Fibula Jaw in a Day: State of the Art in Maxillofacial Reconstruction

Abstract

Microvascular free tissue transfer has been one of the greatest milestones in reconstruction of the mandible and maxilla after tumor ablative surgery. Although fibula free flap reconstruction allows for immediate bony reconstruction, dental rehabilitation usually requires 6 to 12 months before it is completed. This can have a serious psychological impact on patients because they go without teeth during this timeframe. The "jaw-in-a-day" procedure was previously described by a group at New York University Medical Center. It allowed for tumor removal and full jaw reconstruction and dental rehabilitation in 1 surgery. This report describes 3 patients treated with this novel technique and adds to the 4 cases previously reported in the literature. To their knowledge, the authors are the second group to report on this technique. A series of photographs and videos are referenced in this article to illustrate the different steps used in this procedure.

Combination of biomechanical evaluation and accurate placement of dental implants: a new concept of virtual surgery in maxillary and mandibular functional reconstruction

“…However, little attention has been paid to the biomechanical aspects of these reconstructions in designing surgical plans for replacing missing dentition with masticatory function where the replacements must withstand repeated loading. [16][17][18][19] In case of maxillary or mandibular functional reconstructions with placement of dental implants, greater stresses are expected during mastication than in reconstructions of normal maxillofacial bone, although bite and chewing forces will be reduced postoperatively. [20][21][22] The main contribution of this paper is the design of a precise, individual, virtual surgical plan with favourable biomechanical properties, and the implementation of the plan for maxillary and mandibular reconstructions.…”

“…As numerous studies have reported, fibular segments are usually located parallel to the lower margin of the remaining maxilla or mandible without consideration of the biomechanical aspects. 8,[17][18][19] The substantial effect of maxillofacial reconstruction on biomechanics indicates that the bone may not regenerate, but be absorbed instead, 6,7 because the most suitable position for a graft is probably not at the low margin, according to the FEA assessment. In addition, the low vertical position of dental implants in the fibula leads to prosthodontic difficulties such as thick, overstuffed, soft tissue and excessive height of the dental crown, which increases the risk of peri-implantitis.…”

“…Patient-specific 3-dimensionally-printed surgical tools have been used to translate preoperative designs into surgical realities. 12,13 To position the implants in the fibula accurately, surgeons [17][18][19] have used a dental implantation guide and have placed the dental implants before they moulded the fibular segments. However, the deviation induced by the fibular inset still causes changes in the orientation of the dental implants.…”

Review of surgical resection and reconstruction in head and neck cancer

“… 41 , 101 , 104 With advanced surgical technologies, the fibula can be redesigned and reshaped with the help of 3D printed surgical templates, along with the use of osseointegrated dental implants that are placed at the time of the reconstruction ( Figures 1A & 1B ). 63 , 105 …”

Reconstruction the Postablative Lower Jaw Defects with Vascularized Free Fibula Flap with Further Endosteal Implants

“…In the field of fibula graft, dental implants have been widely used in recent decades [14][15][16]. Among the researchers, there is an unequivocal opinion about the timing of implantation.…”