Mandibular reconstruction in benign tumours using non-vascularized grafts—our treatment protocol

Mandible reconstruction involves a great challenge for Maxillofacial surgeons. Nowadays, the surgical procedures are more predictable returning function and a successful aesthetic outcome as soon as possible. Work and social insertion of these patients who are treated with resective and reconstructive surgery is accomplished in a shorter period of time and have better outcomes. Actually the microvascular free flap technique is the gold standard treatment in reconstruction. However the technical difficulty of the microsurgical reconstruction, the absence of trained surgeons and the limited amount of bone for the later dental implant placement are the disadvantages in relation to the non-vascularized grafts (Iliac Crest). This is a retrospective study of 9 patients, 5 men and 4 women with an average of age of 34 years (15–52 years). The diagnoses were; Ameloblastoma ( N = 3), Ossyfing Fibroma ( N = 2), Mixoma ( N = 3) and Sclerosing Osteomyelitis ( N = 1). Tooth extractions were made 6 weeks previous to resection. Hemimandibulectomy and reconstruction at same surgical time were performed in each patient. All the procedures were carried out using an extraoral approach avoiding oral contact. Locking plates previously shaped using stereolithographic models were used. Mandibular segment was reconstructed with Iliac Crest blocks. Ninety percent of the patients maintained sufficient amount of bone that allowed a dental implant treatment. One case (Sclerosing Osteomyelitis) presented 50% bone resorption of the iliac crest graft due to communication with oral cavity. Non-vascularized grafts (Iliac Crest) are less complex and require less time in relation to vascular grafts. Also they contribute a great amount of bone in wide and height to place dental implants properly. To improve the final outcome is important to avoid graft overloading and the communication with the oral cavity. Key words : mandibular reconstruction; tumour resection; nonvascularized grafts

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Jan 21, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Mandibular reconstruction in benign tumours using non-vascularized grafts—our treatment protocol
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