Long-term fate of the vascularized iliac crest bone graft for mandibular reconstruction

Article Abstract:

Reconstruction of the mandible (lower jaw bone) may be required for patients with cancer or sarcoma of the head and neck. Reconstruction may be performed using bone graft material from another part of the body. A favorite source of bone for mandibular grafting is the crest of the iliac bone (hip bone), which provides a large quantity of cortico-cancellous bone, a vascular supply, and a contour similar to that of the mandible. It is necessary to be able to evaluate the graft, especially if it is to undergo further manipulation, such as fixation of dental prostheses to the bone. A study was undertaken to evaluate a new technique, bone single photon emission computed tomography (SPECT) scintigraphy. This technique can quantitate graft activity three-dimensionally. Nine patients who underwent iliac crest bone grafting for mandibular reconstruction were evaluated using SPECT two days after surgery. SPECT scanning was repeated one year after surgery. Eight of the nine early postoperative scans showed increased activity within the graft, suggesting anastomotic (joining) patency ('hot' scans); one scan was suggestive of graft occlusion ('cold' scan). At one year postoperative follow-up, seven of the original eight 'hot' scans continued to show elevated activity. To date, five patients have undergone successful implantation of dental prosthesis. It seems that these mandibular grafts sustain a high level of metabolic activity long-term, making such grafts suitable for further reconstruction, including dental prosthetic implantation. It is concluded that bone SPECT may be helpful in identifying patients who may be future candidates for fixed dental prosthesis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Innovations, Evaluation, Physiological aspects, SPECT imaging, Single photon emission computed tomography

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The iliac crest and the radial forearm flap in vascularized oromandibular reconstruction

Article Abstract:

Oromandibular (mouth-jaw) reconstruction is more frequent in men than women and is commonly performed to restore appearance and function after surgical treatment for squamous cell carcinoma, a type of malignant tumor. In this type of reconstructive surgery bone and skin are taken from one part of the body, a donor site, and are grafted to an another area from which diseased bone was removed. A review of vascularized oromandibular reconstruction is presented. In 60 cases the iliac crest of the pelvic bone was used; these results are compared with 13 cases in which radial bone-skin flaps from the lower arm were used as donor tissue. Cosmetic outcome and function, as well as operative and postoperative courses were evaluated. The strengths and weaknesses of each procedure are discussed. Patients who had oromandibular reconstruction with the iliac crest had more skin breakdown and exposure of bone. The well-vascularized skin of the radial flap was superior to groin skin for lining the oral cavity. The iliac crest is strong and its shape and curvature match the mandible, or jaw, making it especially suitable in cases that require massive reconstruction. The bulk of the iliac crest limits its use in repairing small defects. The radial forearm flap is a thin, pliable and well vascularized skin paddle; its use is limited by its size and bone shape. Radial forearm flaps are most effective for reconstructing small or medium bone gaps. In borderline cases the authors prefer to use the radial forearm method because of it provides superior healing within the mouth. The two techniques are complementary in a wide variety of situations. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Methods, Surgery, Plastic, Plastic surgery, Autografts

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Reconstruction of mandibular defects in irradiated patients

Article Abstract:

A patient with cancer of the head or neck area may require reconstruction of the mandible (lower jaw bone). This reconstruction may be carried out with insertion of a metal plate. Success has been reported using metal reconstruction plates. A prospective study was undertaken to evaluate the use of titanium reconstruction plate (THORP) in patients about to undergo mandibular reconstruction and who were expected to undergo radiotherapy following surgery. The average age of the patients was 62 years. Thirty-one patients were treated, of whom 16 (51 percent) had undergone prior surgery; 13 (42 percent) had prior radiotherapy; and 11 (35 percent) had prior failed surgery and radiation. The remaining patients had radiation therapy following surgery; 11 had standard radiation and 5 had accelerated fractions. Twelve patients (39 percent) developed major complications of exposure of the plate or formation of a fistula (abnormal passage). The most common cause (5 of 12) of plate exposure was tumor recurrence. It was determined that the factors related to development of complications were poor nutrition, use of accelerated radiation and recurrence of tumor. One patient had an unacceptable result causing cosmetic and functional deformity. The reconstructions healed without complications in 61 percent of patients (19 of 31). The success rate, excluding patients with complications due to tumor recurrence, was 73 percent. Young patients with reasonable expectations of survival are best suited for these procedures. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Complications and side effects, Cancer, Cancer treatment, Radiotherapy, Implants, Artificial, Prostheses and implants

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