Yue He1, Zhi Yuan Zhang, Han Guang Zhu, Yi Qun Wu, Hong Hai Fu. 1. Department of Oral and Maxillofacial Surgery, Shanghai Jiao-Tong University School of Medicine, Shanghai 9th People's Hospital, Shanghai, People's Republic of China. zhangzhy2106@sina.com
Abstract
PURPOSE: The vascularized free fibula flap has become the most popular reconstruction method after mandibular resection because of adequate bone graft length and acceptance of dental implants. However, using 1 fibula bone may produce a height discrepancy between the native mandible and the grafted fibula that results in subsequent difficulty in wearing conventional dentures or osteointegrated implants. Several options can be used to resolve this problem such as delayed onlay bone graft, iliac bone reconstruction, fibula distraction, and double-barrel fibula flap graft. This article describes the reconstruction of segmental mandible defects with the double-barrel fibula flap and denture rehabilitation. MATERIALS AND METHODS: This procedure was used in 7 patients. A donor site fibula corresponding to at least twice the length of the mandibular defect was harvested. Double-barrel free fibula grafting was performed in 6 patients for primary reconstruction and 1 patient for secondary reconstruction, including 3 cases of osteocutaneous flap with skin islands in the reconstruction of a composite defect from a malignant tumor. Prosthodontic treatment was completed in all 7 patients. Four patients received secondary implant-supported dental reconstruction, and 3 patients who received radiation (6,000 cGy) after graft surgery had conventional removable partial dentures. RESULTS: Microvascular fibula transfers were completely successful, and all skin paddles survived without necrosis. The original mandibular contour was maintained by a reconstruction plate; the reconstruction mandibular length was 6.5 to 10 cm, the reconstruction height of the double-barrel fibula was 3.0 to 3.8 cm, and all patients were satisfied with the postoperative facial esthetics and chewing function from the implant-supported denture and removable partial prostheses. CONCLUSIONS: Mandibular segmental defects can be esthetically and functionally reconstructed by a double-barrel vascularized fibula flap that not only matches the height of the native mandible but also allows osteointegrated dental implantation for dental rehabilitation.
PURPOSE: The vascularized free fibula flap has become the most popular reconstruction method after mandibular resection because of adequate bone graft length and acceptance of dental implants. However, using 1 fibula bone may produce a height discrepancy between the native mandible and the grafted fibula that results in subsequent difficulty in wearing conventional dentures or osteointegrated implants. Several options can be used to resolve this problem such as delayed onlay bone graft, iliac bone reconstruction, fibula distraction, and double-barrel fibula flap graft. This article describes the reconstruction of segmental mandible defects with the double-barrel fibula flap and denture rehabilitation. MATERIALS AND METHODS: This procedure was used in 7 patients. A donor site fibula corresponding to at least twice the length of the mandibular defect was harvested. Double-barrel free fibula grafting was performed in 6 patients for primary reconstruction and 1 patient for secondary reconstruction, including 3 cases of osteocutaneous flap with skin islands in the reconstruction of a composite defect from a malignant tumor. Prosthodontic treatment was completed in all 7 patients. Four patients received secondary implant-supported dental reconstruction, and 3 patients who received radiation (6,000 cGy) after graft surgery had conventional removable partial dentures. RESULTS: Microvascular fibula transfers were completely successful, and all skin paddles survived without necrosis. The original mandibular contour was maintained by a reconstruction plate; the reconstruction mandibular length was 6.5 to 10 cm, the reconstruction height of the double-barrel fibula was 3.0 to 3.8 cm, and all patients were satisfied with the postoperative facial esthetics and chewing function from the implant-supported denture and removable partial prostheses. CONCLUSIONS: Mandibular segmental defects can be esthetically and functionally reconstructed by a double-barrel vascularized fibula flap that not only matches the height of the native mandible but also allows osteointegrated dental implantation for dental rehabilitation.
Authors: Carlos Navarro Cuéllar; Manuel Tousidonis Rial; Raúl Antúnez-Conde; Santiago Ochandiano Caicoya; Ignacio Navarro Cuéllar; Gema Arenas de Frutos; Ángela Sada Urmeneta; María Isabel García-Hidalgo Alonso; Carlos Navarro Vila; José Ignacio Salmerón Escobar Journal: J Clin Med Date: 2021-04-29 Impact factor: 4.241
Authors: Raúl Antúnez-Conde; José Ignacio Salmerón; Alberto Díez-Montiel; Marc Agea; Dafne Gascón; Ángela Sada; Ignacio Navarro Cuéllar; Manuel Tousidonis; Santiago Ochandiano; Gema Arenas; Carlos Navarro Cuéllar Journal: Front Oncol Date: 2021-10-05 Impact factor: 6.244
Authors: Narges Shayesteh Moghaddam; Ahmadreza Jahadakbar; Amirhesam Amerinatanzi; Mohammad Elahinia; Michael Miller; David Dean Journal: Plast Reconstr Surg Glob Open Date: 2016-09-08