AAHS ASPN ASRM - 2013 Annual Meeting - American Association ...

ASRM Concurrent Scientific Paper Presentations D-1
Pediatric Mandibular Reconstruction with the Vascularized Fibula Flap: A Long-term Evaluation of Outcomes
Institution where the work was prepared: MD Anderson Cancer Center, Houston, TX, USA
Melissa A. Crosby, MD1; Jack W. Martin1; Geoffrey L. Robb, MD2; David W. Chang1; (1)MD Anderson Cancer Center, (2)The University of Texas M.D. Anderson Cancer Center
Purpose:
The use of osseous and osteocutaneous vascularized fibula transfer in the pediatric population has been shown to be a reliable and successful method for
mandibular reconstruction after oncologic ablative surgery. Questions concerning long-term growth potential of the reconstructed mandible, donor site morbidity,
and need for future orthognathic surgery in a skeletally immature patient remain unanswered. We present our experience and outcomes at MD Anderson
Cancer Center in mandibular reconstruction using the vascularized fibula flap in the pediatric population.
Methods:
A retrospective review of pediatric patients undergoing mandibular reconstruction after ablative oncologic surgery at MD Anderson Cancer Center between
1992- 2005 was performed. Demographic data as well as information concerning flap harvest, complications, functional and aesthetic outcomes were evaluated.
A series of case examples is presented.
Results:
Eleven patients 14 years and younger were found to have undergone mandibular reconstruction with a vascularized fibula flap. Follow-up ranged from 5
months to 10 years. One flap failure occurred due to infection which was salvaged with a second fibula free flap. Recipient site complications including infection,
soft tissue abnormalities and hypertrophic scarring were minimal. Donor site complications were more pronounced with revisional surgeries for a cavovarus
deformity and valgus deformity necessary in two patients. Functional outcomes related to occlusion, diet and physical activity were found to be acceptable
in all patients. Radiographic evaluation demonstrated adequate bony union in all patients.
Conclusion:
Mandibular reconstruction with the vascularized fibula in the pediatric population has been shown to be an efficacious and reliable procedure. In our patient
series a high success rate with good functional and aesthetic outcomes was achieved. Follow-up to assess long- term recipient and donor site morbidity once
skeletal maturity is reached will be necessary to fully assess outcomes.
Oral function reconstruction by vascular fibular bone flap simultaneous dental implants-12 years experience
in Chang Gung Memorial Hospital
Institution where the work was prepared: CHANG-GANG MEMORIAL HOSPITAL, TAIPEI, Taiwan
Yang-Ming Chang, DDS; F.C. Wei; Chang Gung Memorial Hospital
Objective:
This study is aimed to estimate the cumulative survival rate of implants placed in vascularzed flap for oral functional reconstruction
Material & Method:
From 1993 to June 2005, 76 patients with various composite jaw bone defects were reconstructed with a fibula osteoseptocutaneous free flap with simultaneous
placement of dental implants. Male 42, female 34, average 50.4 y/o , total 297 implants (280 in fibula bone, 17 in native mandible ). The indications
for one stage surgical procedure were: the segmental mandibular defect due to an aggressive benign tumor(52), osteomyelitis(5), and osteoradionecrosis(19).
The technique pearls included placement of fibular segment 5 mm higher than the upper native mandible border to overcome problem related to insufficient
alveolar ridge height. Use of waxing screws connected with an implant fixture in the fibula – implant construct to confirm a proper interarch relationship and
position of the implants, and sural nerve grafting for sensory recovery of the lip sensation in benign tumor cases. In the secondary stage reconstruction, keratinized
palatal mcuosa graft was performed around dental implants to acquired good oral hygiene environment.
Result:
All implants were osseointegated (297/297).The bone loss around the implant was less then 1.5mm in an average 21.6 months oral functional loading follow
up. Keratinized mcuosa graft around dental implants provided good oral hygine better than skin graft for patient. The lower lip sensation recovery from post
operation 3 month to 18 months duration. Implant supported prosthesis is better than implant tissue support prosthesis
Conclusion:
Use of the vertical ridge distraction technique or a double- barrel vascularized fibula bone graft were good methods to correct insufficient alveolar ridge height
for segemental mandible reconstruction.
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