Scapular Free Vascularised Bone Flaps for Mandibular Reconstruction: Are Dental Implants Possible?

Abstract

ObjectivesFree fibula flap remains the flap of choice for reconstruction of mandibular defects. If free fibula flap is not possible, the subscapular system of flaps is a valid option. In this study, we evaluated the possibility of dental implant placement in patients receiving a scapular free flap for oromandibular reconstruction.Material and MethodsWe retrospectively reviewed 10 patients undergoing mandible reconstruction with a subscapular system free-tissue (lateral border of the scapula) transfer at the University Hospital Zürich between January 1, 2010 and January 1, 2013. Bone density in cortical and cancellous bone was measured in Hounsfield units (HU). Changes of bone density, height and width were analysed using IBM SPSS Statistics 22. Comparisons of bone dimensions as well as bone density were performed using a chi-square test.ResultsTen patients were included. Implantation was conducted in 50%. However, all patients could have received dental implants considering bone stock. Loss of bone height and width were significant (P < 0.001). There was a statistical significant increase in bone density in cortical (P < 0.001) and cancellous (P = 0.004) bone.ConclusionsDental implants are possible after scapular free flap reconstruction of oromandibular defects. Bone height and width were reduced, while bone density increased with time.

Complex Mandibular Reconstruction for Head and Neck Squamous Cell Carcinoma—The Ongoing Challenge in Reconstruction and Rehabilitation

“…Currently, there is limited information regarding the osseointegration, radiographic bone loss and success of dental implants in SFF. Previous studies, mainly focusing on radiographic bone loss, showed a relatively high rate of bone resorption in SFF, however the effect of the observed bone loss on dental implants remains uncertain [42,43]. This opens the question as to whether the SFF bone volume is adequate for dental implantation.…”

“…One retrospective study found that bone height and width loss in SFF was significant one year after reconstructive surgery, but in this study only six patients received dental implants. Moreover, this study lacked coherence of the study population [42]. A more recent retrospective study, which included five patients with scapula free flaps, compared bone volume loss in several free flaps, but oral rehabilitation based on dental implants was not performed within two years of observation [43].…”

Guide design in virtual planning for scapular tip free flap reconstruction

“…8 This has been supported by clinical reports. 9 The issue of pedicle length has been addressed with the technical modification which elongates the pedicle by using the angular branch off the thoracodorsal artery. 10 This allows harvest of bone from the scapular tip and a significant length of lateral border.…”

“…A comparative anatomical study, specifically addressing available bone stock as a criteria for dental implantability, demonstrated that the scapula had an average cross‐sectional area comparable to the iliac crest and could support implants in nearly 80% of the cadavers studied . This has been supported by clinical reports . The issue of pedicle length has been addressed with the technical modification which elongates the pedicle by using the angular branch off the thoracodorsal artery .…”

Supine positioning for the subscapular system of flaps: A pictorial essay

“…The bone is also easier to osteotomize than the fibula given that it is thinner and that there is a lower risk of injury to the vascular pedicle during this step. Although it is thinner, the scapular bone can still successfully receive dental implants . Despite all of these advantages, many surgeons prefer not to harvest this flap given the challenges associated with positioning, prepping, and draping, the inability to perform a simultaneous ablation and harvest (2‐team approach), and the short‐term limited shoulder range of motion.…”