Feasibility of the vascularized fibula bone graft for reconstruction of the mandible: a cadaveric study.

The aim of this study was to assess the feasibility of the unilateral single-barrel vascularized fibula bone graft (VFBG) for the restoration of mandibular defects. Eighty-one dry mandibles and fibulas were used. Each mandible was marked to measure the total mandible length (TML) and maximum defect length (MDL) for each type of defect (HCH, H, L, C, HC, LC, LCL, HCL; Boyd's classification and angle to angle). The fibula length (FL) was measured. The maximum vascularized fibula length (MVFL) was calculated as FL - 12 (cm). The feasibility of the unilateral single-barrel VFBG to reconstruct the mandible for each type of defect was determined from the MVFL:MDL ratio. Descriptive statistics, the Student's t-test, and Pearson's correlation coefficient were used for the statistical analysis; significance was set at P<0.05. Average TML, FL, and MVFL were 30.82±1.96cm, 31.75±2.23cm, and 19.75±2.23cm, respectively. The average MVFL:MDL ratios of HCH, LCL, and HCL were all <1. There was a significant positive correlation between TML and FL (r=0.48, P<0.01). The unilateral single-barrel VFBG alone is not feasible for the reconstruction of a near-total or total mandibular defect.

Donor-site morbidity after fibula free flap transfer: a comparison of subjective evaluation using a visual analogue scale and point evaluation system.

The aims of this study were: (1) to compare the visual analogue scale (VAS) with the point evaluation system (PES) in the subjective evaluation of donor-site morbidity after fibula free flap transfer; (2) to compare the functional outcomes of fibula free flap surgery between patients with a normal body mass index (BMI) and patients with a high BMI, and between skin paddle and non-skin paddle harvesting; and (3) to determine the correlation between functional outcomes and related factors. This study included 15 patients who underwent a vascularized fibula free flap transfer for oral and maxillofacial reconstruction. Demographic data, preoperative, intraoperative, and postoperative data were collected. Subjective self-evaluation of functional outcomes was done using a VAS followed by a PES. Comparison of the VAS and PES scores was assessed with Pearson's correlation coefficient. The statistical significance was set at P<0.05. The VAS score was significantly correlated with the PES score (r=0.63, P=0.01). The tourniquet times for the skin paddle group were longer than for the non-skin paddle group (P=0.02), while the satisfaction score of the non-skin paddle group was higher than that of the skin paddle group (P=0.03). The VAS is a potential option for the subjective evaluation of donor-site morbidity after fibula free flap transfer.

Proximal tibial bone graft: the volume of cancellous bone, and strength of decancellated tibias by the medial approach.

This study aimed to assess the volume of cancellous bone harvested by the medial approach from proximal tibia and compare the maximal compressive strength of decancellated tibias with intact tibias. Twelve cadavers were studied (11 male; 1 female). Cadavers with a history of bone disease and female cadavers over 60 years of age were excluded. Cancellous bone was taken from the right proximal tibia by the medial approach. Non-compressed and compressed cancellous bone volume was measured. Maximal compressive strength of decancellated tibias and intact tibias was measured and compared. The mean volume of bone harvested was 14.58±3.30 ml with the non-compress technique (range 10.5-19.5 ml) and 6.62±1.60 ml (range 4.0-9.2 ml) with the compress technique. There was no significant difference between the maximal compressive strength of the decancellated tibias and the intact tibias (P=0.085). Sufficient volume of cancellous bone for bone grafting in the oral maxillofacial surgery region can be harvested from the proximal tibia by the medial approach. The strength of decancellated tibias and intact tibias after harvesting cancellous bone graft were not different.

The use of SPECT to evaluate growth cessation of the mandible in unilateral condylar hyperplasia.

In unilateral condylar hyperplasia, for surgical intervention to be effective, the status of condylar bone growth has to be assessed correctly. Previously this assessment relied on serial clinical observations. This study aimed to evaluate the MDP-SPECT method of assessing condylar growth in unilateral condylar hyperplasia. Twenty-six MDP-SPECT of the mandible had been performed; 21 were diagnosed as condylar hyperplasia and five as non-mandibular disease. Three isotope parameters: isotope counts, pixel counts and counts per pixel were summed for each condyle per subject. The percentage difference in isotope uptake of the three parameters between the two condyles was calculated as the ratio of the combined counts of the two sides. These differences significantly correlated with each other (Pearson r=0.78-0.98) and with the clinical status of bone growth (Spearman rho=0.72-0.86). There was a significant difference for the count per pixel between the 'growing' condyle (transaxial, T: 15.05+/-7.14, coronal, C: 12.29+/-7.88), the 'no further growth' condyle (T: 5.22+/-4.08, C: 5.67+/-3.88) and the 'normal' condyle (T: 0.82+/-0.76, C: 1.34+/-0.66). This method was able to separate 'active growth' from 'growth cessation' of the condyle by a single MDP-SPECT of the mandible. However, further studies are needed to confirm this finding.