MatrixMANDIBLE preformed reconstruction plates--a two-year two-institution experience in 71 patients.

PURPOSE: To evaluate handling, complication rates, clinical and treatment outcomes of the MatrixMANDIBLE Preformed Reconstruction Plates (MMPRPs), in particular with regard to the frequency of fatigue fractures and operative time. PATIENTS AND METHODS: A cohort of 71 subjects with an indication for a load-bearing osteosynthesis of the mandible was enrolled in the present study. The indications for plate use were defects due to tumor, trauma, or osteonecrosis. The outcome variables were fitting accuracy, application time, and postoperative complications, defined as plate exposure, loosening of plates or screws, plate fracture, and orocutaneous fistulas. Additionally, the feasibility of a transoral approach was tested. RESULTS: The sample included 71 subjects with a mean age of 54.8 ± 15.0 years, including 43 men (60.6%). MMPRPs could be placed in 70 of the 71 patients. In 10 patients a transoral approach for plate application was successfully performed. The mean time investment to contour the plates was 13.1 minutes. The fitting accuracies of the nonbendable sections were satisfying. No plate fracture was observed within an average follow-up period of 11.8 months. Postoperative complications occurred in 19 (27.1%) of the 70 patients. Plate removal was required in 11 (15.7%) of 70 patients. CONCLUSIONS: The results of the present study suggest that the use of MMPRPs coincides with a reduced operative time and a minimized risk of fatigue fractures. Thus, MMPRPs seem to be a useful standard device in a scope of indications for load-bearing osteosynthesis of the anterolateral division of the mandible, additionally facilitating a transoral approach for application.

Vector control in transportation osteogenesis.

PURPOSE: To evaluate the ability to control vectors in the technique of transportation osteogenesis using 4 principles. PATIENTS AND METHODS: Sixteen defects measuring approximately 30-180 mm were retrospectively evaluated. Vector control was attempted using a single or combination of the following principles: multiple linear vectors, exaggerated linear distraction ("sausage effect"), braced guided distraction, and reorientation osteotomies. Observations were made regarding the ability to create the desired vectors. Angular deviation from desired vectors was determined and recorded numerically by evaluating either submental vertex or occlusal radiographs, stereolithographic models, or digital radiographs. Radiographic evaluation of symmetry alone was not used to determine the desired vector because a more laterally displaced segment was desirable to maintain favorable facial balance when soft tissue deficiency was pronounced. A subjective evaluation scale was developed to supplement the numerical values. RESULTS: Vector control primarily required the use of 2 or more principles. The most common combination was that of exaggerated linear distraction and reorientation osteotomy. CONCLUSION: The use of multiple linear vectors, exaggerated linear distraction ("sausage effect"), reorientation osteotomies, and braced guided distraction greatly assisted the operator in achieving the goal of symmetrical reconstruction. Transportation osteogenesis may be considered an effective tool in the box to reconstruct patients. In cases in which vector control is achieved, the advantages of diminishing the volume of bone graft required or achieving final bony reconstruction can outweigh the disadvantages of the technique.

The use of free fibular flap for functional mandibular reconstruction.

PURPOSE: The purpose of this investigation is to document our experience using the free vascularized fibular flap for comprehensive reconstruction of discontinuity defects in the mandible, after combined resections of malignant and aggressive odontogenic tumors, with special emphasis on functional aspect of the reconstruction process. MATERIALS AND METHODS: The study group consisted of consecutive patients treated for reconstruction of discontinuity defects of the mandible, using the fibular vascularized free flap, between 1997-2002. All procedures were performed in the same hospital and by the same surgical team. RESULTS: A total of 13 patients (9 males, 4 females) were treated in our department in a period of 6 years for reconstruction of discontinuity mandibular defects using the free fibula vascularized flap. Wound healing disturbances at the donor site occurred in 4 cases. Two flaps were lost, 1 because of total failure in a patient who was heavily irradiated because of osteosarcoma, the other because of resorption of the bone tissue transfer in a case of total avulsion of the mandible caused by a fall from height. CONCLUSION: Fibula free vascularized flap is a safe and reliable method for comprehensive functional and esthetic mandibular defect reconstruction. Our protocol has a significant impact on preserving the patients quality of life.

Rehabilitation of an irradiated mandible after mandibular resection using implant/tooth-supported fixed prosthesis: a clinical report.

Patients undergoing mandibular resection often have facial asymmetry and cosmetic disfigurement, which include a retruded, deviated mandible, motor and sensory deficiencies, and abnormal intermaxillary relationship and occlusion. An implant-supported fixed prosthesis can be an optimal treatment modality. However, there is a problem in creating a repeatable, stable plane of occlusion and maxillomandibular relationship. This report describes the treatment sequence and considerations to rehabilitate a patient undergoing mandibular resection and radiotherapy with an implant-supported fixed prosthesis.

Functional rehabilitation following resection of the floor of the mouth: the nasolabial flap revisited.

INTRODUCTION: The aim of this study was to analyse the results of treatment following reconstruction of intraoral soft tissue using a nasolabial flap, with particular consideration of functional aspects. MATERIAL AND METHODS: In 26 patients (over a period of 10 years), the intraoral repair of the defect was carried out in the anterior floor of the mouth, 19 have received a unilateral and seven a bilateral nasolabial flap. The defects were caused by resection of squamous cell carcinomas (T1-T2) of the intraoral mucosa in 24 cases and osteoradionecrosis with soft tissue loss in two cases. RESULTS: Complications of local wound healing were observed in three cases. In 23 patients the subsequent prosthetic rehabilitation was successful and allowed a return of masticatory function. In the other three cases, a secondary operation for flap remodelling would have been preferred, but the patients declined these operations. CONCLUSION: The nasolabial flap for replacement of soft tissue in the floor of the mouth represents a functional and aesthetically satisfactory alternative to reconstruction by microsurgically anastomosed flaps in cases with defects of up to 5 x 5 cm in size, especially in older, medically compromised patients who are therefore of poorer surgical risk.

[Reconstruction of the anterior floor of the mouth with nasolabial flaps. Report of 10 years' experience]. / Die Rekonstruktion des vorderen Mundbodens durch den Nasolabial-Lappen. Ein 10-jähriger Erfahrungsbericht.

The aim of this study was to analyse, with particular consideration to functional aspects, the results of treatment following the reconstruction of intraoral soft tissue using a pedicled nasolabial flap. Over a period of 10 years (1.1.1990-31.12.1999) the intraoral repair of the defect was carried out in 20 patients in the region of the anterior floor of the mouth, using a unilateral nasolabial flap in 13 cases and a bilateral nasolabial flap in 7 cases. The reasons for the defects were resection of squamous cell carcinomas (T1-T2) of the intraoral mucosa in 19 cases and osteoradionecrosis with soft tissue defect in one case. Local wound healing disturbance was observed in two cases. In 18 patients the prosthetic rehabilitation was successful and allowed a return to masticatory function. In another three cases a secondary operation for flap remodelling was needed. In one case three ITI-Implants were inserted between the foramina 12 months following the placement of the flap. A magnetically retained full denture has been functioning normally for more than four years. The nasolabial flap for the replacement of soft tissue in the mouth appears to represent a functionally and aesthetically satisfactory alternative to reconstruction by microsurgery, in cases of small to medium-sized defects, especially in older, medically compromised patients with an enhanced surgical risk

Mandibular reconstruction with full thickness calvarial bone and temporal muscle flap.

Eleven patients underwent mandibular reconstruction with pedicled temporal muscle flaps combined with vascularised or free full thickness calvarial bone grafts. Six were primary and five secondary reconstructions. The indications were squamous cell carcinoma (n = 6), radio-osteonecrosis (n = 4), and gunshot wound (n = 1). Five patients also had endosseus implants, either simultaneously or delayed. The only major complications were necrosis of the whole calvarial bone (n = 1) and permanent facial nerve palsy (n = 1). The advantages of using full thickness calvarial bone are that it is thick enough to take an endosseous implant, morbidity is low, there is virtually no postoperative pain, the scar is invisible, and there is only one donor area for both hard and soft tissue. Transplantation of full thickness calvarial bone and temporal muscle is a viable alternative to an osseomyocutaneous microvascularised free flap for reconstruction of the mandible when the neck has been previously operated on or irradiated, and anastomosis may be critical.

Treatment of a microvascular reconstructed mandible using an implant-supported overdenture: case report.

Oral rehabilitation of patients with mandibular discontinuity defects is a challenging problem facing both the surgeon and the dentist. Advances in microvascular surgery have provided the surgeon with methods to repair the partially resected mandible with vital bone grafts. Often, however, reconstruction of the bony defect alone does not guarantee an adequate foundation for successful conventional prosthetic rehabilitation. Osseointegrated implants placed into the microvascularized grafted bone offer an opportunity for improved function and patient satisfaction. The following case presentation reports the use of an implant-supported overdenture in a vascularized iliac bone graft to reconstruct a partially resected mandible.

Dual free flap transfer using forearm flap for mandibular reconstruction.

To reconstruct a composite mandibular defect, we have simultaneously transferred a vascularized bone graft or osteocutaneous flap together with a forearm flap. The radial forearm flap, being thin, pliable, and having a long vascular stalk, served as mucosal lining and/or an interpositional flap acting as a vascular bridge. Between 1982 and 1989, we used this procedure in 17 patients with a mandibular defect or deformity which developed following treatment of oral cancer. Our clinical experience has demonstrated that this dual free tissue transfer has many advantages. It is useful for obtaining a good alveolar ridge in patients with a composite mandibular defect. It is applicable in cases where only a single pair of recipient vessels are present and may be useful when the recipient vessels are positioned some distance from the defect.