title: Efficacy of distraction osteogenesis for mandibular reconstruction in previously irradiated areas: clinical experiences.
abstract: The efficacy of distraction osteogenesis in an irradiated area is controversial, although this procedure is now widely used in the field of craniomaxillofacial surgery. We report the clinical results from 4 patients with mandibular defects treated by lengthening of the irradiated mandibles. All patients had a mandibular defect caused by ablation of a malignant tumor. They had undergone radiotherapy at a total dose of 30 to 50 Gy to the surgical site after tumorectomy. Distraction osteogenesis was used as the secondary reconstruction method in 6 sites of the remaining irradiated mandibles and in 1 site of the transferred vascularized scapula after radiotherapy. The transported segment was obtained by corticotomy with an initial gap of 0 to 2 mm, and internal extension plates were used. Distraction was commenced after a latency period of 7 to 10 days and performed at the rate of 0.25 to 1.0 mm/d. The total amount of distraction and consolidation periods ranged from 15 to 25 mm and 120 to 193 days, respectively. In 5 of the 6 sites in the remaining irradiated mandibles, satisfactory bone formation in the distraction gap was observed, although a fracture after new bone formation was observed in 1 site. Fibrous callus formation was observed in 1 irradiated site only, and satisfactory results were obtained in another site of transferred vascularized scapula in the same patient. From these experiences, we believe that distraction may provide a reconstruction option for mandibular defects even under irradiated conditions because the procedure is simple and less invasive.
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Iwate Medical University, Faculty of Medicine, Morioka, Japan. kkashiwa@iwate-med.ac.jp
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Kashiwa
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Takaya
authors.initials: T
authors.lastname: Nohara
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Yasuoka
authors.forename: Yuko
authors.initials: Y
authors.lastname: Hosoya
authors.forename: Hitomi
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Takayuki
authors.initials: T
authors.lastname: Honda
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kimura
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016025:Bone Transplantation; D002146:Bony Callus / Q000473:pathology; D006801:Humans; D016268:Internal Fixators; D008334:Mandible / Q000473:pathology / Q000528:radiation effects / Q000601:surgery*; D008337:Mandibular Fractures / Q000209:etiology; D008339:Mandibular Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D008875:Middle Aged; D010012:Osteogenesis / Q000502:physiology; D019857:Osteogenesis, Distraction / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult