Reconstruction of bony mandibular and maxillary defects with one single transfer of a free fibula osteocutaneous flap

Laure, B.; Sury, F.; Martin, Thomas E.; Chabut, Arnaud; Goga, D.

doi:10.1016/j.bjps.2007.06.007

Cited by 21 publications

(14 citation statements)

References 6 publications

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“…[2][3][4] These have been mostly used in malignancy 2 and accidental injuries. 3,5 In one of these articles, the authors describe reconstructing mandible and maxilla defects with the same fibula flap, removing a segment of bone but retaining the periosteal continuity. 3 The design of flap here is also similar, except that our case had a history of prior surgery with an existing ALT flap.…”

Section: Discussionmentioning

confidence: 99%

“…Impressive attempts at simultaneous reconstruction of defects involving both maxilla and mandible using free bone flap have been reported in literature before, though very few in number 234. These have been mostly used in malignancy2 and accidental injuries 35. In one of these articles, the authors describe reconstructing mandible and maxilla defects with the same fibula flap, removing a segment of bone but retaining the periosteal continuity 3.…”

Section: Discussionmentioning

confidence: 99%

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Reconstruction of a Combined Maxillectomy and Segmental Mandibulectomy Defect in a Seven-Year-Old with a Single Free Fibula Osteocutaneous Flap

Joseph

Thankappan

Iyer

2017

Craniomaxillofacial Trauma & Reconstruction

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Vascularized bone flaps form an integral part of head and neck reconstruction. Nevertheless, the best results in complex head and neck defects are far from optimal. A combined defect involving the maxilla and mandible may ideally require two bone flaps for reconstruction. The purpose of this article is to report a case of single-stage bony reconstruction of a combined maxilla and mandible defect after a benign tumor excision in a 7-year-old girl, using a free fibula flap. This case is unique in many aspects such as the age of the patient, the defect created by an arteriovenous malformation, and the case being a failure of a previous bony reconstruction with a vessel-depleted neck. Case ReportA 7-year-old girl, a case of arteriovenous malformation of left maxilla region, with a history of prior left total maxillectomy, presented with a recurrent lesion involving the ramus of the mandible. The reconstruction was first attempted with a free fibula flap, which failed, and then with an anterolateral thigh (ALT) flap which was successful. The orbital floor reconstruction was done with a titanium mesh. The computed tomographic (CT) scan at presentation showed residual arteriovenous malformation involving ramus and coronoid process of left mandible with cortical destruction (►Figs. 1 and 2). There was no evidence of recurrence at previous operated site. A carotid angiogram showed feeders from left external carotid artery with draining veins to both internal jugular veins.She underwent wide excision of the lesion with segmental mandibulectomy through a midline lip split with chin sparing incision and cheek flap approach. Bone resection involved segmental mandibulectomy from first premolar tooth on the left side to the ascending ramus and coronoid, preserving the condyle. The upper alveolus defect of the previous surgery was also considered. This was previously reconstructed with a soft-tissue flap only (►Fig. 3). A 2-mm titanium plate was pre bent using three-dimensional, CT-based contouring. This Keywords ► combined maxilla and mandible defect ► maxillary reconstruction ► mandibular reconstruction ► pediatric patient ► fibula flap AbstractCombined upper alveolectomy and segmental mandibulectomy are complex defects. Reconstruction of these defects is usually suboptimal. We describe the case of a pediatric patient with vessel-depleted neck with recurrent vascular malformation involving the ramus and coronoid process of mandible and a previous history of maxillectomy and a reconstruction with anterolateral thigh flap. The patient underwent wide resection. The defects involving the upper alveolus and mandible were simultaneously reconstructed with a single free fibula flap.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Reconstruction of a Combined Maxillectomy and Segmental Mandibulectomy Defect in a Seven-Year-Old with a Single Free Fibula Osteocutaneous Flap

Joseph

Thankappan

Iyer

2017

Craniomaxillofacial Trauma & Reconstruction

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“…The few cases that have been reported in the literature document the use of two separate flaps: either two distinct free flaps, or one free flap combined with a separate pedicled flap (Hanasono, Corbit, Yu, & Skoracki, ; Laure, Sury, Martin, Chabut, & Goga, ; Nisanci, Turegun, Er, & Sengezer, ; Nguyen, Wu, Chang, & Cheng, ; Panje, ; Punpale, Rajendra Prasad, Shetty, Kadam, & Udupa, ; Siemssen, Kirkby, & O'Connor, ). A single free fibula flap can be used to reconstruct both the mandible and maxilla by removing an intervening bone segment allowing the segment to be transferred to the maxilla as a pedicled osseous flap (Laure et al, ; Punpale et al, ). While this technique avoids a second set of microanastomoses, the positioning of the flaps is limited by the length of the intervening pedicle between the two bone segments.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous vascularized bony reconstruction of the maxilla and mandible using a single fibula: A case report

et al. 2017

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Simultaneous maxillary and mandibular reconstruction is exceedingly rare. These are complicated cases, requiring consideration of multiple variables: defect components, donor site morbidity, recipient vessels, and so forth. We describe a unique case of secondary maxillary/mandibular reconstruction in a 59-year-old male. The original defect was created after removal of a buccal squamous cell carcinoma, involving the external cheek skin, buccal mucosa, right mandibular body, and right inferior maxilla; a free vertical rectus abdominis musculocutaneous flap was used for the initial reconstruction. At the time of presentation to our clinic, the patient was tube-feed-dependent, unable to speak, and distressed regarding his appearance. We revised his reconstruction, rebuilding his maxilla and hemimandible using two free fibula flaps from a single fibula. The fibulae were vascularized via vein grafts and an ALT flap was used for external cheek resurfacing. All flaps survived and there were no complications at seven months since his surgery (when this report was written). The patient had intelligible speech and maintained adequate nutrition with a soft diet. Simultaneous vascularized bony reconstruction of the maxilla and mandible using a single fibula flap may be performed safely and with good outcomes.

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“…Authors commented that the use of an osteocutaneous fibular graft for midfacial reconstruction is beneficial especially in the freely movable soft tissue component which is not the case in other composite grafts [ 9 ]. It has also been reported to successfully provide a platform for the future insertion of dental implants and prosthesis placement although not following the normal anatomy [ 25 ]. The use of an osteomyocutaneous fibular flap was also applied in several studies to reconstruct oncologic defects with esthetically and functionally acceptable results to both patients and surgeons [ 8 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Midfacial Reconstruction â€“ A Systematic Review

Emara

ElFetouh

Hakam

et al. 2016

Open Access Maced J Med Sci

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AIM:Different lesions affecting the midfacial regions require surgical reconstruction. The aim of this study was to assess the different methods used in midfacial reconstruction after maxillectomy procedures. The various reported surgical reconstructive techniques focusing on the esthetic and functional outcomes are to be reviewed in this article.MATERIAL AND METHODS:A thorough PUBMED and hand-search of journals of relevance was performed on related terms and yielded 772 titles of which 45 abstracts were selected and obtained as full articles for further evaluation while the rest were excluded by title/abstract. According to the inclusion criteria; 14 of these studies were used to complete this article.RESULTS:In this review we showed that fibular and radial vascularized grafts were the most commonly reported methods in literature with a few other options. Computer aided design and surgical planning has been also reviewed and seems to be a rapidly evolving option for maxillofacial reconstruction. Lack of RCTs (randomized controlled trials) and large scale case series was noticed in this review making the evidence of poor quality.CONCLUSION:Methods of evaluation of reconstruction options mainly qualitative and subjective made the evaluation of the techniques in this review difficult.

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Reconstruction of bony mandibular and maxillary defects with one single transfer of a free fibula osteocutaneous flap

Cited by 21 publications

References 6 publications

Reconstruction of a Combined Maxillectomy and Segmental Mandibulectomy Defect in a Seven-Year-Old with a Single Free Fibula Osteocutaneous Flap

Reconstruction of a Combined Maxillectomy and Segmental Mandibulectomy Defect in a Seven-Year-Old with a Single Free Fibula Osteocutaneous Flap

Simultaneous vascularized bony reconstruction of the maxilla and mandible using a single fibula: A case report

Midfacial Reconstruction â€“ A Systematic Review

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