Resection Of Mandible Research Articles

Jaw osteonecrosis after dental implants associated with oral bisphosphonates – case report of resection of mandible

Osteonecrosis of the jaw is associated with defects in vascularization and with the use of oral bisphosphonates. Osseous exposition and infection may occur. Recommended treatment is variable, from antibiotic medication, bony decortication to resections of the mandible in severe cases. Reconstruction of mandible, in cases of resections is essential for maintaining esthetic profile and adequate form and function. Objective: To report a case about the dangers oforal bisphosphonates in association with invasive procedures such as dental implants Case report: Female patient, 64 years-old, with osteonecrosis of the jaw caused by use of oral bisphosphonates after rehabilitation with dental implants. She had an edentulous and atrophic mandible and poor healthy. After diagnosis, partial resection of the jaw was performed together with the reconstruction with titanium plate, with no success. Then, iliac bone graft fixed by plates and screws was attempted, again with no success. Conclusion: Despiteof the small number of cases of osteonecrosis associated with oral bisphosphonate reported in the literature, a simple implant surgery could result in adverse consequences if the use of this medication were overlooked in the anamnesis.

Jaw osteonecrosis after dental implants associated with oral bisphosphonates – case report of resection of mandible

Osteonecrosis of the jaw is associated with defects in vascularization and with the use of oral bisphosphonates. Osseous exposition and infection may occur. Recommended treatment is variable, from antibiotic medication, bony decortication to resections of the mandible in severe cases. Reconstruction of mandible, in cases of resections is essential for maintaining esthetic profile and adequate form and function. Objective: To report a case about the dangers of oral bisphosphonates in association with invasive procedures such as dental implants Case report: Female patient, 64 years-old, with osteonecrosis of the jaw caused by use of oral bisphosphonates after rehabilitation with dental implants. She had an edentulous and atrophic mandible and poor healthy. After diagnosis, partial resection of the jaw was performed together with the reconstruction with titanium plate, with no success. Then, iliac bone graft fixed by plates and screws was attempted, again with no success. Conclusion: Despite of the small number of cases of osteonecrosis associated with oral bisphosphonate reported in the literature, a simple implant surgery could result in adverse consequences if the use of this medication were overlooked in the anamnesis.

Nonvascularised fibular bone graft after vascular crisis — a compensate on the failure of vascularised fibular

Objectives: To discuss the feasibility of preserving nonvascularised fibular bone grafts after the failure of vascularised free fibular flaps and clarify the key points. Methods: Ten patients who had preserved nonvascularised fibular bone grafts after the vascular crisis of vascularised free fibular flaps were included in this study. All of these cases were performed in Peking University School and Hospital of Stomatology from 1 January 2010 to 31 December 2014. Segmental mandible resection was performed due to tumours and trauma, reconstructed with vascularised free fibular flaps simultaneously. After the first operation, vascular circulation could not be obtained again. Nonvascularised fibular bone grafts were kept to restore the function and the facial aesthetics. At this time, the soft tissue, which included muscle, fascia and marrow, should be removed as thoroughly as possible and rigid fixation was done. Then intraoral incision was closed by several layers and water-tight result should be gotten. Proper drainage was put and kept for a few days after operation accompanying with sufficient antibiotics. Findings: Nonvascularised fibular bone grafts were preserved successfully without infection in all 10 cases. Follow-up results proved that all grafts have good combination with the residual mandible. The basic function and facial aesthetic results was kept and the patients were satisfied. Conclusion: Nonvascularised fibular bone grafts can be preserved successfully to restore the segmental bone defect of mandible after the failure of vascularised free fibular flaps. Some special key points should be pay attention to get good result.

Secondary mandibular reconstruction for paediatric patients with long-term mandibular continuity defects: a retrospective study of six cases

Paediatric patients with long-term mandibular continuity defects following segmental resection usually present severe functional and cosmetic deformities. Secondary mandibular reconstruction for these patients is very challenging. Literature reports on how to handle these patients are scarce. The aim of this study was to describe the authors’ experience in handling those paediatric patients who have not undergone primary reconstruction, for whom the final goal of treatment is to restore a symmetrical facial appearance, masticatory function, and speech. This was a retrospective analysis of the data of six patients who underwent radical mandible resection in childhood, without immediate bone restoration, and who then underwent a secondary mandibular reconstruction procedure after reaching adulthood, during the period 2009 to 2015. The multidisciplinary treatment procedure, selection of the donor site, and reconstructive approach are discussed. Key points in relation to secondary mandibular reconstruction with the aim of achieving not only good functional and cosmetic results, but also an improvement in the paediatric patient's psychological and social outcomes, are emphasized.

Rapid prototyped patient specific guiding implants in critical mandibular reconstruction.

Large tumours of the mandible need immediate reconstruction to provide continuity of the mandible, satisfactory function of the jaw, as well as an acceptable aesthetic outcome. In this prospective study we described the immediate reconstruction of the mandible using computer aided design and 15 rapid prototyped patient specific implants (PSI) in 14 patients suffering from benign or malignant tumours demanding continuity resection of the mandible. The scaffold PSI was filled with β-tricalcium phosphate granules and autologous bone. Microvascular reconstruction was additionally needed in 12/15 cases. The clinical follow up was on average 33 months and the radiological follow up was on average 21 months. In nine cases the healing was uneventful. One patient lost the microvascular flap during the first postoperative week and one patient needed a revision due to perforation of the mucosa at the site of the PSI. Four patients had a major complication due to perforation of the mucosa leading to infection, which resulted in the total or partial removal of the PSI. The PSI seems to be a promising solution for treatment of patients demanding large reconstruction after mandible resection. The benefits are decreased rate of donor site complications and more accurate and prompt surgical procedure.

A standardized formula for aesthetic mandibular reconstruction using an osteocutaneous fibular free flap

Supported by the International Research & Development Program of the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (NRF-2015K1A3A9A01028230).

Odontogenic Myxoma of Mandible with Unusual (Sunburst) Appearance: A Rare Case Report

Odontogenic Myxoma of Mandible with Unusual (Sunburst) Appearance: A Rare Case Report

Prospective biomechanical analysis of donor-site morbidity after fibula free flap.

The fibula free flap (FFF) is a standard method for osseous reconstruction. The purpose of this study was to investigate functional deficits after harvesting a free fibula flap. We designed and implemented a prospective clinical cohort study. The study sample consisted of patients undergoing mandible resection and reconstruction with a fibula free flap. The primary endpoint was the time-dependent difference in maximum peak power per body mass (MPP). In addition, balance ability, American Orthopedic Foot and Ankle Society (AOFAS) score, sensory limitations, general surgical complications, and the range of motion were recorded. A total of 27 patients were examined pre- and postoperatively (8 months on average). MPP and balance ability were significantly reduced (p<0.001) postoperatively. Furthermore, a deficit in dorsal extension and a considerable reduction of the AOFAS score were recorded. For the primary outcome, there were no significant predictors on multivariate analysis. Our results indicate a postoperative reduction of lower limb performance with a relevant impact on everyday activities, equivalent to the average loss of 7 life years of a healthy, fit individual. However, these data do not challenge the value of this commonly used microvascular graft. Future efforts should focus on the development of strategies to minimize the associated donor-site morbidity.

Up-and-Coming Mandibular Reconstruction Technique With Autologous Human Bone Marrow Stem Cells and Iliac Bone Graft in Patients With Large Bony Defect

Large bony defects followed by resection of the mandible need to be reconstructed by various surgical techniques such as the fibular flap. In this article, we report the case of mandibular reconstruction with autologous human bone marrow mesenchymal stem cells and autogenous bone graft, followed by placement of dental implants and prosthodontic treatment in a patient who has been failed to reconstruct mandibular bone defect after resection of mandible.

Unusual Presentation of a Sarcoma of the Mandible

A 24 year old female presents with complaints of pain and swelling to the right mandible. A panorex radiograph was obtained that demonstrated a radiolucent trabeculated lesion extending from tooth #32 to the condylar neck. Buccal and lingual soft tissue bony expansion was evident on clinical exam. Twobiopsieswere obtained; the firstwas inconclusive and the second demonstrated a giant cell reparative granuloma. Upon composite resection of the right mandible and reconstruction with a vascularized free fibula flap, final pathology resulted in a diagnosis a low grade fibrohistiocytic sarcoma. The incidence of a sarcoma of themandible is extremely rare, with 32 confirmed cases reported in the literature. We present the misdiagnosis from a benign pathological case of a giant cell reparative granuloma to a malignant fibrohistiocytic sarcoma.

A clinical case of single-stage correction of penetration combined orofacial defect with two microsurgical autografts

After surgical treatment for locally advanced oral tumors with resection of soft tissues, mucosal membrane, and facial skeletal structures, there are penetration combined defects, removal of which is a challenge for reconstructive surgeons. Mandibular repair is one of the problems in the correction of combined oral defects. Surgeons use different grafts to remove mandibular defects. One-flap transplantation does not always solve all reconstruction problems and ensure the repair of the mucosal membrane, a soft-tissue component, skin integuments, and facial skeleton. The authors describe a clinical case of successful single-stage correction of penetration combined orofacial defect after resection of the tongue, mouth floor, en bloc resection of the lower jaw and mental soft tissues, bilateral cervical supramyochoroidal lymphadenectomy, stage LCL CM mandibular defect formation after J. Boyd, by using two microsurgical autografts (a peroneal skin-muscle-skin autograft and a radial skin-fascia one) in a 39-year-old female patient clinically diagnosed with carcinoma of the left mandibular alveolar ridge mucosa, Stage IVA (T4аN0M0). The Department of Microsurgery, P.A. Herzen Moscow Oncology Research Institute, Ministry of Health of Russia, has gained experience in comprehensively correcting extensive combined maxillofacial defects with two or more grafts in 27 patients who underwent autografting with a total of 73 flaps. The most functionally incapacitating and life-incompatible defect was removed at Stage 1 of reconstructive treatment. Delayed reconstruction was made after a complex of specialized antitumor therapy and assessment of treatment results in the absence of progressive growth. A great problem during multi-stage defect correction is presented by the lack of recipient vessels after cervical lymphadenectomy, the presence of soft tissue scar changes, trismus, temporomandibular joint ankylosis, contractures and displacement of the edges of the resected mandible, and autografting into the chronically infected area. Single-stage repair, including that using a few microsurgical autografts, is the operation of choice for adequate anatomic and functional rehabilitation, permits the promptest recovery of patients, reduces a postoperative period, and allows them to undergo an antitumor treatment cycle. However, the repair is possible, when the risk of disease progression is low, in specialized centers and when there are trained head and neck surgery and reconstructive microsurgery specialists and anesthesiologists.

Health-related quality of life after segmental resection of the lateral mandible: Free fibula flap versus plate reconstruction

ObjectivesSegmental resection of the mandible causes functional, aesthetic and social problems affecting health-related quality of life (HRQoL). It is often assumed that reconstruction with composite free flaps guarantees better function and aesthetics than bridging the defect with reconstruction plates. MethodsUsing the European Organization for Research and Treatment of Cancer questionnaires (EORTC QLQ-C30 version 3.0 and EORTC QLQ-H&N35), we compared HRQoL in patients who received free fibula flaps versus reconstruction plates after segmental resection of the lateral mandible. ResultsThirty-seven completed questionnaires (18 fibula reconstructions and 19 patients with reconstruction plates) were available. Reconstruction with a free fibula flap did not provide clear additional benefit to bridging the defect with a reconstruction plate after segmental resection of the lateral mandible. In particular aspects known to have the most impact on HRQoL like swallowing, speech and chewing were not influenced by the type of reconstruction. ConclusionsReconstruction of segmental defects of the lateral mandible with free fibula flap and reconstruction plate resulted in comparable HRQoL. If dental rehabilitation by means of dental implants is not anticipated in the fibula, then plate reconstruction with adequate soft tissue remains a suitable technique for the reconstruction of segmental defects of the lateral mandible.

舌全摘出術，喉頭摘出術，下顎骨区域切除術後症例の摂食嚥下障害

舌全摘出術，喉頭摘出術，下顎骨区域切除術後症例の摂食嚥下障害

Kısmi Olarak Mandibulası Çıkarılmış Hastanın İmplant Destekli Hareketli Protez ile Rehabilitasyonu

Patients who have jaw resections with unrestored mandible display cosmetic disfigurement, compromised function, and frustration in social functions. Implant retained prosthesis is the best treatment option for these patients. Furthermore, this treatment improves the quality of life. However, mandibular resection patients usually undergo radiotherapy, so implants may fail, and treatment plan can be changed. The purpose of this clinical report is to present a patient with a partially resected mandible treated with implant supported prosthesis. A 51 year-old man with partially resected mandible was referred to prosthetic department for the treatment. The patient was treated with implant supported removable prosthesis with presicion attachments as locator and bar retained attachments. For improving the retantion; an extracoronal attachment was placed to remaining canine. And the maxilla was rehabilitated with fixed partial dentures and presicion attachment prosthesis. Finally, the patient was satisfied with the final result of the function and esthetic appearance of the prostheses.

Virtual surgical design in accurate mandibular reconstruction with vascularized fibular graft

Objective To introduce the application and assess the outcome of ProPlan CMF software in virtual surgery of mandibular resection and reconstruction with vascularized fibular graft.Methods Nineteen patients were performed mandibular resection,and immediate reconstruction with free fibular graft by application of ProPlan CMF software between March 1,2013 and January 31,2014,including 7 cases of osteoradionecrosis,6 cases of adamantoblastoma,4 cases of carcinoma of gingiva,2 cases of intra-osseous carcinoma of mandible.There were 12 males and 7 females,with an age range of 21-73 years (median,54 years).In each case,three-dimensional spiral CT scan of mandible and fibula was obtained before operation.The CT data were imported into the ProPlan CMF software and the virtual surgical planning was performed.After that,the mandibular rapid prototyping and surgical guide plates were made according to customized design.The segmental resection of mandible,titanium plate bending,fibular molding,insetting and fixing were then carried out by using these surgical guide plates.Results Operations were undertaken successfully according to preoperative design in all nineteen patients and negative margin was detected by intraoperative frozen section.The fibula was cut,shaped and fixed accurately.The operations took 4.5-7.0 hours (mean,5.5 hours).Primary healing of incision was obtained without complications except fistula in 2 cases of osteoradionecrosis,which were resolved with local wound care after 4 weeks.19 patients were followed up between 3 months to 1 year and all patients were alive with disease free.All patients were satisfactory with their maxillofacial appearance,occlusion and function.The ranges of mouth opening was 2.0-4.0 cm.The postoperative panoramic radiographs or CT scan showed perfect situation and contour of fibular graft.Healing of the donor site occurred without significant complications.All patients started early postoperative ambulation,and walked normally after 2 or 3 months.Conclusion The application of ProPlan CMF software in virtual surgical design and guide plates creation can simplify the operation,and improve the accuracy of mandibular resection and reconstruction,especially the spatial relationship of the mandible and the fibula graft.It is worth promotion widely in clinical practice. Key words: Fibular graft; Mandibular reconstruction; ProPlan CMF software; Three-dimensional spiral CT; Guide plate

Effect of implant assisted partial overdenture with neutral zone concept in partially resected mandible restoration on facial contour and bone density

This study was performed to evaluate the effect of implant assisted partial overdenture located in neutral zone for restoring partially resected mandible on facial contour and bone density. Material and methods10 patients their age range from 18 to 45 years were selected. Each patient had partially resected mandible with osseous bone graft. Patients received removable partial overdenture assisted by two implants with suitable length and diameter guided by CBCT scan using early loading protocol two months after implant insertion. That partial overdenture respected neutral zone registration. Patients were recalled after two months from transitional partial denture insertion, two months after implant insertion and two months after implant assisting removable partial overdenture for facial symmetry evaluation, and assessment of bone quality. The data were collected, tabulated and statistically analyzed using test (ANOVA) with repeated measures comparing different follow up periods for bone density, and paired t-test comparing facial symmetry before reconstruction versus after reconstruction and mirror images to healthy side. ResultsCurrently it was found that early loading protocol with two implants supported mandibular partial overdenture with neutral zone in reconstructed resected mandible produce implant success rates, and improve facial asymmetry.

Vascularized Free Fibula Flap for Reconstruction of Mandibular Defects

Objective: To assess the versatility of vascularized free fibula flap in reconstruction of various defects of mandible. Study Design: Prospective study. Duration of Study: March 2009 to March 2012. Methodology: The study group consisted of 10 patients who underwent resection of mandible for various reasons and reconstruction of continuity defects using a vascularized free fibular flap. The mandible was resected for ameloblastoma in 4 cases, squamous cell carcinoma in 1 case, odontogenic keratocysts in 3 cases and ossifying fibroma in 2 cases. The type of reconstruction performed was primary in 9 patients in which osseous fibula flap was used and secondary in 1 patient in which osseocutaneous flap was used. Results: There were 10 patients which include 5 males and 5 females within age group of 20 to 50 years with mean age of 35 years. All flaps survived except in 1 patient who had donor site morbidity. Flap perfusion was seen immediately after anastomosis and was maintained throughout the follow-up period of minimum 6 months. All patients were kept in nasogastric feeding for 5 days and then began oral feeding and walking with some aid in 2nd week and became completely ambulant in 4th week postoperatively. Conclusion: In our study, we conclude that vascularized free fibula flap is a versatile option for reconstruction of large mandibular defects with its good quality and quantity of bone and ease of manipulation to restore the original anatomy of the mandible and permit implant based prosthetic rehabilitation.

Extremely aggressive behavior of central giant cell granuloma after biopsy:a case report

Although central giant cell granulomas (CGCGs) appear to be benign, their radiographic findings are active. These tumors become severely invasive with the stimulus of surgery, resembling malignant tumors. Achieving the correct diagnosis is reportedly difficult because CGCGs are very similar to odontogenic jaw tumors. We herein describe an intriguing case of a 21-year-old male patient who was referred to our outpatient clinic with persistent swelling of the left buccal region. After making a provisional diagnosis of ameloblastoma from panoramic and computed tomography images, a biopsy was performed. Nine days after this operation, the intraoral lesion started to enlarge, causing facial disfigurement. Soon afterward, this lesion was examined by computed tomography, magnetic resonance imaging, and by both bone and tumor scintigraphy. Segmental resection of the mandible was conducted in the hospital, and the histopathological appearance was consistent with CGCG. Although CGCG tends to be indolent, the present case suggests that the stimulus of surgery can trigger clinically invasive behavior more characteristic of malignancy. CGCG exhibits variable features, but with the stimulus of surgery, its clinical behavior becomes extremely invasive, resembling a malignant tumor. The CGCG in the present case showed unusual development and intriguing radiographic and histopathological findings. It is important to be aware of the findings that can help to achieve a correct diagnosis.

Oral Rehabilitation Outcomes After Free Fibula Reconstruction of the Mandible Without Condylar Restoration

Resection of the posterior mandible for tumor or osteonecrosis may include the mandibular condyle, an integral part of the temporomandibular joint (TMJ). Condylar reconstruction, including use of prostheses, the native condylar head, or part of the fibula, all have associated drawbacks including skull base erosion and the potential for ankylosis and TMJ dysfunction as well as the increased difficulty associated with trying to recapitulate the TMJ with high fidelity. We report our experience leaving a single side of the reconstructed mandible unsecured to the glenoid fossa, allowing the mandible to "hang." We hypothesized that a good functional recovery may be achieved with this simple approach while avoiding the potential for ankylosis and TMJ dysfunction. A retrospective chart review of all patients undergoing free fibula reconstruction of the mandible with condylar removal was performed. Outcomes were determined by maximum interincisal opening, occlusion, and diet after full recovery. Six patients were studied. Two had condylar reconstruction with a contoured fibular head secured to the glenoid fossa. One of them had progressive postoperative trismus and ankylosis. One patient was reconstructed with the native condyle rigidly fixed to the fibula flap, complicated by avascular necrosis requiring condylar resection, with good function afterward. Three patients were left to "hang." All 3 had either normal or improved function after surgery. Two had slight ipsilateral deviation on mouth opening. Function can reliably be reestablished after segmental mandibulectomy and condylectomy with a vascularized fibula flap whose distal end is not precisely contoured or actively seated in the glenoid fossa, as a valid alternative to condylar reconstruction.

Glandular Odontogenic Cyst: Case Report

Glandular odontogenic cyst is a rare developmental cyst characterized by local aggressive behavior. Woman, 73, complained of a bluish swelling of the lingual portion of the anterior mandible that extended from tooth #33 to #44 and had been present for 4 years. Panoramic and periapical radiographs from the area showed an extensive multilocular radiolucent image on the anterior mandible. Incisional biopsy revealed a glandular odontogenic cyst. Treatment was en-bloc resection of the anterior mandible. Histological analysis of the surgical specimen confirmed the diagnosis of glandular odontogenic cyst. The patient was rehabilitated with a removable partial denture and has been in clinical and radiological follow-up for months with no signs of local recurrence.