Mandibular Reconstruction with Osseointegrated Implants into the Free Vascularized Radius

Ra, Mounsey; Jb, Boyd

doi:10.1097/00006534-199409000-00006

Cited by 35 publications

(8 citation statements)

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“…Although some surgeons still use the radial forearm composite flap, the potential for fracture of the radius and the paucity of bone that can be reliably transferred have limited its use and the enthusiasm for applying it to oromandibular reconstruction in all but a handful of centers. 5 The following report is a retrospective review of the experience of 1 microvascular surgeon (M.L.U.) in oromandibular reconstruction involving 210 cases from March 1987 to June 1997.…”

Section: Methodsmentioning

confidence: 99%

Oromandibular Reconstruction Using Microvascular Composite Flaps

Urken¹,

Buchbinder²,

Costantino³

et al. 1998

Arch Otolaryngol Head Neck Surg

394

288

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The success of the use of vascularized bone free flaps in restoring continuity to the mandible is clearly demonstrated in this series. There was an acceptable incidence of donor- and recipient-site complications that resulted in minimal long-term morbidity. The careful selection of a donor site(s) for oromandibular reconstruction allows for an optimal restoration of bony and soft tissue defects. Dental implants can be safely used in oromandibular reconstruction with a high level of success. Placing these implants during the initial surgery shortens the duration for achieving dental rehabilitation and enhances the success of the implants when postoperative radiotherapy is administered.

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Section: Methodsmentioning

confidence: 99%

Oromandibular Reconstruction Using Microvascular Composite Flaps

Urken¹,

Buchbinder²,

Costantino³

et al. 1998

Arch Otolaryngol Head Neck Surg

394

288

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show abstract

“…64 The main criticism of the radial forearm osteocutaneous flap is the incidence of fracture of the radius after flap harvest, which, in the literature, has ranged from 0 to 67%. [62][63][64][65] Methods to prevent this include use of a keel-shaped osteotomy, 62 prophylactic plating 66 of the radius, bone grafting of the donor, and preventing overzealous bone harvest. Other limitations include an unsightly donor site as well as requirement for a volar splint or cast if a split-thickness skin graft is used to aid in closure of the donor site.…”

Section: Radial Forearm Osteocutaneous Flapmentioning

confidence: 99%

Reconstruction of Mandibular Defects

Chim

Salgado

Mardini

et al. 2010

Seminars in Plastic Surgery

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Defects requiring reconstruction in the mandible are commonly encountered and may result from resection of benign or malignant lesions, trauma, or osteoradionecrosis. Mandibular defects can be classified according to location and extent, as well as involvement of mucosa, skin, and tongue. Vascularized bone flaps, in general, provide the best functional and aesthetic outcome, with the fibula flap remaining the gold standard for mandible reconstruction. In this review, we discuss classification and approach to reconstruction of mandibular defects. We also elaborate upon four commonly used free osteocutaneous flaps, inclusive of fibula, iliac crest, scapula, and radial forearm. Finally, we discuss indications and use of osseointegrated implants as well as recent advances in mandibular reconstruction. Continuing advances in mandibular reconstruction have greatly improved functional and aesthetic outcomes for patients. Outcomes from free vascularized bone flaps have proved markedly superior to those obtained from use of nonvascularized options such as reconstruction plates and bone grafts. The free fibula flap continues to remain the gold standard for mandibular reconstruction against which other modalities are compared.The mandible serves several important functions in the head and neck, which can be restored to nearnormality with the use of vascularized bone flaps. It provides a stable platform for the oral cavity and also a structure to which muscles attach. Most importantly, it allows mastication by providing a stable counterpoint to the maxilla and serving as a base for attachment of dentition. It facilitates speech, swallowing, and breathing by maintaining space within the oral cavity and allowing the tongue to function. It also serves an aesthetic function, defining the projection of the lower third of the face. ANATOMY OF THE MANDIBLEThe mandible is a U-shaped bone that articulates with the skull base through two unique temporomandibular joints (TMJs), which allow smooth and coordinated mouth opening. The TMJ is a diarthrodial joint, consisting of two bones articulating in a discontinuous fashion allowing freedom of movement dictated by muscles and limited by ligamentous attachments. The TMJ is also lined on its internal aspect by synovium, which secretes synovial fluid, serving both as a lubricant and a nutrition source for joint structures.

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“…Salivary secretion is reduced, and speech, chewing (mastication), swallowing and aesthetics are often impaired. [1][2][3][4][5][6][7][8] Due to the changed intra-oral conditions (changed anatomy, oral sequelae of radiotherapy) the possibilities to obtain proper stability and retention for a mandibular prosthesis are seriously at risk. 1,[9][10][11] For example, particularly after radiotherapy, the load-bearing capacity of both the native and reconstructed tissues is compromised.…”

Section: Introductionmentioning

confidence: 99%

Rehabilitation of oral function in head and neck cancer patients after radiotherapy with implant-retained dentures: Effects of hyperbaric oxygen therapy

et al. 2007

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Surgical treatment of malignancies in the oral cavity and subsequent radiotherapy often result in an anatomic and physiological oral condition unfavorable for prosthodontic rehabilitation. The objective of this prospective study was to assess the effect of hyperbaric oxygen therapy on treatment outcome (condition of peri-implant tissues, implant survival, oral functioning and quality of life) of prosthodontic rehabilitation with implant-retained lower dentures in radiated head and neck cancer patients 6 weeks and 1 year after placing the new dentures. The treatment outcome was assessed in a group of 26 head neck cancer patients who were subjected to radiotherapy after tumour surgery. Standardized questionnaires were completed and clinical and radiographic assessments were performed. After randomization, endosseous Brånemark implants were placed in the anterior part of the mandible either under antibiotic prophylaxis (13 patients) or under antibiotic prophylaxis combined with pre and postsurgery hyperbaric oxygen (HBO) treatment (13 patients). In the HBO and non-HBO group eight implants (implant survival 85.2%) and three implants (implant survival 93.9%) were lost, respectively. Peri-implant tissues had a healthy appearance in both groups. Osteoradionecrosis developed in one patient in the HBO group. All patients functioned well with their implant-retained lower denture. The quality of life related to oral functioning and denture satisfaction were improved to a comparable extent in the HBO and non-HBO group. Implant-retained lower dentures can improve the quality of life related to oral functioning and denture satisfaction in head and neck cancer patients. Adjuvant hyperbaric oxygen therapy could not be shown to enhance implant survival in radiated mandibular jaw bone.

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Mandibular Reconstruction with Osseointegrated Implants into the Free Vascularized Radius

Cited by 35 publications

References 0 publications

Oromandibular Reconstruction Using Microvascular Composite Flaps

Oromandibular Reconstruction Using Microvascular Composite Flaps

Reconstruction of Mandibular Defects

Rehabilitation of oral function in head and neck cancer patients after radiotherapy with implant-retained dentures: Effects of hyperbaric oxygen therapy

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