Distraction osteogenesis in secondary microsurgical mandible reconstruction: report of seven cases.
BACKGROUND
Fibula, ilium and scapula are the preferred donor areas for vascularised bone grafts. For secondary mandibular reconstruction, however, compromises often have to be made as a result of the poor quality of the covering soft tissue and recipient vessels especially in irradiated patients. Callus distraction osteogenesis is a complementary method for optimising the intermaxillary relationship and the facial profile from an aesthetic point of view.


METHODS
Thirteen distractions were performed in seven patients following microsurgical mandibular reconstruction over a period of 4 years, all by the same surgeon. Intra-oral distraction devices were predominantly applied. After a 7-day healing period, the callus distraction was begun, involving two advisements per day of 0.5mm each. The distraction devices were removed after a consolidation phase of 4-5 months.


RESULTS
Ten of the 13 distractions were uneventful with an average bone lengthening of 20mm, retained after a follow-up time of 6-47 months (average 27 months). The intermaxillary relationship and the facial profile were improved in all cases. Distraction plate fractures, screw loosening or absence of new bone formation were the complications encountered in the other three patients.


CONCLUSIONS
Regarding the high complication rate, a successful outcome cannot be expected with greater certainty. Thus the indication should be stringent when including this procedure within the possible treatment alternatives available to the clinician.
Li
Lei
L
Department of Oral and Maxillofacial Surgery, Medical Centre Oldenburg, Germany. evan_li@web.de
Blake
Felix
F
Gbara
Ali
A
Gudewer
Eva
E
Schmelzle
Rainer
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D016025:Bone Transplantation / Q000379:methods / Q000502:physiology; D002146:Bony Callus / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery*; D019186:Mandibular Advancement / Q000379:methods*; D008339:Mandibular Neoplasms / Q000534:rehabilitation* / Q000601:surgery; D008866:Microsurgery; D008875:Middle Aged; D019857:Osteogenesis, Distraction / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps / Q000098:blood supply