Mandibular Reconstruction, State of the Art
Julio ACERO
Oral & Maxillofacial Surgery Department, Quirón University Hospital, Madrid, Spain (Head: Associate Professor J. Acero) Section of Oral & Maxillofacial Surgery Department, Gregorio Marañon Hospital, Complutense University, Madrid (Section Chief: Associate Professor J. Acero)
Hellenic Archives of Oral & Maxillofacial Surgery (2011) 2, 63-78
SUMMARY: Mandibular bone loss can result in severe aesthetic and functional consequences for the patient, posing a challenge to the reconstructive maxillo-facial surgeon. Advent of microvascular surgery revolutionized mandible reconstruction introducing the possibility to transfer vascularized bone and soft tissues with high success rate. Major donor sites are the fibula, iliac crest and scapula. Planning of the reconstruction and advantages and disadvantages of the different reconstructive methods are discussed. The iliac crest provides an excellent bone for mandibular reconstruction but has some limits concerning length and versatility of soft tissues. The fibula permits the repair of large mandibular defects due to its length while the scapular osteocutaneous flap allows for the reconstruction of limited bone defects associated with large soft tissue defects. Nonvascularized reconstructive methods are associated with higher failure rates but can be considered in selected cases.
KEY WORDS: mandibular reconstruction, free flaps
REFERENCES
Acero J, Concejo C, De Paz V, Fernández Alba J, Verdaguer JJ, Navarro C: Reconstrucción mandibular asociada a grandes defectos de partes blandas. Versatilidad del colgajo osteofasciocutáneo escapular. Rev. Esp. Cirugí a Oral y Maxilofacial 23: 81- 89, 2001
Acero J, García E: Reoperative midface reconstruction. Oral Maxil - lofac Surg Clin North Am 23(1):133-51, 2011
Bak M, Jacobson AS, Buchbinder D, Urken ML: Contemporary reconstruction of the mandible. Oral Oncology 46: 71-76, 2010
Bianchi B, Ferrari S, Poli T, Bertolini F, Raho T, Sesenna E: Oroma - ndibular reconstruction with simultaneous free flaps: experience in 10 cases. Acta Otorhinolaryngol Ital 23:281-290, 2003
Blackwell K, Buchbinder D, Biller H, Urken M: Reconstruction of massive defects in the head and neck: the role of simultaneous distant and regional flaps. Head Neck 19(7):620-8, 1997
Chen J, Liu Y, Ping F, Zhao S, Xu X, Yan F: Two-step transport disk distraction osteogenesis in reconstruction of mandibular defects involving body and ramus. Int J Oral Maxillofac Surg 39: 573-579, 2010
Cohen A, Amir Laviv A, Berman P, Nashef R, Abu-Tair J: Mandibular reconstruction using stereolithographic 3-dimensional printing modeling technology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 108:661-666, 2009
Cuesta M, Ochandiano S, Riba F, Duarte B, Navarro-Cuellar C, Navarro-Vila C: Oral rehabilitation with osseointegrated implants in oncologic patients. J Oral Maxillofac Surg 67: 2485- 2496, 2009
Demergasso F, Piazza M: Trapezius myocutaneous flap in reconstructive surgery for head and neck cancer: an original technique. Am J Surg 138: 533-536, 1979
Disa J J, Cordeiro PG: Mandible reconstruction with microvascular Surgery. Seminars in Surgical Oncology 19: 226-234, 2000
Eckardt A, Fokas K: Microsurgical reconstruction in the head and neck region: an 18-year experience with 500 consecutive cases. J Cranio-Maxillofac Surg 31:197-201, 2003
Ettl T, Driemel O, Dresp B, Reichert T, Reuther J, Pistner H: Feasi - bility of alloplastica mandibular reconstruction in patients following removal of oral squamous cell carcinoma. J Cranio Max Fac Surg 38: 350-354, 2010
Frodel J , Funk G, Capper D, Fridrich K, Blumer J, Haller J, Hoffman H: Osseointegrated implants: a comparative study of bone thickness in four vascularized bone flaps. Plast Recons Surg, 92, (3) : 449-455, 1993
Gaggl AJ, Buerger H, Mueller E, Chiari F M: A combined anterolateral thigh flap and vascularized iliac crest flap in the reconstruction of extended composite defects of the anterior mandible. Int. J. Oral Maxillofac. Surg 36: 849–853, 2007
Gilbert A: Vascularized transfer of the fibula shaft. Int J Microsurg 1: 100-102, 1979
Gonzalez R, Rubio P, Naval L, Rodriguez F, Escorial V, Martos P, Muñoz M, Sastre J, Gil Jl, Diaz F: Internal distraction osteogenesis in mandibular reconstruction: Clinical experience in 10 cases. Plast Reconstr Surg 121: 563-575, 2008
González-García R, Naval-Gías L: Transport Osteogenesis in the Maxillofacial Skeleton.Outcomes of a Versatile Reconstruction Method Following Tumor Ablation. Arch Otolaryngol Head Neck Surg 136:243-250, 2010
Hidalgo A: Fibula free flap: A new method of mandible reconstruction. Plast Reconstr Surg 84;71-79, 1989
Hidalgo DA, Cordeiro P, Disa J: Refinements in mandible reconstruction. Oper Tech Plast Surg 3: 257-262, 1996
Ilizarov G: The tension-stress effect on the genesis and growth of tissues: part I. The influence of stability of fixation and soft tissue preservation. Clin Orthop Relat Res 238: 249-81, 1989
Iseli TA, Yelverton JC, Iseli CE, Carroll WR, Magnuson JS, Rosenthal EL: Functional outcomes following secondary free flap reconstruction of the head and neck. Laryngoscope 119: 856-860, 2009
Ivy R, Epes BM: Bone grafting for defects of the mandible. Milit Surg 60: 286-300, 1927
Jacobson A, Buchbinder D, Hu K, Urken ML: Paradigm shifts in the management of osteoradionecrosis of the mandible. Oral Oncology 46: 795-781, 2010 Koshima I, Yamamoto H, Hosoda M, Moriguchi T, Orita Y, Nagayama H: Free combined composite flaps using the lateral circumflex femoral system for repair of massive defects in the head and neck region: An introduction of the chimeric flap principle. Plast Reconstr Surgery 92: 411-420, 1993
Leake DL, Rappoport M: Mandibular reconstruction: bone induction in an alloplastic tray. Surgery 72: 332-336, 1972
Li L, Blake F, Gbara A, Gudewer E, Schmelzle R: Distraction osteogenesis in secondary microsurgical mandible reconstruction: re - port of seven cases. J Cranio Maxillofac Surg 36: 273-278, 2008
Lopez.Arcas JM, Arias J, Del Castillo JL,, Burgueño M, Navarro I, Moran MJ, Chamorro M, Martorell V: The fibula osteomyocutaneous flap for mandible reconstruction: A 15 year experience. J Oral Maxillofac Surg 68: 2377-2384, 2010
Maranzano M, Freschi G, Atzei A, Miotti AM: Use of vascularized iliac crest with internal oblique muscle flap for mandible reconstruction. Microsurgery 25: 299–304, 2005
Moscoso J, Keller J, Genden E, Weinberg H, Biller H, Buchbinder B, Urken M: Vascularized bone flaps in oromandibular reconstruction. A comparative anatomic study of bone stock from various donor sites to assess suitability for enosseous dental implants. Arch Oto Head Neck 120: 36-43, 1994
Navarro C, Borja A, Cuesta M, Lopez J, Salmeron JI, Barrios JM: Aesthetic and functional reconstruction with the trapezius osseomyocutaneous flap and dental implants in oral cavity cancer patients. J Cranio Maxillofac Surg 24: 322-329, 1996
Navarro-Cuellar C, Ochandiano S, Riba F, Lopez FJ, Acero J, Cuesta M, Navarro-Vila C: Implant-supported rehabilitation usig the fibula free flap. Rev Esp Cirug Oral y Maxilofac 28: 263-275, 2006
Pirgousis P, Eberle N, Fernandes R: Reoperative mandibular reconstruction. Oral Maxillofac Surg Clin North Am 23(1):153-160, 2011
Pogrel MA, Podlesh S, Anthony JP, Alexander J: Comparison of vascularized and nonvascularized bone grafts for reconstruction of mandibular continuity defects. J Oral Maxillofac Surg 55: 1200- 1206, 1997
Ramasastry SS, Tucker JB, Swartz WM, Hurwitz DJ: The internal oblique muscle flap: An anatomic and clinical study. Plast Reconstr Surgery 73: 721-733, 1997
Sacco AG, Chepeha DB: Current status of transport-disc-distraction osteogenesis for mandibular reconstruction. Lancet Oncology 8: 323-330, 2007
Sanders R, Mayou B: A new vascularized bone graft transferred by mi - crovascular anastomosis as a free flap. Br J Surg 66: 787-788, 1979
Schuller-Gotzburg P, Pieschberger M, Rammerstorfer FG, Krenkel C: 3D-FEM and histomorphology of mandibular reconstruction with the titanium functionally dynamic bridging plate. Int J Oral Maxillofac Surg 38: 1298-1305, 2009
Snyder CC, Levine GA, Swanson HM, Browne EZ: Mandibular lengthening by gradual distraction: preliminary report. Plast Reconstr Surg 51: 506-508, 1973 Swartz WM, Banis JC, Newton ED, Ramasastry SS, Jones NF, Acland R: The osteocutaneous scapular flap for mandibular and maxillary reconstruction. Plast reconstr Surg 77: 530-545, 1986
Taylor GI , Townsend P , Corlett R: Superiority of the deep circumflex iliac vessels as the supply for free groin flaps: experimental work. Plast Recons Surg 64: 595-604, 1979
Torroni A, Gennaro P, Aboh IV, Longo G, Valentini V, Iannetti G: Microvascular reconstruction of the mandible in irradiated patients. J Craniofacial Surg 18(6):1359-1369, 2001
Urken ML, Vickery C, Weinberg H, Buchbinder D, Biller HP: The internal oblique-iliac crest osseomyocutaneous free flap in oromandibular reconstruction. Arch Otolaryngol Head Neck Surg 115: 339-349, 1989
Urken ML, Weinberg H, Vickery C, Buchbinder D, Lawson W, Biller HF: Oromandibular reconstruction using microvascular composite free flaps. Report of 71 cases and a new classification scheme for bony, soft tissue and neurologic defects. Arch Otolaryngol Head Neck Surg 117(7): 733-744, 1991
Urken ML: Iliac Crest osteocutaneous and osteomusculocutaneous. In Urken ML, Cheney ML, Sullivan MJ, Biller HF, editors. Atlas of regional and free flaps for head and neck reconstruction. New York: Raven Press,1995. P 261-290
Valentini V, Gennaro P, Aboh IV, Longo G, Mitro V, Ialongo C: Iliac crest flap: Door site morbidity. J Craniofac Surg 20: 1052-1055, 2009
Villaret DB, Futran NA: The indications and outcomes in the use of osteocutaneous radial forearm free flap. Head Neck. 25(6):475- 81, 2003
Vu D, Schmidt BL: Quality of life evaluation for patients receiving vascularized versus nonvascularized bone graft reconstruction of segmental mandibular defects. J Oral Maxillofac Surg 66: 1856- 1863, 2008
Wei F Celik N, Yang W, Chen IH, Chang YM, Chen H: Compli - cations after Reconstruction by Plate and Soft-Tissue Free Flap in Composite Mandibular Defects and Secondary Salvage Re - construction with Osteocutaneous Flap. Plastic Reco nstructive Surg 112:37-42, 2003
Wei FC, Celik N, Yang W, Chen I, Chang Y, Chen H: Complications after reconstruction by plate and soft tissue free flap in composite mandibular defects and secondary salvage reconstruction with osteocutaneous flap. Plastic Reconstr Surg 112 (1): 37-42, 2003
Xingzhou Q, Chenping Z, Laiping Z, Min R, Shanghui Z, Mingyi W: Deep circumflex iliac artery flap combined with a costochondral graft for mandibular reconstruction. In press. Br J Oral Maxillofac Surg doi:10.1016/j. bjoms.2010.10.008, 2010
Yamada H, Ishihama K, Yasuda K, Hasumi-Nakayama Y, Okayama M, Yamada T, Furusawa K: Precontoured mandibular plate with three-dimensional model significantly shortened the mandibular reconstruction time. Asian Journal of Oral and Maxillofacial Surgery 22: 198-201, 2010
How to cite this article:
|
View the full-text PDF:
|
| ||