Contemporary reconstruction of the mandible.
Reconstruction of the mandible has evolved significantly over the last 40years. Early attempts were often disfiguring and wrought with complications but with the introduction of free tissue transfer of well vascularized bone in the 1970's there was a significant improvement in outcomes. In recent years the harvest, inset, and microvascular anatomosis have been refined to the point that success rates are reported as high as 99% throughout the literature. Focus has now shifted to optimizing functional and aesthetic outcomes after mandible reconstruction. This paper will be a review defect classification, goals of reconstruction, the various donor sites, dental rehabilitation, new advances, and persistent problems. Reconstruction of segmental mandibular defects after ablative surgery is best accomplished using free tissue transfer to restore mandibular continuity and function. Reestablishing occlusion and optimizing tongue mobility are important to post-operative oral function. Persistent problems in oro-mandibular reconstruction relate to the effects of radiation treatment on the native tissue and include xerostomia, dysgeusia, osteoradionecrosis and trismus. These problems continue to plague the oral cancer patient despite the significant advances that allow a far more complete functional restoration than could be accomplished a mere two decades ago.
Bak
Mathew
M
Department of Otolaryngology-Head and Neck Surgery, Beth Israel Medical Center, Albert Einstein College of Medicine, New York, NY, USA.
Jacobson
Adam S
AS
Buchbinder
Daniel
D
Urken
Mark L
ML
D016025:Bone Transplantation / Q000379:methods* / Q000639:trends; D015921:Dental Implants; D004954:Esthetics; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible / Q000098:blood supply / Q000601:surgery*; D008339:Mandibular Neoplasms / Q000098:blood supply / Q000532:radiotherapy / Q000601:surgery*; D008833:Microcirculation / Q000502:physiology; D019651:Plastic Surgery Procedures / Q000379:methods* / Q000639:trends; D013524:Surgical Flaps / Q000098:blood supply; D016896:Treatment Outcome
D015921:Dental Implants