ABSTRACT
A series of 28 consecutive cases of mandibular reconstruction by means of reconstructive plates and myocutaneous flaps were reviewed. In all cases mandibular resection was indicated for treatment of squamous cell carcinoma of the oral cavity: 25 pelviglossomandibulectomies (resulting in large defects from the angle of the mandible), 2 Commando operations (resulting in lateral defects) and 1 anterior sectional mandibulectomy (resulting in an anterior defect). Tumour stages were T1-T2 (4 cases) and T3-T4 (24 cases). Success was defined as plate maintenance 6 months' postoperatively/postradiotherapy. The overall success rate was 32.2%. Lateral-centre-lateral (L-C-L) defects had 32% success, L (lateral) defects had 50% success and in the single case of a C (centre) defect, the plate was not maintained. Stainless steel reconstruction plates showed a similar success rate as titanium plates (30% versus 34%). In cases not submitted to radiotherapy there were more maintained plates than in cases that received radiotherapy (45.5% versus 23.6%). Reconstruction plates are not effective in bridging large defects of the resected mandible. Only in selected cases that are not eligible for microvascular free flaps should plates and myocutaneous flaps be considered as an option for mandibular reconstruction.
Subject(s)
Bone Plates/adverse effects , Mandible/surgery , Mandibular Prosthesis , Oral Surgical Procedures , Plastic Surgery Procedures , Adolescent , Adult , Aged , Carcinoma, Squamous Cell/radiotherapy , Carcinoma, Squamous Cell/rehabilitation , Carcinoma, Squamous Cell/surgery , Child , Cranial Irradiation/adverse effects , Dental Alloys , Female , Humans , Male , Mandibular Neoplasms/radiotherapy , Mandibular Neoplasms/rehabilitation , Mandibular Neoplasms/surgery , Mandibular Prosthesis/adverse effects , Middle Aged , Pectoralis Muscles/transplantation , Prosthesis Failure , Skin Transplantation , Stainless Steel , Surgical Flaps , TitaniumABSTRACT
The authors present a review of 14 patients with temporomandibular joint ankylosis treated between March 1992 and February 1997. Etiology of the ankylosis was trauma in four patients, ear infection in two, systemic infection in one case, congenital in another, and unknown in six. Patients were divided into two groups, according to their age: 16 years and under and over 16 years of age. The basic principle of surgical treatment in both groups is ample access for osseous resection and coronoidectomy. Costochondral grafts were used in group one (nine patients), while interposition of a silicone block, was performed in the second group (five patients). Follow-up evaluations were from twelve to 53 months (average 28.2 months). One case of recurrence occurred in the first group and no recurrences in the second group. The average long-term mouth opening in both groups was 32.8 mm.