TY - JOUR
T1 - Reconstruction of Posterior Mandibulectomy Defects in the Modern Era of Virtual Planning and Three-Dimensional Modeling
AU - Chang, Edward I.
AU - Boukovalas, Stefanos
AU - Liu, Jun
AU - Largo, Rene D.
AU - Hanasono, Matthew M.
AU - Garvey, Patrick B.
N1 - Publisher Copyright:
© 2019 American Society of Plastic Surgeons.
PY - 2019/9/1
Y1 - 2019/9/1
N2 - Background: Posterior mandibulectomy defects can be reconstructed using either soft tissue or vascularized bone. The authors hypothesize that advances in computer-aided design and manufacturing (CAD-CAM) have resulted in osteocutaneous free flaps now proving superior to soft-tissue flaps. Methods: The authors conducted a retrospective review of all free flap reconstructions of posterior mandibulectomy defects where the condyle was resected from 2005 to 2016. Results: Overall, 291 patients (mean age, 56.9 years; mean body mass index, 26.2 kg/m2) underwent posterior mandible reconstruction with 169 soft-tissue flaps and 122 osteocutaneous free flaps (90 free-hand versus 32 CAD-CAM). Forty patients (13.7 percent) required two free flaps to reconstruct the defect, most commonly a fibula osteocutaneous flap for the mandibulectomy defect and a soft-tissue flap for external coverage. Postoperatively, there were no differences in the incidence of trismus between soft-tissue versus vascularized bone flaps; however, malocclusion was most common in patients with soft-tissue flaps (p < 0.001). Patients with CAD-CAM bone reconstruction experienced significantly less malocclusion (p < 0.001), were more likely to progress to a regular diet (p = 0.001), and trended to having superior speech (p = 0.057) compared with the other cohorts. There were six total flap losses, with no difference between soft-tissue and bony flaps. Conclusions: Although reconstruction of posterior mandibulectomy defects should be based on the patient's comorbidities, surgeon comfort, and available resources, patients undergoing reconstruction of posterior mandibulectomy defects reconstructed with CAD-CAM-assisted fibulas experienced superior postoperative function compared with soft-tissue flaps or free-hand fibula flaps. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
AB - Background: Posterior mandibulectomy defects can be reconstructed using either soft tissue or vascularized bone. The authors hypothesize that advances in computer-aided design and manufacturing (CAD-CAM) have resulted in osteocutaneous free flaps now proving superior to soft-tissue flaps. Methods: The authors conducted a retrospective review of all free flap reconstructions of posterior mandibulectomy defects where the condyle was resected from 2005 to 2016. Results: Overall, 291 patients (mean age, 56.9 years; mean body mass index, 26.2 kg/m2) underwent posterior mandible reconstruction with 169 soft-tissue flaps and 122 osteocutaneous free flaps (90 free-hand versus 32 CAD-CAM). Forty patients (13.7 percent) required two free flaps to reconstruct the defect, most commonly a fibula osteocutaneous flap for the mandibulectomy defect and a soft-tissue flap for external coverage. Postoperatively, there were no differences in the incidence of trismus between soft-tissue versus vascularized bone flaps; however, malocclusion was most common in patients with soft-tissue flaps (p < 0.001). Patients with CAD-CAM bone reconstruction experienced significantly less malocclusion (p < 0.001), were more likely to progress to a regular diet (p = 0.001), and trended to having superior speech (p = 0.057) compared with the other cohorts. There were six total flap losses, with no difference between soft-tissue and bony flaps. Conclusions: Although reconstruction of posterior mandibulectomy defects should be based on the patient's comorbidities, surgeon comfort, and available resources, patients undergoing reconstruction of posterior mandibulectomy defects reconstructed with CAD-CAM-assisted fibulas experienced superior postoperative function compared with soft-tissue flaps or free-hand fibula flaps. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
UR - http://www.scopus.com/inward/record.url?scp=85071608102&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85071608102&partnerID=8YFLogxK
U2 - 10.1097/PRS.0000000000005954
DO - 10.1097/PRS.0000000000005954
M3 - Article
C2 - 31461040
AN - SCOPUS:85071608102
SN - 0032-1052
VL - 144
SP - 453e-462e
JO - Plastic and reconstructive surgery
JF - Plastic and reconstructive surgery
IS - 3
ER -