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Tamaki A, Sethuraman S, Shi L, Zhao S, Carver KC, Hatef A, Luttrull M, Seim NB, Kang SY, Ozer E, Agrawal A, Old MO. Bone Union of Osseous Microvascular Free Tissue Transfer in Mandibular Reconstruction. OTO Open 2022; 6:2473974X211070258. [PMID: 35047718 PMCID: PMC8761882 DOI: 10.1177/2473974x211070258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/13/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives Osseous microvascular free tissue transfer (MFTT) is the gold standard for reconstruction for most segmental mandibulectomy defects. The most common osseous MFTT utilized in reconstruction is the fibular, scapular, and osteocutaneous radial forearm (OCRF) free flap. We evaluated postoperative bone union as well as clinical complications following MFTT and the impact of various patient and reconstructive characteristics, including type of osseous MFTT. Study Design Retrospective cohort study. Setting Tertiary care academic hospital. Methods This study examined patients who underwent osseous MFTT for mandibular defects from January 2017 to January 2019. Results An overall 144 osteotomies in 58 patients were evaluated. Of the 144 junctions, 28 (19.4%) showed radiographic nonunion. Patients who underwent preoperative (odds ratio [OR] = 0.30, P = .027) and postoperative (OR = 0.28, P = .003) radiation had a significantly lower bone union score. Time from surgery to postoperative imaging was associated with higher bone union scores (OR = 1.07, P = .024). When bone union scores were compared among types of MFTT, fibular (OR = 5.62, P = .008) and scapular (OR = 4.69, P = .043) MFTT had significantly higher scores than OCRF MFTT. Twelve (20.7%) patients had postoperative complications. There was no statistically significant correlation between clinical complications and various variables, including type of osseous MFTT. Conclusion Pre- and postoperative radiation and time from surgery have an impact on bone union. Regarding the type of MFTT, fibular and scapular MFTT appeared to have higher bone union when compared with OCRF. There was no impact of bone union or type of osseous MFTT on clinical complications.
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Affiliation(s)
- Akina Tamaki
- Department of Otolaryngology–Head and Neck Surgery, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Akina Tamaki, MD, Department of Otolaryngology–Head and Neck Surgery, Case Western Reserve University, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH 44106, USA.
| | - Shruthi Sethuraman
- Department of Otolaryngology–Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Lucy Shi
- Department of Otolaryngology–Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Songzhu Zhao
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA
| | - Keith C. Carver
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Angel Hatef
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michael Luttrull
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Nolan B. Seim
- Department of Otolaryngology–Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Stephen Y. Kang
- Department of Otolaryngology–Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Enver Ozer
- Department of Otolaryngology–Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Amit Agrawal
- Department of Otolaryngology–Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Matthew O. Old
- Department of Otolaryngology–Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Gaur V, Doshi AG, Palka LR. Mandibular reconstruction using single piece zygomatic implant in conjunction with a reinforcing Fibular Graft Union: A case report. Int J Surg Case Rep 2020; 73:347-354. [PMID: 32745726 PMCID: PMC7398898 DOI: 10.1016/j.ijscr.2020.07.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 11/29/2022] Open
Abstract
Presenting to our knowledge, for the first time in literature, a case report on the long term follow-up of an implant retained fixed prosthesis on free fibular reconstruction with a single piece zygomatic implant and single piece bicortical implant via a flapless approach and immediate functional rehabilitation. The technique involved the concept of "Remote Bone Anchorage" in conjunction with the union of grafted free fibula flap with the native mandible. It was facilitated with a single piece zygomatic implant engaged in the mandible and splinted with single piece implants on the grafted fibula as needed for prosthetic functional reconstruction. The author has reported a unique concept of immediate functional rehabilitation in the fibular graft therefore providing additional splinting of the vascularized free fibula to the mandible by splinting them with single piece zygomatic cortical implant.
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Affiliation(s)
- Vivek Gaur
- Jaipur Dental College, Maharaj Vinayak Global University, Jaipur, India.
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A 20-year experience of immediate mandibular reconstruction using free fibula osteocutaneous flaps following ameloblastoma resection: Radical resection, outcomes, and recurrence. Arch Plast Surg 2019; 46:426-432. [PMID: 31550747 PMCID: PMC6759441 DOI: 10.5999/aps.2018.01487] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 08/23/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The mandible is an important structure that is located in the lower third of the face. Large mandibular defects after tumor resection cause loss of its function. This study assessed the outcomes and tumor recurrence after immediate mandibular reconstruction using a free fibula osteocutaneous flap following radical resection of ameloblastoma. METHODS This is a retrospective non-randomized study of outcomes and tumor recurrence of all patients diagnosed with mandibular ameloblastoma from August 1997 until August 2017 (20 years) requiring free fibula osteocutaneous flap reconstruction at a single institution. The patients were identified through an electronic operative database; subsequently, their medical records and photo documentation were retrieved. RESULTS Twenty-seven patients were included in this study. Eighteen patients were male, while nine were female. The majority of the patients (48.1%) were in their third decade of life when they were diagnosed with ameloblastoma. All of them underwent radical resection of the tumor with a surgical margin of 2 cm (hemimandibulectomy in cases with a large tumor) and immediate mandibular reconstruction with a free fibula osteocutaneous flap. Two patients required revision of a vascular anastomosis due to venous thrombosis postoperatively, while one patient developed a flap recipient site infection. The flap success rate was 100%. There was no tumor recurrence during a mean follow-up period of 5.6 years. CONCLUSIONS Mandibular ameloblastoma should be treated with segmental mandibulectomy (with a surgical margin of 2 cm) to reduce the risk of recurrence. Subsequent mandibular and adjacent soft tissue defects should be reconstructed immediately with a free fibula osteocutaneous flap.
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Shokri T, Stahl LE, Kanekar SG, Goyal N. Osseous Changes Over Time in Free Fibular Flap Reconstruction. Laryngoscope 2018; 129:1113-1116. [PMID: 30284247 DOI: 10.1002/lary.27337] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/04/2018] [Accepted: 05/11/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Evaluate bone resorption in free fibular grafts and document resorption behavior as compared to dentulous and edentulous autochthonous mandibular bone. STUDY DESIGN Retrospective Chart review. METHODS Postoperative computed tomography images were used to evaluate fibular graft resorption rates and corresponding sites of the dentulous or edentulous mandible. Bone height, width, and cortical thickness were measured. RESULTS Eighteen patients underwent fibula free flap reconstruction following resection of a primary head and neck cancer. Mandibular defects were classified using Jewer's classification. The average interval loss of osseous height was 0.23 ± 0.09 mm/yr for fibula flap, 0.55 ± 0.13 mm/yr for dentulous native mandible, and 0.98 ± 0.41 mm/yr in edentulous native mandible. Change in osseous width was 0.19 ± 0.08 mm/yr, 0.55 ± 0.33 mm/yr, and 0.73 ± 0.15 mm/yr, respectively. Rate of superior cortical resorption was 0.33 ± 0.34 mm/yr, 0.35 ± 0.13 mm/yr, and 0.53 ± 0.11 mm/yr in fibula flap, dentulous, and edentulous mandible, respectively. Inferior cortical resorption rates were quantified as 0.30 ± 0.11 mm/yr, 0.35 ± 0.08 mm/yr, and 0.51 ± 0.08 mm/yr. CONCLUSIONS Fibula free flap reconstruction of the mandible provides excellent functional results and allows for stable outcomes. Bone resorption is significantly lower in fibular graft compared with both edentulous and dentulous mandible. Edentulous bone displays significantly increased rates of atrophy in comparison to the dentulous mandible. This may have implications with regard to long-term viability of both the fibular flap and native mandible. The role of dental restoration on overall osseous stability warrants further research. LEVEL OF EVIDENCE 4 Laryngoscope, 129:1113-1116, 2019.
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Affiliation(s)
- Tom Shokri
- Department of Surgery, Division of Otolaryngology Head and Neck Surgery, Hershey, Pennsylvania, U.S.A
| | - Lauren E Stahl
- Department of Surgery, Division of Otolaryngology Head and Neck Surgery, Hershey, Pennsylvania, U.S.A
| | - Sangam G Kanekar
- Department of Radiology, Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, U.S.A
| | - Neerav Goyal
- Department of Surgery, Division of Otolaryngology Head and Neck Surgery, Hershey, Pennsylvania, U.S.A
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Petrovic I, Rosen EB, Matros E, Huryn JM, Shah JP. Oral rehabilitation of the cancer patient: A formidable challenge. J Surg Oncol 2018; 117:1729-1735. [PMID: 29723421 PMCID: PMC6135661 DOI: 10.1002/jso.25075] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 03/28/2018] [Indexed: 02/03/2023]
Abstract
Rehabilitation of oral functions following surgery on the jaws is a goal that is often difficult to achieve. Removable dentures supported by remaining teeth or gum are often unstable and seldom satisfactory. On the other hand, endosseous (dental) implants offer a mechanism to provide stability to the dentures. This review, discusses factors related to the tumor, patient, treatment, and physicians which impact upon the feasibility and success of dental implants in patients with oral cancer.
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Affiliation(s)
- Ivana Petrovic
- Straumann Maxillofacial Dental Implantology Research Fellow, Dental Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Evan B Rosen
- Dental Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Evan Matros
- Plastic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joseph M Huryn
- Dental Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jatin P Shah
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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van Gemert JTM, Abbink JH, van Es RJJ, Rosenberg AJWP, Koole R, Van Cann EM. Early and late complications in the reconstructed mandible with free fibula flaps. J Surg Oncol 2018; 117:773-780. [PMID: 29448299 PMCID: PMC5901040 DOI: 10.1002/jso.24976] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 12/13/2017] [Indexed: 11/11/2022]
Abstract
Background and Objectives Evaluation of mandibular reconstructions with free fibula flaps. Identification of factors associated with major recipient site complications, that is, necessitating surgical intervention under general anaesthesia. Methods Seventy‐nine reconstructions were included. The following factors were analyzed: fixation type, number of osteotomies, site of defect (bilateral/unilateral), surgeon, sex, ASA classification, continuous smoking, pathological N‐stage, age, defect size, flap ischemic time, and postoperative radiotherapy. Proportional hazards regression was used to test the effect on the time between reconstruction and intervention. Results Sixty‐nine (87%) of the 79 fibula flaps were successful at the last follow‐up. Forty‐eight major recipient site complications occurred in 41 reconstructions. Nineteen complications required surgical intervention within six weeks and were mostly vascular problems, necessitating immediate intervention. These early complications were associated with defects crossing the midline, with an estimated relative risk of 5.3 (CI 1.1‐20, P = 0.01). Twenty‐nine complications required surgical intervention more than 6 weeks after the reconstruction. These late complications generally occurred after months or years, and were associated with smoking, with an estimated relative risk of 2.8 (CI 1.0‐8.3, P = 0.05). Conclusions Fibula flaps crossing the midline have a higher risk of early major recipient site complications than unilateral reconstructions. Smoking increases the risk of late complications.
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Affiliation(s)
- Johannes T M van Gemert
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan H Abbink
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Robert J J van Es
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Antoine J W P Rosenberg
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ron Koole
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ellen M Van Cann
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
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Devireddy SK, Senthil Murugan M, Kishore Kumar RV, Gali R, Kanubaddy SR, Sunayana M. Evaluation of Non-vascular Fibula Graft for Mandibular Reconstruction. J Maxillofac Oral Surg 2014; 14:299-307. [PMID: 26028850 DOI: 10.1007/s12663-014-0657-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 07/01/2014] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Functional and cosmetic defects in maxillofacial region are caused by various ailments like trauma, neoplasm, developmental, infections and iatrogenic causes. Reconstruction of these defects with free flaps remains the gold standard but demerits like need for surgical expertise and equipment, prolonged duration of surgery, compliance of the patient and increased cost are associated with microvascular reconstruction. Hence reconstruction with nonvascular bone grafts can be considered when defect is nonirradiated and <9 cm and with sufficient soft tissue cover available. PURPOSE To retrospectively evaluate clinical, radiological outcome and complications encountered with mandibular reconstruction using non vascular fibula graft. PATIENTS AND METHODS This retrospective study included 7 patients who were treated in the Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Nellore, AP between 2011 and 2013 with histologically proven benign osteolytic lesions of mandible that require a segmental mandibulectomy and primary reconstruction using autogenous non-vascularised fibular graft. The clinical case records of the patients and personal patient assessment forms (Quality of Life Assessment Forms) were analysed. They were recalled every 3rd, 6th and 9th month after surgery for evaluation of clinical, radiological outcome of the graft and complications occurring at recipient and donor sites. RESULTS In all the 7 patients, the lower border continuity was maintained except in one where the graft was dislodged. Tongue movements in all the patients were unrestricted. Jaw movements were affected in cases of ramus defects with slight deviation to operated side and reduced mouth opening. Radiological observations revealed no significant changes in 3 months except for slight reduction in graft height. The radioopaque bridging with continuity of lower border of mandible was noticed in 6th month indicating the take of the graft. This was achieved in every case except in one where the graft was lost due to dislodged reconstruction plate. In 9th month the edges of the graft i.e., graft to native mandible junction showed more resorption (3 mm) especially where there is >2 mm of gap. Whereas increase in height of graft in other areas especially in graft to graft junction was seen. Significant graft resorption was seen in two cases. There were no major complications associated with the donor site. CONCLUSION Avascular fibula graft although a second choice to vascularised fibula, is a favourable option for mandible defects of 6-10 cm under optimum conditions especially in developing countries where financial and/or surgical resources are limited. An attempt for primary reconstruction with this is never futile as it prevents aesthetic deformity even in the event of failure and thus makes secondary reconstruction easy. However in order to confirm the results a prospective study with large scale of patients is necessary.
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Affiliation(s)
- Sathya Kumar Devireddy
- Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Chintareddypalem, Nellore, 524002 A.P. India
| | - M Senthil Murugan
- Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Chintareddypalem, Nellore, 524002 A.P. India ; OMFS, SRM Dental College and Hospital, Ramapuram, Chennai, India
| | - R V Kishore Kumar
- Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Chintareddypalem, Nellore, 524002 A.P. India
| | - Rajasekhar Gali
- Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Chintareddypalem, Nellore, 524002 A.P. India
| | - Sridhar Reddy Kanubaddy
- Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Chintareddypalem, Nellore, 524002 A.P. India
| | - M Sunayana
- Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Chintareddypalem, Nellore, 524002 A.P. India
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Abstract
The field of head and neck surgery has gone through numerous changes in the past two decades. Microvascular free flap reconstructions largely replaced other techniques. More importantly, there has been a paradigm shift toward seeking not only to achieve reliable wound closure to protect vital structures, but also to reestablish normal function and appearance. The present paper will present an algorithmic approach to head and neck reconstruction of various subsites, using an evidence-based approach wherever possible.
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Shen Y, Sun J, Li J, Shi J, Ow A. Long-Term Results of Partial Double-Barrel Vascularized Fibula Graft in Symphysis for Extensive Mandibular Reconstruction. J Oral Maxillofac Surg 2012; 70:983-91. [DOI: 10.1016/j.joms.2011.02.125] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 02/01/2011] [Accepted: 02/16/2011] [Indexed: 10/17/2022]
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Chang EI, Clemens MW, Garvey PB, Skoracki RJ, Hanasono MM. Cephalometric analysis for microvascular head and neck reconstruction. Head Neck 2012; 34:1607-14. [PMID: 22290660 DOI: 10.1002/hed.21967] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 08/04/2011] [Accepted: 09/07/2011] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND While a large body of literature exists involving normative measurements for the craniofacial skeleton, few have analyzed the necessary dimensions that are pertinent in reconstruction using microvascular free flaps. METHODS Cephalometric analysis was performed using 3-dimensional CT scans from 70 adults. Relevant dimensions of the fibula were obtained from a subset of 20 patients. RESULTS Normative cephalometric values, including various distances and angles, for the mandible and maxilla were obtained and compared to the dimensions of the fibula. Comparisons were made between measurements from men and women, and patients with full dentition and edentulous patients. Schematics for designing mandibular and maxillary reconstructions are presented. CONCLUSION When premorbid craniofacial anatomy cannot be discerned in the setting of extensive trauma or tumor involvement, normative dimensions may be a helpful guide for flap design and should be in the armamentarium of surgeons engaged in complex head and heck reconstruction.
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Affiliation(s)
- Edward I Chang
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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López-Arcas JM, Arias J, Del Castillo JL, Burgueño M, Navarro I, Morán MJ, Chamorro M, Martorell V. The Fibula Osteomyocutaneous Flap for Mandible Reconstruction: A 15-Year Experience. J Oral Maxillofac Surg 2010; 68:2377-84. [DOI: 10.1016/j.joms.2009.09.027] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 07/08/2009] [Accepted: 09/16/2009] [Indexed: 10/19/2022]
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Gbara A, Darwich K, Li L, Schmelzle R, Blake F. Long-Term Results of Jaw Reconstruction With Microsurgical Fibula Grafts and Dental Implants. J Oral Maxillofac Surg 2007; 65:1005-9. [PMID: 17448854 DOI: 10.1016/j.joms.2006.06.294] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2005] [Revised: 12/30/2005] [Accepted: 06/01/2006] [Indexed: 11/20/2022]
Abstract
PURPOSE The aim of this retrospective study was to evaluate the long-term utility of the free fibula flap for the reconstruction of the maxilla and mandible and to investigate its suitability for prosthetic rehabilitation with dental implants focusing on implant survival and implant-related morbidity. MATERIALS AND METHODS Thirty patients who underwent microsurgical reconstruction of the upper or lower jaw after resection from 1992 to 1994 and were available for follow-up examination were included in the investigation. The primary afflictions were malignant tumors, alveolar atrophy, or osteomyelitis. Clinical and radiologic findings were gathered and evaluated with emphasis on the radiologic follow-up as well as clinical investigations disclosing implant-related complications. RESULTS The fibula proved very suitable for the reconstruction of the upper and lower jaw, allowing rehabilitation with dental implants in all cases. Additionally, the peri-implant bone resorption and the overall complication rate proved to be low. In 93 of 128 implants, probing depths ranged from 2 to 3 mm. In 20 implants, probing depths of 4 to 6 mm were observed. In 4 implants, probing depths of greater than 7 mm were observed. These values corresponded with the radiologically assessed values. CONCLUSION The reconstruction of the upper and lower jaw with a microsurgically reanastomosed fibula flap, in combination with dental implants, leads to satisfactory functional and esthetic results. The fibula flap seems resistant to peri-implantary resorption processes and is capable of withstanding the masticatory forces that develop during functional loading. In conjunction with the new prosthetic attachments, like the titanium magnetic inserts, the fixation of cover dentures and the oral hygiene is simplified and improved.
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Affiliation(s)
- Ali Gbara
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Tie Y, Wang DM, Ji T, Wang CT, Zhang CP. Three-dimensional finite-element analysis investigating the biomechanical effects of human mandibular reconstruction with autogenous bone grafts. J Craniomaxillofac Surg 2006; 34:290-8. [PMID: 16781160 DOI: 10.1016/j.jcms.2006.03.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2004] [Accepted: 03/17/2005] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To investigate the biomechanics of the mandible following reconstruction with autogenous bone grafts. MATERIAL Computerized tomography scan images of a human mandible, fibula and iliac crest were collected and used to build models on a PC. METHODS Four finite-element analysis (FEA) models of mandibles reconstructed with autogenous bone were created. The principal stresses of marked points, the Von Mises stresses at anatomical index regions, and the force values of temporo-mandibular joints and masticatory muscles were calculated. RESULTS Compared with the normal mandible, the one repaired with a fibula had greater Von Mises stresses on the grafted bone; the one repaired with iliac crest bone had the similar distribution of the Von Mises stresses as in the normal mandible. The principal stresses in the autograft varied between tensile and compressive stresses from the right graft/bone binding interface to the left in all reconstructed mandibles. On the whole, the maximum Von Mises stress was greater on the mandible reconstructed with fibula than that reconstructed with iliac crest. CONCLUSION Mandibles repaired with iliac crest grafts have more mechanical properties similar to normal than those repaired with fibula grafts.
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Affiliation(s)
- Ying Tie
- Institute of Life Quality via Mechanical Engineering, School of Mechanical and Power Energy Engineering, Shanghai Jiaotong University (SJTU), China
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Jin P, Yi Z, Yan YG. Bone Density of Non-vascularised Iliac Bone Grafts in Mandibular Reconstruction: Long-term Evaluation. ACTA ACUST UNITED AC 2003. [DOI: 10.1016/s0915-6992(03)80037-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Discussion. Plast Reconstr Surg 2002. [DOI: 10.1097/00006534-200208000-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hidalgo DA, Pusic AL. Free-flap mandibular reconstruction: a 10-year follow-up study. Plast Reconstr Surg 2002; 110:438-49; discussion 450-1. [PMID: 12142657 DOI: 10.1097/00006534-200208000-00010] [Citation(s) in RCA: 263] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Free-flap reconstruction of oncologic mandibular defects has become the modern standard of care. However, no previous studies have established the long-term results of such reconstructions. The objective of this study was to review functional and aesthetic outcomes in patients a decade after free-flap mandibular reconstruction.A single surgeon's experience with free-flap reconstruction of the mandible was retrospectively reviewed. Eighty-two consecutive patients who underwent reconstruction from January of 1987 to December of 1990 were identified. Of the 34 patients still alive, 20 agreed to participate (response rate, 59 percent). To assess complications and functional outcome, patients were interviewed using validated questions and questions developed specifically for the study. Aesthetic outcome was judged by two independent observers. Panorex radiographs were obtained to assess bone resorption. Bone height was measured at standardized locations on the body, ramus, and symphysis and compared with the immediate postoperative Panorex radiographs. Differences in Panorex magnification were adjusted for by comparison of miniplate measurements. Mean length of follow-up was 11 years. Mean patient age at the time of the study was 48 years. Nineteen of 20 patients had malignant disease, one of whom had a local recurrence during the follow-up period. Two patients received radiation therapy preoperatively and 13 postoperatively. Mean length of mandible resection was 13 cm. Defect types were as follows (Jewer's classification): 12 L, 4 H, 3 LC, and 1 LCL. All flaps survived. At 10-year follow-up, aesthetic outcome was judged to be excellent in 55 percent of patients, good in 20 percent, fair in 15 percent, and poor in 10 percent. The aesthetic results were remarkably stable over time. Slight accentuation of subtle postoperative asymmetry became evident as facial aging progressed. Dental rehabilitation in the study group included five patients with osteointegrated implants and seven with conventional dentures. Seventy percent of patients reported a regular diet. The remainder required a soft diet. Food tolerance was good, as rated by the List Scale (mean score, 77 percent). Seventeen patients had easily intelligible speech, whereas three were intelligible with effort. At the midbody of the mandible, 92 percent of the postoperative bone height was preserved; at the midramus, 93 percent was maintained; and at the symphysis, 92 percent remained. In several patients, there was greater age-related bone loss from the residual native mandible compared with the reconstructed site. One patient developed an orocutaneous fistula following postoperative radiation therapy. Nine patients had miniplates removed, either because of plate problems or to allow implant placement. There were no cases of osteoradionecrosis, bone fracture, or miniplate fracture. There was no significant long-term disability related to the donor site.Free-flap reconstruction of the mandible provides excellent functional and aesthetic results that remain stable over time. Bone resorption is surprisingly minimal, even in the face of postoperative radiation therapy. The majority of patients are able to tolerate a regular diet and to either wear dentures or acquire osteointegrated implants. Acceptable speech and appearance are restored and continue to be a source of patient satisfaction at least a decade after surgery.
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Affiliation(s)
- David A Hidalgo
- Division of Plastic Surgery, Cornell University Medical College, New York, NY, USA.
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Update on microvascular free tissue transfer: new trends and applications. Curr Opin Otolaryngol Head Neck Surg 2000. [DOI: 10.1097/00020840-200008000-00004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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