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 91 records · Page 5Linked to original sources

PubMed2005

Long-term outcome and factors influencing bridging plates for mandibular reconstruction.

Vascularized bone grafts have become the preferred method of mandibular reconstruction. However, the technique is considered to increase both the operating time and blood loss, which might be associated with an increased morbidity and mortality. We conducted a retrospective analysis of 100 consecutive patients who underwent immediate bridging plate reconstruction. The median follow-up duration was 70 months. The 5-year overall survival rate was 69.9%. Cox multivariate analysis revealed that red blood cell transfusion was an independent prognostic factor for the overall survival. The plate survival with no complications was 62.2% at 5 years. Anterolateral defects and preoperative radiotherapy emerged as an independent adverse factor for plate survival. The use of bridging plates is an option for lateral mandibular reconstruction with no preoperative irradiation to avoid the risk from blood transfusion.

Adolescent↗

PubMed1999

Assessment of plate use for mandibular reconstruction: has changing technology made a difference?

Reconstruction of mandibular defects with a variety of alloplastic materials during a 22-year period was reviewed. Outcomes were examined to determine whether specific plating technology affected the incidence of plate-related complications including plate exposure, plate fracture, and plate removal. Repair with the miniplate, reconstruction plate, titanium hollow screw reconstruction plate, and locking reconstruction plate was evaluated. Although the incidence of plate fractures has decreased, there was no significant change in the rate of plate exposure. Recurrent disease was noted to be a significant contributing factor in the development of plate-related complications.

Adult↗

PubMed1999

Mandibular reconstruction: free flap vs AO plate.

The purpose of this study was to compare the use of the AO reconstruction plate with immediate free vascularized bone graft mandibular reconstruction. From April 1989 to December 1993 we performed 13 cases of mandibular reconstruction. Reconstruction plates were used in 4 and immediate free bone grafts were used in 9 patients. The overall success rate for use of the plate was 2 of 4 (50%). In one of the plate failure patients, the plate was removed eight months postoperatively. She was able to wear a dental prosthesis. Cancer destruction and microvascular anastomosis of the first seven free flaps were performed by one surgical team. Only 4 free flaps were successful (success rate was 44%). We found that the use of AO plate with flap for lateral defect was relatively safe, simple, functional, time-saving, cosmetically acceptable and could be used successfully in post-operative irradiated patients. Success rate of the free flap was better with two surgical teams. The long-term result of the free flap was more reliable than the AO plate.

Adult↗

PubMed1994

The AO system for primary mandibular reconstruction.

We reviewed the records of 27 patients who underwent primary mandibular reconstruction with AO plates to investigate the outcome and complications of this procedure. Immediate soft-tissue flap coverage was required in 26 patients. Early complications were seen in 44% of the patients, with the highest incidence after irradiation (P = 0.02). Late complications were mostly related to tumor recurrence (12). Late complications not associated with recurrence were persistent pain (2), minor infections (3), plate exposure (3), and plate fracture (1). Good to excellent cosmetic results were obtained in all but 1 patient. Full mastication was not possible for any of our patients, and therefore function was not fully restored. Speech and deglutition were mostly influenced by the amount of soft-tissue resection. Mean follow-up was 20 months (range 3 to 52). At last evaluation, 12 patients were alive and free of disease, and 15 were dead of disease or other causes. Our results show that primary mandibular reconstruction with rigid plates is a safe, effective, and reliable technique to restore mandibular continuity and cosmesis. For lateral defects, this method is a viable alternative to free vascularized osseocutaneous flaps.

Adult↗

PubMed1995

Histomorphometric examinations of free revascularised iliac crest bone after transplantation for mandibular reconstruction.

At the present time the vascularised bone graft is the best procedure for reconstruction of mandibular defects in poor recipient tissues. We obtained 23 drill biopsies from different regions of vascularised bone transplants during the removal of the osteosynthesis plates from 14 patients who had poor recipient tissues. For comparison, we took five biopsies from the native iliac crest and eight biopsies from six patients with avascular bone transfer into unimpaired surrounding tissues. Microradiographs of the bone preparations were used for a computerised semi-automatic morphometric analysis. We evaluated the volumetric density (VV, %) and the mean trabecular diameter (D-TRAB, micron). In the central regions, the revascularised transplants decreased in volumetric density and in mean trabecular diameter. Compared with the average values of iliac crest bone, the avascular grafts increased in both parameters. The revascularised grafts showed significantly lower volumetric density and significantly lower mean trabecular diameters in the central regions than in the regions near to the mandibular stump. The avascular grafts actually showed the reverse effect. The results are discussed with particular reference to the quality of the recipient tissues, to the maintenance of graft viability, to functional stress, and to the design of the transplant.

Adult↗

PubMed1995

Five-year follow-up of mandibular reconstruction with hydroxylapatite and the mandibular staple bone plate.

PURPOSE: To evaluate the results of hydroxylapatite augmentation of the mandible followed by placement of the mandibular staple. PATIENTS AND METHODS: Sixty patients 5 or more years postsurgery were evaluated. Patients were followed yearly with clinical and radiographic examinations. RESULTS: The decrease in augmentation height was 2.8 mm (33%) after the first year and only minimal in the following years. The following problems were seen: hyperplastic tissue around posts (eight patients), small dehiscences were seen in the saddle area after 2 years (11 patients), large dehiscences with significant hydroxylapatite loss in five patients. One patient needed a secondary augmentation. CONCLUSION: Prosthetic stabilization and function were excellent throughout the study period and there was a uniformly high degree of patient satisfaction.

Adult↗

PubMed2000

Mandibular reconstruction in children.

Facial deformities due to loss of mandibular segments in children lead to severe functional and psychological disturbances. Such deformities should be corrected taking into account both contour and function. In addition, they should be planned for long-term growth and performed in the fewest possible surgical stages. This article presents the experience in seven cases of mandibular reconstruction in children after surgical ablation for benign conditions. We performed a scapular flap in one case and fibular flaps in six. The mean age of the patients was 9.1 years. Follow-up ranged from 1.5 to 5 years. All flaps survived. No osseous remodeling was needed in any case. All patients showed symmetrical facial and mandibular growth, as well as adequate masticatory function. Excision of the tumor and reconstruction should be carried out in the same surgical procedure whenever possible. The fibula was used in most cases because of its easy dissection, the ample amount of bone it provides, and the potential to redirect it. The author favors mandibular reconstruction in children with a free flap, as this approach offers adequate form and function in the long term.

Adolescent↗

PubMed1991

Mandibular reconstruction using the skeletal pin fixation system.

Excellent results were obtained in mandibular reconstruction by using the skeletal pin fixation system. The remaining bone was fixed before segmental resection. Case 1 was a 35-year-old male with a cementifying fibroma in the 2/6 region. We used the HH type pin fixation system and Kirschner wire (diameter 3.0 mm) for the fixation of the mandibular resection end. Case 2 was a 51-year-old male with an ameloblastoma in the 6/4 region. We used the HY type pin fixation system before mandibular resection. Case 3 was a 45-year-old female with an ossifying fibroma in the 6/4 region. The same fixation system was used as in case 2. In all cases, mandibular reconstruction was carried out with iliac bone graft and A-O plate.

Adult↗

PubMed1993

Fixation of the vascularized bone graft in mandibular reconstruction.

One hundred and forty vascularized bone grafts were used for mandibular reconstruction in 135 patients. Most followed surgical ablation of squamous carcinoma recurring (or persisting) after irradiation. This paper analyzes the fixation techniques and their effects on bony union. Of 140 vascularized bone grafts, 132 survived and were reviewed. Fifty were stabilized using rigid techniques and 82 by interosseous wires. Rigid fixation had a success rate of 94 percent, while nonrigid techniques resulted in bony union in 96.3 percent. The three failed cases of rigid fixation occurred when short mandibular compression plates were used in iliac crest grafts. We conclude that vascularized bone grafts exhibit a high degree of bony union and that fixation technique--rigid versus nonrigid--appears unimportant in this context. Compression plating is clearly bone-dependent. Nevertheless, use of the reconstruction plate simplifies mandibular reconstruction, and the extra hardware does not appear to increase infection or other soft-tissue complications.

Adult↗

PubMed1995

[Mandibular reconstruction in oncology: discussion of indications].

The aim of the study was to assess the results of segmental mandibular resections and the validity of mandibular reconstructions. The medical records of 95 patients treated between January 1, 1987 and December 31, 1992 were reviewed. There were 82 (86%) carcinomas, 9 ameloblastomas and 4 sarcomas. Among the 82 patients treated for carcinoma, the overall 2- and 5-year survival rates were 70% and 33% respectively. The functional results evaluated one year after surgery showed no significant difference according to the reconstruction procedure: myocutaneous flap, osteomyocutaneous flap, titanium mandibular reconstruction plate or microsurgical transfer. The most important factor in functional rehabilitation is the amount of soft tissue resected. In head and neck oncology, aggressive surgical reconstruction of the mandible must only be used in patients with good general status and fair survival probability.

Adolescent↗

PubMedDate not supplied

Soft tissue coverage of mandibular reconstruction plates.

Free tissue transfer was compared to pectoralis major flap coverage of mandibular reconstruction plates in a retrospective review. The study group consisted of 14 patients whose composite defects were reconstructed with metal plates covered with either pectoralis flaps (9) or soft tissue free flaps (5). Four patients in the pectoralis group (44%) had plates that extruded compared to none in the free flap group. The mean operating room time for the free flap group (721 minutes) was longer than the pectoralis group (550 minutes), but the overall hospital stay for the free flap group (20 days) was half that of the pectoralis group (39 days). The pectoralis group required more secondary procedures (88%) than the free flap group (20%). Free flaps have a higher success rate, a shorter hospital stay, and require fewer additional procedures than do pectoralis flaps. This justifies the longer operating time and greater technical complexity of free tissue transfer for reliable coverage of mandibular reconstruction plates.

Aged↗

PubMed2004

The anatomical basis of the osteo-musculo-cutaneous trapezius flap in mandibular reconstruction.

The osteo-musculo-cutaneous trapezius flap has seen its indications in mandibular reconstruction reduced since the appearance of micro-anastomotic flaps. However, it may still be useful when the patient has marked atheroma contraindicating a free flap. While the arterial supply of this flap is well known, the same is not true for its venous drainage. The preservation of the accessory nerve and its limits in mandibular reconstruction has been little studied. We carried out a study on 30 subjects (60 cadaveric dissections of trapezius flaps) in order to address these questions. The study has been completed by a surgical series of five patients. The cadaveric study allowed demonstration of the variability of venous drainage of this flap, which depended on the external jugular vein in 80% of cases, the subclavian vein in 12% of cases and on both veins in about 8% of cases. The accessory nerve in one third of cases passed through the middle of the arteriovenous pedicle making its preservation impossible. The segment of the scapular spine allowed reconstruction of about 9 cm of mandible including the mental protuberance in 95% of cases. The surgical study confirmed the data of the cadaveric study and showed the value of this flap when free flaps are contraindicated.

Cadaver↗

PubMed1992

[Free composite flaps with the fibula and their adaptation to mandibular reconstructive surgery. Apropos of 9 cases].

Although revascularized fibula bone transfers have been used in reconstructive surgery of long bones for about fifteen years, the first reported cases of mandibular reconstruction were only published in 1989 by Hidalgo. The mandible and the fibula actually have very few points in common apart from their respective length and a certain similarity of cross-section. However, free composite flaps including the fibula are adapted to reconstruction of the mandible for several reasons: the length of the bone which can be raised (25 cm) and osteotomized into several fragments; the addition of other components (skin, aponeurosis, muscle, etc.) for skin and/or mucosal repair; the spatial independence of these various elements; the microsurgical qualities of the peroneal artery. This possibility of multidirectional and multiple tissue bony mandibular reconstruction is analysed on the basis of 9 clinical cases: 5 cases of traumatic sequelae of the lower third of the face following gunshot injuries, 2 cases of radiation osteonecrosis, 2 benign bone diseases. The triple bone, integument and vascular adaptation between the fibular donor site and the recipient site must be assessed preoperatively. Due to the quality of the morphological and functional results compared with the limitations of other free composite bone transplants, the authors propose free composite fibular flaps as adapted and adaptable solutions for one-stage reconstruction of extensive mandibular defects (> 10 cm) associated with small or large mucocutaneous lesions.

Adult↗

PubMed2004

Comparative study of locking plates in mandibular reconstruction after ablative tumor surgery: THORP versus UniLOCK system.

PURPOSE: This retrospective study compared 2 types of rigid locking plates (THORP and UniLOCK; Stratec Medical, Oberdorf, Switzerland) in 107 patients undergoing reconstruction for bridging mandibular defects following ablative tumor surgery. PATIENTS AND METHODS: From January 1993 to December 2000, 107 patients were reconstructed following ablative tumor surgery with 57 THORP plates and 50 UniLOCK plates. Study follow-up ranged from 18 to 87 months (average, 32 months). Complications were categorized into delayed wound healing, infection, plate exposure, and plate fracture, taking into account the type and timing of reconstruction. RESULTS: Overall type and number of complications show no statistically significant differences between THORP and UniLOCK groups. Infection was the most frequent type of complication (THORP, 30; UniLOCK, 32). Others included delayed wound healing (THORP, 13; UniLOCK, 12), plate exposure (THORP, 8; UniLOCK, 7), and plate fracture (THORP, 5; UniLOCK, 1). Plates were removed in 22 THORP and 11 UniLOCK plates. The most frequent reason for plate removal in both groups was infection. Other reasons for plate removal include tumor recurrence, plate fracture, plate exposure, or a combination of reasons. CONCLUSIONS: THORP and UniLOCK plates do not present statistically significant differences in the parameters studied. Nevertheless, the UniLOCK group had slightly better results. Considering that the THORP system is much bulkier and its screws bigger, our results lead to the conclusion that bridging osteosynthesis with a 2.4 UniLOCK system is adequate for plate reconstruction of mandibular defects.

Adult↗

PubMed2005

Choice of osseous and osteocutaneous flaps for mandibular reconstruction.

Microvascular free flap transfer currently represents one of the most popular methods for mandibular reconstruction. With the various free flap options now available, there is a general consensus that no single kind of osseous or osteocutaneous flap can resolve the entire spectrum of mandibular defects. A suitable flap, therefore, should be selected according to the specific type of bone and soft tissue defect. We have developed an algorithm for mandibular reconstruction, in which the bony defect is termed as either "lateral" or "anterior" and the soft-tissue defect is classified as "none," "skin or mucosal," or "through-and-through." For proper flap selection, the bony defect condition should be considered first, followed by the soft-tissue defect condition. When the bony defect is "lateral" and the soft tissue is not defective, the ilium is the best choice. When the bony defect is "lateral" and a small "skin or mucosal" soft-tissue defect is present, the fibula represents the optimal choice. When the bony defect is "lateral" and an extensive "skin or mucosal" or "through-and-through" soft-tissue defect exists, the scapula should be selected. When the bony defect is "anterior," the fibula should always be selected. However, when an "anterior" bone defect also displays an "extensive" or "through-and-through" soft-tissue defect, the fibula should be used with other soft-tissue flaps. Flaps such as a forearm flap, anterior thigh flap, or rectus abdominis musculocutaneous flap are suitable, depending on the size of the soft-tissue defect.

Bone Transplantation↗

PubMed1990

The functional result of mandibular reconstruction.

A study was performed to determine if patients who underwent mandibular reconstruction were functionally rehabilitated. Five parameters were evaluated: deglutition, mastication, cosmesis, diet, and the use of dentures. Deglutition was not improved in patients who had mandibular continuity restored. Problems with deglutition were related to soft tissue resection. Mastication was poorer in the reconstructed group due to scarring, loss of the muscles of mastication, and inhibition of compensatory mandibular motion. Cosmesis was improved in patients who had immediate restoration of mandibular continuity. Cosmesis was not improved in patients with delayed mandibular reconstruction due to previous scarring. Prosthetic rehabilitation was poor in both groups of patients. Reconstructed patients had a greater number of hospitalizations due to management of, or complications from reconstructive surgical procedures. The results of this study suggests that restoration of mandibular continuity does not enhance the functional rehabilitation of the majority of patients with oral-pharyngeal malignancy.

Adult↗

PubMed1988

Mandibular reconstruction with vascularized iliac crest: a 10-year experience.

Since 1978, 35 patients have undergone mandibular reconstruction with vascularized iliac crest. During this time, the technique of raising and shaping the iliac crest has undergone a series of modifications. Initially, osteocutaneous segments based first on the superficial circumflex iliac system and later on the deep circumflex iliac system were used. More recently, only the inner table of the ilium has been employed, and where intraoral lining is required, an ulnar forearm free flap has been added. Thirty-two patients were reconstructed successfully. Of the three anastomotic failures, one bony segment was able to survive as a free graft. There were no donor-site complications. With continued experience, operative morbidity has been minimized, while the technique has been modified to tailor the reconstruction to the specific requirements of the patient. It is concluded that vascularized iliac crest provides the most appropriate mandibular reconstruction for a range of congenital and acquired defects.

Adolescent↗

PubMed1994

Advantages of mandibular reconstruction with the titanium hollow screw osseointegrating reconstruction plate (THORP).

Alloplastic reconstruction following segmental mandibulectomy is a simple way to maintain mandibular segmental relationships, partially preserving form and function for many patients. This study is a retrospective review of 40 patients who had mandibular reconstruction with metal plates over a 6-year period (April 1986 through August 1992). The results of reconstruction with titanium hollow-screw osseointegrating reconstruction plates (THORP [n = 12]) and solid screw (SS) steel and titanium plates (n = 28) are compared. One THORP has been removed as compared to 14 SS plates. While the improved results with THORP may be attributable in part to its advanced design, the success of soft-tissue reconstruction and tumor extirpation are important factors in the early outcome seen in this series. Longer follow-up is needed to determine if THORP can serve as a permanent implant. THORP is the authors' method of choice for alloplastic mandibular reconstruction.

Adult↗