Oromandibular reconstruction using a fibula osteocutaneous free flap: four different "preplating" techniques.
BACKGROUND
The aim of oromandibular reconstruction following a partially or fully extended resection is to recreate the normal morphology with a mandibular profile as similar as possible to the original and to restore oral function. Oromandibular reconstruction can be performed with fibula osteocutaneous free flaps combined with the preplating technique. The authors report their experience using the preplating technique for oromandibular reconstruction.


METHODS
Four different methods can be used to mold the titanium plate that will be used in reconstruction against the existing mandible before resection. The preplating technique was used in 18 patients between 1998 and 2003. In eight patients, the external cortical bone of the mandible was spared by the tumor and the vestibular preplating technique was used. In one patient, the internal cortical bone was unaffected and the lingual preplating technique was used. When the tumor affected both the internal and external cortical bones, the double preplating technique was adopted in eight cases and Luhr's approach was used in one case.


RESULTS
A good cosmetic appearance was obtained through the accurate reconstruction of the inferior mandibular border. Mandible continuity was restored, and the masticatory and oral muscles were anchored to the titanium plate, resulting in good occlusal and functional rehabilitation.


CONCLUSIONS
The preplating technique combined with a fibula microvascular free flap is a useful, predictable method for oromandibular reconstruction.
Marchetti
Claudio
C
Department of Maxillofacial Surgery, S. Orsola Hospital, Bologna, Italy. claudio.marchetti@bo.nettuno.it
Bianchi
Alberto
A
Mazzoni
Simona
S
Cipriani
Riccardo
R
Campobassi
Angelo
A
D000293:Adolescent; D000328:Adult; D001860:Bone Plates; D001863:Bone Screws; D003528:Carcinoma, Adenoid Cystic / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D002508:Cephalometry; D004954:Esthetics; D005354:Fibrosarcoma / Q000601:surgery; D005360:Fibula / Q000098:blood supply / Q000637:transplantation*; D006801:Humans; D019248:Jaw Fixation Techniques / Q000295:instrumentation*; D008228:Lymphoma, Non-Hodgkin / Q000601:surgery; D008297:Male; D008336:Mandibular Diseases / Q000601:surgery; D008339:Mandibular Neoplasms / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology / Q000601:surgery*; D009361:Neoplasm Invasiveness; D010000:Osteitis / Q000601:surgery; D012516:Osteosarcoma / Q000601:surgery; D010027:Osteotomy; D019651:Plastic Surgery Procedures; D013524:Surgical Flaps / Q000098:blood supply; D016042:Transplantation, Heterotopic