Reconstruction of segmental mandibular defects: Current procedures and perspectives

Paré, Arnaud; Bossard, Adeline; Laure, B.; Weiss, Pierre; Gauthier, Olivier; Corre, Pierre

doi:10.1002/lio2.325

Cited by 40 publications

(28 citation statements)

References 82 publications

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“…There were three osteocutaneous radial forearm free flaps in this study, while the remaining were fibula flaps. The fibula serves as a workhorse for mandibular reconstruction 24 . Previous reports have found impaired QOL in fibula free flap patients, both in general and in specific domains such as social functioning 25,26 .…”

Section: Discussionmentioning

confidence: 99%

Appearance‐Related Distress and Social Functioning after Head and Neck Microvascular Reconstruction

et al. 2021

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Objectives/Hypothesis To better understand aesthetic patient‐reported outcomes and psychosocial quality of life (QOL) after head and neck microvascular reconstruction for benign or malignant tumors. Study Design Single‐center prospectively obtained in‐office validated questionnaire‐based study. Methods Analysis of prospectively collected surveys at a tertiary care academic center from June 2018 to February 2021. Patients completed two FACE‐Q scales: Appearance‐Related Psychosocial Distress (ARPD) and Social Function (SF). Survey scores, demographics, operative course, and adjuvant therapy data underwent univariate and multivariable analyses. Results One hundred and three patients completed surveys at a median of 13.5 months postoperatively (interquartile range: 5.2–30.8). Mean ARPD from 0 (no distress) to 100 (maximum distress) was 32.4 (standard error of the mean [SEM]: 2.7). Mean SF from 0 (worst functioning) to 100 (best functioning) was 55.5 (SEM: 2.7). Postoperative adjuvant radiation was associated with 13.9% higher ARPD (95% CI: 3.4–24.4, P = .019) and 10.4% lower SF (95% CI: −20.7 to −0.1, P = .047). Each appearance‐related question on the ARPD scale independently predicted impaired SF (P < .001 for all questions). Upon multivariable logistic regression, osteocutaneous reconstruction, compared to soft tissue alone (P = .043), and postoperative adjuvant radiation (P = .014) were associated with higher levels of ARPD. Age, sex, relationship status, anxiety or depression history, defect location, and hospital stay were not significantly associated with ARPD or SF scores. Conclusions Aesthetic outcomes are important determinants of psychosocial QOL following head and neck microvascular reconstruction: an effect that is worsened by adjuvant radiation. Reconstructive surgeons should prioritize aesthetic outcomes, in addition to functional restoration, to optimize social functioning in patients with head and neck tumors. Level of Evidence 3 Laryngoscope, 131:E2204–E2211, 2021

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Section: Discussionmentioning

confidence: 99%

Appearance‐Related Distress and Social Functioning after Head and Neck Microvascular Reconstruction

et al. 2021

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“…There are many etiologies of mandibular defects, including tumors, trauma, osteoradionecrosis, and congenital deformities, [ 6 ] of which tumors are the most common. Mandibular reconstruction followed by tumor ablation remains a considerable clinical challenge.…”

Section: Discussionmentioning

confidence: 99%

The application of chimeric deep circumflex iliac artery perforator flap for oromandibular reconstruction

Zhang¹,

Zeng

Zhou³

et al. 2021

Medicine

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Rationale: The free fibular flap is considered the gold standard, particularly for a mandibular defect combined with a significant soft tissue defect. However, the fibular flap has the disadvantages of a lack of height for postoperative dental restoration and donor site skin graft if the skin paddle is wider than 5 cm. The larger bone and soft tissue defects tend to be reconstructed using either a scapula or a combination of iliac artery and radial free flap. Few cases involving reconstruction using chimeric deep circumflex iliac artery perforator flap (DCIAPF) for mandibular defect combined with more significant soft tissue defects have been reported due to perforator variations. We successfully performed oromandibular reconstruction using chimeric DCIAPF. Patient concerns: A 56-year-old male patient was admitted due to “constant pain in the gradually enlarged right lower gingival mass since the previous four months.” The patient had no other obvious symptoms, and no history of diabetes or hypertension was reported. The patient reported long-term smoking and drinking habits. Diagnoses: Computed tomography (CT) revealed a neoplasm in the right buccal space, which is primarily considered a malignancy. The pathological results of a gingival mass biopsy presented squamous cell carcinoma. Interventions: No operative contraindications were confirmed after regular tests and examinations were undertaken. The patient underwent a primary extent resection of a 6-cm-long mandible, including mass and suprascapulohyoid neck dissection. The oromandibular defects were then reconstructed with chimeric DCIAPF, simultaneously using the iliac crest bone flap to repair the mandibular lateral segment defect and the skin paddle to repair the intraoral soft tissue defect of 5 × 10 cm. Outcomes: The total operating time was five and half hours and blood loss was approximately 500 ml. The operation was successful, with no infections or flap loss. Six months postoperatively, CT showed that the iliac crest bone had connected to the alveolar bone of the mandible. The height of the iliac crest bone was sufficient for postoperative dental restoration. The patient healed without obvious complications and no tumor recurrence. Lessons: Chimeric DCIAPF is an excellent option for mandibular angle or body segment defects combined with significant soft tissue defects.

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“…Titanium reconstruction plates are biocompatible, adaptable to bone surfaces, offer acceptable functional results and give stability to the mandibular segment, preventing its deviation when in function. Planning based on a 3D model includes advantages, such as a special understanding of bone morphology, accurate and previous conformation of the plate and an adequate measure of the graft to be removed, therefore, decreasing the time of surgery and, consequently, the time of exposure of the patient to general anesthesia [4,7,8]. In this case, the use of the pre-contoured reconstruction plate in 3D model allowed adequate adaptation and symmetry, a considerable reduction in the patient's exposure time to general anesthesia and a lower risk of infections due to prolonged wound exposure.…”

Section: Discussionmentioning

confidence: 99%

“…Since this reconstruction involved the ramus and condyle regions, it was decided to use costochondral grafts in order to maintain joint function [7,9,10]. As observed in the intraoperative and imaging exams, the graft was satisfactorily positioned in the mandibular fossa.…”

Section: Discussionmentioning

confidence: 99%

“…Restoration of masticatory, speech and respiratory functions is the main objective of mandibular reconstruction, followed by preservation of dental occlusion and temporomandibular joint, possibility of dental rehabilitation and satisfactory aesthetic results, considering that facial deformities can induce great social impact and psychological repercussions [7]. Maintenance of occlusal function was observed, with joint movements and mandibular perimeter preserved, favoring facial symmetry.…”

Section: Discussionmentioning

confidence: 99%

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Resection of large proportion ameloblastoma with immediate reconstruction: A case report

Everton¹,

Géssica²,

Ricardo³

et al. 2021

Int J Case Rep Images

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Introduction: Ameloblastoma is a benign odontogenic tumor, locally aggressive and highly prone to recurrence. Due to its clinical behavior and high recurrence rate, it is recommended that the treatment of ameloblastoma be radical, which creates a defect in bone continuity, requiring reconstruction of the osteotomized segment.Case Report: A 26-year-old patient diagnosed with a large proportion ameloblastoma of plexiform type in the left mandible, resulting in facial asymmetry and volumetric increase in the left middle and lower thirds of the face sought treatment at Mato Grosso Cancer Hospital. The treatment consisted of resection with immediate reconstruction, using pre-contoured reconstruction plate aided by prototyping and costochondral graft. Conclusion:The graft associated with the reconstruction plate demonstrated good adaptation to the mandibular fossa and preservation of joint function, in addition to minimizing the possible mechanical failures expected from the fixation material. The use of the 3D model to aid in the previous conformation of the plate resulted in less surgical time, adequate adaptation of the material to the bone segment, and better facial symmetry.

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Reconstruction of segmental mandibular defects: Current procedures and perspectives

Cited by 40 publications

References 82 publications

Appearance‐Related Distress and Social Functioning after Head and Neck Microvascular Reconstruction

Appearance‐Related Distress and Social Functioning after Head and Neck Microvascular Reconstruction

The application of chimeric deep circumflex iliac artery perforator flap for oromandibular reconstruction

Resection of large proportion ameloblastoma with immediate reconstruction: A case report

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