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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↗
PubMed1978

Mandibular reconstruction with bone grafts.

A total of 23 patients with partly resected mandible were repaired with autogenous bone grafts from the iliac crest and ribs. The reasons for reconstruction are presented in Table 1. The grafts healed without complications in 21 cases. With the exception of two of the cases with gunshot wounds, all patients recovered good mobility of the jaw and satisfactory mandibular contours. The patients had been folloed up for 6 months to 11 years. Radiographic examination at the last examination showed that resorption of the graft had been only slight or moderate. Through marrow-spongious bone grafts are regarded as best from an osteogenetic point of view, our cases showed that good results can be achieved also with solid block grafts. The authors discuss the use of plate osteosynthesis without IMF instead of other types of graft fixation and IMF. In six cases where the area of the graft was loaded with a prosthesis, resorption was not more extensive than in the other cases.

Adolescent↗
PubMed2001

Lingual nerve injury after use of a cuffed oropharyngeal airway.

The cuffed oropharyngeal airway is a modified Guedel airway and is recommended for anaesthesia in spontaneously breathing patients. To our knowledge this is the first report of transient unilateral lingual nerve palsy after the use of a cuffed oropharyngeal airway to maintain anaesthesia during arthroscopy of an ankle. The aetiology of lingual nerve damage is multifactorial. The possible mechanisms involved include anterior displacement of the mandible during insertion of the cuffed oropharyngeal airway (as in the jaw thrust manoeuvre), compression of the nerve against the mandible, or stretching of the nerve over the hyoglossus by the cuff of the cuffed oropharyngeal airway. We recommend gentle airway manipulation with the use of the cuffed oropharyngeal airway, avoidance of excessive cuff inflation and early recognition of such a complication if it occurs.

Aged↗
PubMed1998

Rigid fixation in mandibular reconstruction.

A primary goal of mandibular reconstruction is to preserve form and function. Free vascularized bone remains the gold standard for mandibular reconstruction of the anterior defect. While lateral mandibular defects need for vascularized bone remain controversial, free bone flaps provide the most reliable bone stock readily available for dental implantation. Mandibular alignment remains critical for recreating the 3-dimensional relationships of mandibular projection, occlusion, and condylar placement. Depending on the defect, a variety of techniques can be used to maintain mandibular alignment. These include prefabrication of the plate, placement of an internal fixation device, and intermaxillary fixation. Fixation techniques in this day and age generally rely on plates and screws. Miniplates are popular among some reconstructive surgeons while others prefer larger reconstruction plates that can span the entire defect. Bony contouring is critical since keeping bone surfaces in contact allows for improved bone healing. Condylar reconstruction this critical, when the ramus and condylar head are resected, require reconstruction to maintain the entire solid arch. A variety of these techniques are discussed. While the challenge remains reconstituting a solid arch, a variety of techniques can be employed. These techniques including fixation technique, bony contour, mandibular alignment, and condylar reconstruction will be discussed.

Bone Plates↗
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↗
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↗
PubMed2001

Donor site angiography before mandibular reconstruction with fibula free flap.

The use of fibular free flaps has become established as a reliable and popular method for reconstruction of segmental mandibular defects. The role of routine preoperative angiography remains controversial. Sixty four digital subtraction angiograms were studied in a series of 39 consecutive patients clinically judged to be satisfactory candidates for fibula free transfer. Angiographic findings revealed vascular anomalies in 10 extremities (15.6%). Regarding the high potential for significant donor site morbidity authors consider vascular imaging essential part of preoperative evaluation.

Adolescent↗
PubMed1997

The role of computed tomographic scanning in the management of facial trauma.

OBJECTIVE: To determine how often the management of patients with blunt facial trauma was altered by plain roentgenograms or facial computed tomographic (CT) scans compared with findings from physical examination. METHOD: This is a retrospective review of consecutive patients admitted with blunt facial trauma and evaluated by the Division of Plastic Surgery from 1988 to 1994. Physical findings were correlated with fractures detected by plain roentgenograms or facial CT reports. Treatment plans were reviewed to determine how management was altered by radiographic studies. Hospital charges were determined for the various studies. RESULTS: One hundred thirty-seven records were reviewed. Thirty patients had only lacerations and no fractures. Two hundred forty-three fractures were detected on physical examination among 98 patients (91.5%). One hundred two patients (95.3%) had facial CT scans and 85 patients (79.4%) had facial plain films obtained. Radiographic findings identified a total of 255 fractures among 107 patients (78%). Ninety-four patients (87.9%) required operative interventions for these facial fractures. Only 19 patients (17.8%) had management altered by radiographic findings: CT scan (7 patients) and plain films (12 patients). The management of 88 facial fractures (34.5%) in this series did not appear to be altered by x-ray findings. Computed tomography was most beneficial in the management of orbital fractures (N = 7). Plain films affected mostly the evaluation of mandibular injuries (N = 7). Selective use of CT scan could lead to hospital savings estimated at $11,864 for the diagnosis of facial fractures after blunt trauma. CONCLUSION: Physical examination reliably assessed the facial skeleton for clinically significant fractures in the majority of patients. In an alert and cooperative patient, CT scan is not required before operative repair in all cases. CT scans are expensive, time-consuming, and labor-intensive and in selected cases add little clinical information to that obtained by physical examination and plain films.

Adolescent↗
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↗
PubMed2001

Sliding osteotomies in mandibular reconstruction.

The aim of this article is to describe a few simple and atraumatic methods for mandibular reconstruction following the ablation of tumors or traumas. These reconstruction techniques are indicated for rebuilding short mandibular defects (less than 4 cm) or for patients in poor general condition with larger defects that cannot be remedied using longer and more complicated procedures. Five types of osteotomies were used: "C," single, double, bilateral sliding, and sagittal sliding. Osteotomies were performed on 14 patients, 13 with malignant tumors and one with a gunshot wound. Good results were obtained in 10 patients, total failure occurred in two, and complications without failure of the reconstruction arose in the other two.

Adult↗
PubMed2003

Reconstruction of composite through-and-through mandibular defects with a double-skin paddle fibular osteocutaneous flap.

Microsurgical reconstruction of composite through-and-through defects of the oral cavity involving mucosa, bone, and external skin has often required two free flaps or double-skin paddle scapular or radial forearm flaps for successful functional and aesthetic outcomes. A safe, reliable technique using a double-skin paddle fibular osteocutaneous flap to restore the intraoral lining, mandibular bone, and external skin is described. A large elliptical or rectangular skin paddle is designed 90 degrees to the longitudinal axis of the fibula, over the junction of the middle and distal thirds of the lower leg, based only on the posterolateral septocutaneous perforators. This skin flap can be draped anteriorly and posteriorly over the fibular bone to reconstruct both the intraoral defect and the external skin defect. The area between the two skin islands of the intraoral flap and the external flap is deepithelialized and left as a dermal bridge between the two skin islands, as opposed to the creation of two separate vertical skin paddles, each based on a septocutaneous perforator. The transverse dimension of the flap can be as great as 14 cm, extending to within 1 to 2 cm of the tibial crest anteriorly and as far as the midline posteriorly, and with a length of up to 26 cm, this flap should be more than sufficient for reconstruction of most through-and-through defects. This technique has allowed the successful reconstruction of large composite defects, with missing intraoral lining, mandibular bone, and external skin, for 16 patients, with 100 percent survival of both skin islands in all cases and without the development of any orocutaneous fistulae.

Adult↗
PubMed1983

Reconstruction of the mandible.

Forty-five patients were evaluated for reconstruction of the mandible. Thirty-four patients had a particulate cancellous bone and marrow (PCM) crib graft placed. Thirty of 34 were successful at the primary operation producing a success rate of 88%. By using secondary procedures all 33 patients repaired to date have been rehabilitated. A dynamic bendable defect bridging plate with cancellous cortical graft (DBDB plate with CCG) was used in 7 patients, 4 of whom had tumor surgery and 3 of whom were operated on after trauma to the anterior mandible. All 7 cases were successfully rehabilitated in achieving a stable, functioning mandibular arch. An osteomyocutaneous flap was planned to reconstruct the anterior mandible in 4 cases; 1 in this group was not reconstructed. The PCM graft has been our first line approach to the mandibular non-union but with experience we are beginning to rely on the DBDB plate with CCG for large bony defects after both trauma and secondarily after tumor surgery. When indicated, the osteomyocutaneous flap has been eminently successful in restoring function and form in the tumor patient.

Bone Transplantation↗
PubMed1990

The functional result of mandibular reconstruction.

A study was performed to determine if patients who underwent mandibular reconstruction were functionally rehabilitated. Five parameters were evaluated: deglutition, mastication, cosmesis, diet, and the use of dentures. Deglutition was not improved in patients who had mandibular continuity restored. Problems with deglutition were related to soft tissue resection. Mastication was poorer in the reconstructed group due to scarring, loss of the muscles of mastication, and inhibition of compensatory mandibular motion. Cosmesis was improved in patients who had immediate restoration of mandibular continuity. Cosmesis was not improved in patients with delayed mandibular reconstruction due to previous scarring. Prosthetic rehabilitation was poor in both groups of patients. Reconstructed patients had a greater number of hospitalizations due to management of, or complications from reconstructive surgical procedures. The results of this study suggests that restoration of mandibular continuity does not enhance the functional rehabilitation of the majority of patients with oral-pharyngeal malignancy.

Adult↗
PubMed1975

Reconstruction of the defective mandible.

In a clinical material consisting of 31 cases of mandibular defects, caused by tumour resection or by trauma, reconstruction has been carried out by means of a stabilizing titanium splint and autologous bone and marrow transplantation, the longest period of observation being 9 years. The functional results obtained are assessed with reference to the cause of resection. Different technical procedures are described and the objectives and the planning of reconstruction of the lower jaw are discussed.

Adult↗
PubMed1981

Mandibular reconstruction using the preformed autologous bone graft.

Preformed bone grafts (PBG) were inserted in large jaw bone defects in 5 patients. The grafts in all cases healed-in rapidly. Two patients died of metastatic sarcoma 1 year after grafting. The other patients are healthy with excellently functioning grafts 3, 5 and 8 years after transplantation, respectively. The preformation of bone grafts is, however, regarded as a resource consuming technique that should be used only in selected cases of mandibular reconstruction. Particularly in young individuals, the better results achieved with PBG, in comparison with other types of grafts, seem to justify the more complicated surgical procedure. Apart from a description of the preformation technique, the present paper also introduces advice as how to minimally traumatize the hard tissues in bone graft surgery.

Adult↗