Functional evaluation following microvascular oromandibular reconstruction of the oral cancer patient: a comparative study of reconstructed and nonreconstructed patients.

Over the past decade, the use of free flap transfers in head and neck surgery has led to remarkable advances in the reliability and the ultimate results of oromandibular reconstruction. Stable and retentive dental restorations have been achieved using enosseous implants placed directly into the vascularized bone flaps. However, the functional assessment of patients who underwent primary mandibular reconstruction with these techniques has not been previously reported. A group of 10 reconstructed and 10 nonreconstructed segmental hemimandibulectomy patients were compared using a battery of tests to assess their overall well-being, cosmesis, deglutition, oral competence, speech, length of hospitalization, and dental rehabilitation. In addition, objective measures of the masticatory apparatus (interincisal opening, bite force, chewing performance, and chewing stroke) were used to compare these two groups as well as normal healthy subjects and edentulous patients restored with conventional and implant-borne dentures. The results show a clear advantage for the reconstructed patients in almost all categories. Persistent problems and future directions in oromandibular reconstruction are discussed.

Functional mandibular reconstruction of patients with oral cancer.

For the patient with oral cancer who has undergone quadrant resection, mandibular reconstruction provides normalization of the lower facial contour, regained architectural support, and reestablishment of occlusal relationships. Reconstruction with vascularized bone offers the most rapid rehabilitation. Replacement of dentition provides improved deglutition, mastication, and speech. In eligible patients the use of osteointegrated implants can provide rigid stabilization for dental prostheses. In previous studies these implants were placed in a secondary procedure. In the present study microvascular mandibular reconstruction was combined with primary placement of osteointegrated implants in the treatment of seven patients. Preliminary results indicate that the combination of procedures can provide more rapid and effective rehabilitation for the patient with cancer. Issues for further study are also identified.

Primary placement of osseointegrated implants in microvascular mandibular reconstruction.

The goal of mandibular reconstruction is to rehabilitate the patient by restoring occlusal relationships, lower facial contour, oral continence, and a denture-bearing surface. One of the major advantages of the use of vascularized bone over all other methods of mandibular reconstruction is its ability to achieve dental rehabilitation rapidly. The use of osseointegrated dental implants is a valuable adjunct in oral rehabilitation. It provides the most rigid form of stabilization to withstand the forces of mastication. In situations in which soft tissue reconstruction or the height of the alveolar ridge is not sufficient for a tissue-borne denture, implants offer the most suitable alternative. Mandibular reconstruction with free tissue transfer techniques is ideally suited for the placement of implants. These can be inserted at the time of mandibular reconstruction. Four months after surgery, when the integration process has occurred, the implants are unroofed, loaded, and ready for prosthetic placement. We will present several representative patients who underwent mandibular reconstruction with microvascular free bone transfer who have been successfully rehabilitated by osseointegrated implants. The process of osseointegration, different types of dental implants, and issues regarding radiation and implants are discussed. This is the first report of dental rehabilitation by primary placement of dental implants in patients undergoing microvascular mandibular reconstruction.

Delivering surface irradiation to persistent unresectable squamous cell carcinomas: a prosthodontic solution.

A simple afterloading maxillofacial radiotherapy prosthesis is used to provide surface irradiation to a persistent superficial carcinoma. Fabrication, loading, and application of the device, as well as indications for and advantages of its use, have been presented.