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PubMedDate not supplied

Immediate mandibular reconstruction: human experience with autogenous frozen mandibular grafts.

Autogenous mandibular grafts that have been cryosurgically devitalized and reimplanted have been studied in the canine. Initial investigations have lent impetus to further application in human cancer surgery. Six patients underwent immediate autogenous mandibular graft reconstruction. All failed because of intraoral complications and decreased vascularization in the midportion of the bone graft. None evidenced recurrence of tumor in bone, although two patient's grafts failed on the basis of tumor recurrence in the adjacent soft tissue.

Carcinoma, Squamous Cell↗
PubMed1995

Primary mandibular reconstruction with the titanium hollow screw reconstruction plate: evaluation of 51 cases.

Fifty-one patients undergoing surgical reconstruction of mandibular defects with the titanium hollow screw reconstruction plate over a 4-year period were analyzed. Plate failure was defined as flap necrosis, plate extrusion, or plate fracture necessitating a further surgical procedure and occurred in 12 patients (24 percent). The incidence was highest for patients who had more than three mandibular regions resected. It was not affected by the primary site of the tumor or whether the patient had received radiation therapy. Although the failure rate was the same whether the patient attained full oral function or was fed by gastrostomy, plate fracture was limited to the former group. The overall cause-specific survival rate for this group of patients was 68 and 56 percent at 1 and 2 years, respectively. In addition, 81 percent of patients attained a full oral diet.

Adult↗
PubMed2004

Mandibular reconstruction with local live vascularised bone transfer.

There are different methods to provide a skeletal support for mandibular reconstruction following the trauma or ablation for tumor in head and neck region. These methods vary from complicated techniques like vascularised free bone grafts to methods like free bone grafts, local vascularised bone grafts, cadaveric irradiated bone grafts and alloplastic material spacers including silastic rubber, polyvinyl plastics, ceramics, hydroxylapatite or metal. The technique employed solely depends upon many factors like expertise available, existing infrastructure, the available time factor and complexity of the defects including the type and extent of tissue loss in the particular patient. The sliding mandibulectomy is a simple method of mandibular reconstruction. This surgical technique is indicated for repairing short mandibular defects up to 9 cm in overall length including the mandibular arch for which extra vertical osteotomies are needed to bend the segment. More so it has its value in patients with poor prognosis and poor general conditions in whom longer and complicated mandibular reconstruction procedures with free vascularised bone flaps are not advisable. This article describes different types of sliding osteotomies used to harvest live bone flaps for rebuilding the mandibular defects including the arch of the mandible for patients who have undergone malignant tumor ablation. Primary reconstruction for the mandibular skeletal support was obtained in 18 cases with vascularised live-bone graft through various sliding osteotomies in different combinations. Complications, failures and success rate of sliding mandibulectomies and osteotomies have been analyzed and discussed in detail.

Aged↗
PubMed1993

Dental implantation to free scapular bone flap used for mandibular reconstruction.

Three patients who underwent mandibular reconstruction with a free vascularized scapular osteocutaneous flap after tumor resection are presented. Dental reconstruction was performed on three patients by implanting an artificial dental root into the grafted bone. The procedures for dental implantation were done just as on a normal jaw, and did not require hospitalization of the patients. They were followed up for 3 to 5 years after dental reconstruction. They have been able to masticate and ingest in a virtually normal manner during these periods. They also showed good appearance of the reconstructed mandible and dentes. On the basis of these results, the indication and evaluation of this procedure are discussed.

Adolescent↗
PubMed2006

Transient recycling of resected bone to facilitate mandibular reconstruction--a technical note.

BACKGROUND: Mandibular reconstruction requires considerable sculptural skills. The intriguingly complex configuration of the structure is difficult to reproduce. It is thus imperative for surgeons to seek a technique that improves the precision of the reconstruction. PATIENT: A 55-year-old male presented with a full thickness cancer (T4+) of his left cheek. Radical ablative surgery resulted in an extensive loss of bone and soft tissue mandating major reconstruction. METHOD: The resected bony specimen was thoroughly denuded, autoclaved, and then placed back into its original site so that the mandible resumed its pre-surgical configuration. A reconstruction plate was applied to maintain structural stability, then the "recycled bone" was used as a template and replaced with a free fibular graft. RESULT: The patient fared well and a follow-up panoramic radiograph demonstrated good alignment and symmetry of the reconstructed mandible. CONCLUSION: This method is a viable option for segmental mandibulectomy defect repair in selected cases. Using this technique, it is possible to restore the original bony contour expediently and accurately.

Bone Plates↗
PubMed2004

Mandibular reconstruction using the titanium functionally dynamic bridging plate system: A retrospective study of 34 cases.

PURPOSE: We sought to examine the use of the Titanium Functionally Dynamic Bridging Plate System (Howmedica Leibinger, Freiburg, Germany) for mandibular reconstruction after oncologic resection in 34 patients. PATIENTS AND METHODS: A retrospective study of 34 patients who had mandibular reconstruction using the titanium dynamic bridging plate system for mandibular reconstruction after oncologic resection were evaluated. The indications and postoperative outcomes were studied. Our evaluation focuses on the tolerance and aesthetic and functional results of this system. RESULTS: The follow-up ranged from 1 to 4 years. At the end of the study, 18 of the 34 patients (53%) still had the plate in place. One plate fracture and 1 plate exposure requiring surgical management were found. Surgical results were satisfying, particularly when looking at healing delay or long-term tolerance. Aesthetic (79% rated the results as good or acceptable) and functional results of this reconstruction material were satisfying. CONCLUSION: This reconstruction system provides a solution for a safe and rapid mandibular reconstruction for patients with a poor prognosis or poor general condition. This method also preserves the possibility of secondary reconstruction.

Adult↗
PubMedDate not supplied

Mandibular reconstruction: bone graft techniques.

Results of treatment in a series of 60 patients undergoing mandibular reconstruction by a variety of methods are reported. Delayed reconstruction was performed, using a titanium mesh tray with cancellous bone fragments and block bone grafts removed from the iliac crest, rib, and mandible in 34 patients, with an overall success rate of 91%. Immediate reconstruction was performed with a wire mesh prosthesis containing particulate bone and composite flaps in 26 patients, with an overall success rate of 46%. Oral contamination of the graft at the time of surgery appeared to be the factor limiting the success of immediate mandibular reconstruction. Block grafts of bone were extremely reliable in reconstituting the continuity of the mandible when inserted through an extraoral approach as a delayed repair. Mandibular reconstruction was successfully accomplished even following high-dose radiotherapy.

Bacterial Infections↗
PubMed1998

Mechanical strength of fracture plates made of titanium for functionally stable mandibular reconstruction.

Plates for functionally stable mandibular reconstruction are successfully introduced with biocompatible titanium. While screws have been the subject of numerous investigations, only few results are available for the mechanical stability of plates. This contribution gives an overview about experimental possibilities to test plates in tensional, bending, and torsional strength as well as fatigue, and reports results about plates made of titanium and oxygen-alloyed titanium. The alloyed material is harder, stiffer and shows higher tensile strengths. In contrast to softer titanium, contouring procedures during implantation can lead to structural defects and an associated higher fracture risk.

Biomechanical Phenomena↗
PubMed1985

Aspects of mandibular reconstruction.

We present in this paper the indications for bony reconstruction following mandibular resection, together with evaluation of the reconstructive techniques available. Case reports illustrate methods we have found satisfactory and are followed by our recommendations for their specific use.

Aged↗
PubMed1994

[Intraoral approach to mandibular reconstruction in surgery of benign tumors].

Nowadays the exclusive intraoral approach is standard in the operative treatment of mandibular fractures. However there is still scepticism in the selection of the intraoral approach for mandibular reconstruction. Between 1980 and 1992 we performed in 21 patients mandibular reconstructions by rib or iliac bone grafts after resections of benign tumors in the mandible. One transplant was lost, the remaining transplants were incorporated without problems. According to our results the exclusive intraoral approach of primary mandibular reconstructions by free bone-grafts after removal is a reliable procedure.

Adolescent↗
PubMed1997

Advantages and limitations of the fibula free flap in mandibular reconstruction.

PURPOSE: The authors analyze the advantages and disadvantages of mandibular reconstruction with a fibula free flap in a retrospective study of 29 cases, and make comparisons with the iliac free flap and the lateral brachial free flap. MATERIAL AND METHODS: Twenty-nine patients (22 male, 7 female) aged 5 to 70 years were studied. Functional and esthetic evaluations were performed together with radiologic examination of the bony calluses. RESULTS: The fibula free flap has advantages for mandibular reconstruction, such as the length of bone available, low morbidity of the donor site, and the possibility of using a skin paddle. However, there is the disadvantage of not being able to reconstruct large soft tissue defects. In addition, bone vascularization is reduced when a large number of osteotomies are required. CONCLUSION: This reconstruction technique is satisfactory for mandibular defects measuring over 20 cm.

Adolescent↗
PubMed1993

[Mandibular reconstruction using a free vascularized fibular flap].

The authors report their experience with the free osseous and osteocutaneous fibular flap used in the complex mandibular reconstruction. After a short review of the mandibular reconstruction possibilities and description of the fibular flap characteristics, the clinical cases are reported and the operative technique used by these authors is detailed. The discussion of the advantages and the disadvantages of this flap in the complex mandibular reconstruction ends the paper.

Adult↗
PubMed1992

The caudal mandibular reconstruction plate: a radiographic and histologic study of an autopsy specimen.

During autopsy, a reconstructed partial mandibular resection was recovered and subjected to histological examination. The mandible had been reconstructed 12 weeks earlier with a caudal plate and autologous cancellous bone from the iliac crest. Undecalcified microsections showed that the plate was firmly anchored by screws on both sides and on one side there was bony union. However, most of the free transplant bone had undergone 'unreplaced resorption.' Nevertheless, this method offers advantages over the conventional method of seating the plate on the buccal aspect and has interesting potential for further development.

Bone Plates↗
PubMed1989

A critical analysis of immediate and delayed mandibular reconstruction using A-O plates.

Eleven patients who underwent mandibular reconstruction with A-O plates were followed up for as long as 40 months. The patients underwent either immediate or delayed mandibular reconstruction. Nine patients had free cortical bone grafts included in the reconstruction. Complications in patients who underwent immediate reconstruction included loss of the bone graft due to infection, external and intraoral exposure of the reconstruction plate, pain, and infection. In the patients with immediate reconstruction, more than 50% of the bone grafts resorbed. There were less complications and minimal bone graft resorption in patients who underwent delayed reconstruction. The cosmetic results were initially good in both immediate and delayed reconstruction but deteriorated as more surgery was required for management of complications. At 40 months, 7 of 11 patients (5 of 9 with immediate reconstruction) had died of local recurrence, distant metastasis, or another primary tumor. No patients were rehabilitated prosthetically. We conclude that while A-O plating is technically easy and has a low perioperative morbidity rate, the long-term morbidity rate is high. This must be weighed against the benefits of the procedure and the probability that the patients will have a poor functional outcome.

Bone Plates↗
PubMed2006

Donor side selection in mandibular reconstruction using a free fibular osteocutaneous flap.

While the free fibular osteocutaneous flap is indispensable for mandibular reconstruction, reliable setting is often difficult because relative positions of the bone, skin island, and vascular pedicle are critical. We have an algorithm for donor-side selection of free fibular osteocutaneous flap. From July 2002 to March 2004, we performed 15 mandibular reconstructions using free fibular osteocutaneous flaps. We retrospectively classified these procedures as follows. In type I (flap harvested ipsilaterally to defect, n = 5), the skin island was fixed to the oral cavity, and the vascular pedicle emerged from the anterior aspect of the fibula. In type II (flap contralateral to defect, n = 5), the skin island was fixed to the oral cavity, and the vascular pedicle arose from the posterior aspect. In type III (flap contralateral to defect, n = 4), the skin island was fixed to the facial skin and the vascular pedicle arose from the anterior aspect. In type IV (flap ipsilateral to defect, n = 1), the skin island was fixed to the facial skin and the vascular pedicle arose from the posterior aspect. Flaps took completely except in 1 group II case with partial necrosis. Close attention to geometric characteristics of a free fibular osteocutaneous flap facilitates reconstruction of mandibular defects and selection of donor side.

Adult↗
PubMed1995

Inferior border titanium cribs in mandibular reconstruction.

A prospective study was made of 14 patients with mandibular continuity defects not involving the condyle who underwent mandibular reconstruction with autogenous particulate cancellous and bone marrow, autologous fibrin adhesive, and custom-made inferior border titanium cribs. The design and fabrication of the cribs were based on the prediction tracing of the mandibular defects from panoramic radiographs. The mandibular arch form, facial contour, and alveolar bone height were restored with high accuracy. The average follow-up time was 30 months. Autologous fibrin adhesive held the bone particles firmly together and accelerated the bone graft healing, which enabled the early removal of the intermaxillary fixation and restoration of the masticatory function. The results of this study demonstrated that the use of inferior border titanium crib designed from a simple, practical, and inexpensive technique is valuable in mandibular reconstruction.

Adolescent↗
PubMedDate not supplied

Mandibular reconstruction of a partial hemimandibulectomy in a dog with severe malocclusion.

OBJECTIVE: To report treatment of severe mandibular malocclusion (after left partial hemimandibulectomy, approximately 7 cm gap). STUDY DESIGN: Clinical report. ANIMALS: A 14-month-old golden retriever. METHODS: After corrective osteotomy of the right horizontal mandibular ramus, normal occlusion was reestablished and temporarily maintained while both mandibles were stabilized by miniplates on the lateral alveolar surface spanning the bilateral mandibular defects (right=1.5 cm, left=7 cm). A fenestrated, monocortical rib graft was positioned beneath the left gingival surface to protect the synthetic graft, which was secured to the miniplate. A mandibular reconstruction plate (right) and a locking mandibular reconstruction plate (left) were secured to the ventral borders of the mandibles. Recombinant bone morphogenetic protein-2 delivered in collagen tricalcium phosphate sponges (rhBMP-2 collagen-TCP sponge) was inserted into both mandibular defects. RESULTS: New bone formation was identified at 3 months and bony remodeling was evident at recheck examinations up to 4 years. Scintigraphy (6 months, 1 year) confirmed graft revascularization and viability. Bone collected (1 year) from the left defect site had robust new bone formation and evidence of continued remodeling. Only minor complications were encountered during the postoperative period and were easily resolved. CONCLUSIONS: Reconstruction of a large mandibular defect was facilitated by use of an osteoinductive factor (rhBMP-2 collagen-TCP sponge) as a graft substitute. CLINICAL RELEVANCE: One-step salvage and reconstruction facilitated by use of an osteoinductive factor, as a graft substitute, may be an alternative strategy for repair of large mandibular defects.

Animals↗