flap transfer using forearm flap for mandibular reconstruction.

To reconstruct a composite mandibular defect, we have simultaneously transferred a vascularized bone graft or osteocutaneous flap together with a forearm flap. The radial forearm flap, being thin, pliable, and having a long vascular stalk, served as mucosal lining and/or an interpositional flap acting as a vascular bridge. Between 1982 and 1989, we used this procedure in 17 patients with a mandibular defect or deformity which developed following treatment of oral cancer. Our clinical experience has demonstrated that this dual free tissue transfer has many advantages. It is useful for obtaining a good alveolar ridge in patients with a composite mandibular defect. It is applicable in cases where only a single pair of recipient vessels are present and may be useful when the recipient vessels are positioned some distance from the defect.

Adult↗
PubMed2001

Donor site angiography before mandibular reconstruction with fibula free flap.

The use of fibular free flaps has become established as a reliable and popular method for reconstruction of segmental mandibular defects. The role of routine preoperative angiography remains controversial. Sixty four digital subtraction angiograms were studied in a series of 39 consecutive patients clinically judged to be satisfactory candidates for fibula free transfer. Angiographic findings revealed vascular anomalies in 10 extremities (15.6%). Regarding the high potential for significant donor site morbidity authors consider vascular imaging essential part of preoperative evaluation.

Adolescent↗
PubMed1996

[Mandibular reconstruction in benign tumors of the mandible].

The authors report ten cases of reconstruction in the mandibular interrupter substance wast after excision of the large benign tumors which dominated by ameloblastoma. The reparation is realised by free no vascularized bone graft, of ten with the iliac crest, rarely with costochondral graft. The lateral mandibular interrupter substance waste concerning the temporo-mandibular joint (type III) is frequent. The reparation often immediate, is realised by the iliac crest graft fixed to mandibular stump with miniatures plaques and intermaxillar blocking. The fonctioning and morphology results in majority is qualified to be mean with a follow-up between 14 and 24 months.

Bone Transplantation↗
PubMed2001

Mandibular reconstruction using microvascular free flaps: a statistical analysis of 178 cases.

For this article, 178 consecutive cases of mandibular reconstruction using microvascular free flaps and performed from 1979 to 1997 were studied. The purpose of this report is to compare flap success rates, complications, and aesthetic and functional results. The ages of the 131 men and 47 women ranged from 13 to 85 years, with an average of 55 years. Donor sites included the rib (11 cases), radius (one case), ilium (36 cases), scapula (51 cases), fibula (34 cases), and soft-tissue flaps with implant (45 cases). Complications included total flap necrosis, partial flap necrosis, major fistula formation, and minor fistula formation. The rate of total flap necrosis involving the ilium and fibula was significantly higher than that of all other materials combined (p < 0.05). The overall rate of implant plate removal, which resulted from the exposure or fracture of the plate, was 35.6 percent (16 of 45 cases). Each mandibular defect was classified by the extent of the bony defect and by the extent of the soft-tissue defect. The extent of the mandibular bony defect was classified according to the HCL method of Jewer et al. The extent of the soft-tissue defect was classified into four groups: none, skin, mucosal, and through-and-through. According to these classifications, functional and aesthetic assessments of deglutition and contour were performed on 115 subjects, and speech was evaluated in 110. To evaluate the postoperative results, points were assigned to each assessment of deglutition, speech, and mandibular contour. Statistical analysis between pairs of bone-defect groups revealed that there was no significant difference in each category. Regarding deglutition, statistical analysis between pairs of soft-tissue-defect groups revealed there were significant differences (p < 0.05) between the none and the mucosal groups and also between the none and the through-and-through groups. Regarding speech, there was a significant difference (p < 0.05) between the none and the through-and-through groups. Regarding contour, there were significant differences (p < 0.01) between the none and the through-and-through groups and between the mucosal and the through-and-through groups. The points given for each function, depending on the reconstruction material, revealed that there was no significant difference between pairs of material groups. From this prospective study, the authors have developed an algorithm for oromandibular reconstruction. When the bony defect is lateral, the ilium, fibula, or scapula should be chosen as the donor site, depending on the extent of the soft-tissue defect. When the bony defect is anterior, the fibula is always the best choice. When the soft-tissue defect is extensive or through-and-through with an anterior bony defect, the fibula should be used with other soft-tissue flaps.

Adolescent↗
PubMed1994

Mandibular reconstruction with the Dacron urethane tray: a radiologic assessment of bone remodeling.

A retrospective study was made of 22 consecutive patients who underwent mandibular reconstruction with a Dacron (Osteo-mesh, Xomed Inc, Jacksonville, FL) tray technique from September 1988 to April 1992. Free autogenous iliac bone, in the form of particulate cancellous chips and marrow, was densely packed into the Dacron tray, that was adapted to bridge the mandibular segmental defect. Sixteen cases underwent uneventful healing with the formation of a continuous bony bridge and union with the remaining mandible. The pattern of bone remodeling and rate of resorption in these cases were assessed by sequential panoramic radiographs taken up to 3 years postoperatively. The mean horizontal dimension of the mandibular defects was 75 mm and the mean vertical reconstructed height was 25 mm. When the grafted bone was radiographically of uniform density, it progressed into a mature trabecular pattern matching that of the normal mandible. However, when there were areas of radiolucency, most likely from inadequate condensation of the graft, such areas were not replaced by bone in the long term. The bony height at both ends and the middle of the reconstructed segment underwent reasonably even resorption and retained about 80% of the bony height over a 3-year period. The rate of resorption was highest in the first 6 months and stabilized at about 2 years. There were six failures, all showing significant irregular bony resorption prior to tray removal.

Adolescent↗