Bridging mandibular bony defect with patient-specific reconstruction plates without hard tissue component of the vascularised grafts

Abstract

IntroductionSeveral surgical techniques are known to repair defects of the mandible after broad continuity resections due to oral cancers. The combined use of free vascularised bone grafts and patient-specific plates has proven to lead to optimal functional and aesthetic results. Yet, donor site morbidity and local mandibular complications suggest the need for ideal patients. Unfortunately, patients with a high comorbidity are frequent in the population of oral cancers which makes it appropriate to think about less complex types of reconstruction of soft and hard tissue. CasesIn this case series our research group focus on four patients who were treated at the department of oral and maxillofacial surgery at the Jan Yperman hospital in Ypres, Belgium, with an invasive oral cancer. Two of them had a high comorbidity, one was edentulous before surgery without a demand for future complex prosthetic restoration and one patient was edentulous and had high comorbidity. So, the favourable outcome of invasive surgery with complex hard tissue reconstruction, by means of vascularised bone grafts, was questioned. Partial mandibular continuity resection with simplified soft and hard tissue reconstruction were deemed the most favourable therapeutic option. All patients recovered well with good quality of life(QoL) until today. DiscussionA current literature overview supports the statement that pre- or postoperative radiotherapy and high comorbidity are valid reasons not to use free vascularised bone grafts in the reconstruction of mandibular defects. Thus avoiding donor site morbidity, free bone flap thrombosis, local mandibular complications and lengthy surgical interventions, and with acceptable QoL.