PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Mandibular Reconstruction”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 199 records · Page 11Linked to original sources
PubMed1999

Mandibular reconstruction in children using the vascularized fibula.

In this study, the authors review their experience with vascularized fibula transfers for mandibular reconstruction in children. They outline the indications for such reconstruction, their method of contouring the fibula to accurately resemble the resected mandible, reconstruction of the temporomandibular joint, and the use of vascularized muscle for the management of associated soft-tissue deficiencies. Ten consecutive patients, 5 to 17 years of age and undergoing this procedure, were assessed from a medical, dental, radiographic, and photographic standpoint. The fibulae were elevated via a lateral approach, osteotomized, as required, and fixation was achieved with titanium miniplates and screws. All transfers survived, with viability confirmed by early postoperative bone scanning. Five patients had temporomandibular joint reconstruction, and five patients required simultaneous reconstruction of soft-tissue defects with associated vascularized muscle. The postoperative follow-up ranged from 3 to 30 months The occlusion of the remaining dentition, mandibular symmetry and projection, adequacy of lining and skin cover, and maximal mouth opening were reassessed. Occlusion was class 1 in all patients, and free-flap stability and function were in the normal range. However, soft-tissue contour was a problem. All wounds healed primarily without donor-site complications and with minimal recipient-site complications.

Adolescent↗
PubMed2001

Mandibular reconstruction using a vascularised fibula osteocutaneous flap in a patient with pyknodysostosis.

We present the first successful report of mandibular reconstruction using a free fibula osteocutaneous flap in a patient with pyknodysostosis. The patient had recurrent refractory osteomyelitis of the mandible, which was initially treated with resection and reconstruction using an AO plate. Recurrent fistula formation with loosening of the plate was treated by radical re-excision and reconstruction with a free fibula flap. The postoperative course was uneventful; at 14 months the bony union was almost complete, without resorption or atrophy of the grafted fibula on radiography.

Adult↗
PubMed1994

[Mandibular reconstruction with a free avascular iliac crest transplant].

119 avascular osseous transplants from the iliac crest were used for mandibular reconstruction. In case of irradiation we prepared the region of transplantation by using myocutaneous flaps. We lost 2.5% of our transplants. Analysing the orthopantomogram after a special method regarding reproducibility, we found a loss of height of the transplant of about 30% in the middle term. During rigid fixation of the transplant in the first 3 month, there was the biggest loss of height. Transplants ending free in the region of the TMJ showed less consistency than transplants interposed between original mandibular bone.

Adolescent↗
PubMedDate not supplied

Acute alcohol withdrawal and free flap mandibular reconstruction outcomes.

OBJECTIVE: To evaluate the effect of acute postoperative alcohol withdrawal on survival of vascularized fibular grafts for mandibular reconstruction. DESIGN: Retrospective case series of 17 consecutive patients. MAIN OUTCOMES MEASURE: Relation between flap survival and alcohol withdrawal. RESULTS: Flap survival rate was 25% for patients who experienced delirium tremens and 85% in the other patients. Had all flaps in patients with postoperative alcohol withdrawal survived, the success rate would have been 89%. Flap loss was related to acute alcohol withdrawal (P =.02, chi2 analysis). The relationship between complication rate and alcohol withdrawal was also significant, using the Fisher exact test. CONCLUSIONS: Fibular free flap reconstruction of the mandible is clearly cost-effective when it facilitates return to social function and productivity. In our experience, acute alcohol withdrawal in the first 72 hours after surgery is associated with a high incidence of flap loss. Therefore, we believe that patients at significant risk for alcohol withdrawal should undergo detoxification preoperatively. Society's economic return for investing in free flap reconstruction comes from minimizing convalescence and maximizing postoperative patient productivity. This return will not be realized for poorly selected patients. We are looking further into the effects of alcoholism on flap survival rates.

Acute Disease↗
PubMed2005

Occult stenosis of the common carotid artery complicating mandibular reconstruction with a fibular free flap.

An unsuspected severely stenosed common carotid artery that compromised a free flap for mandibular reconstruction is described. To our knowledge no one has advocated the assessment of the carotid tree before transfer of free tissue. We suggest that patients with several risk factors for peripheral vascular disease should have colour flow duplex imaging of the carotid system if transfer of free tissue is being considered.

Aged↗
PubMed1986

Primary mandibular reconstruction using the AO reconstruction plate.

Primary reconstruction of segmental defects of the mandible following cancer resection remains a major problem. In 1976, a stainless steel plate was developed by AO/ASIF (Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation) for mandibular reconstruction. This plate completely stabilizes both mandibular stumps without the need for intermaxillary or external fixation. In addition, when bone grafting is performed, the design of this plate promotes revascularization by allowing maximal contact between grafted cancellous bone and surrounding soft tissue. Since April 1985, we have used this reconstruction plate in six patients undergoing composite resection. The technique did not compromise cancer resection, excessively prolong operating time, or alter postoperative management. All six patients have retained the AO reconstruction plate and have been reconstructed successfully with achievement of satisfactory function and cosmesis.

Adult↗
PubMed1988

Mandibular reconstruction in the young adult using free vascularized iliac crest.

Five young adults between the ages of 16 and 27 years underwent mandibular reconstruction with free vascularized iliac crest bone grafts based on the deep circumflex iliac artery. These were the only patients under age 30 years in a series of over 60 patients undergoing this procedure. In all cases, the ipsilateral crest was employed, and special efforts were made to minimize bony bulk by removing the outer cortex and carefully shaping the graft. The bone graft underwent final trimming in situ, the exact dimensions being reproduced from measurements taken from the excised specimen. When bone alone requires replacement, as in the majority of young patients, an excellent functional result can be anticipated. Occlusion can be maintained or even restored, and the normal facial contour can be re-established. Osteointegrated implants hold out the possibility of providing full dental rehabilitation in an age group in which anything less is considered failure. Furthermore, the donor site scar can be hidden by a bathing suit. It is concluded that this form of reconstruction is particularly suitable for the young adult, in whom cosmesis, function, donor site, and freedom from long-term complications are of supreme importance.

Adenocarcinoma↗
PubMed1999

Mandibular reconstruction using bone morphogenetic protein 2: long-term follow-up in a canine model.

OBJECTIVE: To determine the degree of bone resorption and stability of 3-cm, full-thickness canine mandibular defects reconstructed with recombinant human bone morphogenetic protein 2 (rhBMP-2) and a bioerodible particle carrier followed for 30 months after reconstruction. STUDY DESIGN: Nine dogs, divided into three groups, underwent reconstruction of surgically created 3-cm, full-thickness defects of the body of the mandible. METHODS: Mandibular reconstruction was performed via a combined intraoral and extraoral approach. Using standard plating techniques, a unilateral full-thickness, 3-cm defect was created in the body of the mandible. After stabilizing the defects with titanium reconstruction plates, test implants composed of rhBMP-2 and poly(lactide-co-glycolide) bioerodible particles were placed in the mandibular defects of six animals. Reconstruction plates were removed from test animals at 10 weeks. Three short-term test animals were sacrificed 3 months after reconstruction. Three long-term test animals were sacrificed 30 months after reconstruction to determine the degree of resorption and long-term stability of the rhBMP-2-induced bone. Control implants (carrier without rhBMP-2) were used in three animals and were sacrificed at 3 months. At 9 months, long-term animals were advanced to a solid diet. Masticatory function and body weight were monitored periodically to assess diet tolerance. Roentgenographic photodensitometry was performed on serial dental roentgenograms of the reconstructed segments to determine bone density and the degree of bone resorption over 30 months. After sacrifice, reconstructed segments were harvested and embedded in plastic for histological analysis and histomorphometry to determine the percentage of the defect replaced by mineralized bone (area density) and degree of resorption from 3 to 30 months after reconstruction. The main outcome measures were bone density and bone height determined from serial roentgenograms and percentage of the reconstructed segment replaced by mineralized bone (area density) determined from histomorphometry. RESULTS: Control animals without rhBMP-2 showed no evidence of bone formation across the defect. Histological examination revealed good bone formation in two of three of the short-term test animals with a mean area density of 41.0%. The long-term test animals treated with rhBMP-2 demonstrated good bone formation that was comparable to that of normal host bone by 3 months. The roentgenographic photodensity measurements stabilized at 5 months without evidence of persistent bone resorption. The height of the reconstructed segment (rhBMP-2-induced bone) initially decreased, then stabilized by 11 months after reconstruction with no indication of resorption or failure. Histological examination of the long-term test animals revealed good bone formation across the mandibular defects. However, there were localized areas of thinning of the cortical bone as compared with the short-term test animals sacrificed at 3 months. Histological examination verified the loss of height of the bone in the reconstructed segments. The area density (mean) of the long-term test animals was 56.5%. Despite the decrease in height of the induced bone, there was an increase in area density of the bone over time. CONCLUSIONS: This study demonstrated that rhBMP-2 in a bioerodible particle carrier induced new host bone formation across critical-size mandibular defects. The newly formed bone successfully integrated with existing host bone creating a stable union capable of withstanding the forces of masticatory function in a canine. There was some evidence of early bone resorption (thinning of the cortical bone and decrease in height) in the rhBMP-2-induced bone. The rhBMP-2-induced bone stabilized by 11 months after reconstruction and no further resorption was noted. The percentage of area of the defect replaced by rhBMP-2-induced bone (area density) increased over 30 months. (ABSTRACT TRUNCATED)

Animals↗
PubMedDate not supplied

Combined V figure-shaped scapular osteocutaneous and latissimus dorsi myocutaneous flap for composite mandibular reconstruction.

BACKGROUND: As early as 1981, the scapular crest was reported as a versatile donor site of vascularized bone flap. In our institute, much attention has been paid to applying a compound flap based on the subscapular vascular system for composite mandibular reconstruction. METHODS: The combined V figure-shaped scapular osteocutaneous and latissimus dorsi myocutaneous flap has been used for primary or secondary reconstruction of the mandible, intraoral mucosa and/or external skin following major ablation of the malignant tumors in seven patients. RESULTS: There was one total flap failure. Satisfactory results were obtained in the remaining patients. CONCLUSIONS: The V figure-shaped scapular bone flap supplied by the angular branch provides a long rotation arc of vascular pedicle, a long bony segment of more than 14 cm, and a good contour of mental protuberance. The combination of the scapular osteocutaneous flap with latissimus dorsi myocutaneous flap allows reliable reconstruction of massive and three-dimensional composite mandibular defects.

Adult↗
PubMed1991

Mandibular reconstruction using vascularized bone grafts.

Total oromandibular reconstruction following cancer extirpation remains a significant challenge to the head and neck surgeon. Reconstructive goals must address occlusion, salivary continence, mastication, deglutition, and articulation. In this article, various methods of mandibular reconstruction, with special attention to the most recent advances in vascularized bone and free tissue transfer techniques, are reviewed.

Bone Transplantation↗
PubMed1998

[Mandibular reconstruction using "chain flap" of iliac crest free flap and forearm free flap]

OBJECTIVE:Following ablation of oromandibular malignant neoplasms,3 patients underwent immediate mandibular reconstruction using "chain flap".It was composed of iliac crest composite free flap(ICCFF). seven flaps of 3 cases survived completely,follow-up ranged and donor sites were generally satisfactry.Consecutive X-ray films showed that the grafting bone produed a more rapid processes of incorporation and bone remodling,and experienced minimal bony resorption.The results suggested that FFF could remedy defects of soft-tissue compoment of ICCFF.It was an useful method that mandibular reconstructin of large composite defects using "chain flaps" of ICCFF and FFF.

Journal Article↗
PubMed2005

[Segmental mandibular reconstruction by elasticity distraction osteogenesis associated with guided bone regeneration].

OBJECTIVE: To accelerate distraction osteogenesis by utilizing guided bone regeneration technique, and to improve the automatic process of canine segmental mandibular reconstruction by elasticity distraction osteogenesis using shape memory metal alloy distractor. METHODS: Adult hybrid canines were used. Osteotomy was performed to remove a bone segment of 2.5-4.0 cm in one side of the mandible. Mandibular fixation devices and shape memory metal alloy distractor were secured according to the principles of bi-focal distraction technique. A piece of ePTFE membrane was sutured to cover the buccal side of bone defect and osteotomy gap of transport disc, where the periosteum was peeled for exposing mandible in operation. Then the incisions were totally closed. The canines were sacrificed 3 months later to harvest the mandibles for morphological observation and measurement of bone density and intensity. RESULTS: The shape memory metal alloy distractor performed distraction osteogenesis automatically and reconstructed the mandibles with bone defect. A regenerated bone segment of 1.5-2.0 cm was formed in the compression region between transport disc and contralateral mandibular end. The new bone in both of distraction and compression regions had similar height and thickness with normal mandible. Moreover the new bone density and intensity were rather satisfied. CONCLUSIONS: Membrane guided bone regeneration can avoid bone synthesis commonly caused by cicatrization of soft tissue in the bone defect, and accelerate ossification and maturation of new generated bone.

Animals↗
PubMed1994

Autologous fibrin adhesive in mandibular reconstruction with particulate cancellous bone and marrow.

Displacement of bone graft particles during their placement, neck flap closure, and insertion of the freeze-dried mandibular crib housing the graft to the glenoid fossa is a commonly encountered problem during major mandibular reconstruction with autogenous particulate cancellous bone and marrow. Autologous fibrin adhesive proved to be a solution as demonstrated in a series of 33 cases. In addition to adhesive and hemostatic properties, it helped the remodeling process begin about 50% earlier by providing the substratum for migration of mesenchymal cells, accelerating revascularization and migration of fibroblasts, stimulating the growth of both fibroblasts and osteoblasts, and slowing the multiplication of microorganisms. Bony incorporation and remodeling were detected radiographically at the fourth postoperative week compared with the eighth week in bone grafts without autologous fibrin adhesive.

Bone Regeneration↗
PubMed2001

Assessment of the incorporation of revascularized fibula grafts used for mandibular reconstruction with F-18-PET.

AIM: Determination of the range of regional blood flow and fluoride influx during normal incorporation of revascularized fibula grafts used for mandibular reconstruction. Evaluation, if healing complications are preceded by typical deviations of these parameters from the normal range. Assessment of the potential influence of using "scaled population-derived" instead of "individually measured" input functions in quantitative analysis. METHODS: Dynamic F-18-PET images and arterialized venous blood samples were obtained in 11 patients early and late after surgery. Based on kinetic modeling regional blood flow (K1) and fluoride influx (Kmlf) were determined. RESULTS: In uncomplicated cases, early postoperative graft K1--but not Kmlf--exceeded that of vertebrae as reference region. Kmlf values obtained in graft necrosis (n = 2) were below the ranges of values observed in uncomplicated healing (0.0113-0.0745 ml/min/ml) as well as that of the reference region (0.0154-0.0748). Kmlf values in mobile non-union were in the lower range--and those in rigid non-union in the upper range of values obtained in stable union (0.0211-0.0694). If scaled population-derived instead of measured input functions were used for quantification, mean deviations of 23 +/- 17% in K1 and 12 +/- 16% in Kmlf were observed. CONCLUSIONS: Normal healing of predominantly cortical bone transplants is characterized by relatively low osteoblastic activity together with increased perfusion. It may be anticipated that transplant necrosis can be identified by showing markedly reduced F- influx. In case that measured input functions are not available, quantification with scaled population-derived input functions is appropriate if expected differences in quantitative parameters exceed 70%.

Adult↗
PubMed1994

Mandibular reconstruction with cancellous bone, hydroxylapatite and titanium mesh.

Over the past 20 years, titanium mesh combined with autologous iliac crest spongiosa and hydroxylapatite has performed well in the restoration of mandibular discontinuity defects in 79 patients. In 14 irradiated patients with a transplant bed of inferior quality, however, complications and failures occurred more often than in the 65 non irradiated patients. The results of our investigation clearly show that the success of mandibular reconstruction mainly depends on a well vascularized transplant bed.

Adult↗
PubMed1984

Mandibular reconstruction using the Dacron-urethane prosthesis and autogenic cancellous bone: review of 32 cases.

The prosthesis and cancellous bone graft technique has proven to be versatile, reliable, and highly successful when applied to mandibular reconstruction. The type of prosthesis used appears to be of some importance. Analysis of 32 cases in which the Dacron-urethane mandibular prosthesis was used is presented. Among these cases there were one failure (3 percent) and three minor complications (9 percent). These results are superior to those reported in the series in which metallic prostheses were used.

Adolescent↗