Secondary Mandibular Reconstruction After Oral Squamous Cell Carcinoma Resection: Clinical Reevaluation of Transport Disk Distraction Osteogenesis

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Abstract

Besides bone grafting, transport disk distraction osteogenesis (TDDO) is an alternative approach that can be used for the reconstruction of the mandibular arch after neoplastic surgery. Although several animal experiments are reporting about the applicability of this technique, little is known about its long-term success in human beings. In this study, we report about the successful treatment of patients with defects of their mandibular arch due to tumor resection by means of the external bifocal TDDO. A total of 7 patients (n = 3 with lateral, n = 4 with anterior defects) were followed up for a mean period of 56 months. Although neither adjuvant nor neoadjuvant chemotherapy negatively influenced callus formation, prereconstructive radiation with a dose of 51 Gy led to an insufficient callus formation. The reconstruction of anterior defects was unsatisfying because tensions from the soft tissue on the fragile and rubber-like callus negatively influenced the natural arch shaping.

In these cases, additional surgery was often required. However, reconstruction of lateral defects of the mandibular arch was more successful and resulted in functional bone with good quality, in which dental implants could be inserted. The results of this study emphasize that TDDO by means of bifocal distraction provides functional bone comparable to residual bone.

Lateral defects of mandibular arch can be better reconstructed, whereas anterior defects often require additional surgery.

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