METHODS OF MANDIBULAR RECONSTRUCTION

GOALS : Restore form & function of mandible (bony contour, mastication, deglutition, articulation) & maintain
adequate airway
(functional, anatomical & esthetic)
METHODS :
1. Alloplastic implants (plates & screws)
2. Non-vascularized bone graft
3. Vascularized bone transfer
ANATOMY:

ALLOPLASTIC IMPLANTS
METAL USED: Stainless steel, vitallium,
titanium

NON-VASCULARIZED BONE GRAFT

USES: In well-vascularized bed, small to medium
mandibular defects with little or no loss of soft tissue

ADVANTAGES: Alternative until the

reconstructive procedure is perform, used as
permanent fixation.

HARVESTED FROM: Rib & ilium, tibia, fibula, scapula,

humeus, radium & metatarsal bone

DISADVANTAGES: Loosening screws, plate

fracture

TYPES:
1. CANCELLOUS BONE GRAFT
Highest percentage of viable osteoblast -> Resvascularized
rapidly after transplant

2. CORTICOCANCELLOUS GRAFT
Composed of both cortical tissue & trabecular tissue -> Give
good structural support

CLASSIFICATIONS: HCL & o.m.s

H: Lateral defect including condyle but not crossing
midline
C: Central segment (4 incisors + 2 canines)
L: Lateral defect without including condyle
O: Skin or mucosal component
S: Skin
M: Mucosal
SM: Skin + mucosal

VASCULARIZED BONE TRANSFER

1. PEDICLED BONE FLAPS
DEF: Musculocuteneous flaps + a segment of bone with
its blood supply
EG: Rib-pectoralis major, sternum-pectoralis major, Riblattismus dorsi, scapula-trapezius osseomyo-cuteneous
flap

2.MICROVASCULAR OSTEOCUTENEOUS FREE FLAP

TYPES: Radial forearm, iliac crest, scapula, fibula

CHARACTERISTIC OF OSTEOCUTENEOUS FREE FLAPS IN MANDIBULAR RECONSTRUCTION

OSTEOCUTENEO
US FREE FLAP
BLOOD SUPPLY

BONE
AVAILABILITY,
QUALITY
PEDICLE
LENGTH (CM)
SOFT TISSUE &
ADVANTAGES

DONOR SITE
COMPLICATIONS
&
DISADVANTAGE
S

FIBULAR

SCAPULA

ILIAC CREST

RADIAL

Peroneal artery, vein &

comitantes

Circumflex artery, vein &

angular branch of
thoracodorsal artery
Segmental b.s -> Multiple
osteotomy
5-15 cm
Good but not ideal bcoz
limited in length
4-9 cm

Deep circumflex iliac

artery & vein

Radial artery, vein & comitantes

6-16 cm
But shape fixed (curved)

8-12 cm
Fair

8-12 cm
Fair

5-7 cm

Variable

6-16 cm

Segmental b.s -> Multiple

osteotomy
25 cm
Good & unlimited
4-8 cm
Can used in all type of
mandibular defects

Joint instability

Ideal with unlimited size for

skin island but skin is thick
-> Not suitable for ext facial
skin

Limited range of motion

& strength of shoulder

Unpleasant scar

Post op pain & stiffness

of shoulder

Bulky & limited in

mobility

Excellent blood supply for

intraoral lining

RECONSTRUCTION OF RAMUS & CONDYLAR

LATISSMUSS,
SERRATUS, PEDICLE RIB
Thoracodorsal artery, vein
& comitantes

Contour hip
deformity
Post-op pain ->
Delayed
mobilization
Gait disturbance
Inguinal hernia

Patthological radius fracture

(need long cast)
Disturbed sensation
Unpleasant scar

Limited range of
motion & strength of
shoulder
Unpleasant scar

METHOD: - Used titanium prosthesis condyle & attach to the end of bone flap
- Shaping the end of flap to function as condylar