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At least 19 recordsLinked to original sources
PubMed1995

Occipitoparietal bone flap for mandibular reconstruction.

Mandibular reconstruction may prove to be a difficult problem. The use of vascularized bone flaps for mandibular reconstruction has shown better results than bone grafts because they offer solid bone union together with rapid recovery of form and function. The occipital vessels, from the external carotid artery and the jugular vein up to their site of emergence in the occipital fascia, have proved easy to dissect at the neck after section of sternocleidomastoid and splenius capitis longus and brevis muscles. We were able to obtain a long pedicle to move the fascia to distant sites with or without bone. Reconstruction was achieved with a full-thickness occipitoparietal bone flap, pedicled at the occipital vessels, released up to the external carotid artery to yield a long pedicle. We used this technique in four patients (age range, 8-14 years). We used vascular cranial bone for mandibular reconstruction. The cases included three resections for benign tumors (two fibromyxoma and relapsing aneurysmal bone cyst) and one hemifacial microsomia. No complications occurred. We describe some advantages with this procedure. A larger number of cases will allow us to draw further conclusions.

Adolescent↗
PubMed1982

Titanium tray mandibular reconstruction.

Mandibular reconstructions still present a difficult and challenging problem. Failures experienced in using rib or iliac bone grafts stimulated clinical and research activities in evaluating the following new techniques: composite myocutaneous bone flaps, bone transplants with microvascular anastomoses, and freeze-dried homografts. This article describes the usefulness of the titanium tray with or without cancellous iliac bone grafts for mandibular reconstruction. The series presented herein includes 12 patients who underwent mandibular reconstruction after trauma or ablative cancer surgery, No immediate or delayed extrusion of the titanium tray was observed with follow-up as long as eight years after surgery. Advantages and disadvantages of this technique will be discussed.

Bone Transplantation↗
PubMed1988

An approach to mandibular reconstruction.

Mandibular reconstruction requires the restitution of both form and function. Proper preoperative planning, vascularized bone grafts, rigid fixation, flexibility of donor site choices, and restoration of labial, buccal, and lingual sulci lead to optimal reconstruction. We have used this approach in 38 patients; bony survival resulted in 37 and primary union in 35. A main limiting factor exists with individuals who have lost extensive amounts of soft tissue and muscle at the time of tumor resection or trauma. Only by attention to details in the preoperative, intraoperative, and postoperative phases can the best functional and aesthetic results be achieved.

Adult↗
PubMed2001

Microvascularized fibular graft for mandibular reconstruction: detection of viability by bone scintigraphy and SPECT.

Bone allografts are often used in reconstructive mandibular surgery, generally after extensive oncologic resection, post-traumatic pseudoarthrosis, or osteomyelitis. Vascularized fibular bone grafts have advantages compared with other bone grafts in the restoration of the contour and function of defective mandibles. Bone scintigraphy is often used to assess bone revascularization, because positive uptake of Tc-99m hydroxy methylene diphosphonate (HDP) reflects patent anastomoses and viability of the grafted bone. Mandibular reconstruction with a free fibular flap was performed in 11 patients. Bone scintigraphy and SPECT were applied in the follow-up of eight patients. The grafts were assessed semi-quantitatively using a six-grade scoring system based on a comparison of tracer uptake in the graft and in the calvarium. Complications were observed in one graft. Planar scintigrams showed a tracer uptake greater than grade 5 in grafts with an uncomplicated course. SPECT was performed in addition to planar imaging in two patients who had greater graft uptake. A lack of tracer uptake was observed in the failed graft. Bone scintigraphy performed within the first week after the mandibular reconstruction is a useful tool to monitor the viability and early complications of microvascularized fibular grafts and plays an important role in the decision-making process during repeated surgical exploration. SPECT is more sensitive than planar imaging for assessing graft viability.

Adult↗
PubMed1993

Reconstruction of mandibular discontinuity defects using autogenous grafting and a mandibular reconstruction plate: a prospective evaluation of nine consecutive cases.

This article presents the clinical results of a prospective evaluation of nine cases of mandibular discontinuity that were reconstructed using autogenous grafting and a reconstruction plate. All patients were allowed to function immediately postsurgery. Acceptable esthetic and functional results were obtained with minimal donor and recipient site complications. All cases showed complete graft incorporation and restoration of osseous continuity.

Adolescent↗
PubMed2003

Reconstruction of segmental mandibular defects by distraction osteogenesis for mandibular reconstruction.

BACKGROUND: Distraction osteogenesis is an established technique for the lengthening of long bones and correction of selected craniofacial deformities. Regenerate osteoid bone matrix formed during the distraction phase is malleable and can recreate the three-dimensional form of native bones. Animal experiments and early clinical experience have confirmed that distraction osteogenesis can be used for the reconstruction of segmental bony defects. Herein we discuss the principles of distraction osteogenesis in reference to reconstruction of segmental bony defects and report its clinical application of the mandible continuity defects. PATIENTS AND METHODS: Four patients (age, 7-83 years) with critical segmental mandibular defects (range, 3.5 cm-6.5 cm), resulting from ablative oncologic head and neck surgery underwent primary mandibular reconstruction by transport distraction osteogenesis. Two defects were at the angle and body region, one at the body, and the other at the parasymphysis and body region. Synthes Titanium Multi-vector and Leibinger Multi-guide distractors in bifocal (n = 2) and trifocal (n = 2) architecture were used after the stabilization of the segmental continuity defect using a defect-bridging mandibular reconstruction plate. Osteodistraction was carried out at a rate of 1 mm per day, with once or twice a day rhythm, after a 1-week latency period. The consolidation period was equal to the period of distraction. RESULTS: All patients tolerated the distraction procedure. Satisfactory bone formation was observed in two patients, and partial bone formation was seen in one patient. Treatment failure was encountered in one patient who had a second oral cavity primary tumor observed during the consolidation period, requiring interruption of the treatment sequence. CONCLUSIONS: Mandibular reconstruction with distraction osteogenesis is a potentially useful technique in selected patients with segmental mandibular continuity defects after ablative head and neck cancer surgery.

Aged↗
PubMed1994

Mandibular reconstruction with osseointegrated implants into the free vascularized radius.

Complete oral rehabilitation after oromandibular resection is a goal that is frequently difficult to attain. Poor speech, inability to eat a solid diet, and cosmetic deformity are all potential problems. The introduction of osseointegrated implants and free vascularized bone grafting are two techniques that have permitted improved results of oromandibular reconstruction. When used together they provide the best possibility for providing oral continence, a stable denture, and minimal cosmetic deformity. The free vascularized iliac crest has been used widely to reconstruct mandibular defects with the placement of enosseus implants. However, the radius provides a good alternative to reconstruct the mandible. We report four cases of mandibular reconstruction with the use of the free vascularized radius with subsequent placement of osseointegrated implants. The results of these cases suggest that enosseus implants can be used successfully in the radius. The radius is ideal to reconstruct small to moderate-sized defects of the lateral mandible with loss of oral mucosa.

Adult↗
PubMed2004

[Vascularized osseous flaps for mandibular reconstruction after osteoradionecrosis].

INTRODUCTION: The reconstruction of mandibular continuity destroyed by osteoradionecrosis can be a difficult task. The aim of this study was to evaluate the reliability and contribution of vascular osseous flaps for mandibular reconstruction after osteoradionecrosis. MATERIAL AND METHOD: A retrospective study of patients undergoing mandibular reconstruction after osteoradionecrosis between 1989 and 2002 was performed. Twenty-five mandibular reconstructions were performed in 23 patients: 16 fibular free flaps, 5 osteomuscular serrato-costal free flaps, 1 osteocutaneous external brachial free flap, 1 medial femoral condylar free flap and 2 armed pectoralis major pediculed flaps. RESULTS: We observed two major complications (8%): loss of one fibular flap and one medial femoral condylar free flap. We observed 42% minor complications. Overall quality of life was constantly enhanced. DISCUSSION: Fibular flap is definitely a good method for immediate or secondary mandibular reconstruction. A serratocostal flap must be considered as an alternative flap when the fibular flap is unavailable.

Adult↗
PubMed1987

Use of the AO mandibular reconstruction plate for bridging of mandibular defects.

The authors believe that the AO mandibular reconstruction plate provides unique advantages for the reconstruction of mandibular defects. It provides for rigid fixation of the bones and the maintenance of occlusion and contour without the use of intermaxillary fixation or external fixation. The technique adds little time to the procedure, and the expertise needed to apply the technique can be quickly acquired by most surgeons. Although better techniques are being developed and perfected, the mandibular reconstruction plate should be considered for any patients for whom more complex techniques seem inappropriate and for whom reconstruction would otherwise not be considered.

Bone Plates↗
PubMed2004

Mandibular reconstruction with frozen autologous mandibular bone and radial periosteal fasciocutaneous free flap: preliminary report.

The authors present a new method of mandibular reconstruction with frozen autologous mandibular bone. Vascular supply to the neomandible is ensured by the periosteal layer of a microvascular radial periosteal fasciocutaneous free flap, placed so as to envelop the bone and cover the surgical defect. The use of the periosteal layer of the radius to provide new blood vessels to the frozen mandible is an original technical feature that we describe. We describe 2 cases of oral carcinoma involving the mandible, treated with mandibular resection and reconstruction. This technique allows good functional and aesthetic results, avoiding more serious complications related to the use of composite free flaps harvested from distant anatomic donor sites.

Aged↗
PubMedDate not supplied

The current status of mandibular reconstruction using autogenous frozen mandibular grafts.

A review of recent developments in experimental canine surgery using autogenous frozen grafts for mandibular reconstruction has elicited enthusiasm for their human application in cancer surgery. They do reossify, even under adverse conditions of perioperative irradiation, to regenerate a mandibular graft in the dog. Our experience with six patients who underwent immediate autogenous mandibular graft reconstruction is dismal. All failed because of intraoral complications; none evidenced recurrence of tumor in bone. A delayed procedure, in which revascularization of the midportion of the bone graft may be improved, may prevent many of these problems.

Animals↗
PubMed1997

Three different techniques for mandibular reconstruction after hemimandibulectomy.

Mandibular reconstruction is a condition in which both bone defect and function must be restored. A wide range of approaches--from grafts to distant bone flaps--have been used for correcting bony defects. However, adequate mastication has been restored in only a few cases. In this article the results of three different techniques for mandibular reconstruction after hemimandibulectomy were studied. Sixteen patients underwent a second mandibular reconstruction after hemimandibulectomy and were monitored at least 1 year. Three different techniques were used: (1) full-thickness galeoparietal bone flap (eight patients), (2) free iliac crest graft (three patients), and (3) free fibular grafts (five patients). Occlusion on the nonoperated side and the possibility and function of osseointegrated denture in the vascularized bone transfer were evaluated. The full-thickness galeoparietal flap and free iliac crest bone flap appeared to be good options. However, only acceptable or poor occlusion could be achieved on the normal side. The fibular free flap demonstrated good results and good occlusion. Nonetheless, dental implantation was difficult because a prosthesis for reaching the normal height of the mandible was necessary.

Adolescent↗
PubMed1993

A-O reconstruction plate and sternal osteomyocutaneous flap in primary mandibular reconstruction.

Mandibular arch reconstruction remains a functional and aesthetic challenge for the head and neck surgeon. The recent popularity of vascularized free composite flaps has made them a first choice for many surgeons. However, the increased operating time, high failure rate, frequent need for operative rescue, specialized postoperative care and facilities, and specialized training required to perform them have prompted many extirpative surgeons to attempt other techniques or to leave the mandible unreconstructed. Six sternal osteomyocutaneous flaps, a variant of the familiar pectoralis major myocutaneous flap, were utilized to reconstruct mandibular defects of up to 10 cm in patients undergoing composite resection for cancer, with or without preoperative radiotherapy. The use of the A-O reconstructive plate to secure the bony portion of the flap to the unresected mandible has considerably simplified and speeded the procedure over external fixation as originally described. When both soft tissue and bone are required to rehabilitate the operative defect, the sternal osteomyocutaneous flap has proven to be a reliable and time-effective procedure.

Adult↗
PubMed2002

Long-term functional outcome of mandibular reconstruction with stainless steel AO reconstruction plates.

Mandibular continuity defects are usually reconstructed with bone grafts. However, factors associated with the tumour and the patient can still be reasons to choose reconstruction plates. The aim of this study was to find out the results of mandibular reconstructions with stainless steel AO reconstruction plates after a long follow-up period. The records of 36 patients were reviewed for personal data and the history of disease, treatment and complications. Patients with failed reconstructions were compared with those in whom the procedure had been successful. Patients and surgeons gave their opinion on the functional and cosmetic results. The mean follow-up was 39 months (range 4-99); 4 patients were withdrawn because they developed early recurrent disease and in 17 patients the reconstruction failed. We found no significant differences between the successful and the failed group. Fourteen patients could be evaluated for functional outcome, 10 of whom were totally or satisfactorily rehabilitated. Therefore, stainless steel reconstruction plates can be used in patients when other options are inappropriate.

Adult↗
PubMed1989

Primary placement of osseointegrated implants in microvascular mandibular reconstruction.

The goal of mandibular reconstruction is to rehabilitate the patient by restoring occlusal relationships, lower facial contour, oral continence, and a denture-bearing surface. One of the major advantages of the use of vascularized bone over all other methods of mandibular reconstruction is its ability to achieve dental rehabilitation rapidly. The use of osseointegrated dental implants is a valuable adjunct in oral rehabilitation. It provides the most rigid form of stabilization to withstand the forces of mastication. In situations in which soft tissue reconstruction or the height of the alveolar ridge is not sufficient for a tissue-borne denture, implants offer the most suitable alternative. Mandibular reconstruction with free tissue transfer techniques is ideally suited for the placement of implants. These can be inserted at the time of mandibular reconstruction. Four months after surgery, when the integration process has occurred, the implants are unroofed, loaded, and ready for prosthetic placement. We will present several representative patients who underwent mandibular reconstruction with microvascular free bone transfer who have been successfully rehabilitated by osseointegrated implants. The process of osseointegration, different types of dental implants, and issues regarding radiation and implants are discussed. This is the first report of dental rehabilitation by primary placement of dental implants in patients undergoing microvascular mandibular reconstruction.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed2000

[Long-term complications of radiotherapy after mandibular reconstruction with vascularized bnoe graft].

INTRODUCTION: The use of vascularised composite free flaps (VCFF) has become a widely accepted method for primary reconstruction of mandibular defects. Adjuvant or neo-adjuvant radiotherapy (RTH) increases susceptibility to trauma and infections. The aim of this study is to compare the incidence of local complications after mandibular reconstruction with vascularised composite free flaps, related to pre- or postoperative radiotherapy. The effects of these complications on functional rehabilitation with a dental prosthesis fixed on bone implants are also studied. METHODS: Between 1990 and 1999, 49 vascularised composite free flaps were used for mandibular reconstructions (41 iliac crest flaps and 8 fibula flaps). 31 patients (63%) underwent preoperative (8) or postoperative (23) radiotherapy. Short (6-12 months) and long-term (over 12 months) outcomes are analysed separately. The incidence of complications depending on the timing of radiotherapy (neo vs adjuvant) was compared. RESULTS: In the first 12 months the complication rates among the irradiated and non-irradiated patients were 26 and 11% respectively. During short-term evaluation complications were seen in 26% of the irradiated patients and 11% of the non-irradiated group. After 12 months the rate of complications rises to 45% for the irradiated and 18% for the non-irradiated patients. 27% of irradiated patients presented with fistula, 27% with exposed metallic plates and 9% developed osteoradionecrosis of the graft. Dental implants were inserted in 29 grafts, among which 9 had secondary radiotherapy. 90% of the non-irradiated patients and 56% of the irradiated patients chewed with the dental prosthesis fixed on bone implants. DISCUSSION: Regardless of pre- or postoperative timing, radiotherapy clearly augments complications, the incidence of which increases with time. Only in one patient did osteoradionecrosis necessitate removal of the dental prostheses. Inability to chew is linked more to the amount of resection of the mobile tongue than to complications of radiotherapy. We therefore recommend systematically placing dental implants during the initial surgery, unless large soft tissue resection preventing adequate swallowing is required.

Anastomosis, Surgical↗
PubMed2004

Comparison of miniplates and reconstruction plates in mandibular reconstruction.

BACKGROUND: The aim of this study is to compare complication rates of miniplates versus reconstruction plates in the fixation of vascularized grafts into segmental mandibular defects. METHODS: Retrospective analysis of 143 consecutive successful microvascular composite flaps performed between 1993 and 2001 was performed. Data were gathered from a computerized database, case notes and pathology reports. Complications were classified as dehiscence, infection, plate or bone removal. RESULTS: In the series, 49% of patients received miniplates, and 51% received plates. No significant differences in complication rates were found between those grafts fixed with miniplates (27%) and those with reconstruction plates (30%). Plate choice was primarily determined by consultant preference. No significant differences were found in patient, defect, treatment, or follow-up characteristics between the plate groups. Twenty-nine percent of patients had at least one late complication at the reconstructed site, and this was higher (39%) in those who had postoperative radiotherapy. CONCLUSIONS: No evidence was found in this study that the increased rigidity offered by reconstruction plates influences the rate of plate or bone removal, infection, or plate exposure. Thus, the decision to use reconstruction or miniplates is not dependent on the rate of plate complications.

Adult↗