Indications of Free Grafts in Mandibular Reconstruction, after Removing Benign Tumors: Treatment Algorithm

Abstract

Background:Mandibular reconstruction has been the subject of much debate and research in the fields of maxillofacial surgery and head and neck surgery.Materials and Methods:A retrospective observational study was undertaken with 14 patients diagnosed with benign tumorous pathologies and who underwent immediate mandibular resection and reconstruction at the Hospital del Salvador Maxillofacial Surgery Unit and Dr. Rodrigo Fariña’s private clinic between the years 2002 and 2012. We propose a treatment algorithm, which is previous teeth extractions in area that will be removed.Results:Fourteen patients underwent surgery, and a total of 40 dental implants were installed in 6 men and 8 women, the mean age of 33.5 (age range, 14–58 y). Reconstruction with iliac crest bone graft, and rehabilitation following this protocol (average of reconstruction was 8.7 cm), was successful with no complications at all in 12 patients. One patient had a minor complication, and the graft was partially reabsorbed because of communication of the graft with the oral cavity. This complication did not impede rehabilitation with dental implants. Another patient suffered the total loss of the graft due to infection because of dehiscence of oral mucosa and great communication with the mouth. Another iliac crest free graft reconstruction was undertaken 6 months later.Conclusions:The scientific evidence suggests that mandibular reconstruction using free grafts following the removal of benign tumors is a biologically sustainable alternative. The critical factor to improve the prognosis of free grafts reconstruction in benign tumors is to have good quality soft tissue and avoid communication with the oral cavity. For this, it is vital to do dental extractions before removing the tumor.

Sequela de cirurgia para reconstrução mandibular após ressecção de ameloblastoma

“…Fatores fundamentais devem ser considerados quando se trata de propor uma reconstrução, dentre os quais o tamanho e a posição do defeito, a qualidade dos tecidos restantes, vascularização e condição geral do paciente. O resultado final é mais influenciado pela reconstrução do tecido mole do que mesmo pela reconstrução óssea 8 . Nota-se no presente caso que os princípios básicos de reconstrução mandibular não foram obedecidos no primeiro tempo cirúrgico.…”

The Use of the Mandibular Ramus for Alveolar Reconstruction in Oral Implantology

“…Considering that autogenous bone continues to be the "gold standard" (Kluppel et al, 2013), with contemporary applications in both large maxillofacial reconstructions (Fariña et al, 2016) and in smaller reconstructions (Netto et al, 2016), other alternatives for the autogenous block graft extracted from the mandibular ramus have preferentially used homogenous or heterogeneous bone blocks with controversial results. Deluiz et al (2016) studied postoperative complications in 58 patients who required implant-assisted rehabilitation and augmented volume with a block allograft.…”

Characterization of Bone Substitute β-TCP Block for Maxillofacial Reconstruction

“…The craniomaxillofacial defects associated with tumors, trauma and their sequelae are frequent and present a variety of conditions; bone reconstruction is needed and must respond to esthetics and function, which determines a technically demanding process (Sándor et al, 2012;Fariña et al, 2016). The four essential properties in bone reconstruction -osteoconduction, osteoinduction, osteogenesis and osteopromotion (Ripamonti et al, 2001) are related to autogenous grafts, the gold standard in reconstruction.…”