Custom fabrication for mandibular reconstruction

Rhabdomyosarcoma of the oral soft tissues

Between 1944 and 1984 16 patients with rhabdomyosarcoma of the oral soft tissues were treated at the M.D. Anderson Hospital and Tumor Institute. Before 1968 treatment consisted only of surgery. Chemotherapy and radiotherapy were used when surgery was impossible or in an effort to treat recurrent disease. After 1968 treatment design was multidisciplinary and included (excision) biopsy, followed by a combination of high-dose radiotherapy and multidrug chemotherapy. Of the six patients treated before 1968, five (83%) died of disease. In eight of the ten patients treated after 1968, follow-up was 4 years or more. Of these eight patients, seven (87.5%) are free of disease. The clinicopathologic aspects, treatment, complications of treatment, and survival figures are discussed.

Delayed mandibular reconstruction following removal of a mesenchymal chondrosarcoma. Report of a case

An unusual case of mesenchymal chondrosarcoma is presented. Initially seen when the patient was 8 years old, the lesion was repeatedly biopsied and curetted with a diagnosis of odontogenic fibroma. In 1971 a diagnosis of osteosarcoma of the chondroblastic type was made. At that time, the patient underwent a partial mandibulectomy with immediate graft. The patient did well until 1981, when a recurrence of the lesion was noted. The microscopic diagnosis at this time was mesenchymal chondrosarcoma. The treatment of this lesion as a staged procedure with initial resection of the mandible and placement of a silicone rubber mandibular prosthesis is discussed. The second stage of the procedure was definitive mandibular reconstruction, with an allogeneic mandible as a crib for autologous particulate cancellous bone from the iliac crest. Although the prognosis of mesenchymal chondrosarcoma is usually grave, this case is unusual because of its long history of multiple procedures performed prior to the definitive treatment of the lesion 14 years after its discovery. Two-year follow-up since the definitive mandibular reconstruction shows adequate range of motion, excellent healing, and no recurrence.

Custom fabricated silicone rubber implants for tissue augmentation--a review

Forty-five silicone rubber implants fabricated over a 13-year period for tissue augmentation in 44 patients were reviewed. All implants were custom-made with perforations using 382 RTV silicone elastomer. High rates of success and patient compatibility have been recorded.

Mandibular reconstruction and craniofacial fairing

A method of restoring bony contour defects in the craniofacial regions employing a combination graft of autogenous bone and an alloplastic mesh is presented. Osteoinduction occurs within the confines of the alloplastic mesh from the cancellous bone and the resultant new bone conforms to the outline imposed by the alloplastic device. The advantages of this method include those of alloplastic materials combined with those of bone grafting. There is immediate restoration of an aesthetic contour with adequate strength and sound fixation.

Current status of biomaterial's clinical applications in plastic and reconstructive surgery

The use of biomaterials as replacement parts is not new. The concept has fascinated physicians for thousands of years. Using gold plates to reconstruct defects in the skull over 3000 years ago constituted the early record in the literature of use of biomaterials in implantology. The recent advances in space age technology and in clinical biocompatibility has been a major contributing factor in introducing new materials for use as implantology polymers. However, the ideal implant is still not there, and whenever a major reconstruction is required consideration should be given first to the use of autogenous substitutes; when that is not available, then we should resort to inorganic substitutes.

Immediate temporary reconstruction of mandibular continuity defects in cancer patients

A technique is described in detail which will produce a predictable immediate temporary reconstruction of a mandibular continuity defect. The procedure is quick, inexpensive and reliable. A review of various methods of reconstruction is presented and compared with our technique. Complications are discussed. A review of our patients is presented.

Primary tumors of the mandible. A study of 49 cases

Forty-nine cases of primary tumors of the mandible have been reviewed. The anatomic location, pathologic features, sites of metastases, survival rates, and treatment methods were evaluated. Lesions studied included ameloblastoma, osteogenic sarcoma, reticulum cell sarcoma, fibrosarcoma, chondrosarcoma, myxosarcoma, epidermoid carcinoma, adenocarcinoma, and giant cell sarcoma. An in-depth discussion of primary osteogenic sarcoma of the mandible is presented. Because of upper cervical lymph node metastases in two cases of osteogenic sarcoma of the mandible, an upper neck dissection should be considered in the primary treatment. Also presented in this study are the first reported cases or primary myxosarcoma of the mandible and giant cell sarcoma of the mandible. Recent methods of treatment of ablative resection of the mandible followed by immediate or delayed repair are discussed. A revised technic for mandibular replacement which has met with success in six of seven cases is presented.

Prefabricated silicone subdermal mandibular implants: observations and problems related to their application

Success in the use of custom-fabricated Silastic implants in patients with facial contour defects led us to utilize this method in reconstructing mandibular defects. However, mandibular reconstruction with alloplastic material is quite difficult because of the presence of continous stress and motion in that region. The evolution in the use in the use of the mandibular implant from the commercially available one to the K-wire reinforced, prefabricated, silicone implant was largely dependent on the availability of silicone and the ultimate result obtained. In the past few years, about 30 subdermal implants were inserted. Some of those implants were placed immediately into patients undergoing resection for tumor. The implant was prefabricated prior to surgery from x-ray measurements of the anticipated segment to be resected; it was then used to reconstruct the defect prior to the final closure of the operative wound. Other implants were manufactured 6-18 months after resection for tumor or for deformity as a result of trauma. The implants were used to reconstruct the facial defects and to correct the funtional abnormality, such as drooling or deviation of the affected side by the unstable mandibular segment. Patients with severe congenital malformation have soft tissue deficiency in association with their bony malformation. Therefore, implants in such conditions were doomed to failure. Patient selection is the key to successful implantation.