Correction of malocclusion using sliding fibula osteotomy with sagittal split ramus osteotomy after mandible reconstruction

Lee, Dong-Hun,Kim, Seong Ryoung,Jang, Sam,Ahn, Kang-Min,Lee, Jee-Ho Korean Association of Maxillofacial Plastic and Re 2020 Maxillofacial Plastic Reconstructive Surgery Vol.42 No.-

Background: Fibula free flap mandible reconstruction is the standard procedure after wide resection of the mandible. Establishment and maintenance of normal occlusion are important in mandible reconstruction both intraoperatively and after surgery. However, scar formation on the surgical site can cause severe fibrosis and atrophy of soft tissue in the head and neck region. Case presentation: Here, we report a case of severe soft tissue atrophy that appeared along with scar formation after mandibular reconstruction through the fibular free flap procedure. This led to normal occlusion collapse after it was established, and the midline of the mandible became severely deviated to the affected side that was replaced with the fibula free flap, leading to facial asymmetry. We corrected the malocclusion with a secondary operation: a sagittal split ramus osteotomy on the unaffected side and a sliding osteotomy on the previous fibula graft. After a healing time of 3 months, implants were placed on the fibula graft for additional occlusal stability. Conclusion: We report satisfactory results from the correction of malocclusion after fibula reconstruction using sliding fibula osteotomy and sagittal split ramus osteotomy. The midline of the mandible returned to its original position and the degree of facial asymmetry was reduced. The implants reduced difficulties that the patient experienced with masticatory function.

유한 요소법을 이용한 하악골 이부 결손수복에 사용된 재건용 금속판의 응력분포에 관한 연구

오정환,한정수,민지현,문성준,이백수,Oh, Jung-Hwan,Han, Jung-Soo,Min, Jee-Hyun,Mun, Sung-Jun,Lee, Baek-Su 대한악안면성형재건외과학회 2008 Maxillofacial Plastic Reconstructive Surgery Vol.30 No.6

Purpose: This study aimed to evaluate distribution and maximal value of mechanical stresses on the reconstruction plate, bridging mandibular symphysis defect, and to optimize the most appropriate locations of the plate to distribute the stress causing the fracture of the plate. Materials and methods: Four types of reconstruction were constructed by different number and location of the reconstruction plates on the 3 D finite element model (FEM) of a human edentulous mandible; Type I: one plate on the inferior border of the anterior mandible, Type II: one plate on the middle of the anterior mandible, Type III: one plate on the superior border of the anterior mandible, and Type IV: two plates on the inferior and superior border of the anterior mandible. Results: The results showed that the maximal stress of type I (234.29 Mpa) was lower than that of type II (260.91 Mpa) and type III (247.37 Mpa), but higher than that of type IV (186.64 Mpa). We could also observe that the stresses are tending to focus on the inner side and inferior part of the plate which connected proximal segment from the vertical load. Conclusions: On the basis of the findings, it was concluded that using a plate on the inferior border of mandible or two plates on the inferior and superior border of mandible are more favorable to distribute mechanical stresses, which could reduce the fracture of the plate.

Three-dimensional finite element analysis of the splinted implant prosthesis in a reconstructed mandible

Kyung-Hoi Heo,Young-Jun Lim,Myung-Joo Kim,Ho-Beom Kwon 대한치과보철학회 2018 The Journal of Advanced Prosthodontics Vol.10 No.2

PURPOSE. The purpose of this study was to analyze the effects of the splinted implant prosthesis in a reconstructed mandible using three-dimensional finite element analysis. MATERIALS AND METHODS. Threedimensional finite element models were generated from a patient’s computed tomography data. The patient had undergone partial resection of the mandible that covered the area from the left canine to the right condyle. The mandible was reconstructed using a fibula bone graft and dental implants. The left mandibular premolars and molars remained intact. Three types of models were created. The implant-supported prosthesis was splinted and segmented into two or three pieces. Each of these models was further subcategorized into two situations to compare the stress distribution around normal teeth and implants. Oblique loading of 300 N was applied on both sides of the mandible unilaterally. The maximum von Mises stress and displacement of the models were analyzed. RESULTS. The stress distribution of the natural mandible was more uniform than that of the reconstructed fibula. When the loading was applied to the implant prosthesis of reconstructed fibula, stress was concentrated at the cortical bone around the neck of the implants. The three-piece prosthesis model showed less uniform stress distribution compared to the others. Displacement of the components was positively correlated with the distance from areas of muscle attachment. The three-piece prosthesis model showed the greatest displacement. CONCLUSION. The splinted implant prosthesis showed a more favorable stress distribution and less displacement than the separated models in the reconstructed mandible.

두경부 종양에서의 하악골 절제후 재건술

노영수,소상훈,김희동,박찬흠,임현준,정철훈,오석준 대한이비인후과학회 1999 대한이비인후과학회지 두경부외과학 Vol.42 No.8

Reconstruction of Combined Oral Mucosa-Mandibular Defects Using the Vascularized Myoosseous Iliac Crest Free Flap

Jung, Hwi-Dong,Nam, Woong,Cha, In-Ho,Kim, Hyung Jun Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.8

The authors present five cases of combined oral mucosa-mandible defects reconstructed with the vascularized internal oblique-iliac crest myoosseous free flap. This technique has many advantages compared to other conventional methods such as the radial flap, scapula flap, and fibula flap. Vascularized iliac crest flaps provide sufficient high-quality bone suitable for reconstructing segmental madibular defects. Although fibular flaps allow longer donor bone tissue to be harvested, the iliac crest can provide an esthetic shape for mandibular body reconstruction and also provides sufficient bone height for dental implants. Conventional vascularized iliac crest myoosseous flaps have excessive soft tissue bulk for reconstruction of intraoral soft tissue defects. The modification discussed in the present article can reduce soft tissue volume, resulting in better functional reconstruction of the oral mucosa. Another advantage is that complete replacement of the oral mucosa is observed in as early as one month post-operation. The final mucosal texture is much better than that obtained with other skin paddle flaps, which is especially beneficial for the placement of dental implant prostheses. Donor site morbidity looks to be similar to, if not less than that observed for other modalities in terms of function and esthetics. For combined oral mucosa-mandible defects, the vascularized internal oblique-iliac crest myoosseous free flap shows good results with respect to hard and soft tissue reconstruction.

How Can We Improve Crown-Implant Ratio in Reconstructed Mandible with Fibular Free Flap?: A New Surgical Technique Using 3D RP Model and Reconstruction Titanium Plates

Kim, Dong-Young,Ahn, Kang-Min International Society for Simulation Surgery 2017 Journal of International Society for Simulation Su Vol.4 No.1

Fibular free flap reconstruction is the flap of the choice in long-span mandibular bone reconstruction. The most common disadvantage of the fibular flap is short bone height to install dental implant. Double barrel fibular flap has been tried, however, bulky flap in the oral cavity hinder its use. Titanium reconstruction plate has been used simultaneously with the free fibular flap to stabilize occlusion and to fix the fibular flap. In this study, titanium reconstruction plate was fixed in the lower border of the mandible and the fibular free flap was fixed in the superior border of the titanium plate to improve implant-crown ratio. This new technique improved the longevity of the dental prosthodontics with dental implants.

유리 피판술을 포함한 다양한 방법의 하악골의 재건술

김인철,민경원,김진환,박철규,이윤호,김석화,권성택,김지혁,이민구,Kim, In Chul,Minn, Kyoung Won,Kim, Chin Whan,Park, Chul Gyoo,Lee, Yoonho,Kim, Suk Wha,Kwon, Sung Tack,Kim, Ji Hyuk,Lee, Min Goo 대한미세수술학회 2000 Archives of reconstructive microsurgery Vol.9 No.1

Reconstruction of the composite mandibular defect resulting from ablative resection of tumor involved jaw has been challenging task to the plastic surgeon. A wide variety of different techniques were used with limited success until the advent of microsurgery. The high success rate of microsurgical procedures has allowed for significant improvement in both functional and aesthetic results. A variety of free flap donor sites have been used successfully for mandibular reconstruction. Between April of 1991 and August of 1998, 20 mandibular reconstructions were performed for oncologic defects. 4 patients underwent mandibular reconstruction with pectoralis major flap, 3 patients with free nonvascularized bone graft, 1 patient with metal plate. 12 patients underwent microvascular mandibular reconstruction(8: fibula, 4: ilium). The type of free flap was determined by the requirements of the defect. Satisfactory aesthetic and functional results were achieved in all cases without significant complications. So microvascular mandibular reconstruction should be considered as primary choice in all mandibular defect without hesitation.

하악골 부분절개후 재건에 있어 가골신연술의 이용가능에 관한 실험적 연구 : AN EXPERIMENTAL STUDY ON RABBIT

권성택 大韓成形外科學會 1995 Archives of Plastic Surgery Vol.22 No.6

Gradual distraction techniques according to Ilizarov have recently gained popularity around the world. Bone lengthening by distraction osteogenesis has been performed to remodeling the deficient length of bone by doing corticotomy only, whereas cancellous bone maintaing it's continuity. In case of trauma and resection of bone tumor, bony continuity appears to be damaged both cortex and inner cancellous bone frequently. It might be useful clinically if damaged bone after healing could feasible for callotasis. The purpose of this study is to find it's possibility of callotasis after healing of fractured bony segments. After 5mm resection of bodies of 6 rabbits' left mandible(anterior to premolar region) distractable monofixators were applied to fix the proximal and distal segments together. After two weeks of healing period, 3 rabbits kept fixator in situ for another 8 weeks, whereas remained 3 mandibles of rabbit were subjected to be lengthened by gradual distraction. Distraction with the rate of 0.25mm/day was continued until the lower incisors lined with the upper ones. After another 8 weeks of consolidation period, histologic findings of one group of unioned, healed and maintained with fixator without distraction after segmentectomy of mandible,the other group of unioned,healed and distracted segment of mandible. showed osteogenesis almost as complete as those unoperated normal mandible. Lengthening after ostectomy looked so successful that distraction lengthening technique might be used in certain cases of mandibular reconstruction after loss of certain amount of mandible from various causes.

3D-printed titanium implant with pre-mounted dental implants for mandible reconstruction: a case report

Park, Jung-Hyun,Odkhuu, Michidgerel,Cho, Sura,Li, Jingwen,Park, Bo-Young,Kim, Jin-Woo Korean Association of Maxillofacial Plastic and Re 2020 Maxillofacial Plastic Reconstructive Surgery Vol.42 No.-

Background: This clinical case presented a novel method of segmental mandible reconstruction using 3D-printed titanium implant with pre-mounted dental implants that was planned to rehabilitate occlusion. Case presentation: A 53-year-old male who suffered osteoradionecrosis due to the radiation after squamous cell carcinoma resection. The 3D-printed titanium implant with pre-mounted dental implant fixtures was simulated and fabricated with selective laser melting method. The implant was successfully inserted, and the discontinuous mandible defect was rehabilitated without postoperative infection or foreign body reaction during follow-ups, until a year. Conclusions: The 3D-printed titanium implant would be the one of the suitable treatment modalities for mandible reconstruction considering all the aspect of mandibular functions.

The Pros and Cons of Computer-Aided Surgery for Segmental Mandibular Reconstruction after Oncological Surgery

한현호,김학영,이준용 대한두개안면성형외과학회 2017 Archives of Craniofacial Surgery Vol.18 No.3

Computer-aided surgery (CAS) started being used for head and neck reconstruction in the late 2000s. Its use represented a paradigm shift, changing the concept of head and neck reconstruction as well as mandible reconstruction. Reconstruction using CAS proceeds through 4 phases: planning, modeling, surgery, and evaluation. Thus, it can overcome a number of trial-and-error issues which may occur in the operative field and reduce surgical time. However, if it is used for oncologic surgery, it is difficult to evaluate tumor margins during tumor surgery, thereby restricting pre-surgical planning. Therefore, it is dangerous to predetermine the resection margins during the presurgical phase and the variability of the resection margins must be taken into consideration. However, it allows for the preparation of a prebending plate and planning of an osteotomy site before an operation, which are of great help. If the current problems are resolved, its applications can be greatly extended.