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O95. Mandibular reconstruction using vascularized scapular osteocutaneous flap
Abstracts / Oral Oncology 47 (2011) S28–S73
Primary bony reconstruction was performed in 23% of the cases, whereas secondary defect reconstruction was performed in 77% of the cases. Vascularized bone grafts were harvested in 20% of the patients; the majority of patients (80%) were reconstructed using nonvascularized autologous bone grafts. Only 34% of the reconstructed mandibles had further reconstruction with osseointegrated implants. Conclusion: The present retrospective investigation of a large patient cohort highlights the important role of bone grafting of mandibular defects of various etiologies. It further underlines the importance of non-vascularized autologeous bone grafts as the major type of bone graft. The relatively low rate of final implant insertion in particular in tumor patients needs further critical assessment. doi:10.1016/j.oraloncology.2011.06.205
O95. Mandibular reconstruction using vascularized scapular osteocutaneous flap H. Shimamoto *, H. Harada, K. Omura Tokyo Medical and Dental University, Japan Mandibular reconstruction is necessary to relieve the problem that mandibular discontinuity followed by segmental mandibulectomy or hemi-mandibulectomy causes the loss of mandibular contour and decrease of oral function. We usually use vascularized scapular osteocutaneous flap for mandibular reconstruction among variety of the methods reported, because the scapular osteocutaneous flap can be available to reconstruct volume of soft tissue defect and to replicate the appropriate contour of mandible. From April 2001 to December 2010, there were 87 patients whose age ranged from 17 to 74 years with mean 59.0. The reconstructions were performed in 88 mandibles. Diseases caused mandibular defect were malignant tumors in 62 patients, benign tumors in 20 patients and radiation osteonecrosis of the mandible in 5 patients. According to the HCl classification of Jewer, L is the most common defect (45.5%), which is followed by LC (35.2%). Osteotomy of the scapular bone was performed in 36 cases (40.9%) to replicate the contour of mandible. One osteotomy was done in 30 cases (34.1%), and two osteotomies in 6 cases (6.8%). The extent of soft tissue defect was classified as none, mucosa, skin or through-and-through. The most common defect of soft tissue is the mucosa (86.4%). Repositioning of mandibular segments using with ‘‘memory plate’’ and ‘‘bite plate’’ during the operation was mandatory to maintain the post-operative oral function. Total necrosis occurred in 2 cases (2.3%) and partial necrosis in 7 cases (8.0%). It is supposed that vascularized scapular osteocutaneous compound flap is one of the useful methods for mandibular reconstruction. doi:10.1016/j.oraloncology.2011.06.206
O96. Computer-aided stereolithography for presurgical planning in fibula free tissue reconstruction of the mandible S. Khariwala a, J. Sink a, K. Weimer b, D. Kademani * a a b
University of Minnesota, USA Medical Modelling, USA
Introduction: Recently, computer-aided imaging has facilitated pre-surgical modeling for mandibular reconstruction after ablative
S61
surgery. This is accomplished by taking computed tomography (CT) scans of the patient’s craniofacial skeleton and lower extremities and converting these images into three-dimensional (3D) representations. Direct 3D manipulation of the imaging studies can be performed to determine adequate tumor resection margins and allow creation of a custom sterolithographic model to fabricate precontoured reconstruction plates. The purpose of this study is to provide a detailed description and case presentation of the utility of preoperative virtual surgical planning in fibula free flap reconstruction of the mandible. Methods: We present a series of 9 consecutive patients treated at a single tertiary institution, requiring surgical resection and reconstruction for both benign and malignant disease of the mandible treated with presurgical planning. Results: Nine patients were treated consecutively between November 2009 and January 2011 at the University of Minnesota. Patients were aged between 17 and 72 yrs old (average 53). Our data consists of 6 cases of squamous cell carcinoma (SCC), 1 case of osteoradionecrosis (ORN), 1 Leiomyosarcoma and 1 odontogenic myxoma, all occurring in the mandible. All patients were managed with primary surgery treated by segmental resection of the mandible with surgical defects at least 5 cm in size. All surgical margins were tumor-free. In each case, pre-fabricated guides corresponding to the appropriate sites for segmental mandibulectomy and fibula osteotomy were employed. These guides allowed for precise cuts such that fibula inset and plating were essentially seamless with minimal adjustments. Conclusions: Virtual surgical planning fosters multidisciplinary communication and provides accurate presurgical planning, providing optimal reconstructive outcome in patients requiring mandibular reconstruction via fibula free tissue transfer. This combination along with surgical cut guides and templates allows for a precise and swift surgical reconstruction. This abstract will be highlighted with case presentation outlining a systematic approach to presurgical planning for mandibular reconstruction. doi:10.1016/j.oraloncology.2011.06.207
O97. The utility of the multi-island vertical rectus abdominis myocutaneous (VRAM) flap in head and neck reconstruction E. Matros *, N.P. Patel, P.G. Cordeiro Memorial Sloan Kettering Cancer Center, USA Background: Head and neck cancer extirpation frequently creates complex three-dimensional defects involving both intraoral and external tissues. Reconstruction of extensive composite defects can be accomplished either with use of two separate flaps or a single soft tissue folded flap with multiple skin islands. Herein the outcomes and rationale for reconstruction of multi-laminar head and neck defects using the VRAM flap are reported. Methods: A retrospective review was performed of all head and neck reconstructions completed by a single surgeon between 1992 and 2011. Forty-six patients were identified who underwent reconstruction of composite defects using VRAM flaps with more than one skin islands. Oncologic defects were classified into 3 categories based on location: mid-face, lower third of the face, and central neck. Indications and outcomes were reviewed. Results: Patient ages ranged from 7 to 84 years. Forty-five percent had pre-op radiation. Average VRAM skin paddle size was 9 25.5 cm. 96% of cases used two skin-islands. Fifty-nine percent (27/46) of reconstructions were performed in the mid-face for maxillectomy or composite cheek defects. Thirty percent (14/46) of cases
Primary bony reconstruction was performed in 23% of the cases, whereas secondary defect reconstruction was performed in 77% of the cases. Vascularized bone grafts were harvested in 20% of the patients; the majority of patients (80%) were reconstructed using nonvascularized autologous bone grafts. Only 34% of the reconstructed mandibles had further reconstruction with osseointegrated implants. Conclusion: The present retrospective investigation of a large patient cohort highlights the important role of bone grafting of mandibular defects of various etiologies. It further underlines the importance of non-vascularized autologeous bone grafts as the major type of bone graft. The relatively low rate of final implant insertion in particular in tumor patients needs further critical assessment. doi:10.1016/j.oraloncology.2011.06.205
O95. Mandibular reconstruction using vascularized scapular osteocutaneous flap H. Shimamoto *, H. Harada, K. Omura Tokyo Medical and Dental University, Japan Mandibular reconstruction is necessary to relieve the problem that mandibular discontinuity followed by segmental mandibulectomy or hemi-mandibulectomy causes the loss of mandibular contour and decrease of oral function. We usually use vascularized scapular osteocutaneous flap for mandibular reconstruction among variety of the methods reported, because the scapular osteocutaneous flap can be available to reconstruct volume of soft tissue defect and to replicate the appropriate contour of mandible. From April 2001 to December 2010, there were 87 patients whose age ranged from 17 to 74 years with mean 59.0. The reconstructions were performed in 88 mandibles. Diseases caused mandibular defect were malignant tumors in 62 patients, benign tumors in 20 patients and radiation osteonecrosis of the mandible in 5 patients. According to the HCl classification of Jewer, L is the most common defect (45.5%), which is followed by LC (35.2%). Osteotomy of the scapular bone was performed in 36 cases (40.9%) to replicate the contour of mandible. One osteotomy was done in 30 cases (34.1%), and two osteotomies in 6 cases (6.8%). The extent of soft tissue defect was classified as none, mucosa, skin or through-and-through. The most common defect of soft tissue is the mucosa (86.4%). Repositioning of mandibular segments using with ‘‘memory plate’’ and ‘‘bite plate’’ during the operation was mandatory to maintain the post-operative oral function. Total necrosis occurred in 2 cases (2.3%) and partial necrosis in 7 cases (8.0%). It is supposed that vascularized scapular osteocutaneous compound flap is one of the useful methods for mandibular reconstruction. doi:10.1016/j.oraloncology.2011.06.206
O96. Computer-aided stereolithography for presurgical planning in fibula free tissue reconstruction of the mandible S. Khariwala a, J. Sink a, K. Weimer b, D. Kademani * a a b
University of Minnesota, USA Medical Modelling, USA
Introduction: Recently, computer-aided imaging has facilitated pre-surgical modeling for mandibular reconstruction after ablative
S61
surgery. This is accomplished by taking computed tomography (CT) scans of the patient’s craniofacial skeleton and lower extremities and converting these images into three-dimensional (3D) representations. Direct 3D manipulation of the imaging studies can be performed to determine adequate tumor resection margins and allow creation of a custom sterolithographic model to fabricate precontoured reconstruction plates. The purpose of this study is to provide a detailed description and case presentation of the utility of preoperative virtual surgical planning in fibula free flap reconstruction of the mandible. Methods: We present a series of 9 consecutive patients treated at a single tertiary institution, requiring surgical resection and reconstruction for both benign and malignant disease of the mandible treated with presurgical planning. Results: Nine patients were treated consecutively between November 2009 and January 2011 at the University of Minnesota. Patients were aged between 17 and 72 yrs old (average 53). Our data consists of 6 cases of squamous cell carcinoma (SCC), 1 case of osteoradionecrosis (ORN), 1 Leiomyosarcoma and 1 odontogenic myxoma, all occurring in the mandible. All patients were managed with primary surgery treated by segmental resection of the mandible with surgical defects at least 5 cm in size. All surgical margins were tumor-free. In each case, pre-fabricated guides corresponding to the appropriate sites for segmental mandibulectomy and fibula osteotomy were employed. These guides allowed for precise cuts such that fibula inset and plating were essentially seamless with minimal adjustments. Conclusions: Virtual surgical planning fosters multidisciplinary communication and provides accurate presurgical planning, providing optimal reconstructive outcome in patients requiring mandibular reconstruction via fibula free tissue transfer. This combination along with surgical cut guides and templates allows for a precise and swift surgical reconstruction. This abstract will be highlighted with case presentation outlining a systematic approach to presurgical planning for mandibular reconstruction. doi:10.1016/j.oraloncology.2011.06.207
O97. The utility of the multi-island vertical rectus abdominis myocutaneous (VRAM) flap in head and neck reconstruction E. Matros *, N.P. Patel, P.G. Cordeiro Memorial Sloan Kettering Cancer Center, USA Background: Head and neck cancer extirpation frequently creates complex three-dimensional defects involving both intraoral and external tissues. Reconstruction of extensive composite defects can be accomplished either with use of two separate flaps or a single soft tissue folded flap with multiple skin islands. Herein the outcomes and rationale for reconstruction of multi-laminar head and neck defects using the VRAM flap are reported. Methods: A retrospective review was performed of all head and neck reconstructions completed by a single surgeon between 1992 and 2011. Forty-six patients were identified who underwent reconstruction of composite defects using VRAM flaps with more than one skin islands. Oncologic defects were classified into 3 categories based on location: mid-face, lower third of the face, and central neck. Indications and outcomes were reviewed. Results: Patient ages ranged from 7 to 84 years. Forty-five percent had pre-op radiation. Average VRAM skin paddle size was 9 25.5 cm. 96% of cases used two skin-islands. Fifty-nine percent (27/46) of reconstructions were performed in the mid-face for maxillectomy or composite cheek defects. Thirty percent (14/46) of cases