Hemimandibular Reconstruction Research Articles

Combined Use of Endoscopic Techniques and Virtual Surgical Planning for Intraoral Approach for Hemi-mandibular Resection and Reconstruction.

The study aimed to describe our experience in using endoscopic procedures to aid hemi-mandibular reconstruction with bone flaps through transoral approach. Five patients with huge benign mandibular tumors underwent transoral mandibulectomy and hemi-mandibular reconstruction, using endoscopy. Facial symmetry, occlusion, bone healing, and mandibular similarity were all evaluated postoperatively. The paired-samples t test was used to compare quantitative data, and a P value less than 0.05 was considered a significant difference. All five patients who received transoral mandibular surgery recovered in terms of TMJ functionality, facial symmetry, and aesthetic results. Endoscopy monitored and ensured that bone flaps were correctly connected and fixed. The accuracy of endoscopy-guided mandibular reconstruction was confirmed by quantitative examination for four cases, which revealed no statistically significant variations between postoperative CT analysis and preoperative virtual surgical planning data. Endoscopy-assisted virtual surgery may resolve concerns with transoral hemi-mandibular reconstruction and broaden indications for mini-invasive mandibular reconstruction. However, only patients with benign mandibular tumors were included in our study, so surgeons should be very cautious if applying this technique to malignant lesions or bony tumors invading soft tissues.

SURGICAL MANAGEMENT OF GOLDENHAR SYNDROME PATIENT WITH ORTHOGNATHIC SURGERY AND HEMIMANDIBULAR PROSTHESIS: A CASE REPORT

Goldenhar syndrome, also known as hemifacial microsomia (HFM), is a rare congenital disease associated with facial asymmetry and hypoplasia of the jaw. We describe the clinical case of a 13-year-old boy with HFM treated with orthognathic surgery and a customized biphasic calcium phosphate (BCP) bioceramic hemimandibular prosthesis. Clinical and radiographic examination revealed facial asymmetry, right hemifacial microsomia, hypoplasia of the mandible, retrognathism, hypomentonism, canted occlusal plan, and epibulbar dermoid. The primary treatment consisted of bimaxillary orthognathic surgery for occlusal plane correction. Five years later, the patient underwent surgery for hemimandibular reconstruction using BCP customized prosthesis for correction of asymmetry. An improvement of esthetics was noted after surgery.

Novel Geometry of an Extended Length Chimeric Scapular Free Flap for Hemimandibular Reconstruction: Nuances of the Technique Streamlined by In-House Virtual Surgical Planning and 3D Printing for a Severely Vessel-Depleted Neck

Subscapular-based flaps have historically maintained an unparalleled ability to provide a multitude of bone and soft tissue components based on a single vascular pedicle. However, these flaps are often not thought of as an ideal choice for composite defects requiring extended lengths of bone for reconstruction. The ability to harvest long segments of bone and reliably perform multiple contouring osteotomies is fundamental to long-span composite mandibular reconstruction, and microvascular surgeons are often met with significant reconstructive challenges when fibular free flaps cannot be used owing to variant vascular anatomy or occlusive atherosclerotic disease in these specific clinical scenarios. This challenge is further compounded by treatment-related vessel depletion in the neck, which reduces the availability of suitable recipient vessels in close proximity to the reconstruction. We present a case in which all of the aforementioned challenges presented in a single individual, who concomitantly required hemimandibular reconstruction with treatment related vessel depletion in the neck and unsuitable bilateral vascular anatomy in the legs precluding the use of a fibular free flap. This case demonstrates a previously unreported flap component geometry for hemimandibular reconstruction using an extended-length chimeric scapular free flap with scapular tip, lateral scapular border, and parascapular fasciocutaneous skin paddle components.

Hemimandibular Reconstruction of Pediatric Ameloblastoma with Templated Free Fibula Flap.

Hemimandibular Reconstruction of Pediatric Ameloblastoma with Templated Free Fibula Flap.

An anatomical study on the availability of contralateral recipient vessels in hemi-mandibular reconstruction with vascularised free fibula transfer

Background: In mandibular reconstruction with vascularised free fibula transfer, there are situations where the neck on the operated site lacks recipient vessels for vascular anastomosis due to previous radiological/surgical interventions.Methods: The present study aims to clarify the availability of neck vessels on the contralateral side in such situations. Experimental surgery was conducted on 20 fresh cadavers (six males and 14 females). After the left half of the mandible was removed, free vascularised fibula of equivalent length was transferred to fill the defect. The possibility of connecting the peroneal artery and vein to the superior thyroid artery (STA), transverse coli artery (TCA), internal jugular vein (IJV), and external jugular vein (EJV) of the contralateral side was evaluated.Results: In all samples, the peroneal vessels could reach the STA and EJV. However, the peroneal vessels could reach the TCA and IJV of the contralateral side in only 45% and 64.2% of cases, respectively. The average and standard deviation of the lengths by which vessels were insufficient were 1.1 ± 13.9 mm for IJV and 8.8 ± 24.7 mm for TCA.Conclusions: In reference to these findings, it is concluded that, in situations where neck vessels of the defect side are unavailable, availability of the superior thyroid artery and external jugular vein should be examined first. When these vessels are available as recipient vessels, direct vascular anastomosis is highly likely to be successful. In cases where these vessels are unavailable and the transverse coli artery or internal jugular vein is used as the recipient, vascular interposition might be necessary.

3D Stereolithographic Modeling Technique for Hemimandibular Reconstruction Report of a Case with Innovation Technique

Computer aid design and manufacture have been widely applied in oral and maxillofacial surgery. Reconstruction of hemi-mandibular defects after tumor ablation is a major challenge for clinicians due to its complex architecture. We report of a case treated with innovation technique, including the use of computer assisted modeling to preoperatively design of the excision of the mandible tumors and the integration of rapid prototyping techniques in mandibular reconstruction. The patient received hemimandibulectomy for the tumor excision and reconstructed with titanium condyle-plate, and followed up for 4 years without recurrence and retained good function.

Extended Composite Temporoparietal Fascial Flap

The authors have expanded upon a well-described and widely used flap in the head and neck region. The purpose of the cadaver study was to determine the feasibility, angiosome, and the potential application of this pedicled flap in bone tissue engineering of the mandible. A total of 6 fresh human cadaver heads were dissected for a total of 12 flaps. The extended composite temporoparietal fascial flap, based on the superficial temporal artery (STA) and including cranial periosteum, was dissected and the dimensions were measured. Through a combined submandibular and preauricular incision, the mandible was exposed and the dimensions were measured from the sigmoid notch to the gonion angle and from the gonion angle to the symphysis. CT angiography and silicone injections were performed to identify the vascular anatomy of the flap. The combined distance from the sigmoid notch to the gonion and the gonion to the symphysis, plotted versus the cranial apex to tragus length, demonstrated adequate flap dimensions in all specimens for hemi-mandibular reconstruction. The average flap length was 16.5 ± 1.40 cm and the average flap width was 11.4 ± 0.98 cm, resulting in an average flap surface area of 94.5 ± 13.08 cm. Radiographic images and silicone injections confirmed STA perfusion of the cranial periosteum. The extended composite temporoparietal fascial flap with periosteum can be a viable option for providing vascularized periosteum in tissue-engineered craniofacial reconstruction.

Major mandibular reconstruction with vascularized bone grafts: Indications and selection of donor tissue

Free vascularized bones have been shown by many specialists to exhibit specific capabilities of reconstructing a major mandibular defect and can solve problems that may be insoluble by other methods. Nevertheless, absolute indications for using vascularized bone for major mandibular reconstructions have not been sufficiently well delineated to convince people of always considering vascularized bone for major mandibular reconstructions as a first option. Based on our experience with 55 major mandibular reconstructions, we might delineate the absolute indications for using free vascularized bone for major mandibular reconstructions explicitly: 1) osteoradionecrosis of mandible or on irradiated tissue bed; 2) hemimandibular reconstruction with a free end facing the glenoid fossa; 3) long segment mandibular defect, especially across the symphysis; 4) inadequate skin or mucosal lining; 5) defects demanding sandwich reconstruction; 6) inability to obtain secure immobilization on the reconstructed unit; 7) failure of reconstruction by other methods; 8) near total mandibular reconstruction. Selection of donor tissue should be according to 1) the amount of tissue deficiencies, 2) composition of the defect, 3) design and placement of the flap, 4) irradiation on the recipient site or not, 5) which vessels to be used, 6) which flap has the appropriate vessel length 7) skin color and texture of the donor tissue, 8) how many osteotomies required to stimulate the curvature of the resected mandible 9) speed of bony union, 10) feasibility of future osseointegration. We have used three kinds of vascularized bones (iliac bone, fibula, scapula). Iliac bone was most frequently used, and has always been our first choice, since it can carry good quality bone, a large skin flap, and ample soft tissue. The fibula has the merit of being less bulky and good for simultaneous intraoral lining, but the contour is more rigid and the bony height is insufficient. The scapula bone is rarely used at present because of its relative inconvenience.

Hemimandibular reconstruction with bipedicled scapular osteocutaneous free flap

A case report is presented on the successful use of a bipedicled scapular osteocutaneous free flap in a young woman, whose hemimandible was resected because of sarcoma, 1 year prior to presentation. The postoperative course was uneventful and donor site morbidity minimal.

Reconstruction of the Mandible with a Free Iliac Bone Graft and Preformed Temporomandibular Joint Prosthesis: Case Report

The use of preformed vitallium TMJ-prosthesis in combination with a microvascular iliac bone graft is an alternative method for hemimandibular reconstruction. It has several advantages compared with earlier described methods, and we have used it successfully in two cases.