RESUMO
This clinical report describes the multidisciplinary treatment of a 16-year-old girl diagnosed with cemento-ossifying fibroma in the mandible. The resection of the lesion and reconstruction with a free osseous fibula flap with microvascular anastomosis was performed. Four months later, interpositional bone grafting of iliac spongy bone was used to gain bone height at the treated site. Twenty-four months later, 5 dental implants were placed. After a 6-month osseointegration period, a partial screw-retained fixed dental prosthesis was fabricated. Prosthodontic planning and treatment considerations are discussed.
Assuntos
Enxerto de Osso Alveolar , Implantação Dentária Endóssea , Prótese Dentária Fixada por Implante , Prótese Parcial Fixa , Fibroma Ossificante/reabilitação , Mandíbula/cirurgia , Neoplasias Mandibulares/reabilitação , Adolescente , Placas Ósseas , Feminino , Fibroma Ossificante/cirurgia , Humanos , Neoplasias Mandibulares/cirurgia , Retalhos CirúrgicosRESUMO
A series of 28 consecutive cases of mandibular reconstruction by means of reconstructive plates and myocutaneous flaps were reviewed. In all cases mandibular resection was indicated for treatment of squamous cell carcinoma of the oral cavity: 25 pelviglossomandibulectomies (resulting in large defects from the angle of the mandible), 2 Commando operations (resulting in lateral defects) and 1 anterior sectional mandibulectomy (resulting in an anterior defect). Tumour stages were T1-T2 (4 cases) and T3-T4 (24 cases). Success was defined as plate maintenance 6 months' postoperatively/postradiotherapy. The overall success rate was 32.2%. Lateral-centre-lateral (L-C-L) defects had 32% success, L (lateral) defects had 50% success and in the single case of a C (centre) defect, the plate was not maintained. Stainless steel reconstruction plates showed a similar success rate as titanium plates (30% versus 34%). In cases not submitted to radiotherapy there were more maintained plates than in cases that received radiotherapy (45.5% versus 23.6%). Reconstruction plates are not effective in bridging large defects of the resected mandible. Only in selected cases that are not eligible for microvascular free flaps should plates and myocutaneous flaps be considered as an option for mandibular reconstruction.
Assuntos
Placas Ósseas/efeitos adversos , Mandíbula/cirurgia , Prótese Mandibular , Procedimentos Cirúrgicos Bucais , Procedimentos de Cirurgia Plástica , Adolescente , Adulto , Idoso , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/reabilitação , Carcinoma de Células Escamosas/cirurgia , Criança , Irradiação Craniana/efeitos adversos , Ligas Dentárias , Feminino , Humanos , Masculino , Neoplasias Mandibulares/radioterapia , Neoplasias Mandibulares/reabilitação , Neoplasias Mandibulares/cirurgia , Prótese Mandibular/efeitos adversos , Pessoa de Meia-Idade , Músculos Peitorais/transplante , Falha de Prótese , Transplante de Pele , Aço Inoxidável , Retalhos Cirúrgicos , TitânioRESUMO
Mandibular reconstruction is a condition in which both bone defect and function must be restored. A wide range of approaches--from grafts to distant bone flaps--have been used for correcting bony defects. However, adequate mastication has been restored in only a few cases. In this article the results of three different techniques for mandibular reconstruction after hemimandibulectomy were studied. Sixteen patients underwent a second mandibular reconstruction after hemimandibulectomy and were monitored at least 1 year. Three different techniques were used: (1) full-thickness galeoparietal bone flap (eight patients), (2) free iliac crest graft (three patients), and (3) free fibular grafts (five patients). Occlusion on the nonoperated side and the possibility and function of osseointegrated denture in the vascularized bone transfer were evaluated. The full-thickness galeoparietal flap and free iliac crest bone flap appeared to be good options. However, only acceptable or poor occlusion could be achieved on the normal side. The fibular free flap demonstrated good results and good occlusion. Nonetheless, dental implantation was difficult because a prosthesis for reaching the normal height of the mandible was necessary.
Assuntos
Transplante Ósseo/métodos , Mandíbula/cirurgia , Neoplasias Mandibulares/reabilitação , Retalhos Cirúrgicos , Adolescente , Adulto , Ossos Faciais/transplante , Feminino , Fíbula/transplante , Humanos , Ílio/transplante , Masculino , Côndilo Mandibular/cirurgia , Traumatismos Mandibulares/cirurgia , Neoplasias Mandibulares/cirurgia , Procedimentos Cirúrgicos Pré-Protéticos Bucais/métodos , Resultado do TratamentoRESUMO
Mandibular reconstruction may prove to be a difficult problem. The use of vascularized bone flaps for mandibular reconstruction has shown better results than bone grafts because they offer solid bone union together with rapid recovery of form and function. The occipital vessels, from the external carotid artery and the jugular vein up to their site of emergence in the occipital fascia, have proved easy to dissect at the neck after section of sternocleidomastoid and splenius capitis longus and brevis muscles. We were able to obtain a long pedicle to move the fascia to distant sites with or without bone. Reconstruction was achieved with a full-thickness occipitoparietal bone flap, pedicled at the occipital vessels, released up to the external carotid artery to yield a long pedicle. We used this technique in four patients (age range, 8-14 years). We used vascular cranial bone for mandibular reconstruction. The cases included three resections for benign tumors (two fibromyxoma and relapsing aneurysmal bone cyst) and one hemifacial microsomia. No complications occurred. We describe some advantages with this procedure. A larger number of cases will allow us to draw further conclusions.
Assuntos
Transplante Ósseo/métodos , Retalhos Cirúrgicos , Adolescente , Artérias , Criança , Fáscia/irrigação sanguínea , Humanos , Mandíbula/cirurgia , Neoplasias Mandibulares/reabilitação , Osso Occipital/irrigação sanguínea , Osso Occipital/cirurgia , Retalhos Cirúrgicos/irrigação sanguíneaRESUMO
The most frequent options currently available for rehabilitation of patients requiring mandibular resection, are discussed. Accordingly, prostheses are designed depending on the surgical technique employed. The most common characteristics of the oral cavity are reviewed, as well as their involvement in mandibulectomized patients. Finally, the relationship that should exist between maxillofacial prostheses and the stomatological cares required by patients who are candidates for radio and/or chemotherapy is stressed.
Assuntos
Prótese Mandibular , Implantes Dentários , Oclusão Dentária , Humanos , Neoplasias Mandibulares/reabilitação , Neoplasias Mandibulares/cirurgia , Prótese Maxilofacial , Desenho de PróteseRESUMO
Reconstruction of the mandible with iliac crest bone graft has been reported since early 1900'S. The series go from one to 160 cases published. This article shows the way we approached de reconstruction of a patient who came with an hemimandibulectomy due to osteosarcoma.