Abstract
As a result of major ablative surgery, head and neck oncology patients can be left with significant defects in the orofacial region. The resultant defect raises the need for advanced reconstruction techniques. The reconstruction in this region is aimed at restoring function and facial contour. The use of vascularised free flaps has revolutionised the reconstruction in the head and neck. Advances in reconstruction techniques have resulted in continuous improvement of oral rehabilitation. For example, endosteal implants are being used to restore the masticatory function by the way of prosthetic replacement of the dentition. Implant rehabilitation usually leads to improved facial appearance, function, restoration of speech and mastication. Suitable dental implant placement’s site requires satisfactory width, height and quality of bone. Reconstruction of hard tissue defects therefore will need to be tailored to meet the needs for implant placement.The aim of this feasibility study was to assess the compatibility of five standard commercially available dental implant systems (Biomet 3i, Nobel Biocare, Astra tech, Straumann and Ankylos) for placement into vascularised fibula graft during the reconstruction of oromandibular region.Radiographs (2D) of the lower extremities from 142 patients in the archives of the Department of Radiology in University College London Hospitals (UCLH) were analysed in this study. These radiographs were from 61 females and 81 males. Additionally, 60 unsexed dry fibular bones, 30 right sided, acquired from the collection of the Department of Anatomy, University College London (UCL) were also measured to account for the 3D factor.In the right fibula (dry bone), 90% of the samples measured had a width of 13.1 mm. While in the left fibula (dry bone), 90% of the samples measured had a width of 13.3 mm. Fibulas measured on radiographs had a width of 14.3 mm in 90% of the samples. The length ranges of the dental implants used in this study were: 7-13 mm (Biomet 3i), 10-13 mm (Nobel biocare), 8-13 mm (Astra Tech), 8-12 mm (Straumann ) and 8-11 mm (Ankylos).This study reached a conclusion that the width of fibula is sufficient for placement of most frequently used dental implants for oral rehabilitation after mandibular reconstructive procedures.
Highlights
As a result of major ablative surgery, head and neck oncology patients can be left with significant defects in the orofacial region
Radiographs were accessed through the University College London Hospitals (UCLH) Picture Archiving and Communication System (PACS)
The use of vascularised free tissue transfer with hard tissue, especially in vascularised fibula free flap, provides one of the best possibilities for full functional mandibular rehabilitation in combination with dental implants; whether such an approach should occur primarily in combination with the free flap reconstruction or in a later stage is debated; many believe that it increases the survival of composite tissue flaps and enhances functional result [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,23]
Summary
As a result of major ablative surgery, head and neck oncology patients can be left with significant defects in the orofacial region. The resultant defect raises the need for advanced reconstruction techniques. The reconstruction in this region is aimed at restoring function and facial contour. The use of vascularised free flaps has revolutionised the reconstruction in the head and neck. The fibula flap can be used as an osteomuscular flap or osteomyocutaneous flap. The advantage of the latter is to provide a simultaneous reconstruction of intraoral defects (i.e. cheek, palate, floor of the mouth) and cutaneous defects in the same area. The fibular bone (due to its appropriate thickness and bicortical nature), can act as a viable recipient site for implant placement and subsequent implant-supported prosthesis [4]
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