Oromandibular Reconstruction Using Microvascular Composite Free Flaps: Report of 71 Cases and a New Classification Scheme for Bony, Soft-Tissue, and Neurologic Defects

Urken, Mark L.; Weinberg, Hubert; Vickery, Carlin; Buchbinder, Daniel; Lawson, William; Biller, Hugh F.

doi:10.1001/archotol.1991.01870190045010

Cited by 332 publications

(149 citation statements)

References 15 publications

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“…There were 81 papers (16, 24, 29, 30, 31, 33, 38, 47, 49, 53, 55, 57, 63, 65, 66, 69, 71, 73, 75, 76, 81, 84, 89, 91, 95, 97, 99, 100, 103, 104, 107-109, 111-116, 120, 121, 124, 125, 130, 132-134, 137, 140 145-150, 154, 158, 163, 165, 166, 168, 170-173, 180, 184, 185, 188, 194-197, 202, 203, 205, 210, 212, 221, 222, 229) 98, 101, 106, 110, 110, 117-119, 122, 123, 126-129, 131, 135, 138, 139, 141, 143, 151, 153, 156, 159-161, 164, 167, 169, 179, 182, 183, 187, 190, 192, 193, 199, 200, 204, 206, 207, 209, 212, 214, 216, 218, 220, 223, 225, 227, 228) also reconstructed the condyle, compared with 1.6% (6/373) for the iliac crest (13,15,19,60,77,79,86,87,98,105,155,157,161,177,178,183,201,211,212,227 …”

Section: Classificationmentioning

confidence: 99%

Mandibular reconstruction with vascularised bone flaps: a systematic review over 25 years

Brown

Lowe

Kanatas³

et al. 2017

British Journal of Oral and Maxillofacial Surgery

129

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A systematic review was undertaken to explore the mandibular reconstruction techniques and outcomes, using composite free flaps.A total of 9499 mandibular defects were reconstructed with 6178 fibulas, 1380 iliac crests, 1127 composite radials, 709 scapulas, 63 serratus anterior and rib, 32 metatarsals and 10 lateral arm flaps including humerus. The flap failure rate was higher for the iliac crest at 6.2% (66/1059) compared to 3.4% (202/6018) if the fibula, radial or scapula was used (p<0.001). Details relating to osteotomy rate, non-union and fistula rates were evaluated. Iliac crest was most often rehabilitated with implantretained prosthesis (44%, 100/229), compared to 26% (605/2295) (p<0.001) if another flap was used. Changing trends over the study period were not apparent, regarding flap choice or related complications.Although we are able to show some significant differences relating to the type of flap used, it is disappointing to present the underreporting of fundamental outcomes such as the osteotomy rate, non-union and fistula rates. This review demonstrates the need for more comprehensive and consistent outcome reporting, that will allow the comparison of different techniques for similar defects.

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Section: Classificationmentioning

confidence: 99%

Mandibular reconstruction with vascularised bone flaps: a systematic review over 25 years

Brown

Lowe

Kanatas³

et al. 2017

British Journal of Oral and Maxillofacial Surgery

129

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“…The reconstruction of oral cavity defects following OMT resection, including total glossectomy (TG), poses a formidable challenge for the restoration of postoperative oral function (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). The decannulation of a tracheostomy tube or extubation of a endotracheal tube, or restoration of oral intake function unaided by a nasogastric or gastric tube, are representative indicators of the restoration of postoperative oral function in patients that underwent OMT resection with reconstruction (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). Previously, we reported a significant correlation between the likelihood of restoring oral intake function and reduced extents of tongue base resection in an analysis based on 53 patients between 1993 and 2005 (1), and in 25 patients that underwent segmental mandibulectomy (SM) with reconstruction to treat mandibular bone defects between 2004 and 2011 (2).…”

Section: Introductionmentioning

confidence: 99%

Prediction of decannulation, oral intake recovery, overall survival and lung metastasis following oral malignant tumor resection and reconstruction

2017

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Abstract. The present study investigated whether tongue base and mandibular bone defects were associated with the rate of decannulation and oral intake recovery, and survival time, including overall and lung metastasis-free survival time, in patients that underwent oral malignant tumor (OMT) resection with reconstruction. A total of 105 patients that underwent OMT resection with laryngeal preservation and reconstruction were recruited. The extent of defects was classified according to Urken's classification. The rates of decannulation and oral intake recovery were assessed with the Kaplan-Meier method. It was identified that 4-5 section segmental mandibulectomy (SM) and total glossectomy (TG) were significantly associated with a lower rate of decannulation and oral intake recovery by univariate and multivariate analysis using a Cox's proportional model. Patients in the high risk group (4-5 sections or TG) were significantly less likely to achieve decannulation and unaided oral intake. Patients in the high risk group exhibited a significantly shorter overall and lung metastasis-free survival time. Following multivariate analysis adjusted for the clinical stage (IV/I-III), past history of or postoperative radiotherapy (yes/no) and age (per year), the high risk group was associated with a significantly rate of decannulation and unaided oral intake. In conclusion, TG or wide SM is a prognostic parameter for functional and survival outcomes, including lung metastasis, in OMT.

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“…In Urken et al (1991), the authors propose a classification scheme for mandibles based on regions according to anatomical, functional and aesthetic considerations. The online register www.aofoundation.org uses the same classification ( Fig.…”

Section: Clinical Problemmentioning

confidence: 99%

Capturing the multiscale anatomical shape variability with polyaffine transformation trees

Seiler¹,

Pennec²

2012

Medical Image Analysis

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Oromandibular Reconstruction Using Microvascular Composite Free Flaps: Report of 71 Cases and a New Classification Scheme for Bony, Soft-Tissue, and Neurologic Defects

Cited by 332 publications

References 15 publications

Mandibular reconstruction with vascularised bone flaps: a systematic review over 25 years

Mandibular reconstruction with vascularised bone flaps: a systematic review over 25 years

Prediction of decannulation, oral intake recovery, overall survival and lung metastasis following oral malignant tumor resection and reconstruction

Capturing the multiscale anatomical shape variability with polyaffine transformation trees

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