Mandibular Reconstruction using Simulation Surgery after Segmental Mandibulectomy

The fibular free flap is the gold standard for mandibular reconstruction. Accurate 3-dimensional contouring and precise alignment of the fibula is critical for reestablishing native occlusion and facial symmetry. Following segmental mandibulectomy, the remaining mandibular fragments become freely mobile. Various stabilization methods including external fixation, intermaxillary fixation, and preplating with reconstruction plate have been used. We describe a modification to the preplating technique. After wide resection of buccal squamous cell carcinoma, our patient had an 11-cm mandibular defect from the angle of the left mandible to the right midparasymphyseal region. A single 2.0-mm Unilock® (Synthes, Singapore) plate was used to span the defect. This was placed on the vestibular aspect of the superior border of the mandibular remnants before resection. Segmental mandibulectomy was then performed with the plate removed. The spanning plate was then reattached to provide rigid fixation. The fibular bone was contoured with a single osteotomy and reattached. The conventional technique involves molding of the plate at the inferior border of the mandible. This is time-consuming and not possible in patients with distorted mandibular contour. It is also difficult to fit the osteotomized fibula to the contoured plate. In comparison, the superiorly positioned spanning plate achieve rigid fixation of the mandible while leaving the defect completely free and unhampered by hardware, allowing space for planning osteotomies and easier fixation of the neomandible. Using this modified technique, we are able to recreate the original mandibular profile with ease.

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Seven-year follow-up of spontaneous bone regeneration following segmental mandibulectomy: Alternative option for mandibular reconstruction

Dental Research Journal ◽

10.4103/1735-3327.270780 ◽

2019 ◽

Vol 16 (6) ◽

pp. 435

Author(s):

AmirHossein Bani Shah Abadi ◽

AliHossein Mesgarzadeh ◽

Forooz Keshani

Keyword(s):

Bone Regeneration ◽

Mandibular Reconstruction ◽

Alternative Option ◽

Segmental Mandibulectomy

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Fibula Free Flap for Mandibular Reconstruction using Simulation Surgery in Bisphosphonate related Osteonecrosis of the Jaw

Journal of International Society for Simulation Surgery ◽

10.18204/jissis.2015.2.1.001 ◽

2015 ◽

Vol 2 (1) ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Hong-Joon Kim ◽

Jong-Hyun Hwang ◽

Kang-Min Ahn

Keyword(s):

Free Flap ◽

Osteonecrosis Of The Jaw ◽

Mandibular Reconstruction ◽

Fibula Free Flap ◽

Simulation Surgery

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Evaluation of Effective Condyle Positioning Assisted by 3D Surgical Guide in Mandibular Reconstruction Using Osteocutaneous Free Flap

Materials ◽

10.3390/ma13102333 ◽

2020 ◽

Vol 13 (10) ◽

pp. 2333

Author(s):

Seong Ryoung Kim ◽

Sam Jang ◽

Kang-Min Ahn ◽

Jee-Ho Lee

Keyword(s):

Computed Tomography ◽

Free Flap ◽

Mandibular Reconstruction ◽

Surgical Guide ◽

Significant Movement ◽

Flap Fixation ◽

Simulation Surgery ◽

3D Printed ◽

Fibular Free Flap ◽

Postoperative Observation

In the present study, the reproducibility and postoperative stability of a 3D printed surgical guide were evaluated in mandibular reconstruction with an osteocutaneous free flap (OCFF), including a fibular free flap (FFF) and deep circumflex iliac artery free flap (DCIA). Fifteen patients were enrolled, and a 3D surgical guide was fabricated by simulation surgery using preoperative (T0) Computed tomography (CT) images. Mandibular reconstruction was performed with OCFF using the 3D surgical guide. Postoperative CTs were taken immediately, 1 week (T1), and 6 months (T2) after surgery, to evaluate the reproducibility of the 3D surgical guide and condyle stability. Error of the 3D surgical guide ranged from 0.85 to 2.56 mm. There were no differences in reproducibility according to flap type. Condylar error and error at mandible midpoint were significantly different in FFF. However, there was no difference in DCIA error between the condyle and mandible midpoint. Regarding condyle stability 6 months after surgery, condyles moved more than 2 mm (up to 2.85 mm) in FFF, whereas there were no significant movement in DCIA. Careful intraoperative flap fixation and closed postoperative observation should be considered for stable clinical outcome, especially in the case of FFF.

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Transoral Segmental Mandibulectomy and Intraoral Anastomosis for Mandibular Reconstruction Guided by Virtual Surgical Planning and Intraoperative Navigation

Practical Microsurgery Cases ◽

10.1007/978-981-15-9716-9_49 ◽

2021 ◽

pp. 269-272

Author(s):

Jian Sun ◽

Jun Li ◽

Mingming Lv

Keyword(s):

Surgical Planning ◽

Mandibular Reconstruction ◽

Intraoperative Navigation ◽

Virtual Surgical Planning ◽

Segmental Mandibulectomy

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Reconstruction after hemimandibulectomy by a titanium mesh and particulate cancellous bone and marrow harvested from posterior ilia: a case report

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-21-00001 ◽

2021 ◽

Author(s):

Shigeo Ishikawa ◽

Kazyuki Yusa ◽

Kaoru Edamatsu ◽

Shohei Ueda ◽

Ayako Sugano ◽

...

Keyword(s):

Case Report ◽

Cancellous Bone ◽

Mandibular Reconstruction ◽

Titanium Mesh ◽

Limited Evidence ◽

Guiding Principle ◽

Reconstruction Methods ◽

High Predictability ◽

Segmental Mandibulectomy ◽

Ti Mesh

A particulate cancellous bone and marrow (PCBM) graft combined with titanium (Ti-) mesh tray has become one of the most popular mandibular reconstruction methods. The technique has been applied to the mandibular discontinuity defects after segmental mandibulectomy. To the best of our knowledge, there are no reports on using the technique after hemimandibulectomy, during which a wide mandibular resection, including the condyle, is performed. Here we report firstly a case of mandibular reconstruction after hemimandibulectomy, using a plate and soft-tissue free flap, followed by a Ti-mesh and PCBM harvested from the bilateral posterior ilia, which was successful. This case report first revealed how bone resorption occurred clinically in mandibular reconstruction using PCBM and Ti-mesh tray after hemimandibulectomy. We also revealed the high predictability of the mandibular reconstruction using PCBM and Ti-mesh tray after hemimandibulectomy. Our report also provides a guiding principle to overcome the limitation of mandibular reconstruction using PCBM and Ti-mesh tray after hemimandibulectomy. However, our manuscript has limited evidence being a case report.

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