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Mandibular Defects (mandibular + defect)

Distribution by Scientific Domains

Medical Sciences	90%

Selected Abstracts

Reconstruction of the Through-and-Through Anterior Mandibulectomy Defect: Indications and Limitations of the Double-Skin Paddle Fibular Free Flap,

THE LARYNGOSCOPE, Issue 8 2008
Frederic W.-B.
Abstract Objectives/Hypothesis: The purpose of this report is to describe our recent experience using a double-skin paddle fibular free flap (DSPFFF) for reconstruction of the through-and-through anterior mandibulectomy defect and to present a reconstructive algorithm based on the extent of lip and mental skin resection. Study Design: Retrospective review of 10 consecutive patients with through-and-through anterior mandibulectomy defects. Methods: Outcomes that were examined included methods of reconstruction based on the cutaneous defect, flap complications, fistula rate, and donor site complications. Results: Seven patients were reconstructed with a DSPFFF. For lip reconstruction, two patients were also concomitantly reconstructed with Karapandzic or lip advancement flaps. Three patients were reconstructed with both a fibular free flap and a second free flap (1 radial forearm fasciocutaneous flap and 2 anterolateral thigh flaps). The transverse dimensions of the DSPFFFs were as great as 15 cm. None of the patients developed a fistula. All free tissue transfers were successful. One patient developed partial loss of the fibular skin paddle used for submental skin replacement. Conclusions: DSPFFF is a safe and reliable way to reconstruct an anterior through-and-through mandibular defect. Indications for using a DSPFFF are 1) a cutaneous defect that lies at or below the plane of the reconstructed mandible, 2) a transverse width of the oral mucosa and cutaneous defect that does not exceed 15 cm (the approximate distance from the mid-calf to the anterior midline), and 3) a lip defect that, if present, can be reconstructed with local flaps. [source]

Vivosorb®, Bio-Gide®, and Gore-Tex® as barrier membranes in rat mandibular defects: an evaluation by microradiography and micro-CT

CLINICAL ORAL IMPLANTS RESEARCH, Issue 5 2008
Pepijn F. M. Gielkens
Abstract Objectives: The objectives of this study were to determine whether a new degradable synthetic barrier membrane (Vivosorb®) composed of poly(dl -lactide-,-caprolactone) (PDLLCL) can be useful in implant dentistry and to compare it with collagen and expanded polytetrafluoroethylene (ePTFE) membranes. Material and methods: In 192 male Sprague,Dawley rats, a standardized 5 mm circular defect was created through the right angle of the mandible. New bone formation was evaluated by post-mortem microradiography and micro-CT (,CT) imaging. Four groups (control, PDLLCL, collagen, ePTFE) were evaluated at three time intervals (2, 4, and 12 weeks). In the membrane groups the defects were covered; in the control group the defects were left uncovered. Data were analysed using a multiple regression model. Results: New bone formation could be detected by post-mortem microradiography in 130 samples and by ,CT imaging in 112 samples. Bone formation was progressive in 12 weeks, when the mandibular defect was covered with a membrane. Overall, more bone formation was observed underneath the collagen and ePTFE membranes than the PDLLCL membranes. Conclusions: In contrast to uncovered mandibular defects, substantial bone healing was observed in defects covered with a PDLLCL membrane. However, bone formation in PDLLCL-covered defects tended to be less than in the defects covered with collagen or ePTFE. The high variation in the PDLLCL samples at 12 weeks may be caused by the moderate adherence of this membrane to bone compared with collagen. These results indicate that further study is needed to optimize the properties of PDLLCL membranes. [source]

Efficacy of small reconstruction plates in vascularized bone graft mandibular reconstruction,

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 7 2006
D. Gregory Farwell MD, FACS
Abstract Background: Utilization of vascularized bone grafts rigidly fixated with titanium reconstruction plates is the method of choice for reconstruction of segmental mandibular defects. We hypothesized that the use of the newer 2.0-mm locking reconstruction plate (LRP) is not associated with higher rates of complications when compared with larger, previously used plating systems. Methods: A retrospective case series of 184 patients undergoing 185 vascularized bone graft reconstruction procedures of the mandible was conducted. Results: There were 37 plate complications. There was no significant difference in complication rates for the 2 most used plate types (14.5% with the 2.0-mm LRP and 22.2% with the 2.4-mm LRP). Conclusions: Use of the smaller 2.0-mm LRP was not associated with an increase in the complications of plate fracture, exposure, infection, or nonunion. Because of its lower profile and ease of application, the 2.0-mm LRP is our plate of choice for mandibular reconstruction. © 2006 Wiley Periodicals, Inc. Head Neck, 2006 [source]

Primary oromandibular reconstruction using free flaps and thorp plates in cancer patients: A 5-year experience,

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 1 2003
Tito Poli MD
Abstract Background. Low-profile second-generation THORP titanium plates combined with soft tissues free flaps (forearm or TRAM) can be used for oromandibular reconstruction in patients with SCC in advanced stage (stage III,IV). Methods. To evaluate long-term stability and possible complications of this reconstructive technique, we recorded, retrospectively, data of 25 patients with posterolateral oromandibular defects after tumor resection collected during a 5-year period. Results. All free flaps were successfully transferred, although eight patients were initially seen with delayed hardware-related reconstructive complications: plate exposure in four patients and plate fracture in four patients. Conclusions. Nowadays, the state-of-the-art treatment for mandibular defects is primary bone reconstruction with bone free flaps, but in selected cases (elderly patients, poor performance status, posterolateral oromandibular defects, soft tissue defects much more important than bone defects) the association with THORP plate-soft tissue free flaps represents a good reconstructive choice. © 2002 Wiley Periodicals, Inc. Head Neck 24: 000,000, 2002 [source]

Lingual cortical mandibular defects (Stafne's defect): an anthropological approach based on prehistoric skeletons from the Canary Islands

INTERNATIONAL JOURNAL OF OSTEOARCHAEOLOGY, Issue 2 2002
John R. Lukacs
Abstract While posterior lingual mandibular depressions (Stafne's defect) are often discussed in clinical reports, they are rarely the subject of anthropological research. This situation is paradoxical since osteologists and skeletal biologists are in a position to enhance understanding of the trait's aetiology by systematically recording the trait in recent and prehistoric skeletal collections. This report reviews anthropological studies of cortical defects of the mandible, recommends a protocol for recording observations in trait variation, and presents new data for the prevalence of Stafne's defect,lingual cortical defects of the mandibular corpus. Among the Guanches of Tenerife in the Canary Islands (Spain), the prevalence of lingual cortical defects is 3.32% (15/452), males are more frequently affected than females, and there is a tendency for individuals with antemortem tooth loss to display larger lesions than individuals without antemortem loss of teeth. Defects of the left side are somewhat more variable in position than defects located on the right. In comparative perspective, prevalence of lingual cortical defects among the Guanches is high, given the overall 1.07% prevalence reported for archaeological series (Finnegan & Marcsik,1980), but is similar to figures reported for the Avar period sample from Hungary 3.73%. Prospects for the use of lingual cortical defects as non-metric traits of value in population distance studies remain uncertain since variation in trait expression may have a high environmental component. However, if human osteologists routinely include observations of lingual mandibular cortical defects in their analysis of skeletal collections, the data required to elucidate factors responsible for the trait's cultural, ecological, temporal and geographical patterning will more rapidly become established. Copyright © 2002 John Wiley & Sons, Ltd. [source]

Rehabilitation by means of osseointegrated implants in oral cancer patients with about four to six years follow-up

JOURNAL OF ORAL REHABILITATION, Issue 3 2006
J. SEKINE
summary, This paper describes the reconstruction of mandibular defects in four oral cancer patients using iliac crest bone grafts and osseointegrated implants. In three patients, reconstructive surgery using a reconstruction plate and free forearm skin flap was performed following tumour and segmental mandibular resection. After 7,9 months, mandibular reconstruction with a free iliac bone graft was carried out. In one patient, reconstructive surgery was performed with vascularized iliac bone grafting with an anterolateral thigh flap at the same time as the tumour resection. Fixtures were placed in the transplanted bone, and abutments were connected 6,9 months later together with vestibuloplasty. Gingival grafts were used to replace the skin flap around abutments. All implants survived throughout the approximately 4,6 years observation time. Marginal bone loss of the graft was originally several millimetres but less than 1·5 mm. Bone loss as well as management of peri-implant soft tissue was also discussed. [source]

Primary reconstruction of small mandibular defects by using mandibular remnant,

JOURNAL OF SURGICAL ONCOLOGY, Issue 7 2006
FRCS(Glasg), FRCSEd, Kumar Alok Pathak MS, MNAMS
No abstract is available for this article. [source]

Radial Forearm Osteocutaneous Free Flap in Maxillofacial and Oromandibular Reconstructions

THE LARYNGOSCOPE, Issue 9 2005
J H. Kim MD
Abstract Objectives/Hypothesis: The radial forearm osteocutaneous free flap is an excellent reconstructive modality for oromandibular and maxillofacial reconstruction in certain well-defined circumstances. The initial concern over donor site morbidity and the ability of the bone to reconstruct mandibular defects have led to only a few published series. Study Design: Retrospective study of the experience of two tertiary medical centers with radial forearm osteocutaneous free flap. Methods: Retrospectively, 52 patients were studied who underwent radial forearm osteocutaneous free flap reconstruction for cancer (49 cases) and trauma (3 cases). Bone length and skin paddle harvested, general morbidity (hematoma, wound infection, and dehiscence), recipient site morbidity (nonunion of neomandible, flap failure, and bone or plate exposure), and donor site morbidity (radius bone fracture, plate exposure, and skin graft failure) were reviewed. Results: The average skin paddle size was 55.1 cm2 (range, 15,112 cm2). The average radius bone harvest length was 6.3 cm (range, 2.5,11 cm). Donor site complications included tendon exposure (3 cases), radius bone fracture (1 case), and exposure of the plate (0). Recipient site complications included nonunion of the mandible (4), exposed mandible (1), exposed mandibular plates (2), exposed maxillary plates or bone (0), venous compromise (1), and flap failure (1). Two patients had perioperative deaths. Conclusion: Radial forearm osteocutaneous free flap is a valuable and viable option for oromandibular and maxillofacial reconstruction. [source]

Vivosorb®, Bio-Gide®, and Gore-Tex® as barrier membranes in rat mandibular defects: an evaluation by microradiography and micro-CT

Reconstruction of maxillary and mandibular defects using prefabricated microvascular fibular grafts and osseointegrated dental implants , a prospective study

CLINICAL ORAL IMPLANTS RESEARCH, Issue 5 2004
Claude Jaquiéry
Abstract: The fibular flap can be used for a variety of indications. Recently, the treatment of four patients with severely atrophied upper jaws using a method to prefabricate the vascularized fibular graft has been published. This technique consists of a two-stage operation procedure that allows simultaneous prosthodontic rehabilitation and immediate placement of dental implants. In this paper eight patients with 29 ITI implants (Straumann AG, Waldenburg, Switzerland) who had reconstruction of either the upper or lower jaw are presented. The aim of the study was (i) to evaluate the behavior of the newly formed soft tissue around implants inserted in the fibula by applying periodontal parameters, (ii) to monitor prospectively the integration of the implants in the fibular graft, and (iii) to assess the osseous integration of the fibular graft used for reconstruction of the upper or lower jaw. Two implants failed during the observation time because of avascular bone at the distal end of the fibular graft. Stabilization of the graft, however, was never compromised. Due to the prefabrication firmly attached gingiva-like soft tissue could be provided preventing periimplant soft tissue inflammation and facilitating oral hygiene. After 1 year of observation the mean attachment level was similar to implants placed in original bone whereas vertical bone loss measured radiographically was lower in the present study. This may indicate that the remodeling of a bicortical bone requires a longer period of time compared with the bone of the alveolar crest. The prospective 1-year results are promising but long-term evaluation of periodontal and radiological parameters are required. Résumé Le lambeau péroné peut être utilisé pour une variété d'indications. Récemment le traitement de quatre patients avec une atrophie sévère des mâchoires supérieures et utilisant une méthode pour préfabriquer un greffon péroné vascularisé a été publié. Cette technique consiste en une opération en deux étapes qui permet la réhabilitation prothétique simultanée et le placement immédiat des implants dentaires. Dans ce rapport huit patients avec 29 implants ITI (Straumann AG, Waldenburg, Switzerland) ont eu une reconstruction de la mâchoire supérieure ou inférieure. Le but de cette étude a été 1) d'évaluer le comportement des tissus mous nouvellement formés autour des implants insérés dans le péroné en appliquant les paramètres parodontaux, 2) de suivre d'une manière prospective l'intégration des implants dans le greffon péroné et 3) d'examiner l'intégration osseuse de l'implant péroné utilisé pour la reconstruction de ces mâchoires. Deux implants ont échoué durant la période d'observation parce que l'os alvéolaire n'était pas vasculariséà la partie distale du greffon. La stabilisation du greffon n'a cependant jamais été compromise. La préfabrication d'un tissu ressemblant à de la gencive préfabriquée a permit d'éviter l'inflammation gingivale et de faciliter l'hygiène buccale. Après une année d'observation le niveau d'attache moyen était semblable au niveau des implants placés dans l'os original tandis que la perte osseuse verticale mesurée radiographiquement était inférieure dans l'étude présente. Ceci peut indiquer que le remodelage de l'os bicortical requiert une période plus importante comparée à l'os du rebord alvéolaire. Ces résultats prospectifs à une année sont encourageants mais l'évaluation à long terme des paramètres parodontaux et radiologiques reste encore nécessaire. Zusammenfassung Der Fibula-Lappen kann bei einer Vielzahl von Indikationen angewendet werden. Kürzlich wurde eine Publikation über die Behandlung von vier Patienten mit stark atrophierten Oberkiefern mittels vorfabrizierten vaskularisierten Fibula transplantaten veröffentlicht. Diese Technik besteht aus einer Operation in zwei Phasen, welche die Sofortimplantation von dentalen Implantaten und gleichzeitige prothetische Rekonstruction erlaubt. In diesem Artikel werden acht Patienten mit 29 Implantaten (Straumann AG, Waldenburg, Switzerland), bei welchen entweder eine OK- oder UK-Rekonstruktion durchgeführt wurde, präsentiert. Das Ziel der Studie war (i) das Verhalten des neu gebildeten Gewebes um die Implantate, welche in die Fibula eingesetzt worden waren mittels parodontalen Parametern zu untersuchen, (ii) die Integration der Implantate in das Fibula-Transplantat prospektiv aufzuzeichnen und (iii) die ossäre Integration des für die Rekonstruktion des OK oder UK verwendeten Fibula-Transplantats zu ermitteln. Zwei Implantate zeigten während der Beobachtungsperiode Misserfolge wegen avaskulärem Knochen an den distalen Enden des Fibula-Transplantats. Die Stabilisierung des Transplantats war jedoch niemals beeinträchtigt. Durch die Vorfabrizierung konnten gut angewachsene gingiva-ähnliche Weichgewebe geschaffen werden, welche eine periimplantäre Entzündung der Weichgewebe verhinderten und die Mundhygiene erleichterten. Nach einer Beobachtungszeit von einem Jahr war das mittlere Attachmentniveau ähnlich dem von Implantaten, welche in alveolären Knochen inseriert worden waren, während der radiologisch gemessene Knochenverlust in der vorliegenden Studie geringer war. Dies könnte ein Indiz dafür sein, dass die Remodellierung eines bikortikalen Knochens im Vergleich zum Alveolarknochen längere Zeit benötigt. Die prospektiven Resultate nach einem Jahr sehen vielversprechend aus, aber es muss eine Auswertung der parodontalen und radiologischen Parameter über einen längeren Zeitraum durchgeführt werden. Resumen El colgajo peroneal puede ser usado para una variedad de indicaciones. Recientemente se ha publicado el tratamiento de cuatro pacientes con maxilares superiores severamente atróficos usando un método para prefabricar el injerto peroneal vascularizado. Esta técnica consiste en un procedimiento de operación de dos fases que permite la rehabilitación prostodóntica y la colocación inmediata de implantes dentales simultáneamente. En este artículo se presentan ocho pacientes con 29 implantes ITI (Strauman AG, Waldenburg) teniendo una reconstrucción de tanto el maxilar superior como del inferior. La intención del presente estudio fue (i) evaluar el comportamiento de del tejido blando neoformado alrededor de los implantes insertados en la tibia aplicando parámetros periodontales, (ii) monitorizar prospectivamente la integración de los implantes en el injerto perineal y (iii) valorar la integración ósea del injerto perineal usado para la reconstrucción del maxilar superior o inferior. Dos implantes fracasaron durante el periodo de observación debido a hueso sin vascularización en el final distal del injerto perineal. De todos modos, la estabilización del injerto no se vio nunca comprometida. Debido a la prefabricación se pudo suministrar un tejido blando tipo encía adherida previniendo inflamación del tejido blando periimplantario y facilitando la higiene oral. Tras un año de observación el nivel de inserción medio fue similar a los implantes insertados en las áreas de hueso original mientras que la pérdida de hueso vertical medida radiograficamente fue menor en el presente estudio. Esto puede indicar que el remodelado de un hueso bicortical requiere un periodo mas largo de tiempo comparado con el hueso de la cresta alveolar. Los resultados prospectivos de un año son prometedores pero se requieren evaluaciones de los parámetros periodontales y radiológicos a largo plazo. [source]