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Results for “Mandibular Reconstruction”

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At least 109 records · Page 6Linked to original sources

PubMed2000

Factors influencing the long-term outcome of mandibular reconstruction.

PURPOSE: The aim of this study was to understand the association of 30 candidate variables with the outcome of mandibular reconstruction. PATIENTS AND METHODS: Seventy cases of mandibular reconstruction performed between 1976 and 1991 were identified. Medical records were reviewed for all patients. Thirty variables, including patient factors, preoperative preparation, and intraoperative and postoperative findings were determined for each patient. Bone graft outcome was evaluated in 2 ways: 1) Fisher's exact tests and logistic regression models were used to determine the association between the clinical parameters and the success of the bone graft at 1 year and 2) proportional hazard regression models were then used to identify the predictors of bone graft survival time from the 30 chosen variables. RESULTS: Multivariate analysis determined that greater blood loss during the procedure (P = .018) and the presence of postoperative recipient site complications (P = .010) were significantly associated with bone graft failure during the first year. The diagnosis of malignant disease (P = .006), the use of sternocleidomastoid muscle (SCM) flaps for soft tissue augmentation (P < .001), longer duration of suction drainage (P = .001), and the presence of postoperative recipient site complications (P = .013) were found to be significant predictors of graft survival time in the proportional hazard regression model. CONCLUSIONS: The analysis of parameters associated with bone graft outcome may aid in surgical decision making and help improve the likelihood of a successful result in the future.

Adolescent↗

PubMed2000

Influence of the prosthetic restoration modality on bone loss around dental implants placed in vascularized iliac bone grafts for mandibular reconstruction.

OBJECTIVES: Is bone loss associated with implants placed in vascularized iliac crest bone grafts for mandibular reconstruction dependent on the prosthetic restoration modalities used? STUDY DESIGN: Eleven vascularized iliac crest bone grafts for mandibular reconstruction were examined after ablative tumor surgery. Forty implants loaded for at least 1 year were observed for up to 6 years. Horizontal and peri-implant bone loss was assessed for 2 groups: 6 patients with implant-supported bridges and 5 patients with implant-retained overdentures. RESULTS: Horizontal bone loss reached a steady state around 2 mm after an observation time of 2 years. Bony pockets had a depth of less than 1 mm. The described pattern was nearly independent of the prosthetic restoration modality used. The implant survival rate was 97.6%. CONCLUSIONS: Vascularized iliac crest bone grafts are safe implant-bearing areas. Implant-retained overdentures can be used with as good a longterm efficacy as the more complicated implant-supported bridges.

Bone Transplantation↗

PubMed2005

Postoperative radiotherapy after titanium plate mandibular reconstruction for oral cavity cancer.

OBJECTIVE: To study the impact of postoperative radiotherapy (RT) on titanium plate mandibular reconstruction. METHODS: Between 1997 and 2002, 66 patients with oral cavity cancers had immediate titanium plate mandibular reconstruction. Thirty-four patients (51.5%) received postoperative RT and 32 patients were treated with surgery alone. Follow-up ranged from 12 to 58 months (median, 24 months). RESULTS: Sixteen of 66 patients (24.2%) had major complications. Ten of 34 patients (29.4%) who received RT had complications compared with 6 of 32 patients (18.8%) after surgery alone (P = 0.312). The plate was removed in 11 patients (16.7%). The success rate of titanium plate reconstruction was 27 of 34 patients (79.4%) who received RT and 28 of 32 patients (87.5%) after surgery alone (P = 0.378). CONCLUSION: The addition of postoperative RT did not increase the risk of complications or the likelihood of successful titanium plate reconstruction.

Aged↗

PubMed1985

The use of osteosynthesis in immediate and delayed mandibular reconstruction.

Principles of osteosynthesis utilizing dynamic compression plating have been used in immediate and delayed mandibular reconstruction in five patients. Intermaxillary fixation was not used. Follow-up ranged from eight to 14 months. Four of five patients have viable bone grafts at the present time. One bone graft has been lost due to infection. We feel mandibular reconstruction based on principles of osteosynthesis helps to rapidly restore cosmesis and function with minimal morbidity.

Bone Plates↗

PubMed2005

The use of free fibular flap for functional mandibular reconstruction.

PURPOSE: The purpose of this investigation is to document our experience using the free vascularized fibular flap for comprehensive reconstruction of discontinuity defects in the mandible, after combined resections of malignant and aggressive odontogenic tumors, with special emphasis on functional aspect of the reconstruction process. MATERIALS AND METHODS: The study group consisted of consecutive patients treated for reconstruction of discontinuity defects of the mandible, using the fibular vascularized free flap, between 1997-2002. All procedures were performed in the same hospital and by the same surgical team. RESULTS: A total of 13 patients (9 males, 4 females) were treated in our department in a period of 6 years for reconstruction of discontinuity mandibular defects using the free fibula vascularized flap. Wound healing disturbances at the donor site occurred in 4 cases. Two flaps were lost, 1 because of total failure in a patient who was heavily irradiated because of osteosarcoma, the other because of resorption of the bone tissue transfer in a case of total avulsion of the mandible caused by a fall from height. CONCLUSION: Fibula free vascularized flap is a safe and reliable method for comprehensive functional and esthetic mandibular defect reconstruction. Our protocol has a significant impact on preserving the patients quality of life.

Adolescent↗

PubMed1988

Use of the Kirschner wire for mandibular reconstruction.

An adaptation of the Kirschner wire, using tie wires for fixation of the Kirschner wire in primary mandibular reconstruction following ablative surgery, is described. Eighteen patients with a Kirschner wire serving as a prosthesis following mandibular resection were followed up. Except for three patients, who had extensive resection of the tongue, all patients were judged as having satisfactory mastication and deglutition. Only two patients required another operation for wire-related complications. The Kirschner wire, when modified as presented, proved a dependable and stable prosthesis for mandibular reconstruction.

Adult↗

PubMed1993

[The role of implants in functional mandibular reconstruction].

More frequently after oncological resection, the mandibular reconstruction is done with microsurgically anastomosed free flaps. The titanium implants propose to the patients an oral rehabilitation with best functional and aesthetic results. It is very true in oncological surgery with or without radiotherapy.

Combined Modality Therapy↗

PubMed1997

The free fibula bone graft for salvaging failed mandibular reconstructions.

PURPOSE: The purpose of this study was to determine the efficacy of vascularized free fibula bone grafts for mandibular salvage reconstruction. PATIENTS AND METHODS: Seven patients had fibula grafts after failed attempts at mandibular reconstruction. The prior attempts involved 20 operative procedures. Four of the seven patients (57%) had a history of radiation to the affected mandible. Bony defects averaged 10.2 cm (range, 4.5 to 24 cm), and the associated soft tissue defects averaged 6 x 12 cm. Average follow-up was 16 months. Cosmetic (facial symmetry) and functional (speech quality, oral continence, deglutition, donor site morbidity, dental rehabilitation) results were evaluated by questionnaire and clinical examinations. RESULTS: Soft tissue coverage and mandibular restoration were successful in all patients, and flap survival was 100%. Five of the seven patients (70%) achieved good or excellent functional results, and five of seven (70%) achieved good or excellent esthetic results. Complications were minimal, and the average hospital stay was 14 days. CONCLUSIONS: When the initial attempt at mandibular reconstruction is unsuccessful, mandibular function and esthetics can be salvaged with reliable vascularized soft tissue and bone flaps. As long as appropriate flap options are considered and the patient is medically stable, successful mandibular reconstruction should be achievable despite the number or cause of prior failed attempts.

Adult↗

PubMed1989

Functional mandibular reconstruction of patients with oral cancer.

For the patient with oral cancer who has undergone quadrant resection, mandibular reconstruction provides normalization of the lower facial contour, regained architectural support, and reestablishment of occlusal relationships. Reconstruction with vascularized bone offers the most rapid rehabilitation. Replacement of dentition provides improved deglutition, mastication, and speech. In eligible patients the use of osteointegrated implants can provide rigid stabilization for dental prostheses. In previous studies these implants were placed in a secondary procedure. In the present study microvascular mandibular reconstruction was combined with primary placement of osteointegrated implants in the treatment of seven patients. Preliminary results indicate that the combination of procedures can provide more rapid and effective rehabilitation for the patient with cancer. Issues for further study are also identified.

Adult↗

PubMed1999

[Applied anatomy of bone flap pedicled with spina scapular branch of transverse cervical artery for mandibular reconstruction].

OBJECTIVE: To study the anatomical basis of vascularized spina scapular bone flap, which was used in mandibular reconstruction. METHODS: Fifteen adult cadavers were adopted in this study. The two common carotid arteries of each cadaver were intubed and perfused with red emulsion respectively. Then the course and distribution of the transverse cervical artery(TCA) and its spina scapular branches were observed on 30 sides. RESULTS: The TCA was divided into two segments: the cervical segment originated from the origin of the artery to the superior margin of the trapezius muscle, and the dorsal segment originated from the superior margin of the trapezius muscle to the site where the TCA bifurcated into the superficial and deep branches. The average length and original caliber of the cervical segment were(4.7 +/- 0.1) cm and (4.0 +/- 0.1) mm. The average length and original caliber of the dorsal segment were (5.88 +/- 0.63) cm and (3.30 +/- 0.35) mm. 86.7% spina scapular branches originated from the superficial branch of TCA and 13.3% from TCA. The length of the spina scapular branch was (4.97 +/- 1.68) cm and its external diameter was (2.08 +/- 0.27) mm. It constantly sent 4-8 periosteal branches to spina with 0.20-1.25 mm in caliber. CONCLUSION: The spina scapular branch of TCA is one of the main blood supplier to the spina scapular area. The spina scapular flap pedicled with spina scapular branch of TCA may provide a new operation for mandibular reconstruction, whose circumpoint locates at the origin of the dorsal segment and the average length of the pedicle is 10.85 cm which enough to transposite to mandibular area.

Arteries↗

PubMed1988

AO/ASIF plate for mandibular reconstruction in tumor surgery: results in 20 cases.

Between May, 1983, and February, 1987, the authors performed mandibular reconstruction using an AO/ASIF plate in 20 patients. Apart from accurate modelling of the resected segment using a template, the key features of the technique include firm fixation and wrapping the plate with pectoralis major muscle. In 19 cases the plate was inserted at the same operation as the resection of a malignant neoplasm. In 10 cases the anterior mandibular osteotomy was placed on the far side of the midline, while in five the mandible was disarticulated through the temporomandibular joint. Eleven patients are alive (average survival 22 months) and nine have died (average survival 10 months). Two AO/ASIF plates have required removal because of exposure, while in three patients limited plate exposure was corrected with a minor surgical procedure. Seven patients had soft tissue complications that were managed conservatively. Nine of the patients had been irradiated previously. Five patients were fitted with dentures successfully. The authors believe that this technique provides a safe, rapid, functional and esthetically satisfactory method of mandibular reconstruction in the patient undergoing surgery for malignant disease.

Adult↗

PubMed2000

[Application of distraction osteogenesis in functional mandibular reconstruction].

OBJECTIVE: To study the application of distraction osteogenesis in mandibular functional reconstruction. METHODS: Three kinds of mandibular distractors were used in 6 cases who had different mandibular defects because of tumor resection. For two cases with defect of most part of ramus specially desinged distractors were used in order to keep the normal height of the ramus. In one case the trifoci distraction principles were used and a trifoci distractor was desinged. In three cases the vertical distractors made in Germany or China respectively were used. The average age of 6 patients was 31.5 years old (from 8 to 54). RESULTS: The mandibular lengthenings in 5 cases were fully successful according to the direction and distance desinged before distraction. In one case the trifoci distraction principle was applied and a proximal 23 mm mandibular defect was corrected successfully, however, the 23 mm distal mandibular defect had not corrected because the screws for fixation of the transport block was loosened. No infection and dysosteogenesis were happened in all cases. CONCLUSIONS: Distraction osteogenesis can successfully be used in mandibular functional reconstruction and has much more advantages than traditional techniques. The most favorable time for distraction osteogenesis in mandibular reconstruction is at the same stage of tumor resection.

Adolescent↗

PubMed1999

Vascularized bone flaps versus nonvascularized bone grafts for mandibular reconstruction: an outcome analysis of primary bony union and endosseous implant success.

BACKGROUND: Functional restoration following resection or traumatic injury to the mandible depends on the reliability of the bony reconstruction to heal primarily and support endosseous implants. Although vascularized bone flaps (VBF) and nonvascularized bone grafts (NVBG) are both widely used to reconstruct the mandible, indications for each remain ill-defined. The purpose of this study was to compare bone graft/flap healing and success of implant placement in patients reconstructed with VBF versus NVBG. METHODS: Over the past 10 years, 75 consecutive mandibular reconstructions were performed (26 free bone grafts, 49 vascularized bone flaps). Etiology of the defect, history of irradiation, bone defect size, number of operations, graft/flap success, and dental implant success rates were determined and compared. Bone graft/flap success was defined as complete bony union. Implant success was defined as complete osseointegration. Mean follow-up was 3 years. RESULTS: Free flaps were used primarily for malignant disease (78%, 38/49). Bone grafts were used primarily for benign disease (88%, 23/26). History of prior irradiation: 11% (3/26) NVBG versus 45% (22/49) VBF. Length of bony defect (mean): 8.1 cm NVBG versus 9.4 cm VBF. Successful bony union, any size defect: 69% (18/26) NVBG versus 96% (47/49) VBF (p < .0005); lateral defects only: 75% (15/20) NVBG versus 100% (17/17) VBF (p < .05). Number of operations to achieve bony union (mean), any size defect: 2.3 NVBG versus 1.1 VBF (p < .001); lateral defects only: 1.9 NVBG versus 1.0 VBF (p < .005). Twenty-two patients (29%) had a total of 104 endosseous implants placed (NVBG: 8 patients, 33 implants; VBF: 14 patients, 71 implants). Immediate implants placed: 0/33 NVBG versus 54% (38/71) VBF. Overall implant success: 82% (27/33) NVBG versus 99% (70/71) VBF (p < .0001). Implant success in VBF patients with a history of RT: 100% (15/15). CONCLUSIONS: Despite the fact that patients reconstructed with VBFs were older, had larger defects, and were treated primarily for malignant disease and therefore had a higher incidence of irradiation to the affected mandible than in patients treated with NVBGs, the incidence of bony union was higher, requiring fewer operations to achieve union, and the implant success rate was significantly greater than for NVBG patients. Results were similar when considering lateral defects only. Based on these results, VBFs are indicated in most cases of mandibular reconstruction; NVBGs are effective for short bone defects (<5-6 cm), in nonirradiated tissue, and/or in patients determined to be too medically compromised to tolerate the additional operative time required for a free-flap reconstruction.

Adolescent↗

PubMed2000

Mandibular reconstruction following ablative tumour surgery: an overview of treatment planning.

BACKGROUND: In the last half century the evolution of mandibular reconstruction has resulted in a multitude of surgical procedures that have been brought about by advances made in bone science, grafting techniques and materials technology. With the ever increasing number of surgical options currently available it has become essential to take stock of these achievements and reconsider the fundamental principles of reconstructive surgery. METHODS: The choice of reconstructive techniques is only part of a wider number of variables that must be considered which will ultimately determine the success or failure of the procedure. RESULTS: Variables likely to influence the outcome of mandibular reconstruction are the site and extent of the defect, the needs and tolerance of the patient, the timing of reconstruction and the surgical skill and techniques available. CONCLUSION: By careful consideration of these cardinal variables it may be possible to formulate a treatment plan that will not only satisfy the essential needs of the patient but also help increase the likelihood of a successful outcome.

Bone Transplantation↗

PubMed2006

Tissue reaction to poly (lactic-co-glycolic acid) copolymer membrane in rhBMP used rabbit experimental mandibular reconstruction.

A rabbit experimental mandibular defect was reconstructed with 1% atelocollagen gel including rhBMP-2 10microg and a covering a poly (lactic-co-glycolic acid) copolymer (PLGA) membrane. For this experiment, eight male rabbits were used and a histological study was conducted. Our study purpose was to examine the effects and fate of PLGA membrane during bone reconstruction. PLGA membrane was phagocytized by foreign body giant cells and macrophages in the healing course of reconstruction osteogenesis. These histological data suggest that the PLGA membrane was gradually absorbed and replaced by fibrous connective tissue or bone tissue. In the osteogenesis course, the outer periphery of the new bone was maintained by PLGA membrane without expansion.

Animals↗

PubMed1997

Mandibular reconstruction with fibular osteoseptocutaneous free flap and simultaneous placement of osseointegrated dental implants.

Insertion of osseointegrated dental implants several months after mandibular reconstruction using vascularized composite bone grafts has proved to be a successful method to achieve mastication and complete oral rehabilitation. Theoretically with primary placement of implants into the new mandible a better access to the bone is achieved, interdental relationships are easier to determine, and oral rehabilitation can be attained in a shorter period of time. Previous results describing this approach, however, are inconclusive and controversial. This review describes our experience with primary insertion of dental implants into fibular flaps used for mandibular reconstruction during ablative surgery. Adequate selection of patients for this combined procedure depends mainly on the pathological nature of the mandible and perioperative radiotherapy. Preoperative determination of soft-tissue and bone requirements, number of osteotomies, rigid fixation method, and familiarity with the use of osseointegrated implants are important factors that must be considered for adequate surgical planning and to achieve good results.

Dental Implantation, Endosseous↗

PubMed2002

[The utility of vascularized free fibula flap in mandibular reconstruction: a clinical report of 25 cases].

OBJECTIVE: The purpose of this study was to evaluate the advantages and disadvantages of vascularized free fibula flap as a new method for mandibular reconstruction. METHODS: 25 cases (17 male to 8 female) who have received mandibular reconstruction with free vascularized fibular flaps in our hospital were studied retrospectively. The average length of the fibula grafts is 10.0 cm (range from 5.5 to 16 cm). 3 cases received primary insertion of osteointegrated dental implants into the free fibula flap, and all these 5 implants survived. RESULTS: All flaps except 1 were viable. 62% of the cases took normal diet postoperatively, and the remainder took soft diet as well. All patients spoke clearly. No ankle unstability was reported. And the aesthetic assessments in all patients were good or fair. CONCLUSION: Vascularized free fibular flap takes its distinct advantages to other autogeneous free bone flaps and is confirmed to be one of the optimal methods for mandible reconstruction by our study.

Adolescent↗

PubMed1993

Mandibular reconstruction: experience with the free vascularized fibula transfer.

Mandibular resection, following surgery for tumor or osteoradionecrosis, leaves a patient with a swallowing, speech, and cosmetic disability. Repair of the oromandibular defect is difficult and various prostheses and grafts have been used and reported. The most popular form of mandibular reconstruction is the use of the free, vascularized bone transfer. We report our experience with the free vascularized fibula bone transfer in eight patients.

Aged↗