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Risk factors and surgical refinements of postresective mandibular reconstruction: a retrospective study.

Sakakibara A, Hashikawa K, Yokoo S, Sakakibara S, Komori T, Tahara S - Plast Surg Int (2014)

Bottom Line: Results.Radiation therapy and closure without any flaps were significantly related to infection or plate exposure.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan.

ABSTRACT
Background. Postresective mandibular reconstruction is common in cases of oral and mandibular tumors. However, complications such as infection, plate exposure, or plate fracture can occur. We identified several significant risk factors of complications after reconstructive surgery and compared the effectiveness of different surgical techniques for reducing the incidence of complications. Methods. This study is a retrospective analysis of 28 oromandibular cancer cases that required reconstructive surgery between January 1999 and December 2011 at Kobe University Graduate School of Medicine in Japan. All cases were classified using Hashikawa's CAT and Eichner's classification methods. Then, we determined whether these classifications and different treatment or surgical methods were significantly related to complications. Results. Complications after mandibular reconstruction occurred in 10/28 patients (36%). Specifically, five patients had plate fractures, four had plate exposures, and one had an infection. Radiation therapy and closure without any flaps were significantly related to infection or plate exposure. The wrap-around technique of securing reconstruction plates was used in 14 cases, whereas the run-through technique was used in two cases. Conclusions. The success of mandibular reconstruction depends on both mechanical and biological factors, such as the location of defects, presence of occlusions, and the amount of vascularization of the flap.

No MeSH data available.


Related in: MedlinePlus

Schematic representation of Eichner's index. Shaded teeth indicate occlusal contacts between natural teeth or fixed prostheses in the premolar and molar regions that constitute occlusal support zones (OSZs). Category A contains 4 OSZs. A1: complete dentition. A2: missing teeth in one arch. A3: missing teeth in both arches. Category B contains 1–3 OSZs or contacts in the anterior area only. B1: 3 OSZs. B2: 2 OSZs. B3: 1 OSZ. B4: contacts in the anterior area only. Category C does not have any OSZs. C1: teeth in both arches. C2: teeth in one arch. C3: edentulous.
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fig5: Schematic representation of Eichner's index. Shaded teeth indicate occlusal contacts between natural teeth or fixed prostheses in the premolar and molar regions that constitute occlusal support zones (OSZs). Category A contains 4 OSZs. A1: complete dentition. A2: missing teeth in one arch. A3: missing teeth in both arches. Category B contains 1–3 OSZs or contacts in the anterior area only. B1: 3 OSZs. B2: 2 OSZs. B3: 1 OSZ. B4: contacts in the anterior area only. Category C does not have any OSZs. C1: teeth in both arches. C2: teeth in one arch. C3: edentulous.

Mentions: For each case, we used two different classification systems, namely, Hashikawa's CAT classification and Eichner's index, to classify segmental mandibular defects and occlusal patterns, respectively. Although the HCL or Urken classification system [8, 9] is a well-known system for classifying mandibular defects, we used the CAT system because it is newer than the HCL system and is more suitable for classifying oncological segmental mandibular defects. In the CAT classification system [10] (Figure 4), “C” refers to defects in the condylar head of the mandible, “A” refers to defects in the mandibular angle, and “T” refers to defects in the mental tubercle. In Eichner's classification system [11] (Figure 5), patients are classified into one of six groups based on the presence or absence of occlusal contacts in the premolar and molar regions. After making these classifications, we examined whether radiotherapy or the type of musculocutaneous flaps used during reconstruction was related to the occurrence of infections or plate exposure. We also compared the effectiveness of the wrap-around and run-through techniques.


Risk factors and surgical refinements of postresective mandibular reconstruction: a retrospective study.

Sakakibara A, Hashikawa K, Yokoo S, Sakakibara S, Komori T, Tahara S - Plast Surg Int (2014)

Schematic representation of Eichner's index. Shaded teeth indicate occlusal contacts between natural teeth or fixed prostheses in the premolar and molar regions that constitute occlusal support zones (OSZs). Category A contains 4 OSZs. A1: complete dentition. A2: missing teeth in one arch. A3: missing teeth in both arches. Category B contains 1–3 OSZs or contacts in the anterior area only. B1: 3 OSZs. B2: 2 OSZs. B3: 1 OSZ. B4: contacts in the anterior area only. Category C does not have any OSZs. C1: teeth in both arches. C2: teeth in one arch. C3: edentulous.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4150385&req=5

fig5: Schematic representation of Eichner's index. Shaded teeth indicate occlusal contacts between natural teeth or fixed prostheses in the premolar and molar regions that constitute occlusal support zones (OSZs). Category A contains 4 OSZs. A1: complete dentition. A2: missing teeth in one arch. A3: missing teeth in both arches. Category B contains 1–3 OSZs or contacts in the anterior area only. B1: 3 OSZs. B2: 2 OSZs. B3: 1 OSZ. B4: contacts in the anterior area only. Category C does not have any OSZs. C1: teeth in both arches. C2: teeth in one arch. C3: edentulous.
Mentions: For each case, we used two different classification systems, namely, Hashikawa's CAT classification and Eichner's index, to classify segmental mandibular defects and occlusal patterns, respectively. Although the HCL or Urken classification system [8, 9] is a well-known system for classifying mandibular defects, we used the CAT system because it is newer than the HCL system and is more suitable for classifying oncological segmental mandibular defects. In the CAT classification system [10] (Figure 4), “C” refers to defects in the condylar head of the mandible, “A” refers to defects in the mandibular angle, and “T” refers to defects in the mental tubercle. In Eichner's classification system [11] (Figure 5), patients are classified into one of six groups based on the presence or absence of occlusal contacts in the premolar and molar regions. After making these classifications, we examined whether radiotherapy or the type of musculocutaneous flaps used during reconstruction was related to the occurrence of infections or plate exposure. We also compared the effectiveness of the wrap-around and run-through techniques.

Bottom Line: Results.Radiation therapy and closure without any flaps were significantly related to infection or plate exposure.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan.

ABSTRACT
Background. Postresective mandibular reconstruction is common in cases of oral and mandibular tumors. However, complications such as infection, plate exposure, or plate fracture can occur. We identified several significant risk factors of complications after reconstructive surgery and compared the effectiveness of different surgical techniques for reducing the incidence of complications. Methods. This study is a retrospective analysis of 28 oromandibular cancer cases that required reconstructive surgery between January 1999 and December 2011 at Kobe University Graduate School of Medicine in Japan. All cases were classified using Hashikawa's CAT and Eichner's classification methods. Then, we determined whether these classifications and different treatment or surgical methods were significantly related to complications. Results. Complications after mandibular reconstruction occurred in 10/28 patients (36%). Specifically, five patients had plate fractures, four had plate exposures, and one had an infection. Radiation therapy and closure without any flaps were significantly related to infection or plate exposure. The wrap-around technique of securing reconstruction plates was used in 14 cases, whereas the run-through technique was used in two cases. Conclusions. The success of mandibular reconstruction depends on both mechanical and biological factors, such as the location of defects, presence of occlusions, and the amount of vascularization of the flap.

No MeSH data available.


Related in: MedlinePlus