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Two cases of oromandibular reconstruction after the resection of mandibular ameloblastoma using autoclave autogenous bone
Abstracts early intervention would be the important to diminish complication incidences. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.325
63 Vascularized free fibular flap for immediate mandibular reconstruction following ressection of benign odontogenic tumors: a case series P.H. Luiz de Freitas 1,∗ , M.H. Melo da Costa 2 , B.J. dos Santos Júnior 1 , N. de Souza Vitorino 1 , R. da Costa Ribeiro 1 , N. Provenzano 1 , E.M. Ferreira de Oliveira 1 1 Oral and Maxillofacial Surgery and Traumatology, Dr. Mário Gatti City Hospital, Brazil 2 Private Practice, Campinas, Brazil
Introduction: Reconstructive surgery in the maxillofacial complex has experienced a great progress especially due to the introduction and refinement of procedures involving microvascularized tissue transfer to address reconstruction of primary bone defects. Microvascularized flaps maintain a vascular supply and have been demonstrated to result in fewer postoperative complications when compared to nonvascularized grafts. Agressive treatment of odontogenic tumors often wind up creating complex mandibular defects that severely impact the patient’s quality of life. The free fibular flap is a versatile and reliable option for microsurgical reconstruction of large mandibular defects, as it provides an adequate quantity of bone that can be shaped for adaptation to the remaining mandible. Also, its height allows for posterior rehabilitation with implant-based prostheses. Case report: In this work, we present our experience with immediate mandibular reconstruction with the vascularized free fibular flap following ressection of benign odontogenic tumors (3 patients, 2 with diagnosis of ameloblastoma and 1 with diagnosis of mixoma). In two of these cases, discopexy was performed concomitantly with the grafting procedure in an attempt to maintain temporomandibular joint function on the affected side. Surgical planning, perioperative management and complications are discussed with the pertinent literature background. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.326
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64 Two cases of oromandibular reconstruction after the resection of mandibular ameloblastoma using autoclave autogenous bone
65 Oral reconstruction using free fibular flap and do after surgical excision of malignant tumor in mandible
T. Kutsuna ∗ , H. Watanabe, C. Mochida, D. Soga, Y. Yoshihama, S. Kondo, T. Shirota, S. Shintani Oral and Maxillofacial Surgery, Showa University of School of Dentistry, Ota-ku, Japan
C. Oh ∗ , K. Chung, J. Hur, S. Jang, S. Jung, M.-S. Kook, H. Park, H.-K. Oh, S.-Y. Ryu Department of Oral & Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 2nd Stage of Brain Korea 21, Chonnam National University Hospital, Gwangju, Republic of Korea
Purpose: Many approaches have been used for the reconstruction of mandible after resection of head and neck tumor. Vascularized or non vascularized bone grafts, titanium meshes with iliac particulate cancellous bone and marrow have been used to reconstruct the mandible as a major technique because of its high success rate. However, reconstruction of these techniques had a problem with a shape identical to the resected mandible. We experienced 2 cases of mandibular reconstruction which was performed using a regrafted bone reconstruction technique. Patients and methods: Two male patients aged 70 and 76 years were treated for recurrent ameloblastomas. Cortical bone tray was obtained after removing tumor and was heat-treated in an autoclave for 30 min to cause tumor cell death. The heat-treated bone was returned to its original place with a titanium plate. Iliac particulate cancellous bone and marrow (PCBM) was grafted into the lumen of the cortical bone tray. Results: In our 2 patients, 2 years after surgery, the reconstructed mandible was perfectly taken, and no postoperative complications occurred. Conclusion: This technique was able to completely reconstruct a threedimensional mandibular form and resort the normal shape of the mandible. Heattreated oromandibular reconstruction is a useful technique that minimizes orofacial deformities. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.327
Successful reconstruction of defective jaw after cancer surgery for cancer patients must be a formidable challenge for a oral and maxillofacial surgeon. Previous treatment for mandibular cancer mainly focused on a wide surgical excision followed by reconstruction using free flap without functional and facial appearance recovery. Recently, however, as oral cancers occur not only in older people but also occur in young people from age of 20–30, reconstruction surgery to rebuild surgically removed mandible to previous condition has become very important. Particularly, as dental implant has become popular, increased number of prosthodontic treatment via dental implant are provided to mandibular cancer patients. However, insufficient height and width of removed mandibles cause many problems in functional recovery by prosthesis with or after implant installation. Therefore in order to recover the height and width of the mandible, several bone grafts such as iliac graft were performed, but due to the limitation of bone mass sampling, we could not obtain the desired results. On the contrary, DO recovered the height and width of the mandible similar to the previous appearance, and it satisfied the conditions for implant installation. In our cases, oral reconstruction using free fibular flap reconstruction and DO after surgical excision of mandibular cancer showed a promising result. Especially, prosthetic treatment by PFM after implant installation has recovered previous appearance and function of patients, and patients’ satisfaction was improved. Therefore, we would like to report the case, and speculate on the surgical methods and their results. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.328
63 Vascularized free fibular flap for immediate mandibular reconstruction following ressection of benign odontogenic tumors: a case series P.H. Luiz de Freitas 1,∗ , M.H. Melo da Costa 2 , B.J. dos Santos Júnior 1 , N. de Souza Vitorino 1 , R. da Costa Ribeiro 1 , N. Provenzano 1 , E.M. Ferreira de Oliveira 1 1 Oral and Maxillofacial Surgery and Traumatology, Dr. Mário Gatti City Hospital, Brazil 2 Private Practice, Campinas, Brazil
Introduction: Reconstructive surgery in the maxillofacial complex has experienced a great progress especially due to the introduction and refinement of procedures involving microvascularized tissue transfer to address reconstruction of primary bone defects. Microvascularized flaps maintain a vascular supply and have been demonstrated to result in fewer postoperative complications when compared to nonvascularized grafts. Agressive treatment of odontogenic tumors often wind up creating complex mandibular defects that severely impact the patient’s quality of life. The free fibular flap is a versatile and reliable option for microsurgical reconstruction of large mandibular defects, as it provides an adequate quantity of bone that can be shaped for adaptation to the remaining mandible. Also, its height allows for posterior rehabilitation with implant-based prostheses. Case report: In this work, we present our experience with immediate mandibular reconstruction with the vascularized free fibular flap following ressection of benign odontogenic tumors (3 patients, 2 with diagnosis of ameloblastoma and 1 with diagnosis of mixoma). In two of these cases, discopexy was performed concomitantly with the grafting procedure in an attempt to maintain temporomandibular joint function on the affected side. Surgical planning, perioperative management and complications are discussed with the pertinent literature background. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.326
1123
64 Two cases of oromandibular reconstruction after the resection of mandibular ameloblastoma using autoclave autogenous bone
65 Oral reconstruction using free fibular flap and do after surgical excision of malignant tumor in mandible
T. Kutsuna ∗ , H. Watanabe, C. Mochida, D. Soga, Y. Yoshihama, S. Kondo, T. Shirota, S. Shintani Oral and Maxillofacial Surgery, Showa University of School of Dentistry, Ota-ku, Japan
C. Oh ∗ , K. Chung, J. Hur, S. Jang, S. Jung, M.-S. Kook, H. Park, H.-K. Oh, S.-Y. Ryu Department of Oral & Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 2nd Stage of Brain Korea 21, Chonnam National University Hospital, Gwangju, Republic of Korea
Purpose: Many approaches have been used for the reconstruction of mandible after resection of head and neck tumor. Vascularized or non vascularized bone grafts, titanium meshes with iliac particulate cancellous bone and marrow have been used to reconstruct the mandible as a major technique because of its high success rate. However, reconstruction of these techniques had a problem with a shape identical to the resected mandible. We experienced 2 cases of mandibular reconstruction which was performed using a regrafted bone reconstruction technique. Patients and methods: Two male patients aged 70 and 76 years were treated for recurrent ameloblastomas. Cortical bone tray was obtained after removing tumor and was heat-treated in an autoclave for 30 min to cause tumor cell death. The heat-treated bone was returned to its original place with a titanium plate. Iliac particulate cancellous bone and marrow (PCBM) was grafted into the lumen of the cortical bone tray. Results: In our 2 patients, 2 years after surgery, the reconstructed mandible was perfectly taken, and no postoperative complications occurred. Conclusion: This technique was able to completely reconstruct a threedimensional mandibular form and resort the normal shape of the mandible. Heattreated oromandibular reconstruction is a useful technique that minimizes orofacial deformities. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.327
Successful reconstruction of defective jaw after cancer surgery for cancer patients must be a formidable challenge for a oral and maxillofacial surgeon. Previous treatment for mandibular cancer mainly focused on a wide surgical excision followed by reconstruction using free flap without functional and facial appearance recovery. Recently, however, as oral cancers occur not only in older people but also occur in young people from age of 20–30, reconstruction surgery to rebuild surgically removed mandible to previous condition has become very important. Particularly, as dental implant has become popular, increased number of prosthodontic treatment via dental implant are provided to mandibular cancer patients. However, insufficient height and width of removed mandibles cause many problems in functional recovery by prosthesis with or after implant installation. Therefore in order to recover the height and width of the mandible, several bone grafts such as iliac graft were performed, but due to the limitation of bone mass sampling, we could not obtain the desired results. On the contrary, DO recovered the height and width of the mandible similar to the previous appearance, and it satisfied the conditions for implant installation. In our cases, oral reconstruction using free fibular flap reconstruction and DO after surgical excision of mandibular cancer showed a promising result. Especially, prosthetic treatment by PFM after implant installation has recovered previous appearance and function of patients, and patients’ satisfaction was improved. Therefore, we would like to report the case, and speculate on the surgical methods and their results. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.328