Objective To investigate the clinical value of occlusal guide plate combined with intermaxillary fixation screw in mandibular defect repair with free fibular flap. Methods Between August and December 2011, 7 patients with mandibular tumor were treated, including 5 cases of ameloblastoma and 2 cases of gingival cancer. Of 7 patients, 4 were males and 3 were females, aged 32-65 years (median, 50 years). Occlusal guide plate was prepared and the implanted position of intermaxillary fixation screws was determined preoperatively. Hemimandibulectomy was performed in 5 cases, half mandibular segmental resection with condyle reservation in the other 2 cases. The free fibular flaps of 11-13 cm in length were harvested for repairing mandibular defects. When the free fibular flaps were fixed, the occlusal guide plate and intermaxillary fixation screws were utilized to restorate the occlusal relation. The donor site was sutured directly. Results The average operation time was 9.5 hours (range, 7-12 hours). All free fibular flaps survived completely. All incisions at the donor site and recipient site healed by first intention. All patients were followed up 10-14 months with an average of 12.3 months. All patients had symmetrical face, good occlusal relation, normal mouth opening, and normal mandibular lateral movement, and no pain of bilateral temporomandibular joints occurred. Panoramic tomography showed good mandibular contour and the suitable emplacement of fibular flaps postoperatively. No tumor recurrence occurred during follow-up period. Conclusion When repairing the mandibular defect with free fibular flap, occlusal guide plate with intermaxillary fixation screw contributes to simplifying operation, accurate recovery of the appearance and occlusal relation, and improving the oral comfort level postoperatively.
Objective To evaluate the directional significance of SurgiCase software in free fibula mandibular reconstruction. Methods Between September 2010 and March 2012, 10 patients with mandibular defect underwent free fibula mandibular reconstruction. There were 7 males and 3 females, with an age range of 19-43 years (mean, 27 years). The extent of lesions was 7 cm × 5 cm to 16 cm × 8 cm. In each case, three-dimensional spiral CT scan of the maxilla, mandible, and fibula was obtained before surgery. The CT data were imported into the SurgiCase software and the virtual surgery planning was performed. After that, the mandibular rapid prototyping was made according to customized design. The reconstruction surgery was then carried out using these preoperative data. During actual surgery, the extent of mandibular defect was from 6 cm × 3 cm to 16 cm × 5 cm; the length of fibula which was used to reconstruct mandible was 6-17 cm; and the area of flap was from 6 cm × 5 cm to 16 cm × 6 cm. Results Preoperative data could not be applied because the intraoperative size of tumor was larger than preoperative design in 1 case of mandibular ameloblastoma, and the fibula was shaped according to the actual osteotomy location; operations were performed successfully according to preoperative design in the other 9 patients. The operation time was 5-7 hours (mean, 6 hours). Primary healing of incision was obtained, without early complications. Ten patients were followed up 1 year. At last follow-up, 8 patients were satisfactory with the appearance and 2 patients complained with unsatisfied wide facial pattern. The panoramic radiograghs showed good bone healing. The range of mouth opening was 2.5-3.5 cm. Conclusion SurgiCase software can provide precise data for free fibula mandibular reconstruction during surgery. It can be applied widely in clinic.
【Abstract】 Objective To evaluate the feasibility and effectiveness of reconstruction of mandibular bone defects using three-dimensional skull model and individualized titanium prosthetics from computer assisted design. Methods Between July 2002 and November 2009, 9 patients with mandibular defects accepted restorative operation using individualized bone prosthetics. Among 9 cases, 4 were male and 5 were female, aged 19-55 years. The causes of mandibulectomy were benign lesions in 8 patients and carcinoma of gingival in 1 patient. Mandibular defects exceeded midline in 2 cases, involved condylar in 4 cases, and was limited in one side without involvement of temporo-mandibular joint in 3 cases. The range of bone defects was 9.0 cm × 2.5 cm-17.0 cm × 2.5 cm. The preoperative spiral CT scan was performed and three-diamensional skull model was obtained. Titanium prosthetics of mandibular defects were designed and fabricated through multi-step procedure of reverse engineering and rapid prototyping. Titanium prosthetics were used for one-stage repair of mandibular bone defects, then two-stage implant denture was performed after 6 months. Results The individualized titanium prosthetics were inserted smoothly with one-stage operative time of 10-23 minutes. All the cases achieved incision healing by first intention and the oblique mandibular movement was corrected. They all got satisfactory face, had satisfactory contour and good occlusion. In two-stage operation, no loosening of the implants was observed and the abutments were in good position with corresponding teeth which were designed ideally before operation. All cases got satisfactory results after 1-9 years of follow-up. At last follow-up, X-ray examinations showed no loosening of implants with symmetry contour. Conclusion Computer assisted design and three-dimensional skull model techniques could accomplish the design and manufacture of individualized prosthetic for the repair of mandibular bone defects.
【Abstract】 Objective To investigate the effectiveness of the medical calcium sulfate—OsteoSet bone graft substitute in the treatment of defect after excision of jaw cyst. Methods Between December 2009 and May 2010, 15 cases of jaw cystic lesion were treated，including 9 males and 6 females with an average age of 36.6 years (range, 15-75 years). Orthopantomography (OPT) method was used to measure the cyst size before operation, and the size ranged from 1.5 cm × 1.5 cm to 8.0 cm × 3.0 cm. The range of bone defect was from 1.5 cm × 1.5 cm × 1.5 cm to 8.0 cm × 3.0 cm × 3.0 cm after cyst excision intraoperatively. The patients underwent cyst curettage and OsteoSet bone graft substitutes implantation (2-15 mL). Radiological method was used to evaluate the repair effect of OsteoSet pellets. Results The pathology biopsy was periapical cyst in 7 cases, odontogenic keratocyst in 5 cases, and dentigerous cyst in 3 cases. Fifteen patients were followed up 6-12 months. Thirteen patients achieved wound healing by first intention; 2 cases had longer drainage time (5 and 7 days, respectively), the incision healed after the pressure bandage. Swelling occurred in 1 case after 1 month with no symptom of infection. No postoperative infection and rejection was found. The X-ray examination showed that the materials filled the bone defect well after 1 day of operation. OsteoSet bone graft substitutes were absorbed by one-half after 1 month of operation and totally after 3 months by OPT. The low density area was smaller in the original cysts cavity, and high density in the cysts increased significantly with fuzzy boundaries of cysts. At 6 months after operation， there was no obvious difference in image density between the original cavity and normal bone, and the capsule cavity boundary disappeared, and defect area was full of new bone. Conclusion The medical calcium sulfate—OsteoSet bone graft substitute is an ideal filling material for bone defect.
【Abstract】 Objective To assess the feasibility and clinical outcomes of artificial condylar process in reconstruction of the temporomandibular joint. Methods Between January 2005 and January 2010, the reconstructions of the temporomandibular joints with artificial condylar process were performed in 10 cases (11 sides, including 7 left sides and 4 right sides). There were 7 males and 3 females with an average age of 50 years (range, 40-68 years). Mandibular condyle defects were caused by mandible tumor in 7 patients with a mean disease duration of 15 months (range, 9-24 months) and by bilateral condylar fractures in 3 patients with the disease duration of 2, 3, and 2 days respectively. According to Neff classification, there were type M and A in 1 case, type M and B in 1 case, and type M in one side and subcondylar fracture in the other side in 1 case. Results Incisions in all patients healed by first intention, and no complication occurred. All cases were followed up 1 to 4 years, showed facial symmetry and good occluding relation, and the mouth opening was 22-38 mm (mean, 30 mm). No temporomandibular joint clicking or pain and no recurrence of tumor were observed. Most of the artificial condylar process were in good position except 1 deviated from the correct angle slightly. All the patients could have diet normally. Conclusion The results of temporomandibular joint reconstruction after tumor resection with artificial condylar process are good, but the clinical outcome for intracapsular condylar fracture is expected to be further verified.
Objective To investigate the method of combining radial forearm free flap and adjacent tissue flap in reconstruction of palatomaxillary defects and its effectiveness. Methods Between March 2005 and May 2010, 17 patients with palatomaxillary defects were treated. There were 11 males and 6 females with an age range of 45-74 years (mean, 62.5 years), including 1 case of benign tumor and 16 cases of malignant tumors (7 cases of squamous cell carcinoma of palate, 1 case of recurring squamous cell carcinoma of palate, 1 case of malignant melanoma of palate, 1 case of adenoid cystic carcinoma of palate, 1 case of malignant melanoma of maxilla, 1 case of ductal carcinoma of maxilla, and 4 cases of squamous cell carcinoma of maxilla). The maxillectomy defect ranged from 7.0 cm × 5.5 cm to 10.0 cm × 7.5 cm. According to Brown’s classification for the maxillectomy defect, there were type II in 15 cases, type III in 2 cases. Palatomaxillary defects were repaired with radial forearm free flap and buccal fat pad in 11 cases, and with radial forearm free flap, buccal fat pad, and mandibular osteomuscular flap pedicled with temporal muscle in 6 cases. The effectiveness was evaluated after operation by observing the vitality of the flap, the functions of speech, swallowing, breath, and the facial appearance. Results All cases were followed up 6-12 months without tumor recurrence. All flaps and skin grafts at donor sites survived. The functions of seech, swallowing, and breath were normal without obvious opening limitation. The facial appearance was satisfactory without obvious maxillofacial deformity. No enophthalmos occurred in patients with orbital floor and infraorbital rim defects. The patients had no oronasal fistula with satisfactory oral and nasal functions. Conclusion According to the type of palatomaxillary defects, it can have good early effectiveness to select combining radial forearm free flap and buccal fat pad or combining radial forearm free flap, buccal fat pad, and mandibular osteomuscular flap for repairing defects.
Objective To compare the effectiveness of open reduction and conservative treatment for pediatric mandibular condylar fractures and to provide the evidence for the selection of cl inical therapy. Methods The cl inical data were retrospectively analyzed from 25 patients with the mandibular condylar fractures between January 1988 and December 2006. Of them, 8 patients (11 fractures) were treated with surgical treatment (surgical group) and 17 patients (22 fractures) withnon-surgical treatment (non-surgical group). In surgical group, there were 6 males (9 fractures) and 2 females (2 fractures) with an age range of 8-13 years; fracture was caused by tumbl ing in 7 cases and by traffic accident in 1 with an interval of 1-6 days between injury and hospital ization; and 5 cases were identified as unilateral condylar fractures (3 compl icated by mental fractures) and 3 cases as bilateral condylar fractures compl icated by mental fractures. In non-surgical group, there were 12 males (15 fractures) and 5 females (7 fractures) with an age range of 3-12 years; fracture was caused by fall ing from height in 4 cases, by tumbl ing in 10, and by traffic accident in 3 with an interval of 1-25 days between injury and hospital ization; and 12 cases were identified as unilateral condylar fractures (3 compl icated by mental fractures) and 5 cases as bilateral condylar fractures (1 compl icated by mental fracture). Results Incision healed by first intention in surgical group, and 25 cases were followed up 1-6 years with an average of 3.5 years. At 12 months after treatment, no temporomandibular joint pain, eating disorder, or l imited mandibular movement occurred in 2 groups. No significant difference was observed in opening mouth extent, protrusive and lateral movements between 2 groups at 6 and 12 months (P gt; 0.05). During centric occlusion, mental point located at the midl ine with symmetric face figure. Two patients in surgical group and 3 in non-surgical group had sl ight snap when opening their mouths. Mandible deviation was observed in 3 patients of 2 groups, respectively when gaping. The X-ray films showed heal ing of fracture and condylar remodel ing at 3-6 months. Mandibular ramus were symmetric in cephalometry. Conclusion Good effectiveness can be obtained by surgical or non-surgical treatment in pediatric mandibular condylar fractures. Considering the pediatric mandibular condyle having powerful heal ing and reconstructing potency and avoiding secondary injury on the temporomandibular joint from surgery, non-surgical treatment should be first selected for the pediatric mandibular condylar fractrues in patients under 7 years.
【Abstract】 Objective To evaluate the effect on repairing composite defect of mandible and skin by pre fabricatedmusculocutaneous flap including ectopic bone induced by BMP-2 and collagen in rabbits’ latissimus dorsimuscle. Meth ods Twenty-four rabbits (4-6 weeks old) were randomly divided into 3 groups: experimental, control and blank control group (n=8 in each group). Composite carriers composed of BMP-2 and collagen I sponge were implanted into latissimus dorsi muscle pouches of rabbits. The bone formation was evaluated with roentgenography, ALP staining, Von Kossa staining, HE staining, toluidine blue staining and CD31 immunohistochemical labell ing of microvessels. After 6 weeks, the mandibular defect of 8 mm in diameter with local skin defect of 2 cm × 3 cm was made in experimental group, and a musculocutaneous flap including ectopic-induced bone was prefabricated to transfer and repair the composite defect. The mandibular defect of 8 mm in diameter without local skin defect was made in control and blank control group. Free ectopic-induced bone was used for the repair of mandibular defect in control group, but repairing was not performed in blank control group. All the samples were detected 6 weeks after operation for tetracycl ine fluorescent staining, X-ray, histological examination and bone quantity analysis to evaluate the effect. Results Bone formation induced by BMP-2/collagen composites were found as woven bone between 4 to 6 weeks. It showed that cartilaginous osteogenesis was the mainly type of bone formation. Microvessels could beseen in the bony tissues. The composite defects of mandible and skin were healed well in the experimental group. Major bony tissue were seen in the control group, while it still remained bony defect in the blank control group. The bone quantity analysis in the experimental, control, and blank control group were (1.594 ± 0.674), (0.801 ± 0.036), and (0.079 ± 0.010) mm2, there were significant differences between each groups (P lt; 0.05). Conclusion Prefabrication of musculocutaneous flap including boneinduced by the composite of BMP-2 and collagen is feasible and prevalent. It can be regarded as vascularized bone graft and used in repairing composite defect of bone and skin.
Objective To build up a new contour and functional reconstruction technique of mandibular defects with rapid prototyping and reverse engineering technique. Methods From April 2002 to August 2004, 4 cases of mandibular defects due to resection of large mandible lesion were treated. Of 4 patients, there were 3 females and 1 male, with an age range of 21-42 years, which underwent secondary operation and presented a deviation as mandibular movement. The openingmouth extent was 1.8-2.5 cm(2.2 cm on average). The data of defects area were renewed withMimics and Geomagic Studio software; and the titanium reconstructive frame was designed and manufactured with rapid prototyping technigue. Defect were reconstructed by using CT digital data of patients. Results The CT data could be used by image software directly. The implant design could be completed by computer-aimed design(CAD)/computer-aided manufacture(CAM). The resin model and titanium frame were manufactured accurately by RP technique. Four patients achieved one stage healing. After a follow-up of 3 months to 2 years, largemandibular defect was reconstructed satisfactorily and the opening-mouth extent was 3.03.4 cm(3.2 cm on average). The occluding relation was normal. The implant denture was put on and the mastication function was good in 1 case. Conclusion Individual design and repair of large mandibular defect with CAD/CAM techniques is worth extending application clinically. It is a simple and accurate method.