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Kasper R, Scheurer M, Pietzka S, Sakkas A, Schramm A, Wilde F, Ebeling M. MRONJ of the Mandible—From Decortication to a Complex Jaw Reconstruction Using a CAD/CAM-Guided Bilateral Scapula Flap. Medicina (B Aires) 2023; 59:medicina59030535. [PMID: 36984535 PMCID: PMC10052135 DOI: 10.3390/medicina59030535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/26/2023] [Accepted: 03/03/2023] [Indexed: 03/12/2023] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) has been an integral part of the maxillofacial patient population for some time. The therapeutic concept ranges from conservative approaches over less extended decortications to major jaw resections, which can result in a considerable loss of quality of life. Based on three case reports, this paper presents the long-term history of patients with MRONJ of the mandible, whose disease ultimately resulted in partial or total mandibular resection and subsequent multisegmental reconstruction using a microvascular anastomosed bone flap. Furthermore, a suitable alternative for complex mandibular reconstruction is demonstrated when using a free fibula flap is not possible. The options are limited, particularly when multisegmental restoration of mandibular continuity is required. One case presents a mandible reconstruction using a CAD/CAM-guided bilateral scapular free flap (CAD/CAM = Computer-Aided Design and Manufacturing), which has not been described for this purpose before. Due to the complexity, computer-assisted surgery and patient-specific implants seem reasonable, which is why a special focus was applied to this topic.
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Affiliation(s)
- Robin Kasper
- Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Academic Hospital of the University of Ulm, 89081 Ulm, Germany
- Correspondence:
| | - Mario Scheurer
- Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Academic Hospital of the University of Ulm, 89081 Ulm, Germany
| | - Sebastian Pietzka
- Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Academic Hospital of the University of Ulm, 89081 Ulm, Germany
- Department of Oral and Maxillofacial Surgery, University Hospital Ulm, 89081 Ulm, Germany
| | - Andreas Sakkas
- Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Academic Hospital of the University of Ulm, 89081 Ulm, Germany
- Department of Oral and Maxillofacial Surgery, University Hospital Ulm, 89081 Ulm, Germany
| | - Alexander Schramm
- Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Academic Hospital of the University of Ulm, 89081 Ulm, Germany
- Department of Oral and Maxillofacial Surgery, University Hospital Ulm, 89081 Ulm, Germany
| | - Frank Wilde
- Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Academic Hospital of the University of Ulm, 89081 Ulm, Germany
- Department of Oral and Maxillofacial Surgery, University Hospital Ulm, 89081 Ulm, Germany
| | - Marcel Ebeling
- Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Academic Hospital of the University of Ulm, 89081 Ulm, Germany
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Taxis J, Nobis CP, Grau E, Kesting M, Moest T. Retrospective three-dimensional analysis of bone resorption volumes of free microvascular scapular and fibular grafts. Br J Oral Maxillofac Surg 2022; 60:1417-1423. [PMID: 36153162 DOI: 10.1016/j.bjoms.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/16/2022] [Accepted: 08/17/2022] [Indexed: 12/31/2022]
Abstract
Defects in head and neck regions are standardly treated with microvascular grafts, such as free scapular (SFF) and fibular flaps (FFF), which are subject to a certain amount of bone resorption over time. The aim of this study was the 3-dimensional evaluation of bone resorption volume in both grafts. Over a period of 10 years, computed tomograms (CT) of patients with mandibular reconstructions with SFFs and FFFs were examined. The respective grafts were segmented as well as 3-dimensionally measured. Furthermore, factors such as gender, age, nicotine abuse, previous disease with type 2 diabetes, and adjuvant therapies, were examined for their influence. A total of 211 CT scans from 67 patients (40 SFFs and 27 FFFs) were included in the study. SFFs showed slightly higher median bone volumes (87.60% at 730 days and 86.55% at 1500 days) than FFFs (84.40% at 730 days and 82.10% at 1500 days). When final volumes were considered, FFFs had higher mean volume values (88.22%) than SFFs (83.82%), with significant correlation between resorption volume and time progression (r = 0.357, p = 0.024). All previously mentioned factors had no significant effect on bone resorption. Bone volumes of FFFs showed postoperative volume reductions similar to those of SFFs, with isolated SFFs having markedly lower volume values. The choice of a microvascular graft for reconstruction in the mandible proves difficult regarding bone resorption. The presented results may support decisions about future transplantations.
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Affiliation(s)
- Juergen Taxis
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glueckstraße 11, 91054 Erlangen, Germany.
| | - Christopher-Philipp Nobis
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glueckstraße 11, 91054 Erlangen, Germany.
| | - Elisabeth Grau
- Department of Oral and Maxillofacial Surgery, Leipzig University Medical Center, Liebigstraße 12, 04103 Leipzig, Germany.
| | - Marco Kesting
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glueckstraße 11, 91054 Erlangen, Germany.
| | - Tobias Moest
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glueckstraße 11, 91054 Erlangen, Germany.
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Markov NM, Grachev NS, Babaskina NV, Demenchuk PA, Vorozhtsov NV, Dudaeva AA. [Dental rehabilitation in the complex treatment of children and adolescents with maxillofacial neoplasms]. STOMATOLOGII︠A︡ 2021; 99:44-62. [PMID: 33416233 DOI: 10.17116/stomat20209906244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
THE PURPOSE Of the study was to improve algorithms and methods of complex dental rehabilitation of children and adolescents with maxillofacial neoplasms. MATERIALS AND METHODS Sixty-seven patients aged from 2 to 17 years (average age 10.43±4.56; 30 boys, 37 girls) underwent complex rehabilitation as a part of neoplasm treatment (40 benign, 27 malignant). Patients were divided into 3 groups: group 1 aged 2 to 7 years; group 2 aged 8 to 12 years; group 3 aged 13 to 17 years. RESULTS Structural integrity of upper and lower jaws was reconstructed using vascularized bone flaps (27 cases), non-vascularized bone flaps (5 cases), titanium reconstructive plates (11 cases) or individual titanium endoprostheses of the temporomandibular joint (2 cases). Orthodontic, orthopedic and surgical dental treatment was performed at all stages of rehabilitation of patients and had its own characteristics depending on the group affiliation. CONCLUSION Algorithms for dental rehabilitation of children and adolescents with maxillofacial neoplasms have been improved on the base of performed treatment.
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Affiliation(s)
- N M Markov
- Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology of the Ministry of Healthcare of the Russian Federation, Moscow, Russia.,Central Research Institute of Dentistry and Maxillofacial Surgery of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - N S Grachev
- Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - N V Babaskina
- Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - P A Demenchuk
- Main Military Clinical Hospital named after Academician N.N. Burdenko of the Ministry of Defense of the Russian Federation, Moscow, Russia
| | - N V Vorozhtsov
- Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - A A Dudaeva
- Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
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Long-Term Effect of Honeycomb β-Tricalcium Phosphate on Zygomatic Bone Regeneration in Rats. MATERIALS 2020; 13:ma13235374. [PMID: 33256248 PMCID: PMC7731290 DOI: 10.3390/ma13235374] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 12/23/2022]
Abstract
In recent years, artificial bones with high biocompatibility have been developed for hard tissue reconstruction. However, current bone replacement methods are inadequate for large defects, causing infection, exposure, and damage. We have developed a new honeycomb β-tricalcium phosphate (TCP) material, which achieved good bone regeneration after implantation in a rat complete zygomatic bone defect. In this study, we further investigated the ability of honeycomb β- TCP for remodeling after bone regeneration as a long-term result. Bone morphogenic protein (BMP)-2-free honeycomb β-TCP (TCP group) and honeycomb β-TCP with BMP-2 (BMP group) were implanted in the zygomatic bone of rats. Micro-computed tomography was performed to track the zygomatic bone morphology, and specimens were histologically examined for osteogenesis and remodeling. In the TCP group, no bone formation was observed at 1 month, but it was observed at 6 months. Bone formation was observed in the BMP group at 1 month, and β-TCP absorption reproducing the zygomatic bone morphology was observed at 6 months. This honeycomb β-TCP with BMP-2 may provide appropriate remodeling that reproduces good bone formation in the early stage and good morphology in the long term, offering an alternative bone reconstruction material to vascularized bone grafts.
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Ou Q, Wu P, Zhou Z, Pan D, Tang JY. Complication of osteo reconstruction by utilizing free vascularized fibular bone graft. BMC Surg 2020; 20:216. [PMID: 33008361 PMCID: PMC7531124 DOI: 10.1186/s12893-020-00875-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/21/2020] [Indexed: 12/19/2022] Open
Abstract
The success of free vascularized fibular bone graft (FVFBG) has accelerated the osteo reconstruction which results from trauma, resection of a tumor or an infectious bone segment, or correction of congenital deformity. But the complication behind should not be overlooked. The failure could necessitate a second surgery, which prolong the rehabilitation period and produce further health cost. Worst, the patients may suffer a permanent impaired ankle function, or a sustained morpho-functional loss on reconstructive area which are hard to save. To provide an overview of the complication related to reconstruction by FVFBG, a narrative review is conducted to identify the complications including their types and rates, the contributing factors, the approaches to measure and the techniques to avoid. Methodologically, by quick research on Pubmed and abstract reading of reviews, we characterize five reconstructive areas where FVFBG were most frequently applied: extremities, mandible, spine, osteonecrosis of femoral head, and penile. Following, the complications on different reconstructive areas are retrieved, studied and presented in five (or more specifically, six) separate sections. By the way, meaningful difference between FVFBG and other bone flap was presented in a few words if necessary. Donor-site morbidities were studied and summarized as a whole. In these literatures, the evidences documented on limb and mandibular reconstruction have the fullest detail, followed by the spine and lastly the penile. In conclusion, FVFBG, though a mature technique, needs further deep and comprehensive study and maybe device-based assistance to achieve better reconstructive effect and minimize donor-site damage.
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Affiliation(s)
- Qifeng Ou
- Department of Orthopedics, Hand and Microsurgery, Xiangya Hospital, Central South University, No.87 XiangYa Road, Changsha, 410008, Hunan, China
| | - Panfeng Wu
- Department of Orthopedics, Hand and Microsurgery, Xiangya Hospital, Central South University, No.87 XiangYa Road, Changsha, 410008, Hunan, China
| | - Zhengbing Zhou
- Department of Orthopedics, Hand and Microsurgery, Xiangya Hospital, Central South University, No.87 XiangYa Road, Changsha, 410008, Hunan, China
| | - Ding Pan
- Department of Orthopedics, Hand and Microsurgery, Xiangya Hospital, Central South University, No.87 XiangYa Road, Changsha, 410008, Hunan, China
| | - Ju-Yu Tang
- Department of Orthopedics, Hand and Microsurgery, Xiangya Hospital, Central South University, No.87 XiangYa Road, Changsha, 410008, Hunan, China.
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Bulat S, Butsan S, Salikhov K, Abramian S, Arsenidze A. Free fibula flap for reconstruction of the severely atrophic mandible: a retrospective study. Int J Oral Maxillofac Surg 2020; 50:546-554. [PMID: 32893080 DOI: 10.1016/j.ijom.2020.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/06/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022]
Abstract
The purpose of this retrospective study was to assess the feasibility of using a free fibula flap (FFF) for reconstruction of the alveolar region of the severely atrophic mandible, by determining bone stability after dental implant insertion and prosthetic rehabilitation in a series of eight female patients aged 36-65 years. Dental implant insertion was performed 3-4 months after reconstruction. Prosthetic loading was performed 3-4 months after implant insertion. The height of the reconstructed mandible after surgery was 21.20±1.87mm, with an increase of 8.80±1.71mm from the preoperative height. The height of the FFF immediately after reconstruction was 11.24±1.10mm; this showed a vertical loss of 0.99±0.52mm (8.79%) and maintenance of 91.21% of the initial height at a mean 14 months post-reconstruction. Applying the Wical and Swoope formula to estimate the original mandibular body height, it was found that the difference between this calculated height (21.17±3.76mm) and the reconstructed height (21.20±1.87mm) was only 0.03±3.17mm (0.14%). An overall insignificant decrease of 0.46±1.14 cm3 in FFF volume had occurred at 3-4 months after dental implant functional loading, while in two cases an increase in volume was found (1.22cm3 and 1.71cm3). The good and stable results obtained show that the FFF may be used to reconstruct the whole mandibular alveolar region, with the best possible outcomes.
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Affiliation(s)
- S Bulat
- Department of Maxillofacial Surgery, Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia.
| | - S Butsan
- Department of Maxillofacial Surgery, Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - K Salikhov
- Department of Maxillofacial Surgery, Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - S Abramian
- Department of Prosthetic Dentistry and Implantology, Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - A Arsenidze
- Department of Prosthetic Dentistry and Implantology, Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
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Bone volume change following vascularized free bone flap reconstruction of the mandible. J Craniomaxillofac Surg 2020; 48:859-867. [DOI: 10.1016/j.jcms.2020.07.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 06/03/2020] [Accepted: 07/19/2020] [Indexed: 01/18/2023] Open
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Lee DH, Kim SR, Jang S, Ahn KM, Lee JH. Correction of malocclusion using sliding fibula osteotomy with sagittal split ramus osteotomy after mandible reconstruction. Maxillofac Plast Reconstr Surg 2020; 42:21. [PMID: 32607318 PMCID: PMC7311605 DOI: 10.1186/s40902-020-00266-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/17/2020] [Indexed: 11/16/2022] Open
Abstract
Background Fibula free flap mandible reconstruction is the standard procedure after wide resection of the mandible. Establishment and maintenance of normal occlusion are important in mandible reconstruction both intraoperatively and after surgery. However, scar formation on the surgical site can cause severe fibrosis and atrophy of soft tissue in the head and neck region. Case presentation Here, we report a case of severe soft tissue atrophy that appeared along with scar formation after mandibular reconstruction through the fibular free flap procedure. This led to normal occlusion collapse after it was established, and the midline of the mandible became severely deviated to the affected side that was replaced with the fibula free flap, leading to facial asymmetry. We corrected the malocclusion with a secondary operation: a sagittal split ramus osteotomy on the unaffected side and a sliding osteotomy on the previous fibula graft. After a healing time of 3 months, implants were placed on the fibula graft for additional occlusal stability. Conclusion We report satisfactory results from the correction of malocclusion after fibula reconstruction using sliding fibula osteotomy and sagittal split ramus osteotomy. The midline of the mandible returned to its original position and the degree of facial asymmetry was reduced. The implants reduced difficulties that the patient experienced with masticatory function.
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Affiliation(s)
- Dong-Hun Lee
- Department of Oral and Maxillofacial Surgery, Asan Medical Center, Seoul, Republic of Korea
| | - Seong Ryoung Kim
- Department of Oral and Maxillofacial Surgery, Asan Medical Center, Seoul, Republic of Korea
| | - Sam Jang
- Coreline Soft, Seoul, Republic of Korea
| | - Kang-Min Ahn
- Department of Oral and Maxillofacial Surgery, College of Medicine, Asan Medical Center, University of Ulsan, 88, Olympic-ro, Songpa-gu, Seoul, 05505 Republic of Korea
| | - Jee-Ho Lee
- Department of Oral and Maxillofacial Surgery, College of Medicine, Asan Medical Center, University of Ulsan, 88, Olympic-ro, Songpa-gu, Seoul, 05505 Republic of Korea
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An Anatomical Feasibility Study Using a Great Auricular Nerve Graft for Ipsilateral Inferior Alveolar Nerve Repair. J Craniofac Surg 2020; 30:2625-2627. [PMID: 31274821 DOI: 10.1097/scs.0000000000005739] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The great auricular nerve (GAN) has been used for trigeminal and facial nerve repair and the inferior alveolar nerve (IAN) are often sacrificed during segmental mandibulectomy. To our knowledge, only 1 case report has discussed IAN repair using GAN after segmental mandibulectomy. The goal of this study is to clarify the feasibility of using GAN for IAN repair. Eleven sides from 6 fresh frozen Caucasian cadavers were used for this study. The mean age at the time of death was 82.3 years. A submandibular skin incision was made 2 finger breadths below and parallel to the inferior border of the mandible. The GAN was identified and then the mental foramen was found via extraoral dissection. The buccal cortical bone was removed 5 mm posterior to the mental foramen to the wisdom tooth area. Next, the anteroposterior length of the window was measured. The diameter of the IAN at the first molar tooth area was measured. Finally, the GAN was cut with maximum available length to compare to the length of the window in the mandible. The anteroposterior length of the window and diameter of the IAN ranged from 23.1 to 31.2 mm and 1.2 to 2.1 mm, respectively. The length of the available GAN was longer than the ipsilateral bony window of the mandible on all sides. This study might encourage surgeons to consider a new way to treat patients who undergo segmental resection of the mandible with surgical neck dissection with injury to their IAN.
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