Partial Mandibular Resection Research Articles

Analysis of surgical approaches and mandibular treatment strategies for different types of tumors involving parapharyngeal space

In view of the surgical complexity of parapharyngeal space tumors involved, this paper summarized the disease data of patients with parapharyngeal space tumors involved in the Department of Oral and Maxillofacial Surgery, the First Hospital of Shanxi Medical University from January 2015 to January 2021. It also summarized the surgical approach and mandibular management, so as to explore surgical strategies for different characteristics of parapharyngeal space tumors involved. A total of 49 patients, including 28 males and 21 females, median age 52 years (range 24-72 years). They were treated with four surgical approaches for tumor resection, 25 cervical approach, 5 cheek and neck approach, 3 transoral approach, and 16 cervical-maxillary approach. Among the patients treated with cervical-maxillary approach, 3 patients were treated with mandible square resection, and 6 patients were treated with temporary mandible dissection. Seven cases were treated with tumor resection and partial mandibular resection. There are various surgical approaches and mandibular management methods involving tumors in the parapharyngeal space, and clinical decisions should be made based on tumor diameter, location, boundary, blood supply and pathological types.

Telescopic Overdenture Rehabilitation Following Hemimandibulectomy: Case Report

Oral squamous cell carcinoma (OSCC) warrants extensive surgical resection of the affected areas of the oral cavity which takes a tremendous toll on the patient’s functioning, aesthetic as well as social confidence. Replacement of such a large number of teeth along with portions of the alveolar ridge and mucosa warrants exuberant planning to ensure a satisfactory outcome in terms of function and patient comfort. The present case report describes one such case of OSCC that was treated with partial mandibular resection and had a large mandibular defect that was rehabilitated by means of a prosthesis using an interdisciplinary approach.

Is All-on-four effective in case of partial mandibular resection? A 3D finite element study

IntroductionThe aim of the work is to analyze stress distribution on 3D Finite Element (FE) models at bone, implant, and framework level of different designs for fixed implant-supported prostheses in completely edentulous patients, comparing results on whole and partially resected mandibles. Materials and methods3D anisotropic FE models of a whole and of a partially resected mandible were created using a TC scan of a cadaver's totally edentulous mandible. Two types of totally implant-supported rehabilitation were simulated, with four implants: parallel fixtures on whole mandible and on resected mandible, All-on-four-configured fixtures on whole mandible and on partially resected mandible. A superstructure comprising only metal components of a prosthetic framework were added, while stress distribution and its maximum values were analyzed at bone, implant, and superstructure level. ResultsThe results highlight that:(1) implant stresses are greater on the whole mandible than on the resected one;(2) framework and cancellous-bone stresses are comparable in all cases;(3) on the resected mandible, maximum stress levels at the cortical-bone/implant interface are higher than in whole-mandible rehabilitation. The opposite applies for maximum stresses on external cortical bone, measured radially with respect to the implant from the point of maximum stress at the interface. DiscussionOn the resected mandible, All-on-four configuration proved biomechanically superior to parallel implants considering radial stresses on implants and cortical bone. Still, maximum stresses increase at the bone/implant interface. A design with four parallel implants minimizes the stress on a resected mandible while, on the whole mandible, the All-on-four rehabilitation proves superior at all levels (bone, implant, and framework).

Intrapulmonary Metastasis from Adenoid Cystic Carcinoma of the External Auditory Canal: A Case Report.

External auditory canal adenoid cystic carcinoma (EAC) is rare and is associated with nonspecific clinical manifestations such as early ear pain. We report a patient with advanced lung metastases from adenoid cystic carcinoma (ACC) of the EAC, which is difficult to diagnose. Under general anesthesia, lengthened right temporal bone resection, parotidectomy, facial nerve resection, cervical lymph node dissection (I-III), partial mandibular resection, tumor resection in the inferior temporal fossa and lateral femoral flap repair were performed, followed by regular radiotherapy and chemotherapy. During 2years of postsurgical follow-up, there was no recurrence. The combination of early detection, resection, postoperative radiotherapy, and chemotherapy can result in a good therapeutic effect.

Prosthetic Management Following Anterior Segmental Mandibular Resection: A Case Report

The rehabilitation of a patient in the Kennedy class IV situation demands biomechanical balance and aesthetic improvement. Larger defects usually lead to increased movement of the prosthesis, due to the compromised mucosal support and a longer edentulous span of the prosthesis. The article describes the prosthetic management of a patient following partial mandibular resection. The long span of missing teeth and the unavailability of a sufficient number of abutments are challenges for prostheses. This case report describes an inexpensive technique for the fabrication of attachment retained prosthesis over castable bar assembly for rehabilitating the long‑span Kennedy class IV situation.

Temporal Flaps in Head and Neck Reconstructive Surgery: A Systematic Review of Surgical Techniques.

The temporal region is a great source of vascularized flap, providing extremely variable and versatile options for reconstruction in head and neck surgery. Its popularity has led to the conception of a large variety of different flaps, in terms of contents and design. Temporal flaps are highly pliable and flexible, providing adequate bulk to obliterate dead spaces and improving engraftment, thus facilitating wound healing. The need to access different anatomical compartments, often far from the original flap anatomical site, has led surgeons to develop techniques to enlarge pedicles and bulk, by reverting and splitting flaps' contents, as well as through partial mandibular and zygomatic resection. To further increase versatility, a multilayered combination of different regional tissues and muscle segmentation techniques has been described. Historically, each flap has had its own proponents and opponents, but a pointy review systematizing techniques and comparatively analyzing different flaps was still missing in the literature. The field of use of some flaps has been progressively limited by the increasing relevance of free tissue transfers, which nowadays may provide success rates up to 95% with a constrained morbidity, thus offering an effective alternative, when available. Given the wide range of reconstructive strategies based on temporal flaps, there is still a great debate on nomenclature and surgical techniques. The present study systematizes the topic, classifying regional flaps according to contents and indications. Harvesting techniques are described stepwise and schematically illustrated, thus offering an indispensable tool to the armamentarium of reconstructive surgeons.

TREATMENT OF MYXOMA BY PARTIAL RESECTION AND IMMEDIATE RECONSTRUCTION WITH PARTICULATE AUTOGENOUS GRAFT WITH PLATELET-RICH FIBRIN

A 21-year-old man was referred to the oral medicine clinic for investigation of a mandibular lesion after orthodontic documentation. Extraoral examination revealed asymmetry with a volumetric increase of the mandibular angle on the left side. Intraorally, the mucosa was preserved with no expansion. Cone beam computed tomography (CBCT) revealed a well-circumscribed hypodense lesion, with anteroposterior growth involving the mandibular body in the region of teeth 37 and 38. Incisional biopsy was performed based on the diagnosis of odontogenic myxoma that was confirmed in the histopathologic examination. Partial mandibular resection through a Risdon access surgery was conducted under general anesthesia with the installation of mandibular reconstruction plate system of 2.4 mm and immediate reconstruction with a particulate graft of iliac crest associated with platelet-rich fibrin (PRF). The patient is in a follow-up of 6 months, and the last CBCT showed local bone formation.

Treatment of Mandibular Chronic Osteomyelitis Associated with Benign Osteopetrosis

Osteopetrosis is a rare hereditary disorder characterized by dysfunction of osteoclasts and bone resorption. With normal osteoblastic activity, the dysfunction promotes intense bone sclerosis, with reduction of bone marrow. A 48-year-old man with a previous diagnosis of benign osteopetrosis complained of pain and swelling in the right mandibular body. The patient reported undergoing extraction of tooth #46 about 6 months prior to presentation. Intraoral examination demonstrated alveolar bone exposition, mobility of teeth #47 and #45, and suppurative exudate. Computed tomography showed irregular bone resorption of the alveolar and basilar bones extending from tooth #45 up to the mandible ramus. A clinical diagnosis of osteomyelitis was rendered. Partial mandibular resection was performed with the help of an ultrasonic cutting device, and a reconstruction bone plate was inserted. The postoperative control was uneventful, with aesthetics and function re-established, and the patient is satisfied with the treatment. Support: FAPEMIG.

Performing partial mandibular resection, fibula free flap reconstruction and midfacial osteotomies with a cold ablation and robot-guided Er:YAG laser osteotome (CARLO®) – A study on applicability and effectiveness in human cadavers

ObjectiveAim of the study was to prove the safety, accuracy characteristics of contact-free laser osteotomy executed with the cold ablation and robot-guided Er:YAG laser osteotome in a human cadaver test. Material and methodsOn six human cadavers mandible resections with a swallowtail like pattern were performed with the laser system on each side. The defects were reconstructed with a fibula graft of identical design and enlarged by 0.2 units. Mandibles and fibulas width as well surgery times were recorded. Additionally a Le Fort I and median mandible split were done. Macroscopically, the bone margins were examined for necrosis. ResultsLaser osteotomies of the mandible up to a depth of 23 mm were possible without any thermal damage. Repeatability and precision of the system could be easily assessed. With the navigation system precise control of localization was achievable. Mean surgery time for the mandible resection was 13.32 min and for the fibula osteotomy 12.38 min. ConclusionThe simply transmission of a cold ablation and robot-guided laser osteotome in an operation room identical environment for surgical interventions could be demonstrated. Precise osteotomy patterns with freedom in the design and carbonisation-free cut surfaces have been shown.

Treatment of Mandibular Ameloblastoma Involving the Mandibular Condyle: Resection and Concomitant Reconstruction With a Custom Hybrid Total Joint Prosthesis and Iliac Bone Graft.

To describe the treatment of ameloblastoma involving the mandibular body and condyle in 3 patients. This report describes 3 patients with large ameloblastomas (2 were second recurrences) treated by partial mandibular resection. Involvement of the mandibular condyle in these 3 patients made the reconstruction more challenging. Reconstruction included immediate temporomandibular joint replacement by a custom-made alloplastic total joint and mandibular body (Zimmer-Biomet, Jacksonville, FL). These devices were designed using virtual surgical planning software. The 3 patients underwent concomitant bone graft reconstruction using autogenous-free corticocancellous block bone grafts from the iliac crest. This facilitated later dental implant placement and full dental rehabilitation. Direct inferior alveolar nerve repair or nerve graft reconstruction with allograft was also carried out for all 3 patients. Maxillomandibular fixation was not used in all 3 patients. All the 3 patients underwent successful surgery and recovery. Mandibular function was preserved. The concomitant bone graft allowed successful dental implant placement for subsequent planned restorative dentistry. Ameloblastoma involving the mandibular condyle can be successfully treated by resection and concomitant total joint replacement with an alloplastic device. This technique shows promise in that there is rapid return to excellent function thanks to rigid fixation of the construct. Mirroring software used in the prosthesis design facilitates excellent cosmetic outcomes.

Occlusion Guided Double-Barreled Fibular Osteoseptocutaneous Free Flap for Refined Mandibular Reconstruction Aided by Virtual Surgical Planning.

There were many articles about double-barreled fibular flap for mandibular reconstruction. The upper layer bone was suit for implant placement as a new alveolar. The lower layer was necessary for contour. But the accurate relationship between the 2 layers bone was rarely reported. The purpose of this study was twofold: to evaluate the feasibility of the novel design of the double-barreled fibular flap from virtual surgery to actual result; to evaluate the accuracy and results of occlusion-guided double-barreled fibular free flap in mandible reconstruction. From 2010 to 2016, 52 patients underwent segmental mandibular reconstruction with double-barreled fibular osteoseptocutaneous flaps with computer aided design/computer aided manufacturing technique. Preoperative computer tomographic (CT) scans were imported into Mimics 10.01 software (Materialise, Leuven, Belgium) for surgical planning. The peroneal vessel pedicel was designed at the lower barrel segmental bone of the double-barreled fibular flap. The double-barreled bone was strung with 16 mm fixation screws instead of mini-plate. Sixty-three dental implants placement was simultaneous in 30 patients and 32 dental implants placement was in second stage in 18 patients. Postoperative CT and digital imaging were evaluated to assess surgical accuracy using software. The pre- and postoperative morphometric measurements were compared using the Fisher exact t test. Two flaps occurred vascular crisis postoperatively. There was no flap necrosis. Four implants failed during 1 to 5 weeks postoperative. Sixty-six CT scans from 33 patients who underwent partial mandibular resection were analyzed. The dimensions of the double-barreled fibula segments after osteotomy showed no difference from the preoperative virtual surgical planning (VSP). But the condylar locations showed a disposition out of the fossa (P < 0.05), between VSP and postoperative CT scans. There was no difference in implants between VSP and postoperative CT scans. The VSP of relationship of double-barreled fibular is important for segmental mandible reconstruction. The benefit of VSP was to enhance surgical accuracy and safety.

ODONTOGENIC MYXOMA IN MANDIBLE: CASE REPORT WITH TEN YEARS EVOLUTION

Odontogenic myxoma (OM) is a benign, slow-growth, mesenchymal-stemed and locally aggressive neoplasia of the maxilla-mandibular, derived from mesenchymal odontogenic tissues, that comprises less than 5% of odontogenic tumors. In this study is reported a case of a 45-year-old female patient presenting an asymptomatic swelling in the anterior mandible, with stony consistency and 10 years evolution, causing expansion of the lower ridges. Cone beam CT scan revealed multilocular lesion with small and regular loci, and well-defined borders. Histopathologic examination of the incisional biopsy revealed a cellular loose connective tissue of myxomatous appearance. The diagnosis was odontogenic myxoma. The patient underwent partial mandibular resection and no recurrence was observed after 2 years follow-up. Although benign, OM may have an adverse clinical outcome as a result of their infiltrative growth and progressive development. In this case, is intended to discuss the different aspects of its biological behavior and diagnostic criteria.

Treatment and Rehabilitation of Repetitively Recurrent Langerhans Cell Histiocytosis: A Case Report

Langerhans cell histiocytosis (LCH) is characterized by proliferation of histiocyte-like cells (Langerhans cell histiocytes) with characteristic Birbeck granules, accompanied by other inflammatory cells. Treatments of LCH include surgery, chemotherapy, and radiotherapy. One of the representative forms of chemotherapy is intralesional injection of steroids. Surgical treatment in the form of simple excision, curettage, or even ostectomy can be performed depending on the extent of involvement. Radiotherapy is suggested in case of local recurrence, or a widespread lesion. This article shows the case of repetitively recurrent LCH of a 56-year-old man who had been through surgical excision and had to have marginal mandibulectomy and radiotherapy when the disease recurred. After the first recurrence occurred, lesions involved the extensive part of the mandible causing pathologic fracture, so partial mandibular bone resection was performed from the right molar area to the left molar area followed by the excision of the surrounding infected soft tissues. The resected mandibular bone was reconstructed with a segment of fibula osteomyocutaneous free flap and overdenture prosthesis supported by osseointegrated implants.

Botryoid Odontogenic Cyst in Mandible: An Uncommon Case Report

Botryoid odontogenic cyst (BOC) is a rare multilocular variant of lateral periodontal cyst. This lesion is considered to be rare in the maxilla, its prevalence being highest between the fifth and seventh decades of life, without gender predilection. A 52-year-old female was referred for evaluation of a soft, painful swelling extending throughout almost the entire mandible, causing tooth mobility. Computed tomography showed a hypodense image involving all teeth and the basal area of the mandible. An incisional biopsy was performed, and histopathological examination revealed multiple cystic cavities with clear cells distributed throughout the cystic epithelium and focal areas of thickening. The capsule consisted of fibrous connective tissue and showed mononuclear inflammatory infiltrate. Under the diagnosis of BOC, partial mandibular resection with placement of a reconstruction plate was performed. An excisional biopsy confirmed the diagnosis of BOC. No evidence of recurrence was observed during 12 months of follow-up.

Three-Dimensional Virtual Surgery Accuracy for Free Fibula Mandibular Reconstruction: Planned Versus Actual Results

Virtual surgical planning (VSP) can promote efficiency, but the ability to transfer the proposed plan to the actual result has not been adequately studied. The purpose of this study was to morphometrically compare the virtually preplanned scenario with the postoperative 3-dimensional (3D) anatomic result. A retrospective review of 10 patients who underwent mandibular reconstruction using a free fibula flap and VSP were evaluated. Pre- and postoperative Digital Imaging and Communications in Medicine files were imported into Mimics 10.01 software (Materialise, Leuven, Belgium) for surgical planning. Preoperative VSP and 1-week postoperative computed tomographic (CT) scans were evaluated to assess surgical accuracy using VSP. The pre- and postoperative morphometric measurements were compared using the Student t test. Twenty CT scans from 10 patients (mean age, 56.9±20.2 yr) who underwent partial mandibular resection were analyzed. The dimensions of the fibula segments after osteotomy showed no difference from the preoperative VSP (mean difference in fibula height, 1.2 mm; mean difference in width, 0.9 mm; mean difference in length, 1.3 mm). The postoperative anterior and posterior mandibular angles differed from the VSP by 12.4° and -12.5°, respectively. The condylar distance and inclination showed a discrepancy of only 1.7 mm and 4.6°, respectively, between VSP and postoperative CT scans. VSP confers reproducible precision and accuracy for free fibular mandibular reconstruction. The benefit was most striking for large reconstructions requiring multiple fibular segments. Future directions include assessing the use of external registration devices to enhance surgical accuracy and to follow patients longitudinally to monitor the long-term benefit of VSP.

Complex mandibular reconstruction after a partial mandibulectomy with a fibula free graft: A clinical report

This report describes the surgical and prosthetic reconstruction of a partial mandibular resection due to an osteomyelitic variant with a free fibula microvascular graft, dental implant placement, and reconstruction with a computer-aided design/computer-aided manufacturing (CAD/CAM) partial fixed dental prosthesis. A team composed of a prosthodontist, oral and maxillofacial surgeon, and otolaryngologist was required to treat and restore the patient to near normal comfort and function.

Outcome of partial mandibular reconstruction with fibula grafts and implant-supported prostheses

This study sought to evaluate the outcome of patients treated with fibula grafts for partial mandibular reconstruction and implant-supported prosthesis at a Danish university hospital. Patient inclusion criteria were: partial mandibular resection, reconstruction with a fibula graft, and treatment during the period 1998–2011. Patients with incomplete medical records were excluded. Thirty-six patients were included, of whom 16 were treated with an implant-supported prosthesis. Relevant presurgical, intraoperative, and postoperative parameters were registered. The fibula graft survival rate at the last follow-up (mean follow-up 22 months, range 0–89 months) was 97%. Half of the patients experienced non-severe complications such as loosening of osteosynthesis material, fistulae, and graft exposure. One of 37 fibula grafts in the 36 patients was removed due to infection. The implant survival rate was 96%; three of 67 implants were lost due to infection. Eight implants were not included in the prosthetic rehabilitation. Fibula graft surgery for mandibular reconstruction was found to be a reliable treatment modality with a high survival rate. Rehabilitation with implant-supported prostheses was characterized by high survival rates and few complications. The results obtained are comparable to those of previous studies.

Five years follow-up of implant-prosthetic rehabilitation on a patient after mandibular ameloblastoma removal and ridge reconstruction by fibula graft and bone distraction

This case report presents a combination of surgical and prosthetic solutions applied to a case of oral implant rehabilitation in post-oncologic reconstructed mandible. Bone resection due to surgical treatment of large mandibular neoplasm can cause long-span defects. Currently, mandibular fibula free flap graft is widely considered as a reliable technique for restoring this kind of defect. It restores the continuity of removed segment and re-establishes the contour of the lower jaw. However, the limited height of grafted fibula does not allow the insertion of regular length implants, therefore favouring vertical distraction osteogenesis as an important treatment choice. This report presents a patient affected by extensive mandibular ameloblastoma who underwent surgical reconstruction by fibula free flap because of partial mandibular resection. Guided distraction osteoneogenesis technique was applied to grafted bone, in order to obtain adequate bone height and to realize a prosthetically guided placement of 8 fixtures. After osseointegration, the patient was rehabilitated with a full arch, screw-retained prosthetic restoration. At five-years follow up, excellent integration of grafted tissue, steady levels of bone around the fixtures and healthy peri-implant tissues were reported.

Mandibular bone metastasis of rectal cancer: Report of a case

A 56-year-old man was referred with lower rectal cancer showing anal canal invasion and liver metastasis. He underwent an abdominoperineal resection and a partial hepatectomy. Adjuvant therapy with tegafur-uracil and leucovorin was administered postoperatively. Lung metastasis was detected 2 years later and was resected. Right mandibular metastasis was diagnosed 2 months after the resection of the lung metastasis. A partial mandibular resection was performed after chemoradiotherapy, followed by reconstruction with a titanium frame and oral cavity reconstruction with a greater pectoral musculocutaneous flap. The pathological diagnosis was metastatic rectal cancer, and the therapeutic effect chemoradiotherapy was Grade 2. He is presently alive without any evidence of cancer, and has maintained a good quality of life 3 years after the mandibular resection and more than 5 years after his first operation. Mandibular metastasis from rectal cancer is very rare and the prognosis is poor according to the literature, so this case is considered to be very unusual.

Immediate Mandibular Reconstruction of a 5 cm Defect Using rhBMP‐2 After Partial Mandibulectomy in a Dog

To report treatment of a complex odontoma of the mandible by partial mandibulectomy and immediate surgical reconstruction using bridging plate fixation with a synthetic graft. Clinical case report. A 4-year-old male castrated cocker spaniel. Immediate reconstruction of the left mandible (5 cm gap) was performed after complete excision of a complex odontoma. Locking plate fixation was applied immediately before complete excision of the mass. Fixation was removed, then after partial mandibulectomy, including all abnormal tissue, restored to achieve occlusion. The resulting mandibular defect was filled with recombinant human bone morphogenetic protein-2 (rhBMP-2) delivered in an absorbable collagen sponge containing hydroxyapatite/tricalcium phosphate granules (compression resistant matrix [CRM]). New bone growth was evident radiographically and on palpation at 3 months. Bony remodeling was evident during follow-up examinations up to 26 months. Bone collected by biopsy at the graft site at 7 months had robust new bone formation and evidence of continued remodeling. Only minor complications (repeated intraoral plate exposure) were encountered postoperatively and were easily resolved. An osteoinductive factor (rhBMP-2/CRM) was successfully used as a graft substitute in immediate reconstruction of a large mandibular defect. Immediate reconstruction of large mandibular defects with osteoinductive materials as a graft substitute may be a viable alternative to partial mandibular resection or radiation therapy for benign odontogenic tumors in dogs.