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At least 127 records · Page 7Linked to original sources
PubMedDate not supplied

Bone contouring and fixation in functional, primary microvascular mandibular reconstruction.

Experience in over 65 cases of microvascular mandibular reconstruction has resulted in the development of reliable techniques for bone fixation and contouring to achieve the best functional results. Methods of graft contouring and the application of rigid internal fixation are described in detail. Unusual situations in which the tumor extends through the buccal cortex of the mandible, and when condylar replacement is necessary, are presented. The options for managing these situations are discussed.

Bone Transplantation↗
PubMed1983

Mandibular reconstruction using implantable stabilization plates.

The consequences of substantial mandibular loss usually are disturbances in mastication and often in cosmesis. In an attempt to arrive at an easy and reliable technique of reconstructing mandibular defects, a selected group of patients were treated using rigid, implantable reconstruction plates. These were used to provide continuity and stability for the residual mandible with or without the use of graft materials. These have included autogenous fresh, irradiated, or frozen bone, and polytetrafluoroethylene carbon fiber sponge (Proplast). A discussion of the principles and technique of using reconstruction plates is outlined.

Aged↗
PubMed1985

Mandibular reconstruction with microvascular bone transfer. Series of 10 patients.

Mandibular reconstruction with microvascular bone transfer was carried out in 10 patients, including 8 with far advanced intraoral carcinoma and 2 with posttraumatic facial and mandibular defects. Eight patients presented with compromised defects as a result of radiation injury, infection, and scarring. Nine patients experienced primary bony union with complete functional and esthetic reconstruction of the mandible, and two patients eventually received dentures. This technique has resulted in a more effective, more reliable, and earlier reconstruction compared with conventional methods.

Adult↗
PubMed2004

[Changes of bone height after vascularized fibular bone graft in mandibular reconstruction].

OBJECTIVE: To investigate the changes of vascularized fibular bone height after transplantation for mandibular reconstruction. METHODS: Thirty-two patients with mandibular defects were reconstructed with vascularized fibular bone. Postoperative follow-up pantomography was used to evaluate the changes of bone height. RESULTS: At different distance from the vessel pedicles, the changes of bone height showed no significant difference. The height of fibular bone decreased gradually with time and reduced by 6.64% at 1 year postoperatively. CONCLUSIONS: Multiple segmental osteotomies had no effect on blood flow and the different pieces of graft after modeling by osteotomy experienced the similar reconstruction. The volume of grafted fibular bone almost remained stable.

Adolescent↗
PubMed1997

[Mandibular reconstruction using a microvascular method in the transplantation of a fibular flap].

The best results in mandibular reconstruction are achieved by transplantation of vascularised bone. This transplant has an own blood supply therefore its surviving is not influenced by the non-sterile environment of the oral cavity and the insufficient blood supply of the operated area (caused by scar or radiation). A new promising method for reconstruction of a wide segmented defect of the mandible is vascularised fibular flap transplantation. Eight consecutive patients treated with fibular flap transplantation in 1993 and 1994 were reviewed. Osteo- and osteo-cutan flaps were used for reconstruction of the composite tissue defects. The authors report on the surgical technique and their first experiences. The authors consider the application of the fibular flap the most successful procedure of all types of reconstruction of segmented mandibular defect.

Female↗
PubMed1989

Polyurethane-coated Dacron mesh tray for temporary mandibular reconstruction following resection of oral cancer: clinical results of 27 cases.

During a 3-year period from 1983 to 1986, a polyurethane-coated Dacron mesh tray (Xomed Inc, Jacksonville, FL) was used in 27 cases for temporary mandibular reconstruction in patients who had undergone jaw resection for oral carcinoma. Delayed mandibular reconstruction using the Dacron mesh tray combined with rib grafts was performed in three cases. The Dacron mesh tray technique provides good functional and esthetic results and offers several advantages when compared with metal trays. The success rate was 74%; intraoral perforation was the main reason for early removal of the tray.

Adult↗
PubMed1991

A-O plate mandibular reconstruction: a complication critique.

Immediate A-O plate mandibular reconstruction was used in 31 patients, following the excision of malignant disease. This five-year retrospective study shows that 48% (15/31) of the patients are living (one with recurrence), with a mean follow-up of 30 months (range nine to 60 months). The mean survival of the deceased patients was 11 months (range two weeks to 46 months). Postoperative complications are evaluated with respect to the mandibular defect, radiation status, dentition, adjuvant onlay bone grafting and T stage. Briefly, 11/31 patients (36%) enjoyed an uneventful recovery, 9/31 (29%) developed a minor wound complication, 6/31 (19%) developed a major wound complication and 5/31 (16%) had significant aspiration. Four plates were removed and an additional three plates were exposed. In general, those patients in whom the condylar head was removed, or in whom the mandibular resection crossed the midline, experienced more wound complications (67% vs. 37%). Simultaneous onlay bone grafting almost doubled the complication rate and this reconstructive technique has been abandoned. No significant contribution to complication rate was made by radiation status, T stage or dentition in our patient population. In addition, four plates have been uneventfully irradiated postoperatively, and five patients have been successfully fit with dentures over their reconstruction plates.

Adult↗
PubMed1995

Long-term evaluation of patients undergoing immediate mandibular reconstruction.

BACKGROUND: Immediate reconstruction following segmental mandibulectomy is an accepted surgical technique. The benefits and patient selection criteria need to be established. PATIENTS AND METHODS: Forty-seven patients who underwent immediate reconstruction of the mandible were followed for up to 14 years. Survival, complication rates, and functional results were analyzed. RESULTS: Median survival was 39 months and actuarial 5-year survival was 40%. Two patients died in the postoperative period, and 9 suffered major reconstruction-related complications. The majority of these complications were related to the use of reconstruction plates, and occurred when the mandibular defect included the arch or when the plates were covered by pectoralis flaps. Half of the patients interviewed were able to eat a regular diet. CONCLUSIONS: Mandibular reconstruction can be performed safely and expeditiously in nearly all patients undergoing segmental mandibulectomy. Functional results and long-term survival will be acceptable in many cases.

Actuarial Analysis↗
PubMed1994

Primary mandibular reconstruction with bridging plates.

25 cases in which the mandible was resected and reconstructed using a reconstruction plate (AO titanium reconstruction system and Leibinger titanium reconstruction system) are presented. 16 patients suffered from oral carcinoma, 7 presented with odontogenic tumours and 2 had chronic osteomyelitis of the mandible. The mean age was 54.2 years, the male to female ratio was 2.6:1. 3 patients had a reconstruction plate for mandibular resection without continuity defect (marginal resection), in all the other patients the reconstruction plate bridged a mandibular resection with a continuity defect: 13 were located in the body, body-angle or ascending ramus with preservation of the mandibular condyle; 4 hemimandibulectomies with disarticulation of the TMJ; and 5 involved the anterior arch, crossing the midline. 12 patients received radiotherapy (3 pre-operatively). Only 3 patients with significant local side effects needed the treatment to be stopped for a period of time. There was no perioperative mortality. Only one plate was removed. Although minor complications were noted in 11 patients, the general improvement in the functional and cosmetic balance of the patients when compared with patients in whom no plate was used, justifies the use of this reconstruction system, in our opinion.

Adolescent↗
PubMed1994

Mandibular reconstruction with the free fibula osteocutaneous flap.

Experience with 17 mandibular reconstructions by the free fibula flap is presented. The main advantages of this reconstruction method include the bicortical structure of the bone and its adaptability to conform to the mandibular contour. The only real disadvantage is the limited height of the bone graft, which does not allow alveolar ridge reconstruction. An implant-borne dental prosthesis can, however, generally be made for functional occlusal rehabilitation.

Adult↗
PubMed1989

Free scapular osteocutaneous flap for mandibular reconstruction.

Seventeen patients, 4 of whom had osteoradionecrosis, underwent mandibular reconstruction with a revascularized scapular osteocutaneous flap. The mean length of revascularized scapular bone used was 10.4 cm. Nine of the 17 flaps healed uneventfully; however, previously irradiated patients had a higher incidence of postoperative complications. There was only 1 flap failure. We found the free revascularized scapular osteocutaneous flap to be reliable and ideal for the reconstruction of large composite defects of the oral cavity.

Adult↗
PubMed1992

Critical analysis of mandibular reconstruction using AO reconstruction plates.

Forty-one cases (37 patients) of mandibular reconstruction using AO plates were reviewed. The patients' ages ranged from 27 to 83 years (mean, 52.3 +/- 18.1 years) and their cases were followed for 6 to 42 months (mean, 12.7 +/- 8.3 months). Cases were grouped by the location of reconstruction: anterior mandible crossing midline as group A (12 cases), body segment of the mandible as group B (16 cases), condyle and ramus of the mandible as group C (13 cases). The incidence of revision as a measure of outcome was calculated by actuarial methods accounting for loss to follow-up or death. Revision or plate removal occurred in 22.2% (9 of 41 cases), with an incidence of 52.2% (6 of 12 cases) in group A, 12.5% (2 of 16 cases) in group B, and 7.7% (1 of 13 cases) in group C. Combined use of an AO plate and bone graft had a revision rate of 33.3% (4 of 12 cases), whereas the reconstructions with only a plate had a revision rate of 17.2% (5 of 29 cases). The difference between the immediate reconstructions (19.2%; 5 of 26 cases) and delayed reconstructions (26.7%; 4 of 15 cases) was not significant, but delayed reconstruction of the anterior mandible resulted in the highest failure rate (57.1%; 4 of 7 cases). The revision incidence was significantly higher when the area had been radiated (33.3% of 24 radiated cases and 5.7% of nonradiated cases required revision). In particular, the radiated group A had a remarkably higher failure rate (63.2% of 10 cases).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

[Mandibular reconstruction by composite musculocutaneous flap in glossopelvimandibular excisions].

Results of 14 mandibular reconstruction by a composite muscular flap of the pectoralis major and trapezium muscles during widespread glossopelvimandibular excisions are described. The technique employed is outlined, emphasis being placed on the need to observe strict precautions during removal and application of the bone component, to avoid accidental avulsion during reconstruction which could compromise the musculoperiosteal vascularization of the graft. Results are sufficiently encouraging for this type of reconstructive surgery to be proposed in all cases where mandibular repair is necessary after interruption of continuity.

Glossectomy↗
PubMed1994

The neurocutaneous free fibula flap in mandibular reconstruction.

Despite the delayed application of the free fibula flap to mandibular reconstruction, its recognition as a reliable, sensate skin paddle combined with enough bone to repair any mandibular defect and offer bicortical fixation of osseointegrated implants has proved the free fibula flap to be a "workhorse" in the repair of composite mandibular defects. The low donor site morbidity slightly eases the wait for the molecular reconstructive "cocktails" from the shelf of the next millennium.

Adult↗
PubMed1992

[Practically: differential indications of mandibular reconstruction in maxillofacial cancerology].

This study, based on the authors' experience, intends to determine the specific indications of mandibular reconstruction after oncological maxillofacial resections. Mandibular defects without osseous interruption do not necessarily need an osseous reconstruction: the esthetic and functional problems can be resolved using dental osseointegrated implants. On the contrary, mandibular defects with osseous interruption need imperatively an osseous and/or composite reconstruction: the best esthetic and functional results are obtained with an immediate reconstruction by an osseous or osteocutaneous free flap, either from the fibula or the iliac crest. The advantages and the disadvantages of all these reconstruction technics are detailed and largely illustrated.

Adult↗
PubMedDate not supplied

Evaluation of a porous, biodegradable biopolymer scaffold for mandibular reconstruction.

PURPOSE: Bioresorbable bone graft substitutes could eliminate disadvantages associated with the use of autografts, allografts, and other synthetic materials. The authors investigated the osteoinductive capacity of a bioresorbable bone graft substitute made from the unsaturated polyester poly(propylene glycol-co-fumaric acid) (PPF) for mandibular reconstruction in a rat model. The eventual intention is to use this material either as a stand-alone bone graft substitute or as an extender to autograft harvested from mandibular reconstruction sites. MATERIALS AND METHODS: The PPF bone graft was crosslinked in the presence of a hydroxyapatite filler and effervescent foaming agents to develop porosity in situ by generating carbon dioxide during the effervescent reaction of citric acid and sodium bicarbonate. The latter reagents are responsible for foam formation and expansion, resulting in a polymeric scaffold with pore sizes in the range of 100 to 500 microm. Twenty adult Sprague-Dawley rats had 3-mm-diameter cortical defects decorticated on the outer aspect of their left mandibular ramus using a Hall drill. Animals were divided into 2 groups of 10 animals each. Animals in group A were treated with implantation of the PPF-based bone graft substitute. Implants were applied buccally to defects on the left side. In group B animals with similar defects, the drill holes were left to heal unaided. The amount of new bone formation and the presence of an inflammatory infiltrate were evaluated at 7 weeks postoperatively. RESULTS: Histologic analysis of the healing process revealed enhanced in vivo new bone formation with the PPF bone graft substitute. These findings were corroborated by the histomorphometric analysis of new bone formation. DISCUSSION: Results of this study demonstrated biocompatibility of the porous PPF-based scaffold in a mandibular defect. CONCLUSIONS: These findings may have applicability to the further development of bone graft substitutes for oral/maxillofacial applications.

Absorbable Implants↗
PubMed1998

Comparative densitometric study of iliac crest and scapula bone in relation to osseous integrated dental implants in microvascular mandibular reconstruction.

The study was designed to compare dimension and density of four frequently used bone donor regions (the iliac crest, the lateral border of the scapula, the radius and the fibula) with regard to placement of endosseous dental implants in microvascular mandibular reconstruction. The first part of the study reports on the results of bone dimension and density findings for iliac crest and scapula bone. Nearly all of the iliac crests had adequate dimensions for the positioning of four 10 mm implants. In 63% of the scapulae, it was possible to place four 10 mm implants. In the case of the scapula, half of the female subjects lacked enough available bone for the insertion of four 10 mm implants because of their inadequate width. Bone density and cortical thickness was found to be similar in the iliac crest and scapula. Age and side do not have an important influence on cortical bone dimensions and density. In contrast to the iliac crest, the lateral margin of the scapula astonishingly showed increasing values for bone density and increasing thickness of the cortex. Analogical advanced biological age works in conformity with the scapula flap. The results could, together with other clinical criteria, contribute to the choice of the best individual alternative in mandibular reconstruction.

Adult↗