title: Interim reconstruction and space maintenance of mandibular continuity defects preceding definitive osseous reconstruction.
abstract: The use of space maintenance in mandibular defects as an interim measure before definitive osseous reconstruction may prevent problems associated with delayed reconstruction including increased technical difficulty, contracture of soft tissues that limits the volume of the final reconstruction, and the potential for iatrogenic injury to adjacent anatomical structures. The use of a condyle/ramus spacer made of medical grade, ultrahigh-molecular-weight polyethylene, and a flexible body spacer made of high quality, inert, non-toxic medical and food grade silicone rubber, was tested in 38 patients with mandibular defects after the resection of benign but locally aggressive disease, advanced osteomyelitis, and injuries. The spacer was retained for a maximum of 8 weeks, and was then removed through an extraoral approach before definitive reconstruction with a particulate corticocancellous bone graft. One of the 38 patients failed to attend for follow up and returned 7 months later with severe, generalised sepsis that required removal of the spacer and exclusion from the study. Of the remaining 37 patients, 32 healed uneventfully, 1 required removal of the spacer 2 weeks after implantation for intraoral wound dehiscence, and 4 had mild to moderate disturbances of wound healing that required either minor revision or local wound care until removal at the time of reconstruction. The use of a spacer promotes wound healing and simplifies and expedites secondary reconstruction of mandibular defects.
authors: Division of Maxillofacial & Oral Surgery, Chris Hani Baragwanath Hospital & University of the Witwatersrand, Johannesburg, South Africa. ferretti@mweb.co.za
authors: Carlo
authors: C
authors: Ferretti
authors: Ephraim
authors: E
authors: Rikhotso
authors: Enesh
authors: E
authors: Muthray
authors: Johan
authors: J
authors: Reyneke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016025:Bone Transplantation / Q000379:methods; D002648:Child; D017076:Computer-Aided Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D008334:Mandible / Q000601:surgery; D008335:Mandibular Condyle / Q000601:surgery; D008336:Mandibular Diseases / Q000601:surgery; D008338:Mandibular Injuries / Q000601:surgery; D008339:Mandibular Neoplasms / Q000601:surgery; D008341:Mandibular Prosthesis; D019930:Mandibular Prosthesis Implantation / Q000379:methods; D063175:Mandibular Reconstruction / Q000295:instrumentation* / Q000379:methods; D008875:Middle Aged; D010019:Osteomyelitis / Q000601:surgery; D010347:Patient Care Planning; D011095:Polyethylenes / Q000627:therapeutic use; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods*; D012826:Silicone Elastomers / Q000627:therapeutic use; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D014584:User-Computer Interface; D055815:Young Adult
chemical_list: D011095:Polyethylenes; D012826:Silicone Elastomers; C111601:ultra-high molecular weight polyethylene