RESUMEN
Objective @#To review the patients who underwent accurate maxillary and mandibular reconstruction with vascularized osteomyocutaneous flap using virtual surgery and evaluate the postoperative results.@*Methods@# From June of 2009 to December of 2014, ninety-four patients were treated in our department. In virtual surgical planning, maxillectomy and mandibulectomy were simulated and donor site bone was superimposed mirror image of normal maxilla and mandible to complete accurate maxillary and mandibular reconstruction. Maxillectomy, mandibulectomy and bone reconstruction were performed using stereomodels and guided templates to replicate the virtual planning. Actual reconstruction result was compared with that of virtual surgery. The patients were asked to assess their satisfaction with facial appearance at 1 year postoperatively. @*Results@#Good bony unions and occlusion were observed in 94 patients. The actual results were basically in accordance with that of virtual surgery. The actual deviation between postoperative CT and preoperative virtual surgical planning was no more than 1 mm matched by computer software. All patients reported their facial appearance were excellent or good at 1 year postoperatively.@*Conclusion@#The ideal contour of neomaxilla and neomandible and good function with dental rehabilitation can be gained after accurate maxillary and mandibular reconstruction with vascularized osteomyocutaneous flap using virtual surgery.
RESUMEN
Simultaneous restoration of function and appearance should be performed in mandibular reconstruction. Option of reconstructive techniques is determined by cause, location, extent, and classification of the mandibular defects. Vascularize bone graft is one of the most popular technique in current clinical practice of mandibular reconstruction. Fibula is the most common donor site for mandibular reconstruction. The disadvantage of low height of neo-mandible reconstructed by single fibular segment can be solved by vascularized double barrel fibula graft. Using virtual surgical planning and intraoperative navigation for mandibular reconstruction leads to simplify surgical procedure, reduce operating time and injury, and decrease donor site morbidity so that accurate mandibular reconstruction could be completed. Direction of minimal invasive surgery for mandibular reconstruction will be developed by intraoral approach and intraoral anastomosis.
RESUMEN
Objective To explore the clinical applicating and efficacy of free fibula osteomyocutane- ous flap in mandible defect reconstruction in osteoradionecrosis patients.Methods The mandible defects were reconstructed by free fibula flaps with or without muscle cuff.The soft tissue defects were repaired by skin paddles.Status of osteotomy in fibula and flap survival was recorded.The complication in recipient site and donor site,as well as mouth opening and occlusion were reviewed.Facial contour and chewing function after reconstruction were evaluated.Results Patients were followed up 3-16 months.4 free fibula flaps with muscle cuff and 5 without muscle cuff survived well.The size of mandible defects covered from 6cm to 17cm. And the harvested fibula flaps with length of 8.6-17cm were cut into 3 segments in 2 cases,and 2 segments in 5 cases.Fibula flap was divided into 2 segments and overlapped in 2 cases.No serious complication was oh- served in recipient site and donor site.Satisfying esthetic result and normal occlusiong of heath mandible were obtained in all cases.The degree of mouth opening was 2.5-3.3cm.Fair chewing function was revealed in re- constructive region after prosthesia repaired.Conclusion Free fibula osteomyocutaneous flap is relatively ideal reconstruction material of mandible defect in osteoradionecrosis patients for its high survival rate and well esthetic results.