Donor site morbidity following microvascular fibula transfer

Background: The free vascularized fibula has become the first choice of vascularised bone transfer. The advantages of fibula over other microvascular flaps include greater bone length, sufficient pedicle length and size, rich periosteal blood supply, etc.Aim: This study was designed to evaluate the long-term donor site morbidity following microvascular fibula transfer.Methods: This study was conducted over two years, in patients who underwent free fibula flap for various defects which needed a composite osseo-fasciocutaneous flap. They were followed up for one year and the donor site evaluated for complications like edema, pain, anaesthesia, spasm of muscles, Flexor hallucis longus (FHL) contracture, ankle stability and hypertrophic scarring.Results: 28 patients, age ranging 15 to 56 years, of which 22 were male and 6 were female. Total of 7 patients (25%) had complications, of which 6 patients had more than one complication. No patients experienced knee instability, weakness, or decreased range of motion. All patients returned to their normal ambulatory status.Conclusion: Free fibula transfer does have long term donor site complications, but they can be managed conservatively, seldom requiring surgical intervention. However, there are no functional limitations which makes it a feasible option in reconstructing a composite defect.in various literatures.

Mandibular ameloblastoma reconstruction: a case report with 10-year follow-up / Reconstrucción en ameloblastoma mandibular: reporte de caso, con 10 años de seguimiento

Abstract Ameloblastoma is a benign dental tumor mostly found in the mandible, with several variations. The treatment of this pathology ranges from simple enucleation to resection of large sections of the affected bone. There are several options for correcting the sequelae of ameloblastoma treatment, including the use of grafts and currently microvascular free flaps, which have become the standard treatment. This report describes a clinical case of a large mandibular ameloblastoma, which was resected with safety margins about 10 years ago, reconstructed by free grafts in successive surgical times and rehabilitated using removable prostheses. The question is then what the best option is today in the reconstruction of patients affected by this type of pathologies, taking into account emerging options, the clinicians' learning curve and the patients' resources.

Resumen El ameloblastoma es un tumor odontogénico benigno que se encuentra mayormente en la mandíbula, existiendo diversas variedades del mismo. El tratamiento de esta patología va desde la enucleación simple hasta la resección de grandes secciones del hueso comprometido. Para la corrección de las secuelas por tratamiento de ameloblastoma existen varias opciones, entre las que se encuentra el uso de injertos y hoy en día los colgajos libres microvascularizados, que se han convertido en el estándar de tratamiento. El presente reporte pretende mostrar un caso clínico de un gran ameloblastoma mandibular, el cual fue resecado con márgenes de seguridad hace alrededor de 10 años, reconstruido mediante injertos libres en tiempos quirúrgicos sucesivos y rehabilitado mediante el uso de prótesis removibles. Se plantea entonces la pregunta de cuál es la mejor opción hoy en día en la reconstrucción de pacientes afectados por este tipo de patologías, tomando en cuenta las opciones emergentes, la curva de aprendizaje de los clínicos y los recursos de los pacientes.

Tracheostomy and mandibular distraction in acute sleep apnea

Severe restriction of airway volume in the orofacial region, caused by temporomandibular joint (TMJ) ankylosis, may lead to obstructive sleep apnea (OSA). If the TMJ ankylosis is progressive, rarely, the caregivers may fail to notice the problem. Such patients may have only symptoms of snoring, daytime sleepiness, fatigue, inability to concentrate, and irritability. At times, emergency tracheostomy may be needed to increase the oxygen supply. Distraction osteogenesis (DO) is a less invasive surgical technique in the management of such OSA by correcting the reduced airway space. In DO, the angulation of the distractors and the pace of activation determine the success of the neo-generation of segments of bone. The formation of a well-corticated mandibular canal (MC) in the newly generated bone is an evidence of the success of the procedure. Such bilateral formation of the MC is not reported from this part of the world. We report a case of a 4-year-old boy who was struggling with OSA due to TMJ ankylosis. He was successfully treated by bilateral mandibular DO. The formation and cortication of the MC is discussed with emphasis on the neural regeneration.

Reconstrucción de defectos mandibulares: bloque acrílico como mantenedor de contorno de tejidos / Mandibular defects reconstruction: The use of an acrylic block as a space and contour maintainer of the oral tissues

RESUMEN: Introducción: El tratamiento de grandes tumores mandibulares conlleva una alteración anatómica y funcional del paciente. La reconstrucción de estos defectos es un desafío para el cirujano, sin perjuicio que el tratamiento con injertos suele ser la primera opción en la mayoría de los casos, su aplicación podría estar limitada a las consecuencias derivadas de la comunicación del injerto con el medio oral. El presente artículo pretende exponer el uso de acrílico dental como elemento intermediario entre la resección y reconstrucción en situaciones como la descrita. Caso Clínico: Paciente adulta con ameloblastoma mandibular es tratada mediante resección quirúrgica y mantenida con un bloque acrílico en la zona resecada durante 6 meses, con el objeto de permitir el cierre de comunicación de la lesión con el medio oral, reconstruyéndose posteriormente el defecto con injerto libre de cresta ilíaca. Discusión: Las implicancias estético-funcionales de la mandíbula requieren meticulosidad en la reconstrucción de los defectos resultantes a su patología. A través del procedimiento propuesto, se consigue mejorar el pronóstico de la reconstrucción con injerto óseo de un defecto mandibular comunicado al medio oral, obteniéndose buenos resultados morfológicos y funcionales.

ABSTRACT: Introduction: The treatment of large mandibular tumors has anatomic and functional sequelae to the patient. Reconstruction of these defects is a challenge to the surgeon, whereas grafting is the first choice treatment in most cases, its application could be limited by conditions such as a communication with the oral environment. The present article intends to present the use of a methacrylate block as an interim device between resection and reconstruction in situations such as the above described. Case Report: An adult female affected by mandibular ameloblastoma is treated by surgical resection and kept with the aid of a methacrylate block in the resected area for 6 months, allowing closure of the communication between the lesion and the oral environment to be posteriorly treated with a free iliac crest graft. Discussion: Functional and esthetic implications of mandibular resection sequelae mandate a thorough reconstruction of the lasting defects. By the proposed procedure a better prognosis for the reconstruction is achieved when using a bone graft in the setting of a lesion communicated with the oral environment, allowing good morphological and functional results.

Restoration of mandibular continuity using mandibular transport distractor guided by reconstruction plate

Treatment of Pan-craniofacial Polyostotic Fibrodysplasia not Involving Maxilla: Mandible Reconstruction with Free Fibular Bone Flap

Fibrous dysplasia is a benign pathologic condition of bone and causes facial deformity as well as functional problems. The monostotic form of the disease is much more common(70-80 percent) than the polyostotic variety (20-30 percent). In craniofacial fibrous dysplasia, craniofacial involvement occurs in 10-30 percent of monostotic and 50 percent of polyostotic patients. Frontal, sphenoid, ethmoid, and maxilla bones are frequently involved. Jaw involvement may involve a solitary lesion, but nonetheless in more common in the maxilla than in the mandible. We report a case of mandible reconstruction of pan-craniofacial polyostotic fibrous dysplasia that do not involve maxilla. In operation, extensive hemimandibulectomy was done and fibular bone free flap was done for mandible reconstruction. Postoperative 6 months later, focal osteomyelitis was seen in mandible angle. We removed mini-plate and screw and illiac cancellous bone graft was performed. 3 months after second operation, wound healing was uneventful and we have a functionally and cosmetically good outcome.

Vascularized free fibular flap for instant mandible retained condyle and corresponding soft tissue reconstruction / 重庆医科大学学报

Objective:This article discusses a saved-time and strength method with the vascularized fibula free combined flap for instant mandible retained condyle and corresponding soft tissue reconstruction.This method is based on our clinical experience.Methods: 8 patients suffering from combined mandibular defect because of series of reasons were chosen.Combined vascularized fibula free flap for instant mandible retained condyle and corresponding soft tissue reconstruction was performed.The skin paddle(skin island) of the osteocutanous flap was based on the perforators and used to repair mucosal or skin defect,or as an external"monitor",which was shuttle-shaped.The average value of the fibula length is 8.5cm and the average value of surface area of skin paddle(skin island) is 6.5cm?3.5cm.The fibulas were shaped and fixed with long prefabricated titanium plate on 3 patients and with segmented mini-plate/16-holed titanium plate on the rest patients.Results: All flaps survived well without failure except one.All patients had well-incisions,good occlusion,mandibular normal activity and symmetric appearance.But the lasting time of using long prefabricated titanium plate is longer than that of using segmented mini-plate/16-holed titanium plate.Conclusions:Combined vascularized fibula free flap can cut into 2~3 segments based on the mandibular shape and occlusion,shaping and fixation using segmented mini-plate/16-holed titanium plate make the procedure easier and safer.It is advised that the fixation sequence is firstly condyle,secondly the angle and next the mental foreman area and the connection between the fibula and the chin.

HEMI-MANDIBULAR RECONSTRUCTION USING RIB AND PMCB WITH BIOABSORBABLE POLY(PLLA-PGA) MESH TRAY

Loss of mandibular continuity can occur secondary to trauma, infection, or tumor resection. The basic goal of mandibular reconstruction is to restore bony continuity, arch form, osseous bulk, acceptable facial form. During the mandibular reconstruction is considered, surgical choices of using autogenous bone are divided into non-vascularized cortico-cancellous bone block graft, vascularized transfer of a cortico-cancellous bone block, and particulate marrow and cancellous bone(PMCB) graft. The PMCB has been successfully used for the reconstruction of mandibular osseous defect since introduced by Boyne, et al. This graft transplants a great density of osteocompetent cells, and promotes an early revascularization with vascular ingrowth with their particulate nature. However, because of their particulate nature, require tray or crib for containing PMCB. The Titanium mesh and Dacron-urethane trays have been used widely for this purpose, and allogenic mandible or rib, ilium have been also used. Recently, bioabsorbable polymer material is used to surgeon for treatment of craniofacial fracture and congenital anomaly of craniofacial skeleton in the form of plate, mesh and screw. In different natures to metal material, secondary operation is unnecessary due to biological degradation and resorption in the body with timing, and it can give adequate strength during the bone healing period. and it can be contoured easily during the operation. Especially, in pediatric applications, it can diminish the possibility of growth disturbance and back-scattering effects diminished when radiation therapy applied. Recently, the literature was reported for jaw reconstruction with PMCB and bioabsorbable polymer tray with animal study. In this case, 18-years old woman, who was diagnosed as ameloblastoma, was shown hemimandibular osseous defects. We performed secondary reconstruction using PMCB from posterior ilium, and rib bone with bioabsorbable poly(PLLA-PGA) mesh as a tray, and some favorable results were obtained and we report it preliminarily, with literature reviews.