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PubMed2004

Functional rehabilitation of the atrophic mandible and maxilla with fibula flaps and implant-supported prosthesis.

Historically, nonvascularized bone grafts have been the standard treatment for severe mandibular and maxillary atrophy, followed by immediate or delayed implant placement. Extreme atrophy is an unfavorable biological and mechanical location for nonvascularized autologous bone transplants. The authors present the results of a multidisciplinary treatment protocol for rehabilitation of extreme mandibular and maxillary atrophy by use of the vascularized fibular flap. This protocol includes bone augmentation, implant surgery, soft-tissue management, and prosthetic restoration. Since 1993, 18 patients with a mean age of 47.5 years presented with extreme mandibular and/or maxillary atrophy and underwent alveolar crest augmentation with vascularized fibular flaps. Bone healing was achieved in 17 of the 18 patients. Seventy-three osteointegrated implants were inserted in 12 of 17 fibular flaps. Altogether, 62 implants were loaded and 11 dental prostheses were made. Average follow-up of the loaded implants was 41 months. The success rate of loaded implants was 100 percent. The authors strongly recommend the use of the fibular bone flap when dealing with extreme atrophy of the mandible and maxilla and suggest the protocol outlined in this review.

Adult↗
PubMed2005

Virtual planning of composite mandibular reconstruction with free fibula bone graft.

Functional mandibular reconstruction after tumor resection is challenging. Currently, voxel-based craniofacial surgery and virtual planning of craniofacial surgical procedures are becoming increasingly popular. We report on a 56-year-old patient with an infiltrating recurrent squamous cell carcinoma of the mandible and buccal mucosa. Virtual resection of the mandible was accomplished using virtual reality techniques. Based on virtual geometric data, a metal template was configured for optimal contouration of a fibular bone graft while it was still pedicled in the donor field. Our operative procedure demonstrates the usefulness of voxel-based three-dimensional cephalometry in virtual planning of microsurgical bone transfer for mandibular reconstruction.

Bone Transplantation↗
PubMedDate not supplied

Postnatal epiphyseal development: the distal tibia and fibula.

At birth, the distal tibial physis is a transverse structure. However, as the tibia enlarges diametrically and the epiphyseal ossification center matures, the physis becomes increasingly undulated, with peripheral lappet formation. The anteromedial area is the first to develop undulation (Poland's hump). This should not be misinterpreted as an injury or premature epiphyseodesis subsequent to trauma. The tibial secondary ossification center forms within the central epiphysis. The medial margin is irregular and may have peripheral foci of ossification. Between the ages of 7 and 8 years, this secondary center extends into the medial malleolus, reaching the distal tip during adolescence. The malleolar tip may develop accessory ossification. Physiologic epiphyseodesis begins over the medial malleolus and then extends laterally, a pattern of closure that affects fracture patterns (e.g., the fracture of Tillaux). The distal fibular physis also begins as a transverse structure that becomes undulated and has extensive peripheral lappet formation. This physis usually becomes level with the articular surface of the distal tibia after the first year. Enchondromalike extensions of the physis into the metaphysis are common. Accessory ossification may develop at the distal end.

Adolescent↗
PubMed1994

Cytokeratin expression and distribution in adamantinoma of the long bones and osteofibrous dysplasia of tibia and fibula. An immunohistochemical study correlated to histogenesis.

Twenty-four cases of adamantinoma and 24 cases of osteofibrous dysplasia of the long bones were studied to evaluate the expression and distribution of cytokeratin (CK) subtypes in relation to histogenesis and differentiation. The immunohistochemical study was performed on tissue fixed in buffered formalin and embedded in paraffin wax utilizing antibodies to vimentin, factor VIII, epithelial membrane antigen and cytokeratins of different molecular weights. In all cases the vimentin antibody marked positively in stroma, endothelium and osteoblasts, while factor VIII expression was confined to endothelial cells. In 71% of adamantinomas, vimentin showed strong immunoreactivity in the tumour cells of nests and tubules. CKAE1/AE3 and CK19 were strongly expressed in all morphological patterns of adamantinoma emphasizing their epithelial origin, while the antibodies to CK8 and CK18 showed a high percentage of negative responses. In osteofibrous dysplasia the epithelial-like component was much smaller than in adamantinoma and was present in scattered islands composed of a few cell positive for CKAE1/AE3 and CK19 and negative for other keratins. These results suggest that these two lesions are of a similar histogenesis.

Ameloblastoma↗
PubMed2005

Rehabilitation of a bilateral maxillectomy patient with a free fibula osteocutaneous flap.

Rehabilitation of patients who have undergone bilateral maxillectomy is difficult because of extensive loss of bone and soft tissue. In this clinical report, prosthodontic rehabilitation of oral function in a bilateral maxillecitomy patient combined with a new fibular osteocutaneous flap, which was designed to have two oronasal slits for the retention of an obturator prosthesis, was described. A 58-year-old man with a maxillary alveolar carcinoma underwent bilateral maxillectomy. The defect was reconstructed using a vascularized fibular bone wrapped circumferentially with a peroneal flap, which was fixed with miniplates between the right malar prominence and cut edge of the left zygoma remaining two slits anterior and posterior to the graft. Two and half weeks after the surgery, a delayed surgical obturator was delivered and an obturator prosthesis was delivered 6 weeks after the surgery. This obturator prosthesis could be extended into the slits to engage the tissue undercuts, and was stable during use. Mastication, deglutition, articulation and the mid-facial profile of the patient were rehabilitated. After installation of the obturator prosthesis, relining of the prosthesis base was carried out alongside the healing process of the graft, and adjustment of occlusions and high-pressure spots was carried out. No clinical disorders were observed either in the grafted tissue or the obturator prosthesis with a 3-year prognosis. Newly designing a fibular osteocutaneous flap combined with tissue-borne obturator prosthesis is one successful approach to the restoration of oral function, and increases the patient's quality of life after bilateral maxillectomy.

Carcinoma, Squamous Cell↗
PubMed1996

Stress fractures of the fibula in the first few years of life (report of six cases).

Fibular stress fractures in children in the first few years of life are not well known and are often confused with osteomyelitis or malignant bone tumour. This misdiagnosis is followed by nuclear scan, computerized tomography (CT), magnetic resonance (MR) imaging and even biopsy. All these investigations are unnecessary as plain X-rays show diagnostic radiographic findings and misdiagnosis is highly unlikely when they are evaluated in the context of clinical findings.

Child, Preschool↗
PubMed1976

Occupational compression of the common peroneal nerve at the neck of the fibula.

Seven cases of common peroneal nerve compression were seen among farm workers. The symptoms followed working in a sitting position with forward advancement, a position commonly adopted in India for harvesting a crop and hoeing. Motor and sensory impairment was seen in the distribution of the common peroneal nerve, more marked in the distribution of the deep peroneal branch. Motor conduction time, estimated in two cases, was delayed. At exploration, the cause of the compression was found to be a tendinous arch extending along the posterior border of the peroneus longus, and curving backwards and upwards along the lateral border of the soleus. Excision of this arch, with elimination of the origin of the upper part of the peroneus longus, led to disappearance of the neurological deficits.

Adolescent↗