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At least 145 records · Page 8Linked to original sources

PubMed2004

Successful free osteocutaneous scapular flap transfer for mandibular reconstruction in a 93-year-old patient.

With the extension of the average life span and the development of surgical technique, anesthesia, and pre- and postoperative management, operations for elderly patients have become more widely accepted. In the field of plastic surgery, free-flap transfers using microvascular techniques have become a common surgical procedure in reconstruction of the head and neck region after surgical removal of a cancer. There have been several reports of free-flap transfer in patients older than 90 years, but the authors know of no reports of free osteocutaneous flap transfer for mandibular reconstruction, which is a very invasive free-flap surgery, for such patients. The mandible plays a significant role in various kinds of dynamic functions, such as mastication, deglutition, and articulation. Disorder of these functions causes a deterioration in the patient's quality of life. The authors have performed a mandibular reconstruction using an osteocutaneous scapular free flap after resection of a gingival cancer invading the mandibular bone in a 93-year-old Japanese woman. In our case, an osteocutaneous scapular free flap, which permits the patient rapid rehabilitation of the lower leg, is thought to be a good choice because it allows the patient to get out of bed as quickly as possible in the postoperative period to minimize additional complications.

Aged↗

PubMedDate not supplied

Revascularized iliac bone graft for mandibular reconstruction.

Revascularized iliac bone has advantages over other revascularized bone grafts for the reconstruction of large mandibular defects. This is a detailed anatomical study of the blood supply to the iliac bone using microfil and Batson injection methods. It confirms and extends Taylor's study. Clinical results are reported for six cases of extensive mandibular defects which were reconstructed using this method.

Aged↗

PubMedDate not supplied

Mandibular reconstruction using a free vascularised osteocutaneous flap from the internal condyle of the femur.

The authors present a preliminary report of a new microsurgical mandibular reconstruction procedure using a segment of the internal condyle of the femur as a free vascularised bone graft. It is possible to harvest a compound flap including a bony segment measuring 8 X 1.5 X 1.5 cm and a cutaneous saphenous flap with its nutrient pedicle arising from the descending genicular artery and vein. This surgical procedure provides a good cortico-cancellous bony segment and a separate skin flap. Dissection of the flap is sometimes difficult due to the inconsistency of its vascular anatomy; the donor site is left with minimal morbidity but, because of weakening of the femur, our patients are instructed not to return to full weight-bearing before the sixth postoperative week. We consider segmental reconstruction of the mandibular body to be one of the best indications for the flap.

Adult↗

PubMed1978

Mandibular reconstruction with free tissue transfers.

During the past ten years, immediate mandibular reconstruction has gradually fallen into disfavor because of the incidence of infection and the increasing use of preoperative radiation therapy. The difficulty lies in selection of the ideal material for mandibular replacement and the attainment of a healthy recipient bed. An attempt has been made to solve this problem with microsurgical techniques, and our experience in six free tissue transfers utilizing both free rib and free osteocutaneous groin flap transfers is reported. The evolution of these techniques has required confirmation of the feasibility of free flaps in the oral cavity as well as incorporation of a vascularized bone graft in free groin flaps. Based on this experience, the free osteocutaneous groin flap containing a vascularized portion of the iliac crest is preferred for reconstruction of combined and composite deficiencies of the lower jaw. Convincing demonstration of bone viability in composite flaps must await correlation of bone scans with tetracycline labelling.

Adult↗

PubMed1995

Mandibular reconstruction with free vascularized fibular flap.

Although various sources of vascularized bone/composite tissue have been used for mandibular reconstruction, the vascularized fibular flap has been reported to have many advantages over the others and to be the most suitable for bridging a long-span mandibular defect. In this paper, positive experience of 14 consecutive cases in which a free vascularized fibular graft with or without a skin paddle has been used to reconstruct a long mandibular defect is reported. Half of the cases were primarily reconstructed, the rest secondarily. The average length of the fibula graft harvested was 16.7 cm, with a range of 12 to 22 cm. The number of wedge osteotomies ranged from 0 to 4, with an average of 1.67. In ten flaps, a peroneal skin paddle was included. The donor wound was typically closed directly, except in three cases, where a skin graft was used. Vein grafts were performed in five cases to lengthen the pedicle. In two cases, the skin partially necrosed. All scintigrams except one showed good bone viability. But there was no total flap failure. Postoperative facial appearances were fair to excellent, with mouth opening ranging from 21 to 50 mm. Although unusual serious donor wound rupture was experienced in one case, in general the donor site complications were minimal.

Adult↗

PubMed2004

Mandibular reconstruction: are two flaps better than one?

This study compared the combined iliac and ulnar forearm flaps with the osteomusculocutaneous fibular free flap for mandibular reconstruction. A retrospective study of 40 patients who had oromandibular reconstruction was performed, of whom 23 patients had a combined iliac crest without skin and ulnar forearm free flap. Seventeen patients had an osteomusculocutaneous free fibular flap. Ten women and 30 men with a mean age of 57.5 years comprised this study population. Ninety percent of the cases were squamous cell carcinoma (55%, T4), of which 11% were recurrent tumors. Anterolateral mandibular defects constituted 52.9% of the fibular reconstructions and 60.9% accounted for the iliac/ulnar reconstructions. The mean bone gaps were 8.79 cm and 8.95 cm respectively. Functional evaluation was based on the University of Washington Questionnaire through phone calls and personal communication. The mean hospital stay was 15.43 days and 10.09 days for the fibular and iliac/ulnar flaps respectively. The facial artery (64.7%) and facial vein (60%) were the main recipient vessels for the fibular reconstructions whereas the external carotid artery (95.6%) and the internal jugular vein (66.7%) were the main recipient vessels for the iliac/ulnar reconstruction. Overall flap survival was 96.8% (100% of fibular flaps and 95.65% of iliac/ulnar flaps). Two flaps were lost in the iliac/ulnar series because of unsalvageable venous thrombosis. Local complications for the iliac/ulnar flaps were 30.4% but were 5.9% for the fibular reconstructions. Function such as speech, swallowing, and chewing were notably better in the fibular than the iliac/ulnar group in 23 of the patients tested. The cosmetic acceptance of 77.8% of the fibular flaps was judged to be excellent and good, whereas 71.4% of the iliac/ulnar flaps were rated good. It appears that within this study population the free osteomusculocutaneous fibular flap had fewer local complications and a higher flap survival rate than the combined iliac/ulnar forearm flaps. Overall functional outcome was also improved. The use of the double flap may be appropriate in massive oromandibular defects, but may be less appropriate in more modest functional reconstructions of mandibular defects.

Adult↗

PubMed2000

Assessment of the viability of microvascularized bone grafts after mandibular reconstruction by means of bone SPET and semiquantitative analysis.

The purpose of this study was to investigate the value of bone scintigraphy including single-photon emission tomography (SPET) and semiquantitative analysis for the assessment of graft viability following microvascularized bone transplantation. We evaluated 60 scintigraphic studies of 36 patients with 39 bone grafts. Thirty-four investigations were performed 6-11 days (early bone scans) and 26 up to 11 months (late bone scans) after mandibular reconstruction. After administration of 550 MBq technetium-99m methylene diphosphonate, planar scintigrams and a SPET study were performed. The data were reconstructed iteratively. Scans were evaluated visually and semiquantitatively by a region of interest technique using the ratio between transplant and cranium (T/C). Patients with uncomplicated healing showed a T/C ratio >1.0 in early and late bone scans. In cases with necrosis, the T/C ratio was below 1.0 when performing early bone scans. However, in late bone scans, some patients with necrosis showed a slightly increased uptake and a T/C ratio >1.0. The data demonstrate that as early as 6-11 days after mandibular reconstruction, increased tracer uptake proves that the surgery has been successful and indicates a normal healing process. Especially in the early bone scans no false-positive or false-negative results were observed and the T/C ratio clearly differentiated between vital and non-vital bone grafts. At later times false-positive findings could be observed; these were, however, rare because of the significantly higher tracer uptake of the healthy grafts when compared with completely or partially necrotic transplants.

Bone Transplantation↗

PubMed1991

The vascularized fibula graft in mandibular reconstruction.

The use of a vascularized graft from the fibula for mandibular reconstruction is presented. The great strength, pliability, and long vascular pedicle that characterize such grafts make them particularly suitable for this type of repair. The results in six cases were highly satisfactory. Masticatory function was well restored, without alteration of the facial contour, and with minimal sequelae at the donor site.

Adult↗

PubMed2001

Modeling a fibula transplant in mandibular reconstructions: evaluation of the effects of a minimal number of osteotomies on the contour of the jaw.

The fibula osteocutaneous free flap has become the preferred method for most cases of mandibular reconstruction after oncologic surgical ablation. To recreate the parabolic form of the mandible, the fibula has to be divided up into segments using a closed wedge osteotomy technique. The number of osteotomies is preferably kept to a minimum so that segmental periosteal circulation is not compromised and also to keep operating time to a minimum. The limited number of osteotomies creates an angular contour. The aim of this study was to establish the degree to which overcorrection or undercorrection would occur when a subtotal reconstruction from ramus to ramus was simulated using five bony segments and four osteotomies. The study was carried out using 30 preserved jaws; the contour lines of the jaws were transferred onto tracing paper using a cardboard template. The contour of the mandible was divided into five sections (ramus, body, symphysis, body, and ramus). Because of the cutting off of the curvature in the original jaw outline, the lateral side of the body will become narrower and the chin broader. This also results in an underprojection (displacement) of the chin. To follow the original contour of the jaw as accurately as possible, all these anomalies must be minimized. The amount of under- and overprojection is calculated for a displacement of 1.0, 1.5, 2.5, 5.0, 7.5, and 10 mm of the chin. The most accurate reconstruction of the mandibular contour is achieved with a displacement of 1.5 or 2.5 mm. To preserve sufficient periosteal circulation, the minimum width of bone segments must be 15 mm or more. This concerns especially the symphysis section. On the basis of a fibula thickness of 14 mm, the internal bone width of the symphysis section is calculated. With a displacement of 1.5 mm, the average internal width of the bone segment is 14.8 mm, with a range of 9.9 to 23.0 mm (95 percent confidence interval, 12.8 to 16.7 mm). Therefore, a displacement of 2.5 mm with an internal bone width of 16.4 mm is preferred (range, 11.9 to 24.8 mm; 95 percent confidence interval, 15.5 to 18.2 mm). The loss of lateral projection is minimal (5.8 mm) and the resulting chin width is acceptable (average, 35.0 mm). In conclusion, we propose that in a subtotal procedure, an acceptable jaw reconstruction can be achieved with a limited number of osteotomies. The bone length of the symphysis section remains within safe limits. If the defect is of limited dimensions, then the resulting jaw contour is even more accurate.

Anthropometry↗

PubMed1994

Mandibular reconstruction using computer-generated three-dimensional solid models.

In mandibular reconstruction, it is necessary to know the exact, three-dimensional extent of the mandible and its defect; the bone graft must be the exact size and dimension of the defect, to assure a precise three-dimensional configuration of the mandible. Previously, the bone graft had to be reshaped during the operation by trial and error, often a time-consuming procedure. The operative procedure has been simulated in advance using three-dimensional, solid models, which has shortened the operating time required.

Bone Transplantation↗

PubMed1985

Delayed mandibular reconstruction following removal of a mesenchymal chondrosarcoma. Report of a case.

An unusual case of mesenchymal chondrosarcoma is presented. Initially seen when the patient was 8 years old, the lesion was repeatedly biopsied and curetted with a diagnosis of odontogenic fibroma. In 1971 a diagnosis of osteosarcoma of the chondroblastic type was made. At that time, the patient underwent a partial mandibulectomy with immediate graft. The patient did well until 1981, when a recurrence of the lesion was noted. The microscopic diagnosis at this time was mesenchymal chondrosarcoma. The treatment of this lesion as a staged procedure with initial resection of the mandible and placement of a silicone rubber mandibular prosthesis is discussed. The second stage of the procedure was definitive mandibular reconstruction, with an allogeneic mandible as a crib for autologous particulate cancellous bone from the iliac crest. Although the prognosis of mesenchymal chondrosarcoma is usually grave, this case is unusual because of its long history of multiple procedures performed prior to the definitive treatment of the lesion 14 years after its discovery. Two-year follow-up since the definitive mandibular reconstruction shows adequate range of motion, excellent healing, and no recurrence.

Bone Transplantation↗

PubMed1998

[Mandibular reconstruction of gunshot wounds by progressive bone distraction. Report of five cases].

Five adult patients with gunshot wound defect underwent bilateral mandibular lengthening by an extraoral device. All patients presented with interrupting mandibular defect of 50 to 100 mm. Distraction of bone fragments led to mandibular reconstruction without bone grafting and simultaneous expansion of soft tissues, avoiding free or pedicled myocutaneous flaps for soft tissue reconstruction of the lower third of the face. Mandibular distraction also recreated the alveolar ridge with its attached mucosa which is equivalent to the gingiva. It can be used for dental rehabilitation by osseointegrated implants. Avoiding the morbidity and functional problems of classical flaps, mandibular distraction accelerates facial reconstruction, and social reinsertion of these patients.

Adult↗

PubMed2001

Sliding osteotomies in mandibular reconstruction.

The aim of this article is to describe a few simple and atraumatic methods for mandibular reconstruction following the ablation of tumors or traumas. These reconstruction techniques are indicated for rebuilding short mandibular defects (less than 4 cm) or for patients in poor general condition with larger defects that cannot be remedied using longer and more complicated procedures. Five types of osteotomies were used: "C," single, double, bilateral sliding, and sagittal sliding. Osteotomies were performed on 14 patients, 13 with malignant tumors and one with a gunshot wound. Good results were obtained in 10 patients, total failure occurred in two, and complications without failure of the reconstruction arose in the other two.

Adult↗

PubMed2007

Fracture of titanium plates used for mandibular reconstruction following ablative tumor surgery.

PURPOSE: The purpose of this study was to identify reasons for fracture of titanium mandibular reconstruction plates, when used to bridge lateral mandibular defects after ablative tumor surgery. MATERIALS AND METHODS: Sixteen titanium reconstruction plates from sheep mandibles were examined to identify reasons for the plate fractures. The broken plates and the seemingly unbroken plates were examined separately. The plates were removed from the mandibular bone and inspected by dye penetrant examination, metallography, optical microscope, scanning electron microscope, and energy dispersive X-ray spectrometer. Furthermore, axial load fatigue tests were performed in two different environments, air and physiologic salt solution, 0.9% NaCl, to compare titanium behavior in air and the human body. RESULTS: The site of crack initiation was the inner curvature of the reconstruction plate, and the cracks initiated as a result of stress concentration in the shoulder fillet of the plate. The cracks grew in a cyclic manner under masticatory loading of the mandible and the plate. The plate fracture occurred by means of fatigue. The corrosive environment did not affect the failure of the titanium plate, and the fracture was not caused by hydrogen embrittlement. The results revealed that the fatigue properties of the plates may have been impaired by the residual stresses generated in plate bending. CONCLUSIONS: Adjustive bending of the plates, in the surgical operation, may thus be an important cause of fracture of the reconstruction plates, because of generated residual stresses, which affect the mean stress in fatigue loading. To make the plates function without failure the plates should match closely with the three-dimensional shape of the mandible, to avoid any bending in the operative phase.

Animals↗

PubMed1998

Mandibular reconstruction with transforming growth factor-beta1.

HYPOTHESIS: Transforming growth factor-beta1 (TGF-beta1) plus demineralized bone matrix (DBM) will reconstruct a critical mandibular defect devoid of periosteum in a canine model. STUDY DESIGN: Randomized, blinded, placebo-controlled, prospective animal pilot study. METHODS: Canine critical mandibular defects devoid of periosteum were reconstructed with DBM (group 1, n = 3) and DBM plus TGF-beta1 (250 microg TGF-beta1/g DBM) (group 2, n = 3). Radiologic, histologic, and biomechanical testing was performed on the test group and control group specimens at 12 weeks after implantation. RESULTS: A palpable bone bridge was present in the group 2 subjects 5 to 6 weeks after implantation and was never present in the group 1 subjects. Radiologic and histologic examination at the time of harvest (12 weeks after implantation) demonstrated a solid bone bridge in the group 2 subjects and a fibrous union in the group 1 subjects. Group 2 specimens demonstrated failure in four-point bending testing at an average maximum moment of 9.9 +/- 2.2 N-m. This value was 9.4% of the maximum moment of the contralateral nonoperated side. Group 1 specimens were palpably flexible on plate removal and had a biomechanical strength of 0. The difference in strength between group 1 and group 2 was statistically significant (P < 0.02), supporting the hypothesis that the addition of TGF-beta1 to the DBM carrier resulted in the formation of significantly stronger bone in the critical gap. CONCLUSION: The addition of TGF-beta1 to DBM results in healing of a critical bone defect devoid of periosteum in a higher mammalian model.

Animals↗

PubMed1994

Fibula free flap mandibular reconstruction.

The fibula free flap is rapidly becoming the donor site of choice for mandibular reconstruction. Its versatility makes it suitable for the majority of composite mandibular defects. The indications, operative techniques, and postoperative considerations are detailed in this article. Important principles of preoperative preparation, flap design, graft shaping, and bone fixation are included.

Fibula↗

PubMed1985

Mandibular reconstruction in the radiated patient: the role of osteocutaneous free tissue transfers.

This paper discusses our experience with the second metatarsal and iliac crest osteocutaneous transfers for mandibular reconstruction. The prime indication for this type of reconstruction was for anterior mandibular defects when the patient had been previously resected. Midbody to midbody defects were reconstructed with the metatarsal and larger defects with the iliac crest. In most cases, an osteotomy was done to create a mental angle. The evaluation of speech, oral continence, and swallowing revealed good results in all patients unless lip or tongue resection compromised function. Facial contour was excellent in metatarsal reconstructions. The iliac crest cutaneous flap provided a generous supply of skin for both intraoral reconstruction and external skin coverage but tended to be bulky, particularly when used in the submental area. Thirty three of 36 flaps survived completely. Flap losses were due to anastomosis thrombosis (1), pedicle compression (1), and pedicle destruction during exploration for suspected carotid blowout (1). Ninety three percent of bone junctions developed a solid bony union despite the mandible having had a full therapeutic dose of preoperative radiation. Despite wound infections in 8 patients, and intraoral dehiscence with bone exposure in 12 patients, all but one of these transfers went on to good bony union without infection in the bone graft.

Adolescent↗

PubMed1987

Mandibular reconstruction using AO plates.

The AO plate represents an acceptable reconstructive choice for mandibular defects, with an 86.7 percent success rate demonstrated in this series. Because this method utilizes an alloplast which is precisely and quickly applied, virtually all patients requiring mandibular resection can be considered candidates for reconstruction. Adequate vascularized soft tissue coverage is essential to prevent plate extrusion and fistula formation. This is even more important for radiated patients. The pectoralis major myocutaneous flap provides muscle and skin for large anterior defects. Frequently, lateral defects can be closed primarily without using regional flaps. We suggest bone reconstruction to avoid potential plate fracture and to allow placement of functional dentures. Resections in elderly patients and for palliation will result in ideal cosmetic and functional results with the plate alone. If we exclude the four patients reconstructed with calcium hydroxyapatite and the AO plate, the morbidity rate is quite acceptable. With this group excluded, only four fistulas and eight plate exposures occurred. Only four plate removals were required to achieve wound closure. Evaluation of the titanium plate is in progress. It is hoped that better osseous and soft tissue integration will help to decrease wound complications. A large prospective review of postoperative radiotherapy patients using the new titanium plate has been designed to address this issue. The therapeutic choice between the AO plate and free vascularized bone graft reconstruction remains. The decision process is dependent on the technical skills of the surgeon, the treatment plan, the survival characteristics of the tumor, and the physiologic condition of the patient.

Bone Plates↗