Enhancement of the fibula free flap by alveolar distraction for dental implant restoration: report of a case.
We describe the utilization of distraction osteogenesis in the free fibular microvascular bone graft to the mandible for increasing bone height for future osseointegrated dental implants. Successful reconstruction of a resected mandible requires restoration of both function and esthetic form. Although current reconstructive techniques restore anterior-posterior and lateral projection, often the graft's vertical height is not sufficient for the placement of osseointegrated dental implants and subsequent oral prosthesis. The patient was a sixteen-year-old male who was found to have a large desmoplastic fibroma of the left mandible, which was resected. The defect was successfully restored with a free fibular microvascular bone graft and reconstruction plate. Nevertheless, the patient had persistent problems with mastication and it was decided to perform a segmental osteotomy of the neomandible. Two internal vertical distraction devices were then placed in the mandible. The appliances were then activated five days postoperative, twice a day, for a total of 14 days. At that time 1.5 cm of distraction had occurred and the patient was placed in a consolidation phase for four months. The patient then had sufficient bone height and was restored with 8 osseointegrated dental implants.
University of Pennsylvania Hospital, Department of Oral and Maxillofacial Surgery, Philadelphia 19104, USA.
Lawrence
L
Levin
Lee
L
Carrasco
Amin
A
Kazemi
Ara
A
Chalian
D000293:Adolescent; D000540:Alveolar Ridge Augmentation / Q000379:methods*; D001860:Bone Plates; D016025:Bone Transplantation / Q000379:methods*; D003758:Dental Implantation, Endosseous; D018220:Fibroma, Desmoplastic / Q000534:rehabilitation / Q000601:surgery*; D005360:Fibula / Q000601:surgery; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery*; D008339:Mandibular Neoplasms / Q000534:rehabilitation / Q000601:surgery*; D008341:Mandibular Prosthesis; D019857:Osteogenesis, Distraction / Q000379:methods*; D013524:Surgical Flaps