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Experience with segmental reconstruction of the radiated mandible with alloplastic prostheses.

Reconstruction of the mandible after radiation therapy and segmental resection is often complicated by wound breakdown, osteoradionecrosis, and crippling of the oral cavity. These complications make patient salvage after radiated oral carcinoma a high-risk endeavor. Although head and neck surgeons have improved the reliability of mandibular reconstruction with microvascular free tissue transfer, medical and oncologic issues may prohibit their application. This report presents 12 selected cases undergoing alloplastic reconstruction of the mandible and soft tissue reconstruction of the oral cavity. Although not as reliable as some reports of free tissue transfers, the results were reproducible and satisfactory in these cases, with time-efficient hospitalization and functional rehabilitation. Ten of 12 prosthetic reconstructions have been durable in this study population for as long as 36 months.

Aged↗

Retrospective cephalometric analysis of mandibular bone absorption under silicone rubber chin implants.

A longitudinal study was conducted on 85 patients who received silicone rubber implants to the chin. Over half of these patients were found to have some absorption of the bone beneath the implants, and much other information was obtained. There were no concomitant changes in the soft tissue profile in the patients who demonstrated bone absorption under their implants. It appeared that the bone absorption was less when the implant was placed over the hard bone of the lower part of the mandible, rather than higher or over alveolar bone.

Adult↗

A comparison of the results following oromandibular reconstruction using a radial forearm flap with either radial bone or a reconstruction plate.

Fifteen cases of oromandibular reconstruction using a radial osteocutaneous flap were compared with 16 in which the mandible was replaced with a reconstruction plate and a forearm flap was used for intraoral lining. All cases involved oral cancer; most had been irradiated. Nine survived in each group. Complications included one infected nonunion in addition to two bone exposures in the bone group, compared with three cases of plate exposure and two bone exposures in the plate group. Functional results were similar in both, but osteointegrated implants were possible only in the patients receiving bone. Cosmesis seemed somewhat better in the plate group. Donor-site problems were common but minor, and long-term forearm function was slightly reduced in both groups. Although the sample sizes were small, the reconstruction plate together with a radial forearm flap appeared to provide effective reconstruction following composite resection. However, we would not recommend this for the younger patient or in benign disease.

Adult↗

The response of porous hydroxyapatite to contiguous tissue infection.

Two patients are presented in whom severe clinical infection developed in tissue adjacent to and contiguous with previously implanted blocks of porous hydroxyapatite. Both infections resolved with appropriate antibiotics, debridement, and drainage of infected tissues. Hydroxyapatite blocks were left in situ. This unusually favorable response of an alloplast to infection is attributable to the abundant vascular supply of this porous implant. Although reliable dogma can hardly be concluded from two clinical examples, these experiences suggest that once ingrown, porous hydroxyapatite does not behave in a fashion that is typical of foreign bodies in the midst of infection. For the first time, clinical evidence has been offered to support the experimental data that vascularized hydroxyapatite has the ability to resist infection.

Adolescent↗

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↗

Primary mandibular reconstruction with the titanium hollow screw reconstruction plate: evaluation of 51 cases.

Fifty-one patients undergoing surgical reconstruction of mandibular defects with the titanium hollow screw reconstruction plate over a 4-year period were analyzed. Plate failure was defined as flap necrosis, plate extrusion, or plate fracture necessitating a further surgical procedure and occurred in 12 patients (24 percent). The incidence was highest for patients who had more than three mandibular regions resected. It was not affected by the primary site of the tumor or whether the patient had received radiation therapy. Although the failure rate was the same whether the patient attained full oral function or was fed by gastrostomy, plate fracture was limited to the former group. The overall cause-specific survival rate for this group of patients was 68 and 56 percent at 1 and 2 years, respectively. In addition, 81 percent of patients attained a full oral diet.

Adult↗

Mandibular augmentation.

Porous polyethylene implants are available that are designed to augment the mandibular ramus and body. They can be used to increase the bigonial distance in patients with normal mandibular anatomy who desire an increase in lower facial width. When used in combination with extended chin implants, they can camouflage the skeletal contour inadequacies associated with class II mandibular deficiency. The implants are placed through intraoral incisions and fixed with titanium screws. In a clinical experience with 11 patients over 6 years, this technique has proven to be safe and effective.

Adult↗