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O92. Mandible and maxilla reconstruction with free vascularised fibula osteocutaneous flap in pediatric age group
S60
Abstracts / Oral Oncology 47 (2011) S28–S73
Introduction: Implant supported dentures enhance the masticatory and speech function in edentulous patients. Prefabrication of the fibula in cases of secondary reconstruction allows the planning of implant insertion in the fibula before harvesting the fibula. Here the first case is described of a 3D digitally planned implant placement and immediate prosthetic reconstruction of a mandible with a free vascularised fibula in a two step surgical approach. Methods: A 54 year old male treated for oral squamous cell carcinoma developed osteoradionecrosis of the mandible. Reconstruction of the mandible with fibula bone was digitally planned from CT scans. The osteonecrosis of the mandible was virtually resected in the software. Next, the upper dentition and new lower prosthesis were digitally scanned and imported into the software in an anatomical correct position. Two pieces of the digitized fibula were virtually placed in the correct position in the mandible to support the lower dental prosthesis. Implants were digitally planned in the fibula bone for support of the prosthesis. Drilling guides were printed from the software to fit on the actual fibula. First operation: The drilling guide was used to insert the dental implants in the fibula bone while still in position in the lower leg. After the actual insertion in the fibula, the position of the dental implants was digitized and the further prosthetic planning was done from these data. The wound was closed and left for 5 weeks for osseointegration of the implants. After this a suprastructure and prosthesis were made and a cutting guide was digitally planned and printed. Second operation: the osteoradionecrosis was resected, fibula was harvested and osteotomies performed according to the cutting guide. The suprastructure with denture was fixed on the pre-inserted implants after which the fibula was placed in the mandible followed by the vascular anastomosis. Conclusion: It was possible to digitally plan backward from the desired occlusion of the dental prosthesis to the necessary implant position in the fibula. This new and exciting approach yields an optimal placement of the fibula bone in the jaw and immediate loading of the implant supported denture inserted in fibula bone.
093. Anteromedial thigh perforator flap: Review of 40 cases F.-M. Riva *, S.-F. Jeng Chang Gung Memorial Hospital, Dept. of Plastic and Reconstructive Surgery, Taiwan, ROC Background: anterolateral thigh flap proved to be a workhorse for head and neck reconstruction, but an alternative is needed as a rescue for failure or as a second line for cases where ALT has already been harvested previously. Anteromedial thigh could be an effective and reliable perforator flap with a low donor site morbidity. Methods: From 2007 to 2010, 40 anteromedial thigh free flaps in 39 patients were evaluated for head and neck reconstruction after oral cancer resection. Further, 20 of them were evaluated for donor site morbidity. A questionnaire was developed to assess qualitative aspects of morbidity and function while bilateral isokinetic testing of lower extremities was performed to obtain quantitative data. Results: Forty AMT were harvested in 39 patients: in every case a sizable perforator was found and the flap was harvested as planned, the mean pedicle length was 8 cm, 29 of them (72,5%) were true myocutaneous perforators. We had 2 failure that means 95% of total success. The qualitative and quantitative donor site evaluation showed good satisfaction of the patients, good function and good recover of normal activity. Conclusion: The anteromedial thigh flap is a very good and reliable option for head and neck reconstruction when the anterolateral thigh has already been used or in case of intraoperative failure or no sizable perforator. Specifically in this situation AMT can provide a good and reliable alternative without increasing the number of donor sites. Subjective and objective AMT donor site evaluation showed both low morbidity. doi:10.1016/j.oraloncology.2011.06.204
doi:10.1016/j.oraloncology.2011.06.202 O92. Mandible and maxilla reconstruction with free vascularised fibula osteocutaneous flap in pediatric age group S. Selva Seetha Raman *, S. Praba Yadav, S. Vinay Kant, J. Dushyant, S. Nitin, N.S. Bheem
O94. Reconstruction of mandibular defects – A clinical retrospective review over a 25-year period M. Rana *, R. Zimmerer, N.-C. Gellrich, A. Eckardt Oral and Maxillofacial Surgery Hannover Medical School, Germany
Tata Memorial Hospital, Mumbai, India Introduction: Free vascularised fibula is the bone flap of choice for large faciomaxillary bone defects. Though routinely done in adults, not many studies have been done in pediatric age group. Hence we analyzed the free fibula flap done in pediatric patients for post oncological maxillary and mandible bone defects. Methods: In the past 4 years we have done 10 free fibulas in 9 pediatric patients. The maximum follow up period is 4 years. There were 3 maxilla defects and 5 mandible defects. One patient had a recurrence on the other side and a second free fibula was done from the other leg. We had 2 flap losses. Results: There was no major contour deformity of the face. The donor site settled well in all the cases. Discussion: Hence in pediatric age group, free fibula should be considered as the treatment of choice for post oncological bone defects, considering the growth of the graft, resistant to radiotherapy and the relatively no donor morbidity. doi:10.1016/j.oraloncology.2011.06.203
Introduction: Reconstruction of trauma- or mandibular oncologic defects with bony free flaps seems to be considered the gold standard, but the optimal reconstruction of mandibular defects concerning reconstructive options as far as donor site selection, timing of surgery is still controversial. Material and methods: The purpose of this study was to evaluate all reconstructions of mandibular defects of various etiologies being performed at a single institution in a 25-year period. Consecutive patients who underwent reconstruction of mandibular defects following mandibulectomy between 1984 and 2009 were identified. Patient data were obtained from a maintained clinical database. Medical records were reviewed to investigate about etiology of the defect, defect size, donor site, timing of reconstruction, complications of bone grafting, implant insertion into bone grafts, and full prosthodontic restoration. Results: The patient cohort consists of 354 patients (248 males, 106 females). Mandibular reconstruction was required due to the following diagnoses: 74% malignant tumors, 17% benign tumors, 5% osteomyelitis, and 4% trauma. The preferred donor site was the iliac crest (85%) followed by fibula (9%), scapula (5%), and rib (1%).
Abstracts / Oral Oncology 47 (2011) S28–S73
Introduction: Implant supported dentures enhance the masticatory and speech function in edentulous patients. Prefabrication of the fibula in cases of secondary reconstruction allows the planning of implant insertion in the fibula before harvesting the fibula. Here the first case is described of a 3D digitally planned implant placement and immediate prosthetic reconstruction of a mandible with a free vascularised fibula in a two step surgical approach. Methods: A 54 year old male treated for oral squamous cell carcinoma developed osteoradionecrosis of the mandible. Reconstruction of the mandible with fibula bone was digitally planned from CT scans. The osteonecrosis of the mandible was virtually resected in the software. Next, the upper dentition and new lower prosthesis were digitally scanned and imported into the software in an anatomical correct position. Two pieces of the digitized fibula were virtually placed in the correct position in the mandible to support the lower dental prosthesis. Implants were digitally planned in the fibula bone for support of the prosthesis. Drilling guides were printed from the software to fit on the actual fibula. First operation: The drilling guide was used to insert the dental implants in the fibula bone while still in position in the lower leg. After the actual insertion in the fibula, the position of the dental implants was digitized and the further prosthetic planning was done from these data. The wound was closed and left for 5 weeks for osseointegration of the implants. After this a suprastructure and prosthesis were made and a cutting guide was digitally planned and printed. Second operation: the osteoradionecrosis was resected, fibula was harvested and osteotomies performed according to the cutting guide. The suprastructure with denture was fixed on the pre-inserted implants after which the fibula was placed in the mandible followed by the vascular anastomosis. Conclusion: It was possible to digitally plan backward from the desired occlusion of the dental prosthesis to the necessary implant position in the fibula. This new and exciting approach yields an optimal placement of the fibula bone in the jaw and immediate loading of the implant supported denture inserted in fibula bone.
093. Anteromedial thigh perforator flap: Review of 40 cases F.-M. Riva *, S.-F. Jeng Chang Gung Memorial Hospital, Dept. of Plastic and Reconstructive Surgery, Taiwan, ROC Background: anterolateral thigh flap proved to be a workhorse for head and neck reconstruction, but an alternative is needed as a rescue for failure or as a second line for cases where ALT has already been harvested previously. Anteromedial thigh could be an effective and reliable perforator flap with a low donor site morbidity. Methods: From 2007 to 2010, 40 anteromedial thigh free flaps in 39 patients were evaluated for head and neck reconstruction after oral cancer resection. Further, 20 of them were evaluated for donor site morbidity. A questionnaire was developed to assess qualitative aspects of morbidity and function while bilateral isokinetic testing of lower extremities was performed to obtain quantitative data. Results: Forty AMT were harvested in 39 patients: in every case a sizable perforator was found and the flap was harvested as planned, the mean pedicle length was 8 cm, 29 of them (72,5%) were true myocutaneous perforators. We had 2 failure that means 95% of total success. The qualitative and quantitative donor site evaluation showed good satisfaction of the patients, good function and good recover of normal activity. Conclusion: The anteromedial thigh flap is a very good and reliable option for head and neck reconstruction when the anterolateral thigh has already been used or in case of intraoperative failure or no sizable perforator. Specifically in this situation AMT can provide a good and reliable alternative without increasing the number of donor sites. Subjective and objective AMT donor site evaluation showed both low morbidity. doi:10.1016/j.oraloncology.2011.06.204
doi:10.1016/j.oraloncology.2011.06.202 O92. Mandible and maxilla reconstruction with free vascularised fibula osteocutaneous flap in pediatric age group S. Selva Seetha Raman *, S. Praba Yadav, S. Vinay Kant, J. Dushyant, S. Nitin, N.S. Bheem
O94. Reconstruction of mandibular defects – A clinical retrospective review over a 25-year period M. Rana *, R. Zimmerer, N.-C. Gellrich, A. Eckardt Oral and Maxillofacial Surgery Hannover Medical School, Germany
Tata Memorial Hospital, Mumbai, India Introduction: Free vascularised fibula is the bone flap of choice for large faciomaxillary bone defects. Though routinely done in adults, not many studies have been done in pediatric age group. Hence we analyzed the free fibula flap done in pediatric patients for post oncological maxillary and mandible bone defects. Methods: In the past 4 years we have done 10 free fibulas in 9 pediatric patients. The maximum follow up period is 4 years. There were 3 maxilla defects and 5 mandible defects. One patient had a recurrence on the other side and a second free fibula was done from the other leg. We had 2 flap losses. Results: There was no major contour deformity of the face. The donor site settled well in all the cases. Discussion: Hence in pediatric age group, free fibula should be considered as the treatment of choice for post oncological bone defects, considering the growth of the graft, resistant to radiotherapy and the relatively no donor morbidity. doi:10.1016/j.oraloncology.2011.06.203
Introduction: Reconstruction of trauma- or mandibular oncologic defects with bony free flaps seems to be considered the gold standard, but the optimal reconstruction of mandibular defects concerning reconstructive options as far as donor site selection, timing of surgery is still controversial. Material and methods: The purpose of this study was to evaluate all reconstructions of mandibular defects of various etiologies being performed at a single institution in a 25-year period. Consecutive patients who underwent reconstruction of mandibular defects following mandibulectomy between 1984 and 2009 were identified. Patient data were obtained from a maintained clinical database. Medical records were reviewed to investigate about etiology of the defect, defect size, donor site, timing of reconstruction, complications of bone grafting, implant insertion into bone grafts, and full prosthodontic restoration. Results: The patient cohort consists of 354 patients (248 males, 106 females). Mandibular reconstruction was required due to the following diagnoses: 74% malignant tumors, 17% benign tumors, 5% osteomyelitis, and 4% trauma. The preferred donor site was the iliac crest (85%) followed by fibula (9%), scapula (5%), and rib (1%).