Sagittal Split Osteotomy on the Previously Reconstructed Mandible With Fibula Free Flap

Kim, Jin-Wook; Lee, Cheong-Hee; Kwon, Tae-Geon

doi:10.1097/scs.0000000000001058

Cited by 6 publications

(13 citation statements)

References 14 publications

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“…5 The asymmetric mandibular contour and the weak profile could be detrimental to the quality of life for patients with a secondary dentomaxillofacial deformity. Although some studies reported the use of sliding fibula osteotomy to treat malocclusion following mandibular reconstruction with the fibula free flap, [6][7][8] a second operation is needed, and the correction of the maxilla is likely to be neglected, thereby leading to a compromised treatment outcome.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of dentomaxillofacial deformity secondary to a long-term mandibular defect using concomitant orthognathic surgery and fibula free flap: a preliminary study

Cao¹,

Shen²,

Liu³

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Summary: The reconstruction of mandibular defects may be delayed or compromised for many reasons, especially in pediatric patients. With the growth of the remaining mandible and the maxilla in the malocclusion status, secondary dentomaxillofacial deformity is plausible. To treat the concomitant mandibular defect and secondary dentomaxillofacial deformity, a hierarchical algorithm using orthodontics, orthognathic surgery, and fibula free flap was developed. This retrospective case series included six patients with long-term mandibular defects caused by tumor resection without repair or with compromised costochondral reconstruction. All patients were treated using the same staged protocol, but with minor changes: (1) presurgical orthodontics, (2) virtual surgical planning, (3) fabrication of the guides and splints, (4) sequenced operations, and (5) postoperative care. The sequence of surgery included the Le Fort I osteotomy, mandibular sagittal split ramus osteotomy of the remaining ramus, final occlusion registration, repositioning of the distal segment of the mandible, segmented fibula reconstruction, and finally, the fixation of mandibular sagittal split ramus osteotomy. The operations and wound healing were uneventful in all patients, and no flap failure or severe complications were detected. Also, the patients exhibited no signs of temporomandibular joint ankylosis during the follow-up. The subspinale-nasion-supramental angle was significantly reduced after surgery. A significant improvement was detected in the facial contour symmetry measurements postoperatively. This proposed workflow of concomitant orthognathic surgery and the fibula free flap is effective and reliable for the reconstruction of dentomaxillofacial deformity secondary to the long-term mandibular defect.

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Section: Discussionmentioning

confidence: 99%

Reconstruction of dentomaxillofacial deformity secondary to a long-term mandibular defect using concomitant orthognathic surgery and fibula free flap: a preliminary study

Cao¹,

Shen²,

Liu³

et al. 2022

Plastic &Amp; Reconstructive Surgery

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show abstract

“…Large bone defects that arise from mandibular resection can be successfully managed by fibula free flap placement [11]. Currently, the minimization of surgical errors is directly related to improved aesthetic outcomes and functional recovery [12]. In our case, to reduce the likelihood of surgical error and to reduce the operation time, a virtual surgery simulation was performed based on the preoperative CT imaging, and a rapid prototype model was prepared based on the results of the simulation.…”

Section: Discussionmentioning

confidence: 99%

“…Their technique introduced the use of stepped osteotomy in the fibular reconstructed mandible and showed that this method could correct for vertical or horizontal length defects. Kim et al [12] reported that sagittal split osteotomy of previously grafted fibula including the affected mandible ramus has several advantages. They found that the stepped osteotomy method can result in a significant interosseous gap and cause instability of the final occlusion for a long period after surgery, while the SSRO approach increased bone contact which maximized postoperative bone stability.…”

Section: Discussionmentioning

confidence: 99%

Correction of malocclusion using sliding fibula osteotomy with sagittal split ramus osteotomy after mandible reconstruction

Lee

Kim

Jang³

et al. 2020

Maxillofac Plast Reconstr Surg

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Background: Fibula free flap mandible reconstruction is the standard procedure after wide resection of the mandible. Establishment and maintenance of normal occlusion are important in mandible reconstruction both intraoperatively and after surgery. However, scar formation on the surgical site can cause severe fibrosis and atrophy of soft tissue in the head and neck region. Case presentation: Here, we report a case of severe soft tissue atrophy that appeared along with scar formation after mandibular reconstruction through the fibular free flap procedure. This led to normal occlusion collapse after it was established, and the midline of the mandible became severely deviated to the affected side that was replaced with the fibula free flap, leading to facial asymmetry. We corrected the malocclusion with a secondary operation: a sagittal split ramus osteotomy on the unaffected side and a sliding osteotomy on the previous fibula graft. After a healing time of 3 months, implants were placed on the fibula graft for additional occlusal stability. Conclusion: We report satisfactory results from the correction of malocclusion after fibula reconstruction using sliding fibula osteotomy and sagittal split ramus osteotomy. The midline of the mandible returned to its original position and the degree of facial asymmetry was reduced. The implants reduced difficulties that the patient experienced with masticatory function.

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“…The realization of anteroposterior and lateral cephalometries, panoramic x-rays, standardized photographs, study models and three-dimensional reconstruction CT scan images is suggested. 2…”

Section: Discussionmentioning

confidence: 99%

“…Despite the use of these tools and guides that are able to minimize the margin of error as far as the length, position and direction of the bone segments during the reconstruction, a perfect outcome cannot always be guaranteed. 2 –4…”

Section: Introductionmentioning

confidence: 99%

Malocclusion Management Following Mandibular Reconstruction With Free Fibula Flaps

Ardila

Fuentes

Gómez

et al. 2020

Craniomaxillofacial Trauma & Reconstruction

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Study Design: Free fibula flaps are nowadays the gold standard for the surgical reconstruction on large mandibular defects. Malocclusion is an important complication of this type of reconstruction and many of these patients end up requiring subsequent orthognathic corrective surgery. This is a descriptive retrospective case series study. Objective: To describe the demographic data, operative techniques, corrective methods and postoperative results in the management of malocclusion following mandibular reconstruction with free fibula flap. Methods: This case series study included patients who underwent free fibula flap mandibular reconstructions and who that subsequently developed malocclusion requiring orthognathic corrective surgery, from June 2010 to December 2019. Panoramic X-rays, cephalometries and/or 3-D facial reconstruction CT scans were used for surgical planning to create surgical cutting guides, templates and occlusal splints in all the patients that underwent corrective orthognathic surgery. Results: There were 46 patients who underwent a free fibula flap mandibular and maxillary reconstruction at San Jose Hospital between June 2010 and December 2019 of these, 5 patients (10.9%) developed postoperative malocclusion. One case from another institution was added to this study for a total of 6 patients with malocclusion following mandibular reconstruction surgery with a fibula free flap. During the orthognathic surgery, vertical osteotomies were performed in 3 patients and bilateral sagittal split osteotomies were necessary in 2 patients and L-shape in 1 patient. Osteogenic distraction was performed in 3 patients as part of their orthognathic treatment. The fixation methods were based in miniplates for 3 of the patients and lag screws for the remaining 3 patients. With this approach, all patients had an adequate occlusion correction with a 100% consolidation at their 6-month follow up. Conclusion: Malocclusion is a significant complication following mandibular reconstruction surgery that must be identified and managed. In severe cases, it requires corrective orthognathic surgery in severe cases. We have developed a protocol to avoid pitfalls during the primary reconstruction and in case an orthognathic surgery is required for malocclusion correction, preoperative planning with cutting guides and occlusal splints should be assessed, to guarantee favorable results through a reproducible technique.

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Sagittal Split Osteotomy on the Previously Reconstructed Mandible With Fibula Free Flap

Cited by 6 publications

References 14 publications

Reconstruction of dentomaxillofacial deformity secondary to a long-term mandibular defect using concomitant orthognathic surgery and fibula free flap: a preliminary study

Reconstruction of dentomaxillofacial deformity secondary to a long-term mandibular defect using concomitant orthognathic surgery and fibula free flap: a preliminary study

Correction of malocclusion using sliding fibula osteotomy with sagittal split ramus osteotomy after mandible reconstruction

Malocclusion Management Following Mandibular Reconstruction With Free Fibula Flaps

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