血管柄付腓骨移植および骨内インプラントによる下顎骨再建

―広範囲下顎骨欠損症例への対応―

抄録

In mandibular reconstruction, the nonvascularized autogenous iliac bone graft has been greatly used. However, we have used the vascularized fibular graft since 1987, especially for major mandibular defect, because of its length, the flexibility in shaping the bone using multiple osteotoinies, and minimal donor-site morbidity.
This report presents our experience with a case of oromandibular reconstruction using the vascularized fibular osteocutaneous flap and Branemark implants.
The patient was a 16-year-old male and referred to our hospital with the chief complaint of swelling of the right angle of the mandible. He underwent angle-to-angle segmental resection and immediate mandibular reconstruction using an almina ceramic alloplast, after diagnosis of ameloblastoma of the mandible. However, it was exposed externally in the mental region. Therefore, oromandibular reconstruction using the vascularized fibular osteocutaneous flap was done after removal of the alloplast. Although he acquired good mandibular contour, a full denture was fixed by circummandibular wiring because of the deficient vertical height of the graft. Eight years eight months after the operation, 6 implants were placed bicortically into the reconstructed mandible to improve masticatory function.
An implant-supported overdenture was employed because oral hygiene was difficult to maintain with a bone-anchored full bridge. He was satisfied with both esthetic and functional results, which improved the patient's QOL.
It was concluded that major oromandibular reconstruction can be done successfully using the fibular osteocutaneous flap and Branemark implants. In addition, the bicortical structure of the fibular graft is ideal for inserting implants, which show good primary stabilization.