Resection Prosthesis Research Articles

Retro and prospective analysis of complex treatment of a patient with a polyostotic form of osteoclastoma of the maxillofacial region: clinical observation

In global literature there is not sufficient information on the course of the polyostotic form of osteoclastoma and methods of its treatment. For this reason, the analysis of this clinical case may be interesting for oncologists, maxillofacial surgeons and dentists of various specialties, who can reveal both the onset and recurrence of the disease. A characteristic feature of the course of this disease is the relapse of neoplasms with localization of foci in various parts of the upper and lower jaw. A clinical case of polyostotic form of jaw osteoclastoma and patient`s management tactics from 2006 to 2024 are described in the article. The disease was first diagnosed in 2006, when a neoplasm was revealed in the right part of the lower jaw. The neoplasm was removed by resection and mandibular defect was replaced by a carbon implant with further prosthesis. In 2011 a new neoplasm was detected on the left side in the frontal part of the upper jaw. At the same time a relapse of the disease was diagnosed with a new tumor focus in the lower jaw on the right. Surgical treatment was performed. Firstly, the neoplasm in the frontal area of the upper jaw was removed with replacement of the defect with a resection prosthesis. And secondly, a removal of the tumor on the lower jaw with resection of the chin within healthy tissues and replacement of the defect with an implant made of carbon-carbon material "Uglecon M" were performed. In 2023 the patient was invited to the dental hospital of the Clinical Multidisciplinary Medical Center of E.A. Vagner Perm State Medical University for dispensary observation and evaluation of the results of the treatment. The obtained results indicate the need for medical follow-up of patients after surgery for osteoblastoclastoma. The effectiveness of jaw implants made of carbon-carbon composite material " Uglecon M" was proved as well.

Bone turnover profile and muscular status in major orthopaedic surgery: a case series.

BACKGROUND Sarcopenia refers to a chronic loss of skeletal muscle mass, often associated with hypovitaminosis D and advanced age, which involves a greater risk of falls and fractures. The association of sarcopenia and osteoporosis defines osteo-sarcopenia. In this work, the authors analyzed the osteometabolic profile and the loco-regional muscular state of patients undergoing major orthopedic surgery, in order to define the incidence of district osteosarcopenic states, linked to a condition of disuse. METHODS 19 patients (10M-9F), between 15 and 85 years old, underwent major orthopedic surgery (15 resection prosthesis and custom made, 2 resection and reconstruction with transplant) were evaluated, of which 9 on an oncological basis. In all patients, the phospho-calcium metabolism was assessed by blood tests and intraoperative muscle biopsy was performed at the intervention site and contralaterally; in 3 cases a densitometric comparative study of the affected/contralateral limb was performed. RESULTS Results shows 5 patients with hypovitaminosis D; 7 pcs with hypocalcemia; 5 with PTH rise; 4pcs with ALP increase. In 100% of cases, the biopsy revealed sarcopenic patterns exclusively on the affected limb. 2 out of 3 DEXAs (66%) showed loco-regional osteoporosis compared to the contralateral. CONCLUSIONS The fact that in our sample sarcopenia is unilateral affecting only the pathological limb, that it is frequently associated with osteoporosis which is also unilateral and that for the most part it is not associated with vitamin D deficiency, suggests that it is an independent condition, with etiopathogenetic mechanisms different from osteosarcopenia itself. In major orthopedic surgery, bone integration and muscle status are both essential for achieving and lasting positive results. Considering the high incidence of district osteosarcopenia, an integrated surgical, pharmacological, and rehabilitative approach is desirable for the optimization of results, as well as more studies for the definition of the etiopathogenesis of this pathological condition.

The history of resection prosthesis.

The purpose of this historical review is to highlight the progression and development of prosthetic reconstruction with a focus on the modular distal femur with hinged total knee arthroplasty. Scientific literature was searched for descriptions of endoprosthetic reconstruction of the extremities to provide a thorough overview of the subject, focusing the research on the evolution of limb salvage of the distal femur. After the first works of Gluck and Giordano, with ivory and metal and the pioneer shoulder prosthesis by Pean in the late 1890s, a great advancement was brought by reconstructions performed for injured soldiers of the Great War. By the 1940s, replacement of all the main joints had been attempted, and documented. Walldius in the 1950s developed a fully constrained hinge knee, offering for the first time a consistent and replicable method of substituting the joint. In 1953, Shiers' prosthesis allowed for good flexion and extension. Stanmore and GUEPAR group prosthesis in the 1960s were the first to have a different right and left side model. The rotating hinge was developed in 1978 by Walker, with the innovative concept of six degrees of freedom. Between 1979 and 1982, Kotz developed the modular segmental replacement that, added to a fixed hinge knee, permitted the revolutionary creation of the modern distal femur replacement. The study of the materials and mechanical solutions that was brought to the modern distal femur resection prosthesis is a good example of a virtuous multidisciplinary teamwork between orthopaedic surgeons, anatomists, and biomechanical engineers.

Evaluation of Anesthesia Applications and Postoperative Care Results in Patients Who Underwent Reconstruction Surgery with Tumor Resection Prosthesis in Primary and Metastatic Bone Tumors

Evaluation of Anesthesia Applications and Postoperative Care Results in Patients Who Underwent Reconstruction Surgery with Tumor Resection Prosthesis in Primary and Metastatic Bone Tumors

Maxillary resection prosthesis fabricated from urethane dimethacrylate for a patient with polymethyl methacrylate allergy: A clinical report

The surgical resection of malignant tumors often leads to severe bone and soft-tissue deficits that can result in difficulty swallowing, impaired speech, and facial disfigurement. Prosthetic rehabilitation of these patients becomes an integral part of the patient’s recovery and allows for improvement in quality of life. This clinical report describes a patient who underwent an anterior maxillectomy secondary to squamous cell carcinoma. After the insertion of a polymethyl methacrylate (PMMA) interim resection prosthesis, the patient developed a severe allergic stomatitis reaction in the oral cavity and oropharynx. By using the patch test approach, true PMMA allergy was diagnosed along with a suitable PMMA replacement for the prosthesis. A subsequent prosthesis was fabricated from urethane dimethacrylate in place of the standard PMMA.

The use of adaptation training in the immediate postoperative period in patients with acquired defects of the maxillofacial region

Introduction. Surgical treatment of tumors in the maxillofacial region is always accompanied by the involvement of a significant amount of bone structures of the jaws. At the same time, the main method of dental orthopedic treatment of patients is prosthetics with a removable prosthesis. The larger the defect in the maxillofacial region, the more pronounced the subjective feeling of the patient’s rejection of the removable structure.There is a close relationship between the adaptive ability of a person and oral stereognosy as the anatomical and physiological mobility of the tongue and the synthetic activity of the cerebral cortex.One of the options for improving adaptability and increasing the activity of the synthetic activity of the cerebral cortex is a special adaptation training, which includes articulatory movements of the tongue. Stimulation of the muscles of the cheeks and lips with the tongue contributes not only to normal pronunciation / improvement of the intelligibility of the speech stream, but also adapts the tongue to the changed conditions after the imposition of removable prostheses.In connection with the above data, the study objective is to analyze the effectiveness of adaptive training to improve adaptability to removable dentures in patients with acquired defects of the maxillofacial region.Materials and methods. Dental orthopedic treatment of 39 patients was carried out after surgical treatment, including resection of the upper jaw and simultaneous replacement with a removable dental resection shaping prosthesis of the upper jaw directly on the operating table.A clinical control group (n = 40) was introduced to identify parameters in determining the synthetic activity of the cerebral cortex. Depending on the assigned adaptive support, the patients were divided into 2 subgroups: Subgroup 1 – the modernized adaptation training complex was prescribed (n = 18), Subgroup 2 – the standard observation of the patient (n = 21).Stereognostic testing and determination of adaptive capacity before treatment, after 7 / 14 days and 1 / 3 month after the placement of a resection prosthesis.Results. Adaptive support for patients of Subgroup 1 is represented by adaptation training 1 complex (33.3 %). Repeated stereognostic testing 7 days after surgery showed a decrease in adaptive values in all patients. After 14 days, in Subgroup 2, stereognostic testing of patients remained unchanged. Another 14 days (1 month after the placement of a resection prosthesis) in the Subgroup 1 of patients, the reference test values were found in 2.5 % of cases. The number of patients with high and moderate values increased by 1.3 times, and the number of patients with low test values also decreased by 3 times. 3 months after the placement of the resection prosthesis, the test values in Subgroup 1 approached the values before the surgical treatment. None of the patients of Subgroup I had a low level of adaptability.Discussion. The training exercises contributed not only to the muscular development of the tongue, but also stimulated the synthetic activity of the cerebral cortex. In 3 months after the placement of a resection prosthesis in the 1st subgroup of patients, the values of stereognostic testing approached the preoperative level.Conclusion. Normalization of the tone of the muscles of the oral cavity through functional training changes the stereognostic abilities of the patient. All this together increases the patient»s adaptability to removable dentures. Adaptation support reduced the time of adaptation to new removable dentures, which was confirmed by objective research – stereognostic testing. The influence on the synthetic activity of the cerebral cortex through the exercises of training for the tongue increased the adaptability to the resection prosthesis, changed the quality of life for the better.

MANDIBULAR HYBRID CGCG-COF: REPORT OF A RARE ENTITY

<h3>BACKGROUND</h3> The hybrid central giant cell granuloma/central odontogenic fibroma-like (hCGCG/COF) lesion was first described in 1992 and has been reported fewer than 50 times thereafter. Separately, central giant cell granulomas (CGCG) and central odontogenic fibromas (COF) account for approximately 5% and 10% of all benign jaw tumors, respectively. Published literature reveals that the clinical, radiologic, and histologic features of hCGCG/COF lesions share similar characteristics with both entities in varying degrees; however, the precise nature of the lesions remains unclear. <h3>CASE REPORT</h3> A 20-year-old female patient was referred to our clinic by the Head and Neck Oncology Department for comprehensive dental care. Her clinical history began when she presented with complaints of a slowly growing mass in the left posterior mandible with increased bleeding upon toothbrushing over a 3-month period. Clinical exam revealed an expansile mass spanning from the second premolar to the retromolar pad with obliteration of the gingivobuccal sulcus, lingual cortical expansion, and tooth mobility. Neurologic deficits were difficult to ascertain. Panoramic radiography and cone beam computed tomography revealed a unilateral, well-defined, multilocular, partially corticated radiolucent entity with multiple mixed internal radiopacities spanning from the retromolar pad to the second premolar and from the alveolar crest to the inferior border; expansion and thinning of lingual cortical plate; fractured inferior border of mandible; and displacement of the second molar. She was recommended for surgical intervention and subsequently underwent a left segmental mandibulectomy with fibular free flap reconstruction and modified neck dissection. Final pathology showed hybrid CGCG/COF-like lesion; the giant cell granuloma component predominated. The patient is currently functioning well with no mandibular resection prosthesis and is receiving comprehensive care in the Dental Oncology Department. <h3>DISCUSSION/CONCLUSIONS</h3> This case report highlights a rare benign hybrid odontogenic entity and the successful management of the pathology. The case report provides further evidence of successful surgical treatment of hCGCG/COF without recurrence.

Combined rehabilitation of a lower lip defect after resection of floor of mouth cancer: A clinical report

This clinical report describes the successful prosthetic rehabilitation of a deficient lower lip in an edentulous patient who had undergone surgery for removal of a squamous cell carcinoma of the anterior floor of the mouth and vestibule. The rehabilitation used a combined approach of an extraoral lip prosthesis joined by 3 magnets to an intraoral implant-retained mandibular resection prosthesis. The outcome demonstrated rehabilitation of the lower third of the face by eliminating loss of fluids and by improving the facial profile, lip contour and competence, esthetics, the patient’s eating ability, speech intelligibility, and reported quality of life.

Застосування еластичного матеріалу «Ufi Gel P» (VOCO) для корекції резекційного протеза у процесі ортопедичної реабілітації пацієнта з післяопераційним дефектом верхньої щелепи онкологічного генезу. Клінічний випадок

Summary. The prevalence of malignant neoplasms of the oral cavity occupies a significant place in the structure of oncological diseases while the cancer treatment is mainly complex and radical. Reconstructive surgery is most often associated with removable dentures. The patients after an upper jaw resections take a significant part of patients with postoperative defects. There is still no consensus between the specialists on prosthetics for patients after resection of the upper jaw of oncological origin. The literature shows a large number of problems, the main one is the lack of data on the long-term outcome of the prosthesis of these patients, the «temporality» of the prosthetic constructions and the poor prognosis. From this point of view, the use of high quality elastic materials is a successful for current problems resolution. The work describes the correction method of an upper jaw resection prosthesis by means of an elastic pad. The high-potency of the Ufi Gel P VOCO (Germany), A-silicone based material, was demonstrated for the clinical relining of resection prosthesis in distant future. We succeeded to achieve effective denture adhesion by correcting the peripheral flap along the transitory fold and the A-line with Ufi Gel P elastic material. The elastic correction of resection prosthesis allows to provide emergency help, makes the use of the prosthesis more comfortable, catalyzes the adaptation and has a positive impact on the social rehabilitation of cancer patients. Key words: elastic pad, upper jaw resection prosthesis, post-resection distant ptosthetics.

Management by Altering the Design of a Removable Mandibular Resection Prosthesis in a Patient after Marginal Mandibulectomy: A Case Report

Management by Altering the Design of a Removable Mandibular Resection Prosthesis in a Patient after Marginal Mandibulectomy: A Case Report

Methodological recommendations for improving the adaptability of patients with accessed defects of the maxillofacial region

Introduction. After the application of a removable prosthesis, adaptation is one of the most difficult periods for the patient. This period is especially pronounced in the absence of experience in using a removable prosthesis or in the presence of general somatic pathology in parallel. Acquired defects of the maxillofacial area require restoration of anatomical areas of significant volume, and the problem of adaptation to replacement constructions has become significant. The adaptive ability of the patient and oral stereognosy are closely related. Tongue muscles stimulate brain activity to improve the adaptability to removable structures. In this study, a set of special adaptive exercises was developed to increase the synthetic activity of the cerebral cortex and improve adaptability to removable prostheses. Materials and methods. The study involved patients aged 4475 years. All patients were divided into three groups: clinical control (30 people), group with acquired defects of the dentition of the maxilla (25 people), and group with acquired defects of the upper jaw after surgery (25 people). Patients in the clinical comparison group were scheduled for surgical treatment of the teeth and the imposition of immediate prostheses immediately after surgery. Immediate prostheses were made prior to surgery using a standard technique. Results. Patients of the main group with neoplasms of the maxillofacial region were planned to resect the maxilla and apply a resection prosthesis directly on the operating table. Manufacturing of resection shaping prostheses was carried out following the standard procedure. All patients underwent stereognostic testing, and the degree of the patients adaptive ability was determined. Depending on the assigned adaptive support, each group was divided into subgroups. Patients in the first subgroup were prescribed modernized functional training, and patients in the second subgroup received the main treatment without prescribing exercises. Conclusion. On the basis of the results of examination, treatment, and dynamic observation of groups of patients with acquired defects in the dentition, the adaptation support reduced the time of adaptation to new removable dentures. The results were confirmed by objective research through the stereognostic testing and subjective feelings of patients.

Interim Implant-Supported Resection Prosthesis Following Fibula Free Flap Reconstruction of the Arch with Immediate Implants: A Novel Approach for the Oncologic Patient.

Oral cancer treatment involving the maxilla and/or mandible often results in esthetic and functional deficits that can diminish the patient's quality of life. As a result, expeditious reconstruction of the defect and dental rehabilitation is desirable. Dental rehabilitation shortly after reconstruction with an osteocutaneous free flap and resection prosthesis is a persistent challenge for patients with oncologic defects where immediate dental rehabilitation is not a possibility. Additionally, conventional prosthesis fabrication techniques are impractical or impossible due to postoperative anatomical changes and limitations in clinical armamentarium. To address these limitations, a technique and a novel implant-supported prosthetic workflow for the oncologic patient were developed to provide interim dental rehabilitation for such clinical situations. This article describes the prosthesis fabrication technique, reports short-term outcomes, and evaluates patient-reported quality-of-life outcomes using the FACE-Q Head and Neck Cancer Module.

Are Daily Life Activities of Patients with Proximal Femoral Tumor Resection Prosthesis as Good as those of Patients Undergoing Total Hip Prosthesis for Non-Tumor Causes?

The Barthel Index of Activities of Daily Life (ADL) is a scale used to evaluate performance in daily life activities and investigate the reason and resulting relationships in a comprehensive, non-biased manner. The aim of this study was to compare the daily life activities of patients who underwent proximal femoral tumor resection prosthesis assessed by the Barthel Index with the activities of daily living of patients with a total hip prosthesis performed for non-tumor reasons. Twenty-eight patients were included in the study. Sixteen patients underwent hip prosthesis for reasons other than tumor (femur proximal avascular necrosis, coxarthrosis, etc.) and 12 underwent wide resection and femur proximal tumor resection prosthesis due to primary malignant bone tumor or metastasis in the proximal femur. The Barthel Index was used to evaluate their life quality at 3 months. A total of 28 patients (mean age 60.9±1.4 yrs, range 19.0-84.0, 17 female and 11 male patients) were included into the study. Mean ADL score was 84.5±20.6 (5-100.0). While only one patient was totally dependent in terms of daily life activities, 8 other patients were totally independent. When the patient groups were categorized by degree of dependency according to the ADL scores, it was found that dependency states of the two surgery groups were similar in distribution (p=0.212, p=0.703, and p=1.000 respectively). Functional recovering levels were good in the patients who underwent a surgery for proximal femoral tumor resection prosthesis; there was no significant difference when we compared the functional level after total hip prosthesis applied for non-tumor reasons.

Analysis of Difficulties and Complications Following Implantation of Modular Prostheses in Patients with Lower Limb Bone Tumours.

The implantation of a modular prosthesis is the most popular method of reconstruction of bone defects in oncological patients. Along with clear-cut benefits associated with this procedure, there is also an increased risk of complications. Common complications include deep infections, aseptic loosening and mechanical implant damage. This study assessed the risk of complications following the implantation of a resection prosthesis in patients with lower limb bone tumours and to evaluate difficulties encountered during the treatment. A total of 149 patients with lower limb tumours treated at the Department of Oncological Ortho-paedics in Brzozów had resection prostheses implanted in the years 2016 and 2017. We analysed this series and available literature reports with regard to complications of the procedure and those encountered during the treatment. The mean duration of the surgical procedure was 117±45 minutes. Intraoperative complications occurred in 18 cases. Gluteal muscle failure was seen in 34 (43%) of the 74 patients with proximal femoral tumours, and impaired knee extension was noted in 4 (67%) of the 6 patients following resection of the proximal tibia. There were two cases of dislocation following megaprosthetic reconstruction of the hip joint. Impaired wound healing was noted in 7 (5%) patients. Post-operative trophic lesions of the skin were seen in 2 (2%), and peripheral nerve damage in 2 (2%) patients (fibular nerve). Thromboembolic complications were noted in 3 (3%) patients. No aseptic complications, mechanical implant damage or deaths were recorded. 1. The most frequently encountered complication following the implantation of a modular prosthesis was muscle failure, which was associated with the extent of the procedure. 2. Aseptic loosening and mechanical implant damage were rare and occurred in the early postoperative period.

The Effectiveness of Tranexamic Acid in Patients With Proximal Femoral Tumor Resection Prosthesis.

Aim: The aim of this study is to evaluate the risk of thromboembolic events and amount of postoperative blood loss and transfusion in patients who received preoperative tranexamic acid (TXA) administration in proximal femoral resection and endoprosthesis of proximal femur malignant lesion.Methods: In this study, the data of 46 patients who underwent extensive resection and proximal femoral tumor prosthesis for proximal femoral bone malignancies were retrospectively reviewed. Patients were divided into two groups according to preoperative 15 mg/kg bolus intravenous administration of TXA. These patients were compared in terms of postoperative blood loss, postoperative bleeding, and transfusion requirements.Results: There were 46 patients (18 female, 28 male) with a mean age of 60.7±14.7 (19-89) years. Fifteen patients (32.6%) were treated with iv TXA. In the TXA group (46.7%), there was a statistically significant decrease in the need for transfusion compared to the patient group (93.5%) without TXA (p=0.001). Postoperative 24th hour, 48th hour,and total drainage blood loss values were found to be significantly lower in the TXA group (p=0.047, p=0.015, and p=0.019, respectively). There was no thromboembolic event observed.Conclusion: Because of proximal femoral malignancy, extensive tumor resection and preoperative bolus 15 mg/kg TXA administration in proximal femoral prosthesis surgery significantly decreased the amount of postoperative bleeding and transfusion requirement without increasing the risk of thromboembolic event.Level of Evidence: Level III - retrospective comparative study.

Orthopedic treatment of maxillary defects with the use of the residual resection prosthesis with pneumatic obturator

Due to the growth of oncological diseases of the maxillofacial region, there is an increasing need to improve methods of orthopedic treatment of post-resection defects of the upper jaw with modern designs of replacement prostheses. Improving the quality of orthopedic treatment by creating an improved upper jaw resection prosthesis and justifying its use. We studied the effectiveness of orthopedic treatment of post-resection defects of the upper jaw using the proposed replacement prosthesis with a pneumatic obturator. A special questionnaire was used to analyze the level of adaptation and maladaptation of patients. There was a significant decrease in complaints and adaptation time in the group of patients with a replacement prosthesis with a pneumatic obturator. The use of the proposed resection removable prosthesis helps to reduce the period of adaptation to the prosthesis, which indicates that it can be widely used in clinical practice.

Primary Leiomyosarcoma of the Mandible: Posttreatment Malocclusion Treated with an Overpartial Mandibular Resection Prosthesis.

Leiomyosarcoma is a rare malignant condition occurring in the maxillofacial region in which the mandible may be affected. Management of this tumor in the mandible may include segmental mandibulectomy, osteocutaneous fibula free-flap reconstruction, endosseous implants, and postoperative radiotherapy. Posttreatment malocclusion can be managed with an overpartial mandibular resection prosthesis. The purpose of this report is to describe the expeditious oral rehabilitation of an oncologic patient with posttreatment malocclusion, demonstrating the utility of an overpartial mandibular resection prosthesis.

Intraoral Rehabilitation After Marginal Mandibulectomy.

To report the feasibility of oral rehabilitation in patients who had undergone marginal mandibulectomy and to describe the factors that impact the selection of a mandibular resection prosthesis. A retrospective review of patients who had undergone marginal mandibulectomy over a 14-year period at a tertiary care cancer center was undertaken. Measurements of the vertical height and width of the mandible and the distance between the alveolar crest and mandibular canal were measured after marginal mandibulectomy. The feasibility and success of tooth-borne or implant-supported resection prostheses were measured. Following marginal mandibulectomy, the median heights between the alveolar crest and lower border of the mandible were 21.8 mm, 17.7 mm, and 14.3 mm in the anterior, premolar, and molar regions, respectively. However, the median distances between the alveolar crest and the mandibular canal in the premolar and molar regions were only 3.98 and 3.4 mm, respectively. These residual bone measurements are not satisfactory for implant-supported mandibular resection prostheses, which can be considered only in the anterior region of the mandible. Patients with marginal mandibulectomy in the premolar and molar regions can only be rehabilitated with removable dentures, provided they have remaining stable teeth to clasp and anchor the removable denture. Implant-supported resection prostheses after marginal mandibulectomy are feasible only in the anterior segment of the mandible and are not possible in the premolar and molar regions.

Surgical management of primary malignant proximal fibular tumors: Functional and clinical outcomes of 23 patients.

This study aims to evaluate the clinical characteristics and treatment outcomes of patients with primary malignant tumors located in the proximal fibula. This retrospective study included 23 patients (15 males, 8 females; mean age 22.1 years; range, 9 to 63 years) with primary malignant tumors located in the proximal fibula between May 2007 and May 2017. The anamnesis or medical history, physical examination, plain chest radiography, lung computed tomography, direct radiograph, and magnetic resonance imaging of the affected extremity and routine laboratory tests of all patients were evaluated. Of the patients, 11 were diagnosed with osteosarcoma (47.8%), nine with Ewing's sarcoma (39.1%), two with chondrosarcoma (8.7%), and one was diagnosed with synovial sarcoma (4.3%). Pain and palpable mass were the most common symptoms. Six patients had lung metastases at the time of diagnosis. Of the patients, eight were performed Malawer type 1 resection (34.8%), nine type 2 resection (39.1%), four above knee amputation (17.4%), and two proximal tibia tumor resection prosthesis (8.6%). Mean follow-up duration was 36 months (range, 12 to 119 months). Local recurrence developed in three patients. Mean Musculoskeletal Tumor Society (MSTS) score of all patients was 62. Surgical treatment of primary malignant tumors of the proximal fibula is problematic. In appropriate indications, Malawer type 1 resection should be the treatment of choice due to lower local recurrence rates and higher MSTS scores.

Oral rehabilitation for patients with marginal and segmental mandibulectomy: A retrospective review of 111 mandibular resection prostheses

Statement of problemTreatment and timing considerations for patients seeking oral rehabilitation after marginal or segmental mandibulectomy (with osseous reconstruction) are not well understood. PurposeThe purpose of this retrospective review study was to report the type and timing of oral rehabilitation for mandibular defects without discontinuity and to describe additional treatment considerations for rehabilitation. Material and methodsThe records were reviewed of all patients who received a mandibular resection prosthesis after marginal mandibulectomy, marginal mandibulectomy with fasciocutaneous free-flap reconstruction, and segmental mandibulectomy with fibula free-flap reconstruction between 2000 and 2017 in the tertiary cancer care institution. Patients not treated by the Dental Service in the institution were excluded. The specific type of rehabilitation was noted, as was the time interval between primary surgery and prosthesis delivery. ResultsDuring the study period, 111 consecutive patients were treated by the Memorial Sloan Kettering Cancer Center Dental Service for mandibular rehabilitation. Forty-three patients underwent marginal mandibulectomy, 9 patients underwent marginal mandibulectomy with fasciocutaneous free-flap reconstruction, and 59 patients underwent segmental mandibulectomy with fibula free-flap reconstruction. Most patients in all 3 groups received mandibular resection prostheses without the use of endosseous implants. Only 4 (8%) patients who had undergone marginal mandibulectomy underwent endosseous implant placement, all of which followed marginal mandibulectomy in anterior mandibular segments without free-flap reconstruction. Patients who underwent marginal mandibulectomy with fasciocutaneous free-flap reconstruction were only restored with removable mandibular resection prostheses, and none had endosseous implants. In patients who underwent segmental mandibulectomy, 13 (22%) were rehabilitated with endosseous implants. The majority in this cohort (>50%) received radiation therapy as part of their treatment. The median time to oral rehabilitation was 8 months after marginal mandibulectomy, 14 months after marginal mandibulectomy with fasciocutaneous free-flap reconstruction, and 12 months after segmental mandibulectomy with fibula free-flap reconstruction. ConclusionsTiming for oral rehabilitation may differ depending on the treatment modality followed for mandibular tumors in the patient with oral cancer. However, most patients in this cohort underwent rehabilitation with removable mandibular resection prostheses regardless of the timing of care. Endosseous implants were used infrequently, but research is needed to better understand their potential role and indication in the patient with oral cancer.