Reconstrucción del nervio alveolar inferior con aloinjerto de nervio acelular humano en resección mandibular / Reconstruction of the inferior alveolar nerve with human acellular nerve allograft in mandibular resection

La reconstrucción de nervios periféricos con aloinjertos nerviosos acelulares humanos en neurocirugía ha sido bastante estudiada estableciendo su predictibilidad y éxito en intervenciones principalmente en los nervios digitales de las manos. En cirugía maxilofacial existe una creciente investigación para poder restaurar el nervio alveolar inferior en cirugías de resección mandibular en donde la extirpación de esta estructura nerviosa es inevitable. El objetivo de esta publicación es mostrar un reporte de un caso en donde se realizó la reconstrucción del nervio alveolar inferior con aloinjerto de nervio acelular humano (Avance® Nerve Graft, Axogen) con microcirugía para poder proveer de sensibilidad a la región de la cara afectada en un paciente reconstruido con un injerto de fíbula microvascularizada posterior a una hemimandibulectomía por ameloblastoma plexiforme.

The reconstruction of peripheral nerves with allografts of human acellular nerves in neurosurgery is well studied, establishing its predictability and success in interventions mainly in the digital nerves of the hands. In maxillofacial surgery there is a growing investigation to be able to restore the inferior alveolar nerve in mandibular resection surgeries where the removal of this nervous structure is inevitable. The objective of this publication is to show a case report in which the reconstruction of the inferior alveolar nerve was performed with human acellular nerve allograft (Avance® Nerve Graft, Axogen) with microsurgery in order to provide sensitivity to the region of the affected face in a reconstructed patient with a microvascularized bone fibula graft after hemimandibulectomy due to plexiform ameloblastoma.

Vertical distraction osteogenesis of a reconstructed mandible with a free vascularized fibula flap: a report of two cases / 대한악안면성형재건외과학회지

BACKGROUND: The free vascularized fibula flap presents many advantages such as sufficient length of the bony segment, good vascularization, better quality of the bone, and a long vascular pedicle, but it is also associated with some disadvantages with regard to prosthetic rehabilitation because of its limited height. Improvement in bone height is necessary for ideal dental implant treatment of reconstructed mandibles. CASE PRESENTATION: For two squamous cell carcinoma patients, mandibular bone reconstruction was performed secondarily with the peroneal flap after tumor resection. Since the bone height was insufficient at the time of implant treatment, occlusion reconstruction by dental implant was performed after vertical distraction osteogenesis. CONCLUSIONS: Vertical distraction osteogenesis is a suitable treatment option for alveolar ridge deficiency resulting from fibula transplantation for mandibular reconstruction following tumor surgery.

Total reconstruction of mandible by transport distraction after complete resection for benign and malignant tumors.

Background: Distraction osteogenesis (DO) is a recognized technique for the bone lengthening and correction of various mandibular deformities. It has an aided advantage of both osteogenesis and histiogenesis in achieving a bone supported mandibular ridge covered with attached gingiva, forming an appropriate vestibule. Aim: The aim of this study was to present our clinical experience in using transport DO technique (TDO) for treating mandibular bony defects following tumor ablation in both benign and malignant tumor cases. Materials and Methods: This is a retrospective analysis of patients who underwent mandibular TDO for the correction of mandibular segmental defect at authors’ center from 2000 to 2014 with the inclusion criteria of segmental bony defect in the mandible with moderate soft tissue defect. After the latency period of 10 days, the distraction was initiated at a rate of 0.25–1 mm/day. The distraction period continued until the segment with the transport disc reached the distal base. The total consolidation periods ranged from 6 to 14 weeks. Results: The study group consists of 9 cases of TDO for reconstruction of segmental defect following tumor resection, of which 5 cases of benign and 4 cases of malignant tumor resection. The mean (standard deviation [SD]) bony defect length was 48 mm (9.8). The mean (SD) distracted bone lengthening was 43 mm (9.7), with a mean (SD) consolidation period of 17.9 (3.4) weeks. The bony defect involved the hemimandibular angle in four patients, hemimandibular body in three patients, with greater involvement of the body, symphysis in two patients, and of the bilateral mandibular body in two patients. Except for two patients who required additional bone grafting to complete union with the residual bone, other seven patients in the distraction zone showed the complete ossification by radiological evaluation. The mean (SD) consolidation period of 13.56 (1.5) weeks ranging from 12-15 weeks with the mean (SD) follow‑up years is about 8.7 years (2.95) for the cases. Out of the 9 cases, one case had recurrence in the follow‑up period and underwent resection with reconstruction using reconstruction plate in the created bone. The overall success rate of TDO was 88.9% (8 out of 9) in spite of adequate case selection and TDO protocol. Conclusions: TDO potentially benefits patients with segmental bony defects following tumor ablation in mandible. It is an unswerving tool to achieve sufficient bone in mandible in patients who cannot undergo aggressive surgery or poor general health. Bone resorption remains a critical issue for this reconstruction technique, though blood supply is continuously maintained in TDO.

Clinical application of implant assisted removable partial denture to patient who underwent mandibular resection with oral cancer: A case report / 대한치과보철학회지

Mandible defects could be caused by congenital malformations, trauma, osteomyelitis, tumor resection. If large areas are included for reconstruction, those are primarily due to tumor resection defects. The large jaw defect results in a problem about mastication, swallowing, occlusion and phonetics, and poor esthetics causes a lot of inconvenience in daily life. It is almost impossible to be a part underwent mandibular resection completely reproduced, should be rebuilt artificially. This case is of a patient who was diagnosed with squamous cell carcinoma pT1N0M0, stage I in February 2004 and received surgery (combined mandibulectomy and neck dissection operation (COMMANDO) in oromaxillofacial surgery) in March 2004, by implant assisted removable partial denture. We could obtain good retention and stability through sufficient coverage and implant holding. Follow up period was about four years. Mandibular left third molar regions have been observed to have resorption of surrounding bone, and periodic check-ups are necessary conditions.

A two-year audit of non-vascularized iliac crest bone graft for mandibular reconstruction: technique, experience and challenges

OBJECTIVES: Non-vascularized iliac crest bone graft (NVIBG) is a known treatment option in mandibular reconstruction following jaw resection, but no documented review of patients treated with NVIBG exists for northern Nigeria. The experience and technique from a Nigerian tertiary hospital may serve as baseline data for comparison and improvement of practice for other institutions. MATERIALS AND METHODS: A retrospective review of medical records and patient case files from January 2012 to December 2013 was undertaken. All case files and other medical records of patients who had reconstruction with NVIBG for benign or malignant lesions with immediate or delayed reconstruction were selected for review. RESULTS: Twenty patients had mandibular reconstruction with NVIBG during the study period. Two patients were excluded because of incomplete medical records. Eighteen patients' (male=14, female=4) records were reviewed. Their ages ranged from 13 to 62 years (mean 26.0+/-10.6 years). Indications for NVIBG included jaw tumors (n=16; 88.3%), jaw cyst (n=1; 5.6%) and gunshot injury (n=1; 5.6%). Jaw tumors seen were ameloblastoma (n=15; 83.3%) and osteosarcoma (n=1; 5.6%). Treatments done were mandibular resection with condylar resection (n=7; 38.9%), mandibular segmental resection (n=10; 55.6%) and subtotal mandibulectomy (n=1; 5.6%). Patients' postoperative reviews and radiographs revealed good facial profile and continued bone stability up to 1 year following NVIBG. CONCLUSION: NVIBGs provide an acceptable alternative to vascularized bone grafts, genetically engineered bone, and distraction osteogenesis for mandibular reconstruction in resource-limited centers.