Morphometric analysis of paired fibula and mandible for optimal fibular mandibular reconstruction in a Chinese population.

To analyze the morphology of paired fibula and mandible aiming to choose optimal fibular segments for mandibular reconstruction in a Chinses population. A total of 118 cases of paired mandible and fibula was collected. All patients were received preoperative cone beam CT (CBCT) scans for mandibular evaluation and CT-angiographical (CTA) examination of the bilateral lower legs, respectively. The cross-sectional morphological differences between proximal (Side P), middle (Side M) and distal (Side D) segments of fibula and anterior, premolar and molar areas of mandible were compared. The most frequent cross-sectional shape at Side D, Side M and Side P portion of fibula was circular (75.4%), triangular (67.8%) and circular (49.2%), respectively. In anterior, premolar and molar areas of mandible, the most of the cross-section was s-shape (90.82%), straight (83.64%) and oblique (91.89%), respectively. The height and width of upper one third (W1) at Side M were significantly larger than those of Side D and Side P (p < 0.0001). There was significantly difference of width of lower one third (W2) among three groups (p < 0.0001). As for the height and widths of mandible, there was significant difference among anterior, premolar and molar regions (p < 0.0001). The rate of height between Side M of fibula and mandible (H (Side M/area)) was significantly larger than H (Side D/area) and H (Side P/area) (p < 0.01). The ratio of W1 between Side D of fibula and mandible (W1 (Side D/area)) was significantly larger than that of W1 (Side M/area) and W1 (side P/area) (p < 0.05). As for the ratio of W2 between fibula and mandible (W2 (plane/area)), there was significant difference among groups (p < 0.01). The distal and middle segments of fibula were suitable for reconstructing the anterior area of mandible and the proximal segment of fibula was more compatible with the premolar and molar areas of mandible.Clinical Relevance Presurgical morphometric analysis of paired fibula and mandible aids for optimal fibular-based mandibular reconstruction.

Vascular Analysis of Soft Tissues Around the Bone Lesion in Osteoradionecrosis, Medication-Related Osteonecrosis, and Infectious Osteomyelitis of the Jaw.

OBJECTIVE: The histopathological differences of the surrounding soft tissues in osteoradionecrosis of the jaw, medication-related osteonecrosis of the jaw as well as infectious osteomyelitis of the jaw patients were rarely investigated. Here, we focused on the vascular microarchitecture of the soft tissues around bone lesion and compared the microvessel difference of ORNJ, MRONJ, and IOMJ in a quantitative fashion. METHODS: A series of consecutive patients diagnosed as ORNJ, MRONJ, and acute/chronic IOMJ was retrospectively reviewed. All cases received preoperative cone bean computed tomography scans. Immunohistochemistry of CD34 was performed with the streptavidin-peroxidase method and the variables including vascular density, vascular area fraction, mean vessel lumen area, perimeter and diameter of the vessels as well as percentage of lumen less than 400 µm2 were analyzed. RESULTS: The results showed that the vascular-like structures were visible in more cases of acute/chronic IOMJ compared with ORNJ and MRONJ by hematoxylin-eosin staining. Quantitively, our results demonstrated the decreased vascular density, mean perimeter and diameter of the vessels but increased percentage of small vessels in ORNJ and MRONJ patients in contrast with IOMJ patients. CONCLUSIONS: Hypovascularity of surrounding soft tissues could play important roles in the etiology of IOMJ, ORNJ, and MRONJ, and microvessel profile may be a useful pathological diagnostic indicator to differentiate these 3 types of OMJ.

Intraoral versus transcervical approaches in mandibular reconstruction with free flaps: A retrospective study.

This study aims to investigate the clinical and functional differences between intraoral and transcervical approaches for segmental mandible resection and reconstruction with free flaps. Patients diagnosed as benign and low-grade mandibular malignant tumors without neck dissections were retrospectively reviewed and divided into intraoral and transcervical groups. Patients of intraoral group underwent intraoral mandibulectomy and vascular anastomosis was performed through a 2-cm submandibular incision, while traditional submandibular approach was used in transcervical group. Clinical characteristics of two groups were assessed including body mass index (BMI), defect types and number of fibular segments, as well as perioperative variables such as operation time, blood loss, drainage volume. The score of appearance, swallowing and speech using the University of Washington Quality of Life Questionnaire (UW-QOL) was recorded and analyzed 6-month postoperatively. A total of 14 patients in intraoral group and 21 patients in transcervical group was collected, respectively. In intraoral group, intraoperative blood loss and postoperative drainage volume were significantly reduced in comparison with transcervical group (p = 0.0146, p = 0.0017; respectively). The score of appearance was 87.50 ± 12.97 in intraoral group, which was significantly higher than 64.29 ± 12.68 in transcervical group (p < 0.0001). Similar results were found in patients of subtype Class II mandibular defect between two groups. However, patients of intraoral group had a significant increase in operative time and a comparable amount of intraoperative blood loss (p = 0.0472, p = 0.1434; respectively). Within the limitations of the study it seems that an intraoral approach combined with a 2-cm submandibular incision should be preferred over a transcervical approach for segmental mandibulectomy and free flap reconstruction whenever appropriate.