Fibula Onlay reconstruction of the severely atrophic mandible in a patient with chronic lymphocytic leukemia: Case report

Department of Oral and Maxillofacial Surgery, University of California, San Francisco, San Francisco, California, United States
Journal of Oral and Maxillofacial Surgery (Impact Factor: 1.28). 12/2007; 65(11):2367-71. DOI: 10.1016/j.joms.2006.05.048
Source: PubMed
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    ABSTRACT: Vastly different surgical techniques have been advocated for osseous reconstruction of the severely atrophic mandible. Endosseous implants placed in autologous bone grafts have been proposed to minimize graft resorption and restore function; however, sufficient bone must exist to support the implants and prevent pathologic fracture. The purpose of this retrospective analysis was to assess the efficacy of autologous bone grafting and the subsequent placement of endosteal implants as a staged procedure in patients with severely atrophic mandibles. The records of all patients presenting to The University of North Carolina for treatment from 1997 to 1999 with atrophic mandibles (vertical mandibular height <7 mm as measured on panoramic radiographs in at least 1 site at the mandibular midline and at the thinnest portion of the mandibular body) were reviewed. Bone height was assessed preoperatively, immediately postoperatively, at the time of implant placement (4 to 6 months), and again at 12 and 24 months after bone grafting from posterior iliac crest to the mandible via an extraoral approach. Five endosteal implants were subsequently placed in each patient as a delayed procedure 4 to 6 months after bone grafting, and prosthetic rehabilitation was completed with implant supported prostheses. Fourteen consecutive patients were identified with a median preoperative bone height of 9 mm (interquartile range, 25th to 75th percentile [IQ], 7 to 10 mm) in the mandibular midline and 5 mm (IQ, 2 to 5 mm) in the body region. There were no perioperative complications. Median estimated blood loss during the bone graft procedure, as estimated by the surgeon and the anesthesiologist, was 300 mL (IQ, 150 to 1,100 mL), and 1 patient required blood transfusion secondary to symptomatic anemia. The mean loss of vertical bone height after grafting and during the 4 to 6 months before implant placement was 33%. After implant placement and at 12 months, the vertical bone loss was negligible in the implant-supported region and less than 11% in the body region. Reconstruction of the severely atrophic mandible using autogenous corticocancellous bone grafts followed by placement of osseointegrated implants in 4 to 6 months can restore and maintain mandibular bone sufficient to support implants and facilitate successful restoration of occlusion. A prospective study is planned to identify predictors of successful outcomes compared with other surgical/prosthetic treatment.
    Journal of Oral and Maxillofacial Surgery 10/2002; 60(10):1135-41. DOI:10.1053/joms.2002.34986 · 1.28 Impact Factor
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    ABSTRACT: Fifty-eight patients (average age, 60 years) with gross mandibular atrophy had transmandibular implants inserted between 1984 and 1988. This study reports on their progress at 5 and 15 years. In both 1991 and 2000, 50 cases were reviewed, with the other 8 lost to follow-up. Detailed surveys, using exactly the same format, were conducted to determine the outcome of transmandibular implant treatment. The records were reviewed and surviving patients with transmandibular implants were examined. An overall success rate of 80% in 1991 had fallen to 56% by 2000, with a total of 22 implants being removed. Factors involved in failure were age and medical infirmity of the patients, gross mandibular atrophy, and the use of several surgeons, in particular, trainees. This survey shows that the TMI has a progressive long-term failure rate and that extreme care needs to be taken in both patient selection and implant placement.
    Journal of Oral and Maxillofacial Surgery 09/2002; 60(8):851-7. DOI:10.1053/joms.2002.33850 · 1.28 Impact Factor
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    ABSTRACT: Treatment of severe maxillary atrophy despite complex major surgery often ends up with an unsatisfactory result. This paper presents the augmentation of the maxilla with a prefabricated free vascularized fibula flap in combination with ITI implants (Straumann AG, Waldenburg, Switzerland) in 4 patients. The technique of prefabrication for the reconstruction of maxillofacial defects is described based on the experience with 17 patients. The key points of this treatment are i) preoperative planning and fabrication of the drilling template; ii) prefabrication of the fibula with ITI implants and performing of a 'vestibuloplasty" using a skin graft; iii) technical construction and fabrication of the suprastructure and the denture; iv) reconstruction of the maxilla using the prefabricated fibula as free vascularized flap. The reconstructions with the fibula flaps were successful and the 18 ITI implants that have been inserted showed good osseointegration without loss of attachment in all 4 patients after a mean observation period of 12 months.
    Clinical Oral Implants Research 03/2002; 13(1):44-52. DOI:10.1034/j.1600-0501.2002.130105.x · 3.12 Impact Factor
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