Abstract
The current options for mandibular reconstruction are use of metallic plates, non-vascularized bones, pedicled osteomyocutaneous flaps, and free vascularized bone flaps. The use of free vascularized bone flaps clearly provides significant advantages in that it is highly successful, there is an unlimited amount of tissue available, and the harvested tissue can be fabricated to have an ideal configuration for restoration of the surgical defect.
Between March 1995 and April 2006, 59 mandibular reconstructions using free vascularized bone flaps were performed in 57 consecutive cases. Indications for mandibular resection were malignant tumor in 44 cases, benign tumor in 10 cases, and radiation osteonecrosis of the mandible in 3 cases. According to the Boyd's HLC-oms classification of mandibular defects, the most common type of bony defects and soft tissue defects consisted of L-type (74.6%) and m-type (81.4%) defects.
Of these 59 reconstructions, 58 were performed primarily and 1 was done secondarily. Donor sites included the fibula (16 reconstructions) and scapula (43 reconstructions), which were selected considering the bony defect and accompanying soft tissue defect requiring reconstruction, as well as the wishes of the patient. To restore the mandibular contour, 14 vascularized bones had single osteotomy and 3 bones had two osteotomies.
Of 16 fibula flaps, 13 flaps survived, while 2 flaps sustained a partial loss and one flap was a total loss. Of the 43 scapular flaps, 41 flaps survived, and 2 flaps sustained a partial loss. Postoperative mouth-opening was 4.1 cm on average. A total of 18 patients (31.6%) had osteointegrated implants or dentures, and 39 patients (68.4%) had a normal diet. In addition, 41 (85.4%) of 48 patients assessed had satisfactory facial contour postoperatively.
From these results, it can be said that microvascular free bones represent the first choice for mandibular reconstruction.
