Mandibular Reconstruction with Fibula Osteoseptocutaneous Free Flap and Osseointegrated Dental Implants

Kildal, Morten; Wei, Fu‐Chan; Chang, Yang‐Ming; Chen, Hung-Chi; Chang, Ming-Huei

doi:10.1016/s0094-1298(20)32375-0

Cited by 33 publications

(17 citation statements)

References 23 publications

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“…59,[68][69][70][71][72][73][74][75] A minimum of 1 mm of healthy bone surrounding the implants is also required. 76 RECENT ADVANCES Recent research into mandible reconstruction has focused on the use of tissue engineering approaches to repair bone defects, mostly in large animal models such as swine, goats, and primates. Scaffolds ranging from collagen sponges 77 to autologous autoclaved bone 78 have been used together with bone marrow-derived stromal cells and growth factors such as bone morphogenetic protein (BMP)-2 77,79 to facilitate osteogenic differentiation of implanted cells.…”

Section: Osseointegrated Implantsmentioning

confidence: 99%

Reconstruction of Mandibular Defects

Chim

Salgado

Mardini

et al. 2010

Seminars in Plastic Surgery

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Defects requiring reconstruction in the mandible are commonly encountered and may result from resection of benign or malignant lesions, trauma, or osteoradionecrosis. Mandibular defects can be classified according to location and extent, as well as involvement of mucosa, skin, and tongue. Vascularized bone flaps, in general, provide the best functional and aesthetic outcome, with the fibula flap remaining the gold standard for mandible reconstruction. In this review, we discuss classification and approach to reconstruction of mandibular defects. We also elaborate upon four commonly used free osteocutaneous flaps, inclusive of fibula, iliac crest, scapula, and radial forearm. Finally, we discuss indications and use of osseointegrated implants as well as recent advances in mandibular reconstruction. Continuing advances in mandibular reconstruction have greatly improved functional and aesthetic outcomes for patients. Outcomes from free vascularized bone flaps have proved markedly superior to those obtained from use of nonvascularized options such as reconstruction plates and bone grafts. The free fibula flap continues to remain the gold standard for mandibular reconstruction against which other modalities are compared.The mandible serves several important functions in the head and neck, which can be restored to nearnormality with the use of vascularized bone flaps. It provides a stable platform for the oral cavity and also a structure to which muscles attach. Most importantly, it allows mastication by providing a stable counterpoint to the maxilla and serving as a base for attachment of dentition. It facilitates speech, swallowing, and breathing by maintaining space within the oral cavity and allowing the tongue to function. It also serves an aesthetic function, defining the projection of the lower third of the face. ANATOMY OF THE MANDIBLEThe mandible is a U-shaped bone that articulates with the skull base through two unique temporomandibular joints (TMJs), which allow smooth and coordinated mouth opening. The TMJ is a diarthrodial joint, consisting of two bones articulating in a discontinuous fashion allowing freedom of movement dictated by muscles and limited by ligamentous attachments. The TMJ is also lined on its internal aspect by synovium, which secretes synovial fluid, serving both as a lubricant and a nutrition source for joint structures.

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Section: Osseointegrated Implantsmentioning

confidence: 99%

Reconstruction of Mandibular Defects

Chim

Salgado

Mardini

et al. 2010

Seminars in Plastic Surgery

Self Cite

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“…The ilium, fibula, and scapula flaps can all provide at least 1 mm of healthy bone to surround the implants, which is the minimum amount of bone that is required to ensure adequate successful integration of the dental implants. 6 Although more optimal bone height may be achieved with the ilium, the fibula provides adequate bone stock and height to support dental implants 3,11 and remains the authors' preferred donor site for mandibular reconstruction. To use the fibula for osteointegration, it must be placed higher than the inferior border of the native mandible to achieve a compromise between maintaining an external aesthetic appearance and maintaining the possibility of osteointegrated implantation.…”

Section: Bone Flap Selection Methods Of Bone Fixation and Osteointementioning

confidence: 99%

“…Generally, patients with a dismal prognosis, trismus, and severe periodontal disease are excluded from receiving dental integration as these factors negatively affect the final outcome. 6…”

Section: Indications For Osteointegrationmentioning

confidence: 99%

Optimizing Results in Mandible Reconstruction Using Osteointegrated Dental Implants

2003

Seminars in Plastic Surgery

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“…To restore normal appearance to the mandible, the anterior segment and the lower border of the mandible must be restored. With the current ability to restore dentition to the reconstructed mandible, 3,[15][16][17] this option should be made available to appropriately selected candidates. Therefore, the design of the flap should allow this in either the primary or secondary setting.…”

Section: Goal Of the Reconstructionmentioning

confidence: 99%

Mandible Reconstruction with Vascularized Fibula

2003

Seminars in Plastic Surgery

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Mandibular Reconstruction with Fibula Osteoseptocutaneous Free Flap and Osseointegrated Dental Implants

Cited by 33 publications

References 23 publications

Reconstruction of Mandibular Defects

Reconstruction of Mandibular Defects

Optimizing Results in Mandible Reconstruction Using Osteointegrated Dental Implants

Mandible Reconstruction with Vascularized Fibula

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