title: Classification of mandible defects and algorithm for microvascular reconstruction.
abstract: BACKGROUND
  Composite mandibular tissue loss results in significant functional impairment and cosmetic deformity. This study classifies patterns of mandibular composite tissue loss and describes a microvascular treatment algorithm.
  
  
  METHODS
  A retrospective review of microvascular composite mandibular reconstruction from July of 2005 to April of 2013 by the senior surgeon at the R Adams Cowley Shock Trauma Center and at The Johns Hopkins Hospital yielded 24 patients with a mean follow-up of 17.9 months. Causes of composite mandibular defects included tumors, osteoradionecrosis, trauma, infection, and congenital deformity. Patients with composite tissue loss were classified according to missing subunits.
  
  
  RESULTS
  A treatment algorithm based on composite mandibular defects and microvascular reconstruction was developed and used to treat 24 patients. A type 1 defect is a unilateral dentoalveolar defect not crossing the midline and not extending into the angle of the mandible. A type 2 defect is a unilateral defect extending beyond the angle. A type 3 defect is a bilateral defect not involving the angles. A type 4 defect is a bilateral defect with extension into at least one angle. Type 2 defects were the predominant group. Patients had microvascular reconstruction using either fibula flaps (n = 19) or iliac crest flaps (n = 5). Complications included infection, partial necrosis, plate fracture, dehiscence, and microvascular thrombosis.
  
  
  CONCLUSIONS
  This novel classification system and treatment algorithm allows for a consistent and reliable method of addressing composite mandibular defects and focuses on recipient vasculature and donor free flap characteristics.
authors: Baltimore, Md.; and New York, N.Y. From the Division of Plastic, Reconstructive and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center; the Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine; the University of Maryland School of Medicine; and the Department of Plastic Surgery, New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery.
authors: Benjamin D
authors: BD
authors: Schultz
authors: Michael
authors: M
authors: Sosin
authors: Arthur
authors: A
authors: Nam
authors: Raja
authors: R
authors: Mohan
authors: Peter
authors: P
authors: Zhang
authors: Saami
authors: S
authors: Khalifian
authors: Neil
authors: N
authors: Vranis
authors: Paul N
authors: PN
authors: Manson
authors: Branko
authors: B
authors: Bojovic
authors: Eduardo D
authors: ED
authors: Rodriguez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery*; D055806:Microvessels / Q000601:surgery*; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps; D055815:Young Adult