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Technical modifications of double barrel vascularised fibula graft for mandibular reconstruction
508 Free Papers—Oral Presentations
O11.30 Technical modifications of double barrel vascularised fibula graft for mandibular reconstruction Y. Shen, J. Sun ∗ , J. Li, Y.Q. Weng, J. Shi Department of Oral and Maxillofacial Surgery, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Double barrel vascularised fibula graft for mandibular reconstruction is used to maintain the height of the neomandible. Although the results are favourable to most of the patients, it is not an easy task to perform mandibular reconstruction. The purpose of this paper is to describe some modifications to the original technique. The recommended modifications include taking minimal cuff of flexor hallucis longus muscle attached to posteromedial surface of fibula, vertical osteotomy and subperiosteal dissection without removing the segment at the folding region, making bony contact between two fibula struts fixed one another, using the partial double barrel vascularised fibula graft or condylar prosthesis for reconstruction of large mandibular defect, and choosing the side of lower limb and handling the skin paddle based on the site of the soft tissue defect and the direction of vascular pedicle. These modifications are helpful and easy to follow while performing mandibular reconstruction with double barrel vascularised fibula graft. Good aesthetic and functional results were achieved by using the modified techniques in most cases that we had done with our patients. doi:10.1016/j.ijom.2009.03.398
O11.31 Reconstruction of mandibular defect with three types of double barrel vascularised fibula graft J. Sun ∗ , Y. Shen, Y.Q. Weng, J. Li Department of Oral and Maxillofacial Surgery, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Background and Objectives: To improve the height deficiency resulting from the conventional straight fibula graft, three types of double barrel vascularised fibula graft (DBVFG) were used to reconstruct mandibular defect. Methods: Thirty patients underwent reconstruction of large segmental mandibular defects with DBVFG techniques. The reconstructed sites and heights of the fibular were designed on customised
models of the mandible which were made preoperatively by computer-aided design/computer-aided manufacturing (CAD/CAM) techniques in all patients. Three types of DBVFG included DBVFG in the mandibular body, partial DBVFG, and DBVFG combined with condylar prosthesis. DBVFG in the mandibular body (n = 12) or partial DBVFG (n = 10) were performed in different patients according to the location of defect. DBVFG combined with condylar prosthesis (n = 8) were used when the defect involved mandibular body, ramus and condylar process. Results: Vascularised fibula graft in all patients survived without complications in donor site of the lower extremities. The contours of face were satisfied and mouth opening ranged from 2.5 cm to 3.5 cm. The average height of reconstructed mandibles was lower than that of the normal sides by 0.47 cm, ranging from –0.3 cm to 1.5 cm. Occlusions were normal and speeches were comprehensible. Panoramic radiograph and the three-dimensional computed tomography scan revealed that the locations and heights of the fibular bones reach as the preoperative design. The condylar prostheses were located within the glenoid fossa. Conclusion: DBVFG might provide a relatively simple and effective technique for reconstructing large mandibular defects and maintaining the height of the mandible. We suggested that DBVFG be used for reconstruction of defects in mandibular body and mental regions where bear major mastication forces, and artificial prostheses be applied for reconstruction of ramus where bears no-mastication forces.
option for small to moderate sized defects of the oral and perioral regions. Considerable confusion does exist with regard to the pattern of its blood supply and is generally misconstrued as an axial pattern flap based on the facial artery. It has been used as a superiorly or inferiorly based flap making it a two-staged surgical procedure particularly when used for intraoral reconstruction. A variety of surgical modalities used in the past have not proved to be convincingly useful in the successful management of oral sub mucous fibrosis (OSMF). Although nasolabial flaps have been used, there is a paucity of literature with regard to their use in the management of OSMF. One hundred and seventy flaps were performed in 85 patients with bilateral sub mucous fibrosis based on a central subcutaneous pedicle over the last ten years and followed up for a mean period of 66 months. All the flaps healed without any evidence of necrosis, infection or dehiscence with an excellent aesthetic and functional outcome and significant patient satisfaction. The flaps remained viable in all the cases with good healing and adaptation to the recipient site. The sea gull nasolabial flap offers outstanding features, providing supple soft tissue lining and adequate flexibility to the cheek thus facilitating excellent mouth opening on a long term basis. The ease of harvest and negligible aesthetic morbidity makes it a viable option for use in bilateral OSMF. This paper deals with a novel modification of the flap for use in the management of sub mucous fibrosis as a single stage procedure. The anatomic basis of the flap, the factors governing the technique and the logistics of its use in OSMF are discussed.
doi:10.1016/j.ijom.2009.03.399
doi:10.1016/j.ijom.2009.03.400
O11.32 A unique melolabial flap in the surgical management of oral submucous fibrosis—“the sea gull flap”—an experience with 85 cases
O11.33 Free bone grafts for maxillofacial reconstruction. Indications, techniques, fixation
D.P. Tauro Department of Cranio-Maxillofacial, Plastic and Reconstructive Surgery, College of Dental Sciences and Hospital, SS Institute of Medical Sciences and Research Centre, Davangere, Karnataka, India
Melolabial tissues with various modifications have been extensively used for reconstructive purposes in the orofacial region. The nasolabial flap has been widely employed as a versatile reconstructive
C. Alexandridis ∗ , N. Papadogeorgakis Department of Oral and Maxillofacial Surgery, Evagelismos Hospital, University of Athens, Athens, Greece
The purpose of maxillofacial reconstruction after tumour resection is to re-establish form and function. There is a big variety of reconstructive techniques available worldwide. Good reconstructive results are achieved by different clinics with a variety of different surgical techniques. In order to achieve excellent results consistently it needs an interdisciplinary approach of philosophies and specialties. This requires
O11.30 Technical modifications of double barrel vascularised fibula graft for mandibular reconstruction Y. Shen, J. Sun ∗ , J. Li, Y.Q. Weng, J. Shi Department of Oral and Maxillofacial Surgery, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Double barrel vascularised fibula graft for mandibular reconstruction is used to maintain the height of the neomandible. Although the results are favourable to most of the patients, it is not an easy task to perform mandibular reconstruction. The purpose of this paper is to describe some modifications to the original technique. The recommended modifications include taking minimal cuff of flexor hallucis longus muscle attached to posteromedial surface of fibula, vertical osteotomy and subperiosteal dissection without removing the segment at the folding region, making bony contact between two fibula struts fixed one another, using the partial double barrel vascularised fibula graft or condylar prosthesis for reconstruction of large mandibular defect, and choosing the side of lower limb and handling the skin paddle based on the site of the soft tissue defect and the direction of vascular pedicle. These modifications are helpful and easy to follow while performing mandibular reconstruction with double barrel vascularised fibula graft. Good aesthetic and functional results were achieved by using the modified techniques in most cases that we had done with our patients. doi:10.1016/j.ijom.2009.03.398
O11.31 Reconstruction of mandibular defect with three types of double barrel vascularised fibula graft J. Sun ∗ , Y. Shen, Y.Q. Weng, J. Li Department of Oral and Maxillofacial Surgery, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Background and Objectives: To improve the height deficiency resulting from the conventional straight fibula graft, three types of double barrel vascularised fibula graft (DBVFG) were used to reconstruct mandibular defect. Methods: Thirty patients underwent reconstruction of large segmental mandibular defects with DBVFG techniques. The reconstructed sites and heights of the fibular were designed on customised
models of the mandible which were made preoperatively by computer-aided design/computer-aided manufacturing (CAD/CAM) techniques in all patients. Three types of DBVFG included DBVFG in the mandibular body, partial DBVFG, and DBVFG combined with condylar prosthesis. DBVFG in the mandibular body (n = 12) or partial DBVFG (n = 10) were performed in different patients according to the location of defect. DBVFG combined with condylar prosthesis (n = 8) were used when the defect involved mandibular body, ramus and condylar process. Results: Vascularised fibula graft in all patients survived without complications in donor site of the lower extremities. The contours of face were satisfied and mouth opening ranged from 2.5 cm to 3.5 cm. The average height of reconstructed mandibles was lower than that of the normal sides by 0.47 cm, ranging from –0.3 cm to 1.5 cm. Occlusions were normal and speeches were comprehensible. Panoramic radiograph and the three-dimensional computed tomography scan revealed that the locations and heights of the fibular bones reach as the preoperative design. The condylar prostheses were located within the glenoid fossa. Conclusion: DBVFG might provide a relatively simple and effective technique for reconstructing large mandibular defects and maintaining the height of the mandible. We suggested that DBVFG be used for reconstruction of defects in mandibular body and mental regions where bear major mastication forces, and artificial prostheses be applied for reconstruction of ramus where bears no-mastication forces.
option for small to moderate sized defects of the oral and perioral regions. Considerable confusion does exist with regard to the pattern of its blood supply and is generally misconstrued as an axial pattern flap based on the facial artery. It has been used as a superiorly or inferiorly based flap making it a two-staged surgical procedure particularly when used for intraoral reconstruction. A variety of surgical modalities used in the past have not proved to be convincingly useful in the successful management of oral sub mucous fibrosis (OSMF). Although nasolabial flaps have been used, there is a paucity of literature with regard to their use in the management of OSMF. One hundred and seventy flaps were performed in 85 patients with bilateral sub mucous fibrosis based on a central subcutaneous pedicle over the last ten years and followed up for a mean period of 66 months. All the flaps healed without any evidence of necrosis, infection or dehiscence with an excellent aesthetic and functional outcome and significant patient satisfaction. The flaps remained viable in all the cases with good healing and adaptation to the recipient site. The sea gull nasolabial flap offers outstanding features, providing supple soft tissue lining and adequate flexibility to the cheek thus facilitating excellent mouth opening on a long term basis. The ease of harvest and negligible aesthetic morbidity makes it a viable option for use in bilateral OSMF. This paper deals with a novel modification of the flap for use in the management of sub mucous fibrosis as a single stage procedure. The anatomic basis of the flap, the factors governing the technique and the logistics of its use in OSMF are discussed.
doi:10.1016/j.ijom.2009.03.399
doi:10.1016/j.ijom.2009.03.400
O11.32 A unique melolabial flap in the surgical management of oral submucous fibrosis—“the sea gull flap”—an experience with 85 cases
O11.33 Free bone grafts for maxillofacial reconstruction. Indications, techniques, fixation
D.P. Tauro Department of Cranio-Maxillofacial, Plastic and Reconstructive Surgery, College of Dental Sciences and Hospital, SS Institute of Medical Sciences and Research Centre, Davangere, Karnataka, India
Melolabial tissues with various modifications have been extensively used for reconstructive purposes in the orofacial region. The nasolabial flap has been widely employed as a versatile reconstructive
C. Alexandridis ∗ , N. Papadogeorgakis Department of Oral and Maxillofacial Surgery, Evagelismos Hospital, University of Athens, Athens, Greece
The purpose of maxillofacial reconstruction after tumour resection is to re-establish form and function. There is a big variety of reconstructive techniques available worldwide. Good reconstructive results are achieved by different clinics with a variety of different surgical techniques. In order to achieve excellent results consistently it needs an interdisciplinary approach of philosophies and specialties. This requires