Abstract

Mandibular defects may result from tumor ablations, trauma, or radiation necrosis. Significant segmental mandibular loss or hemimandibular loss may sometimes be replaced with mandibular implants by ENT surgeons/oral surgeons/head and neck surgeons. However, this may bring about mandibular implant failure in long-term follow-up. Mandibular implant failures usually manifest as: soft tissue atrophy, mandibular implant extrusion, infection, facial nerve involvement, facial asymmetry, derangement of occlusion and mastication, orocutaneous fistula, etc. Over 30 years, the authors have treated 102 patients with mandibular implant failure. Reconstruction may involve removal of the mandibular implant and immediate replacement of the mandibular defect with a piece of vascularized bone flap, not only to compensate for bone loss but also to replace neighboring soft tissue and possible skin defects. Frequently used flaps have been vascularized iliac bone (89/102) or vascularized fibula grafts (13/102). During follow-up, iliac bone flap reconstruction has yielded more favorable results due to its ample bone bulk and adequate soft tissue coverage. Fibula flaps with osteotomies have been associated with an increasing incidence of malunion/nonunion and subsequent easy deformation.

Highlights

  • Mandibular defects may result from tumor ablations, trauma, or radiation necrosis

  • Significant segmental mandibular loss or hemimandibular loss may be replaced with mandibular implants by head and neck surgeons or oral surgeons in order to terminate surgery quickly [1]

  • We have presented many kinds of failures resulting from mandibular reconstructions with implants

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Summary

Introduction

Mandibular defects may result from tumor ablations, trauma, or radiation necrosis. Significant segmental mandibular loss or hemimandibular loss may be replaced with mandibular implants by head and neck surgeons or oral surgeons in order to terminate surgery quickly [1]. Mandibular implant failure may ensue on long-term follow-up. The cause of mandibular implant failure may be related to high functional demands on mastication, speech, yawning, and singing. The force and pressures imposed on the mandible by chewing, yawning, and mouth opening make mandibular implants liable to extrusion sooner or later. Complications of mandibular implant include infection, loosening, deformation, soft tissue wasting, extrusion, capsular contracture, and sometimes the development of a skin defect owing to infection with subsequent scar contracture (Table 1)

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