Abstract
This study sought to evaluate the outcome of patients treated with fibula grafts for partial mandibular reconstruction and implant-supported prosthesis at a Danish university hospital. Patient inclusion criteria were: partial mandibular resection, reconstruction with a fibula graft, and treatment during the period 1998–2011. Patients with incomplete medical records were excluded. Thirty-six patients were included, of whom 16 were treated with an implant-supported prosthesis. Relevant presurgical, intraoperative, and postoperative parameters were registered. The fibula graft survival rate at the last follow-up (mean follow-up 22 months, range 0–89 months) was 97%. Half of the patients experienced non-severe complications such as loosening of osteosynthesis material, fistulae, and graft exposure. One of 37 fibula grafts in the 36 patients was removed due to infection. The implant survival rate was 96%; three of 67 implants were lost due to infection. Eight implants were not included in the prosthetic rehabilitation. Fibula graft surgery for mandibular reconstruction was found to be a reliable treatment modality with a high survival rate. Rehabilitation with implant-supported prostheses was characterized by high survival rates and few complications. The results obtained are comparable to those of previous studies.
Introduction
A partial mandibular resection may be indicated due to malignancies such as sarcoma, adenocystic carcinoma, lymphoma, and metastases. In previous studies, 57–89% of the patients had a partial mandibular resection due to squamous cell carcinoma. Furthermore, partial mandibular resection may be indicated due to non-malignant pathologies such as ameloblastoma, odontogenic keratocysts, myxoma, osteomyelitis, osteoradionecrosis, and dentigerous cysts.
The resection of bone, mucosa, skin, and muscles in the orofacial region may necessitate the use of a vascularized free flap to reconstruct the defect. Rib, iliac crest, scapula, fibula, and radius have routinely been used as donor sites for vascularized free flaps. A fibula graft has been reported to have several advantages over the other graft candidates, such as better length, which facilitates numerous osteotomies, adequate bone height and width for insertion of implants, low donor site morbidity, the possibility for muscle and skin paddles, good vascularization owing to the periosteal blood supply, and a location of the donor site that allows a two-team surgical approach. The use of combined osseocutaneous grafts has a good outcome in 90% of patients provided recommended guidelines are followed.
The final treatment plan and rehabilitation after partial mandibular reconstruction may include implant insertion into the native mandible and/or into the fibula graft. Previous studies of implants inserted into fibula grafts have revealed high survival rates, ranging from 85% to 100% after 10–12 years of follow-up. To avoid long abutments and the risk of cantilever forces, the position and the quantity of the fibula graft may be changed by vertical distraction osteogenesis. Prosthetic rehabilitation may be compromised by a thick skin paddle, which may diminish lingual and vestibular grooves as well as reduce the mouth-opening capacity. Furthermore, osteosynthesis material may interfere during implant placement, and radiotherapy may reduce the healing capacity of the soft and hard tissues.
The aim of this study was to assess the outcome of partial mandibular reconstruction with fibula grafts and implant-supported prostheses in patients at our institution.
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