Mandibular reconstruction with iliac crest free flap, nasolabial flap, and osseointegrated implants.
OBJECTIVE
Oncologic patients undergoing segmental mandibulectomy with soft tissue resection develop several esthetic and functional sequelae; therefore, the defect must be reconstructed immediately. The iliac crest flap is the only flap that allows reconstruction of the previous dimensions of the mandible. However, the excessive soft tissue of this flap prevents optimal reconstruction of intraoral soft tissue defects.


METHODS
This report describes a reconstructive technique used in 12 patients who underwent segmental mandibulectomy because of soft tissue defects resulting from tumor resection. The technique involves reconstruction of the mandible using an iliac crest flap combined with a nasolabial flap to enable subsequent reconstruction of the intraoral soft tissue and immediate placement of osseointegrated implants.


RESULTS
The osseointegration success rate was 95.2% with a failure rate of 4.8%. Failure particularly affected the irradiated patients. Excellent functional and aesthetic results were obtained with the iliac crest free flap, nasolabial flap and osseointegrated dental implants.


CONCLUSIONS
This technique has several advantages. On the one hand, it enables reconstruction of the original dimensions of the mandible, thus allowing immediate placement of implants in an ideal position for subsequent rehabilitation with a dental prosthesis. On the other hand, the nasolabial flap provides a thin layer of tissue that can be used to reconstruct the anatomy of the oromandibular soft tissue.
Associate Professor, Maxillofacial Surgery, Complutense University Medical School, Madrid, Spain; Staff Member, Oral and Maxillofacial Department, Gregorio Marañón General Hospital, Madrid, Spain. Electronic address: cnavarrocuellar@gmail.com.
Carlos
C
Navarro Cuellar
Staff Member, Oral and Maxillofacial Department, Gregorio Marañón General Hospital, Madrid, Spain.
Santiago José Ochandiano
SJ
Caicoya
Head, Oral and Maxillofacial Department, Ramón y Cajal Hospital, Madrid, Spain.
Julio Jesús
JJ
Acero Sanz
Staff Member, Oral and Maxillofacial Department, Virgen de la Salud Hospital, Toledo, Spain.
Ignacio
I
Navarro Cuellar
Staff Member, Oral and Maxillofacial Department, Gregorio Marañón General Hospital, Madrid, Spain.
Cristina Maza
CM
Muela
Full Professor, Maxillofacial Surgery, Complutense University Medical School, Madrid, Spain; Head and Chair, Oral and Maxillofacial Department, Gregorio Marañón General Hospital, Madrid, Spain.
Carlos
C
Navarro Vila
D000328:Adult; D000368:Aged; D016025:Bone Transplantation / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D015921:Dental Implants; D005260:Female; D058752:Free Tissue Flaps / Q000637:transplantation*; D005887:Gingival Neoplasms / Q000601:surgery; D006801:Humans; D007085:Ilium / Q000601:surgery; D008297:Male; D008339:Mandibular Neoplasms / Q000601:surgery; D063168:Mandibular Osteotomy / Q000379:methods; D063175:Mandibular Reconstruction / Q000379:methods*; D008875:Middle Aged; D009060:Mouth Floor / Q000601:surgery; D009062:Mouth Neoplasms / Q000601:surgery; D016348:Osseointegration / Q000502:physiology*; D018714:Radiotherapy, Adjuvant; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps / Q000601:surgery*; D060053:Transplant Donor Site / Q000601:surgery; D016896:Treatment Outcome
D015921:Dental Implants