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

Abstract

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.

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

“…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.…”

The comprehensive on-demand 3D bio-printing for composite reconstruction of mandibular defects

“…Mandible defects caused by trauma, osteomyelitis, and head and neck cancer require multiple composite tissues such as oral mucosa, dentition, and bone [ 82 ]. Adequate bone volume and vertical height of reconstructed bone are important for further surgical planning and as an indicator of the quality of reconstruction [ 8 ].…”

“…A titanium mesh structure was also suggested that presented an occlusal table for an oral prosthesis as designed with a similar dimension to the original mandible. However, titanium still risks the potential of exposure and breakage of material entailing infection regardless of design [ 82 ]. For this reason, Jeong et al reported that the bioabsorbable scaffold with virtual simulation and 3D printing techniques may replace traditional non-absorbable implants in the future by virtue of its accuracy and biocompatible properties [ 91 ].…”

“…In the case of OCFF, oral mucosa gets positioned on the vascularized free flap that can make blood supply to overlying mucosa and even present well-vascularized soft tissue covering the bone tissue, thereby protecting underlying reconstructed mandible until the OCFF can be successfully integrated into the defect [ 22 , 98 ]. However, the graft materials that failed to get early vascularization would easily be exposed out of the oral cavity and get an infection by oral microflora, which leads to failure of reconstruction [ 24 , 82 ].…”

“…Most cases of mandibular defect accompany the loss of multiple dentitions, which consequently causes an occlusal collision. Rehabilitation of occlusion is the endpoint of mandibular reconstruction [ 82 , 101 ]. Composite tissue reconstruction of the mandible usually does not mean the simultaneous restoration of dentition, even in reconstruction with OCFF.…”