Abstract
We retrospectively analyzed cases with squamous cell carcinoma of the lower gingiva and alveolus who underwent a combination of alveolar ridge and soft tissue reconstruction using a vascularized fibular or hemi-radius graft following marginal mandibulectomy between April 1992 and August 2007, in order to evaluate the validity and indications. Our treatment strategy for mandibular reconstruction after marginal mandibulectomy is as follows: 1. If the vertical alveolar bone defect ranges within 1/3, neither alveolar bone reconstruction nor soft tissue reconstruction is performed, or soft tissue reconstruction alone is performed; 2. If the vertical alveolar bone defect is from 1/3 to 1/2 of the mandible, a combination of alveolar ridge and soft tissue reconstruction using a radial forearm free flap with hemi-radius is performed; 3. If the bone defect accounts for more than 1/2 of the mandible, a combination of alveolar ridge and soft tissue reconstruction using a vascularized fibular graft is performed. The subjects consisted of 24 cases with reconstruction of the alveolar bone and/or soft tissue and 22 cases without reconstruction. In the 24 cases, 17 cases were treated with soft tissue reconstruction alone and 7 cases with the combination of alveolar ridge reconstruction and soft tissue reconstruction. The period from the day of operation to hospital discharge was significantly shorter in the cases without reconstruction than with reconstruction. The period from the day of operation to the insertion of dental prosthesis was significantly shorter with the combination of alveolar ridge reconstruction than with soft tissue reconstruction.
In conclusion, we considered that the combination of alveolar ridge and soft tissue reconstruction using a vascularized fibular or hemi-radius graft following marginal mandibulectomy is a standard therapy for squamous cell carcinoma of the lower gingiva and alveolus.
