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PubMed1992

[History of microsurgical reconstruction of the mandible].

The history of mandibular reconstruction, initially prosthetic, dates back to Ancient Egypt and China, but developed rapidly and diversified from the 19th century onwards when C. Martin, in 1889 developed his "immediate prosthesis applied to resection of the jaws", while A. Barth, in 1895, performed the first bone grafts. The more recent history of microsurgical reconstruction commenced with free rib transfers in 1977-1978 (Ariyan, Couly). Other microsurgical transfers, either pure bone or composite osteocutaneous, osteoseptal or osteomyocutaneous were then rapidly developed and used with varying degrees of success for mandibular reconstruction: inguinoiliac flap (Talyor and Watson, 1978), dorsopedal flap using the second metatarsal (O'Brien, 1979), forearm flap with the radius (Soutar and Mac Gregor, 1986), lateral brachial flap with humerus (Martin, 1988), free fibular flap (Hidalgo, 1989)... and the story continues.

Bone Transplantation↗
PubMed1997

Mandibular reconstruction with fibular osteoseptocutaneous free flap and simultaneous placement of osseointegrated dental implants.

Insertion of osseointegrated dental implants several months after mandibular reconstruction using vascularized composite bone grafts has proved to be a successful method to achieve mastication and complete oral rehabilitation. Theoretically with primary placement of implants into the new mandible a better access to the bone is achieved, interdental relationships are easier to determine, and oral rehabilitation can be attained in a shorter period of time. Previous results describing this approach, however, are inconclusive and controversial. This review describes our experience with primary insertion of dental implants into fibular flaps used for mandibular reconstruction during ablative surgery. Adequate selection of patients for this combined procedure depends mainly on the pathological nature of the mandible and perioperative radiotherapy. Preoperative determination of soft-tissue and bone requirements, number of osteotomies, rigid fixation method, and familiarity with the use of osseointegrated implants are important factors that must be considered for adequate surgical planning and to achieve good results.

Dental Implantation, Endosseous↗
PubMed1986

[Mandibular reconstruction following extensive unilateral resection in children].

Follow up 30 months after extensive bone resection of mandible with disarticulation of condyle for widespread tumor of angle in a 9 1/2 year old child showed very satisfactory functional and esthetic bone reconstruction. Favorable elements were: conservation of periosteum made possible from results of histology of fresh specimen (showing eosinophil granuloma); the immediate insertion of a temporary prosthesis in strengthened resin to maintain anatomical relations and spontaneous functions.

Child↗
PubMedDate not supplied

[Prosthesis of patients after continuant frontal resection of the lower jaw].

The authors stress upon the various functional, physiological and cosmetic disorders in patients with frontal continuat resection of the lower jaw. Their experience in the treatment of eight patients with frontal resection reveals the advantages of the two-part prosthetic constructions, consisting of one fixed part blocking the teeth and one removable part replacing the defect. In all cases with big bone defects in the frontal region of the lower jaw the authors recommend removable partial denture with intracornal channel-shoulder-pin-attachement, being with high functional, medicobiological and aesthetic indices.

Denture Design↗
PubMed2004

The use of implant retained mandibular prostheses in the oral rehabilitation of head and neck cancer patients. A review and rationale for treatment planning.

Surgical treatment of malignancies in the oral cavity (tongue, floor of the mouth, alveolus, buccal sulcus, oropharynx) often results in an unfavourable anatomic situation for prosthodontic rehabilitation. The outcome is a severe disturbance of oral functioning despite the improved surgical techniques for reconstruction that are currently available. Radiotherapy, which often is applied postsurgically, worsens oral functioning in many cases. Main problems that may hamper proper prosthodontic rehabilitation of these patients include a severe reduction of the neutral zone, an impaired function of the tongue, and a very poor load-bearing capacity of the remaining soft tissues and mandibular bone. Many of these problems can, at least in part, be diminished by the use of endosseous oral implants. These implants can contribute to the stabilisation of the prostheses and intercept the main part of the occlusal loading. Surgical interventions after radiotherapy are preferably avoided because of compromised healing, which may lead to development of radionecrosis of soft tissues and bone as well as to increased implant loss. If surgical treatment after radiotherapy is indicated, measures to prevent implant loss and development of radionecrosis have to be considered e.g. antibiotic prophylaxis and/or pre-treatment with hyperbaric oxygen (HBO). To avoid this problem, implant insertion during ablative surgery has to be taken into consideration if postoperative radiotherapy is scheduled or possibly will be applied. This approach is in need of a thorough pre-surgical examination and multidisciplinary consultation for a well-established treatment planning. The primary curative intent of the oncological treatment and the prognosis for later prosthodontic rehabilitation have to be taken into account too.

Dental Implantation, Endosseous↗
PubMed2005

[Metallic condylar head prostheses to replace the temporomandibular joint].

BACKGROUND: Up to now the results after condylar reconstruction of the mandible have been regarded as less than satisfactory. PURPOSE: Functional and aesthetic long-term results after condylar head resection in traumatic and tumour cases with or without replacement by a metallic condylar head prosthesis were compared in a retrospective study. PATIENTS AND METHODS: From 1980 to 2001, 23 temporomandibular joints of 19 patients were reconstructed with metallic condylar head prostheses. The resected region, the contralateral joint, facial and masticatory muscles and the dental system were clinically and radiographically monitored for a mean period of 4 years and 9 months. Seven patients who underwent condylar resection without substitution were observed over an average follow-up time of 7 years and 11 months. RESULTS: Patients who underwent condylar resection without substitution reported more trouble with eating and speaking for a long time. TMJ endoprostheses preserved facial symmetry better. Maximum mandibular opening as well as lateral and protrusive excursions were slightly reduced in comparison with both unaffected controls and patients who underwent condylar resection without substitution. In this study bilateral condylar prostheses exhibited the same functional and aesthetic results as unilateral arthroplasty. CONCLUSIONS: Metallic condylar head prostheses originally developed for temporary replacement worked in some cases as long-term joint replacement but were not able to reach the total functional quality of natural temporomandibular joints.

Bone Plates↗
PubMed1992

Evaluation of mandibular reconstruction techniques following resection of malignant tumors in the oral region.

Over the past 15 years, reconstruction following excision of malignant oral tumors was performed on 27 patients with segmental resection and five patients with hemiresection of the mandible. Following segmental resection, the mandible was reconstructed using an autogenous bone graft in eight patients in whom the surrounding soft tissues were fairly well preserved. Bony union was achieved in six of them. In the remaining two, the graft was removed because of postoperative infection, and one patient underwent secondary bone grafting. A pedicled myocutaneous flap and bone graft was used in seven patients who underwent extensive resection of the surrounding soft tissue. Bony union was achieved in three patients, and one developed pseudoarthrosis. The graft was removed in the remaining three because of postoperative infection. Reconstruction with only a metallic plate for stabilization of the mandible was carried out in six aged or sarcoma-affected patients. In two of them, the postoperative course was uneventful for 4 to 7 years. In the remaining four patients, plate removal was required because of exposure or tumor recurrence. In 5 of 11 patients in whom reconstruction was carried out with a combination of a pedicled myocutaneous flap and metallic plate, the postoperative course was uneventful for 2 to 8 years. Two of these five patients underwent secondary bone grafting. In four of the remaining six patients, the plate was removed because of exposure or improper adaptation to the stump. Two others died of disseminated intravascular coagulation syndrome within 1 month. A prosthesis was used more frequently by patients when reconstruction was performed using a pedicled osteomyocutaneous flap. The metallic reconstruction plate was helpful for restoring mandibular contour.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMedDate not supplied

Mandibular reconstruction: bone graft techniques.

Results of treatment in a series of 60 patients undergoing mandibular reconstruction by a variety of methods are reported. Delayed reconstruction was performed, using a titanium mesh tray with cancellous bone fragments and block bone grafts removed from the iliac crest, rib, and mandible in 34 patients, with an overall success rate of 91%. Immediate reconstruction was performed with a wire mesh prosthesis containing particulate bone and composite flaps in 26 patients, with an overall success rate of 46%. Oral contamination of the graft at the time of surgery appeared to be the factor limiting the success of immediate mandibular reconstruction. Block grafts of bone were extremely reliable in reconstituting the continuity of the mandible when inserted through an extraoral approach as a delayed repair. Mandibular reconstruction was successfully accomplished even following high-dose radiotherapy.

Bacterial Infections↗
PubMed1988

Titanium-coated hollow screw and reconstruction plate system (THORP) in mandibular reconstruction.

Clinical results are presented which have been obtained from mandibular reconstruction with the Titanium-coated Hollow Screw and Reconstruction-Plate system (THORP) in 7 selected patients. In 3 of the patients primary bone grafting was performed with simultaneous implantation of titanium fixtures for dental reconstruction. The reconstruction-plates have shown excellent functional stability with no failures, such as loosening of screws, within an observation period up to 2 1/2 years. The system was submitted to immediate full functional loading despite the limited number of 2-3 fixation screws for each end of the plate. Among several technical advantages of the system are the possibility of lingual plate application and reconstruction with a three-dimensionally free, adjustable condylar prosthesis.

Adult↗
PubMedDate not supplied

A tongue stent for prevention of oral trauma in the comatose patient.

This paper presents the need for and offers a solution to the problem of factitial tongue and other intra-oral injuries in comatose and decerebrate patients. The neurophysiology of jaw movement in the comatose patient is the basis for the design of an intraoral prosthesis which in two patients has prevented discoordinate mandibular chewing movements and facilitated healing of preexisting factitial lesions. The authors delineate in detail the fabrication, insertion, and maintenance of this protective prosthesis and emphasize the need for joint effort between the intensive care, neurosurgical, and oral surgical teams.

Adult↗
PubMedDate not supplied

[Complications of post-irradiation radiotherapy mandibular resection: problems of reconstruction (author's transl)].

One hundred and twenty-six patients underwent a mandibular resection (segmental or marginal) as a part in the treatment of a malignant lesion. The surgical morbidity is increased by the preoperative high-dose irradiation. Complications such as osteitis and/or fracture of the mandible were noted in 31 cases (a total of 80) who underwent a preoperative external irradiation with a tumor-dose of 5,500 rads or higher, whereas only in 8 cases (a total of 46) without such preoperative radiotherapy. Prophylactic antibiotics, the use of flaps to replace the buccal mucosa without any suture-tension, replacement of the mandible by a low profile stainless steel prosthesis are advocated to reduce these postoperative complications.

Anti-Bacterial Agents↗
PubMed1986

Rheumatoid disease and related arthropathies. II. Surgical rehabilitation of the temporomandibular joint.

A new classification of four types of TMJ involvement is proposed to help orient and direct the medical and surgical treatment of patients with rheumatoid disease and related arthropathies. Clinical symptoms, radiographic findings, facial deformity features, treatment planning, and results are discussed, with case reports that illustrate each type. Interpositional polymer laminates, a new glenoid fossa prosthesis, and a metallic condyle are introduced for use in selected cases where erosion and destruction of the condyle, meniscus, and fossa area have produced significant TMJ dysfunction and occlusal-facial deformity.

Adolescent↗
PubMed1989

Temporary silastic implantation following discectomy in the primate temporomandibular joint.

Silastic (Dow Corning, Midland, MI) has been used in the surgical treatment of a variety of temporomandibular joint (TMJ) disorders as either a permanent or temporary implant. In this study four Macaca fascicularis monkeys underwent bilateral TMJ discectomies and high condylar shaves. The experimental side was treated with a Silastic sheet implant which was removed at 3 months postdiscectomy. The contralateral side was left without an implant and served as a control. Animals were killed at 3, 4, 5, and 6 months postoperatively. A fibrous connective tissue capsule was found around the Silastic implant at all time intervals. This capsule formed a single joint space between the inferior surface of the glenoid fossa and articulating surface of the condyle. Three months following implant removal, the capsule was still present and there was no significant inflammatory cell infiltrate. The severity of the degenerative changes was decreased on the implant side.

Animals↗
PubMedDate not supplied

Evaluation of autogenous grafts used in vestibuloplasty.

Vestibuloplasty is indicated when prosthesis stability is poor due to mandibular or maxillary atrophy. The use of autogenous grafts to provide sufficient vestibular depth is widely accepted. In this retrospective study, the outcomes of vestibuloplasty performed on 41 patients using various types of autogenous grafts (full-thickness skin, dermal, reversed dermal, meshed skin and palatal mucosal) are presented. The best results were obtained with palatal mucosal grafts, but graft size is limited. Meshed skin grafts were shown to be the best alternative.

Adult↗