Skip to main content

Mandibular Reconstruction

  • Chapter
  • First Online:
  • 1962 Accesses

Abstract

Patients with mandibular defects suffer from functional and esthetic problems that have significant effects on the quality of life. Reestablishing form and function is the main goal of reconstructive mandibular surgery. This chapter will discuss a step-by-step approach to contemporary mandibular reconstruction.

This is a preview of subscription content, log in via an institution.

References

  1. Pogrel MA. Who was Andy Gump? J Oral Maxillofac Surg. 2010;68(3):654–7.

    PubMed  Google Scholar 

  2. Steckler RM, Edgerton MT, Gogel W. Andy Gump. Am J Surg. 1974;128(4):545–7.

    CAS  PubMed  Google Scholar 

  3. Whymper W. The gunner with the silver mask: being an extraordinary case of extensive destruction of the lower jaw by a shell, vol. 12. London: Medical Gazette; 1833. p. 705–9.

    Google Scholar 

  4. Kaufman MH, McTavish J, Mitchell R. The gunner with the silver mask: observations on the management of severe maxillo-facial lesions over the last 160 years. J R Coll Surg Edinb. 1997;42(6):367–75.

    CAS  PubMed  Google Scholar 

  5. Ballingall SG. Cases and communications illustrative of subjects in military and naval surgery. Edinb Med Surg J. 1842;57:116–21.

    PubMed  PubMed Central  Google Scholar 

  6. Gillies HD. Plastic surgery of the face based on selected cases of war injuries of the face including burns. London: Henry Frowde Oxford University Press, Hodder & Stoughton; 1920.

    Google Scholar 

  7. Ivy RH, Epes BM. Bone grafting for defects of the mandible. Mil Surgeon. 1927;60:286.

    Google Scholar 

  8. Adams WM. Internal wiring fixation of facial fractures. Surgery. 1942;12:523–40.

    Google Scholar 

  9. Blocker Jr TG, Stout RA. Mandibular reconstruction, World War II. Plast Reconstr Surg (1946). 1949;4(2):153–6.

    Google Scholar 

  10. Siemssen SO, Kirkby B, O’Connor TP. Immediate reconstruction of a resected segment of the lower jaw, using a compound flap of clavicle and sternomastoid muscle. Plast Reconstr Surg. 1978;61(5):724–35.

    CAS  PubMed  Google Scholar 

  11. Gullane PJ, Holmes H. Mandibular reconstruction. New concepts. Arch Otolaryngol Head Neck Surg. 1986;112(7):714–9.

    CAS  PubMed  Google Scholar 

  12. Ivy RH. Bone grafting for restoration of defects of the mandible. Plast Reconstr Surg (1946). 1951;7(4):333–41.

    CAS  Google Scholar 

  13. Seward GR. A method of replacing the anterior part of the mandible by a bone graft. Br J Oral Surg. 1967;5(2):99–105.

    CAS  PubMed  Google Scholar 

  14. Millard DR, et al. Interim report on immediate mandibular repair. Am J Surg. 1969;118(5):726–31.

    CAS  PubMed  Google Scholar 

  15. Anlyan AJ. Immediate reconstruction of mandibular defects with autogenous bone chip grafts. Am J Surg. 1965;110(4):564–7.

    CAS  PubMed  Google Scholar 

  16. Wersall J, et al. Split-rib graft for reconstruction of the mandible. Otolaryngol Head Neck Surg. 1984;92(3):271–6.

    CAS  PubMed  Google Scholar 

  17. Schrag C, et al. Complete rehabilitation of the mandible following segmental resection. J Surg Oncol. 2006;94(6):538–45.

    PubMed  Google Scholar 

  18. Disa JJ, Cordeiro PG. Mandible reconstruction with microvascular surgery. Semin Surg Oncol. 2000;19(3):226–34.

    CAS  PubMed  Google Scholar 

  19. Spiessl B. New concepts in maxillofacial bone surgery. Anatomic reconstruction and functional rehabilitation of mandibular defects after ablative surgery. In: Spiessl B, Schmoker R, editors. New concepts in maxillofacial bone surgery. Berlin/Heidelberg: Springer; 1976.

    Google Scholar 

  20. Lavertu P, et al. The AO system for primary mandibular reconstruction. Am J Surg. 1994;168(5):503–7.

    CAS  PubMed  Google Scholar 

  21. Chow JM, Hill JH. Primary mandibular reconstruction using the AO reconstruction plate. Laryngoscope. 1986;96(7):768–73.

    CAS  PubMed  Google Scholar 

  22. Komisar A, et al. The use of osteosynthesis in immediate and delayed mandibular reconstruction. Laryngoscope. 1985;95(11):1363–6.

    CAS  PubMed  Google Scholar 

  23. Wei FC, et al. Complications after reconstruction by plate and soft-tissue free flap in composite mandibular defects and secondary salvage reconstruction with osteocutaneous flap. Plast Reconstr Surg. 2003;112(1):37–42.

    PubMed  Google Scholar 

  24. Spencer KR, et al. The use of titanium mandibular reconstruction plates in patients with oral cancer. Int J Oral Maxillofac Surg. 1999;28(4):288–90.

    CAS  PubMed  Google Scholar 

  25. Kim MR, Donoff RB. Critical analysis of mandibular reconstruction using AO reconstruction plates. J Oral Maxillofac Surg. 1992;50(11):1152–7.

    CAS  PubMed  Google Scholar 

  26. Schusterman MA, et al. Use of the AO plate for immediate mandibular reconstruction in cancer patients. Plast Reconstr Surg. 1991;88(4):588–93.

    CAS  PubMed  Google Scholar 

  27. Tidstrom KD, Keller EE. Reconstruction of mandibular discontinuity with autogenous iliac bone graft: report of 34 consecutive patients. J Oral Maxillofac Surg. 1990;48(4):336–46; discussion 347.

    CAS  PubMed  Google Scholar 

  28. Foster RD, et al. Vascularized bone flaps versus nonvascularized bone grafts for mandibular reconstruction: an outcome analysis of primary bony union and endosseous implant success. Head Neck. 1999;21(1):66–71.

    CAS  PubMed  Google Scholar 

  29. Conley J. Use of composite flaps containing bone for major repairs in the head and neck. Plast Reconstr Surg. 1972;49(5):522–6.

    CAS  PubMed  Google Scholar 

  30. Taylor GI, Miller GD, Ham FJ. The free vascularized bone graft. A clinical extension of microvascular techniques. Plast Reconstr Surg. 1975;55(5):533–44.

    CAS  PubMed  Google Scholar 

  31. Taylor GI, Townsend P, Corlett R. Superiority of the deep circumflex iliac vessels as the supply for free groin flaps. Plast Reconstr Surg. 1979;64(5):595–604.

    CAS  PubMed  Google Scholar 

  32. Sanders R, Mayou BJ. A new vascularized bone graft transferred by microvascular anastomosis as a free flap. Br J Surg. 1979;66(11):787–8.

    CAS  PubMed  Google Scholar 

  33. Swartz WM, et al. The osteocutaneous scapular flap for mandibular and maxillary reconstruction. Plast Reconstr Surg. 1986;77(4):530–45.

    CAS  PubMed  Google Scholar 

  34. Hidalgo DA. Fibula free flap: a new method of mandible reconstruction. Plast Reconstr Surg. 1989;84(1):71–9.

    CAS  PubMed  Google Scholar 

  35. Bak M, et al. Contemporary reconstruction of the mandible. Oral Oncol. 2010;46(2):71–6.

    PubMed  Google Scholar 

  36. Cordeiro PG, et al. Reconstruction of the mandible with osseous free flaps: a 10-year experience with 150 consecutive patients. Plast Reconstr Surg. 1999;104(5):1314–20.

    CAS  PubMed  Google Scholar 

  37. Hidalgo DA, Pusic AL. Free-flap mandibular reconstruction: a 10-year follow-up study. Plast Reconstr Surg. 2002;110(2):438–49; discussion 450–1.

    PubMed  Google Scholar 

  38. Urken ML, et al. Oromandibular reconstruction using microvascular composite flaps: report of 210 cases. Arch Otolaryngol Head Neck Surg. 1998;124(1):46–55.

    CAS  PubMed  Google Scholar 

  39. Slaughter DP, Roeser EH, Smejkal WF. Excision of the mandible for neoplastic diseases; indications and techniques. Surgery. 1949;26(3):507–22.

    CAS  PubMed  Google Scholar 

  40. Ward GE, Robben JO. A composite operation for radical neck dissection and removal of cancer of the mouth. Cancer. 1951;4(1):98–109.

    CAS  PubMed  Google Scholar 

  41. Gurtner GC, Evans GR. Advances in head and neck reconstruction. Plast Reconstr Surg. 2000;106(3):672–82; quiz 683.

    CAS  PubMed  Google Scholar 

  42. David DJ, et al. Mandibular reconstruction with vascularized iliac crest: a 10-year experience. Plast Reconstr Surg. 1988;82(5):792–803.

    CAS  PubMed  Google Scholar 

  43. Boyd JB, et al. Classification of mandibular defects. Plast Reconstr Surg. 1993;92(7):1266–75.

    CAS  PubMed  Google Scholar 

  44. Blackwell KE, Buchbinder D, Urken ML. Lateral mandibular reconstruction using soft-tissue free flaps and plates. Arch Otolaryngol Head Neck Surg. 1996;122(6):672–8.

    CAS  PubMed  Google Scholar 

  45. Deleyiannis FW, et al. Reconstruction of the marginal mandibulectomy defect: an update. Am J Otolaryngol. 2007;28(6):363–6.

    PubMed  Google Scholar 

  46. Jewer DD, et al. Orofacial and mandibular reconstruction with the iliac crest free flap: a review of 60 cases and a new method of classification. Plast Reconstr Surg. 1989;84(3):391–403; discussion 404–5.

    CAS  PubMed  Google Scholar 

  47. Urken ML, et al. Oromandibular reconstruction using microvascular composite free flaps. Report of 71 cases and a new classification scheme for bony, soft-tissue, and neurologic defects. Arch Otolaryngol Head Neck Surg. 1991;117(7):733–44.

    CAS  PubMed  Google Scholar 

  48. Wei FC, et al. Double free flaps in reconstruction of extensive composite mandibular defects in head and neck cancer. Plast Reconstr Surg. 1999;103(1):39–47.

    CAS  PubMed  Google Scholar 

  49. Boyd JB, et al. The free flap and plate in oromandibular reconstruction: long-term review and indications. Plast Reconstr Surg. 1995;95(6):1018–28.

    CAS  PubMed  Google Scholar 

  50. Head C, et al. Microvascular flap reconstruction of the mandible: a comparison of bone grafts and bridging plates for restoration of mandibular continuity. Otolaryngol Head Neck Surg. 2003;129(1):48–54.

    PubMed  Google Scholar 

  51. Urken ML, et al. The internal oblique-iliac crest osseomyocutaneous microvascular free flap in head and neck reconstruction. J Reconstr Microsurg. 1989;5(3):203–14; discussion 215–6.

    CAS  PubMed  Google Scholar 

  52. Urken ML, et al. The internal oblique-iliac crest osseomyocutaneous free flap in oromandibular reconstruction. Report of 20 cases. Arch Otolaryngol Head Neck Surg. 1989;115(3):339–49.

    CAS  PubMed  Google Scholar 

  53. Urken ML, et al. The combined sensate radical forearm and iliac crest free flaps for reconstruction of significant glossectomy-mandibulectomy defects. Laryngoscope. 1992;102(5):543–58.

    CAS  PubMed  Google Scholar 

  54. Gibber MJ, et al. Subscapular system of flaps: an 8-year experience with 105 patients. Head Neck. 2014;37(8):1200–6.

    PubMed  Google Scholar 

  55. Zlotolow IM, et al. Osseointegrated implants and functional prosthetic rehabilitation in microvascular fibula free flap reconstructed mandibles. Am J Surg. 1992;164(6):677–81.

    CAS  PubMed  Google Scholar 

  56. Wei FC, et al. Fibula osteoseptocutaneous flap for reconstruction of composite mandibular defects. Plast Reconstr Surg. 1994;93(2):294–304; discussion 305–6.

    CAS  PubMed  Google Scholar 

  57. Wei FC, Chuang SS, Yim KK. The sensate fibula osteoseptocutaneous flap: a preliminary report. Br J Plast Surg. 1994;47(8):544–7.

    CAS  PubMed  Google Scholar 

  58. O’Leary MJ, Martin PJ, Hayden RE. The neurocutaneous free fibula flap in mandibular reconstruction. Otolaryngol Clin North Am. 1994;27(6):1081–96.

    PubMed  Google Scholar 

  59. Kuo YR, et al. Free fibula osteocutaneous flap with soleus muscle as a chimeric flap for reconstructing mandibular segmental defect after oral cancer ablation. Ann Plast Surg. 2010;64(6):738–42.

    CAS  PubMed  Google Scholar 

  60. Beppu M, et al. The osteocutaneous fibula flap: an anatomic study. J Reconstr Microsurg. 1992;8(3):215–23.

    CAS  PubMed  Google Scholar 

  61. Wei FC, et al. Fibular osteoseptocutaneous flap: anatomic study and clinical application. Plast Reconstr Surg. 1986;78(2):191–200.

    CAS  PubMed  Google Scholar 

  62. Wong CH, et al. Use of the soleus musculocutaneous perforator for skin paddle salvage of the fibula osteoseptocutaneous flap: anatomical study and clinical confirmation. Plast Reconstr Surg. 2007;120(6):1576–84.

    CAS  PubMed  Google Scholar 

  63. Frodel Jr JL, et al. Osseointegrated implants: a comparative study of bone thickness in four vascularized bone flaps. Plast Reconstr Surg. 1993;92(3):449–55; discussion 456–8.

    PubMed  Google Scholar 

  64. Rodriguez ED, et al. Near-total mandible reconstruction with a single fibula flap containing fibrous dysplasia in McCune Albright Syndrome. J Craniofac Surg. 2007;18(6):1479–82.

    PubMed  Google Scholar 

  65. Moscoso JF, et al. Vascularized bone flaps in oromandibular reconstruction. A comparative anatomic study of bone stock from various donor sites to assess suitability for endosseous dental implants. Arch Otolaryngol Head Neck Surg. 1994;120(1):36–43.

    CAS  PubMed  Google Scholar 

  66. Jones NF, et al. The “double barrel” free vascularized fibular bone graft. Plast Reconstr Surg. 1988;81(3):378–85.

    CAS  PubMed  Google Scholar 

  67. Wallace CG, et al. Harnessing the potential of the free fibula osteoseptocutaneous flap in mandible reconstruction. Plast Reconstr Surg. 2010;125(1):305–14.

    CAS  PubMed  Google Scholar 

  68. Horiuchi K, et al. Mandibular reconstruction using the double barrel fibular graft. Microsurgery. 1995;16(7):450–4.

    CAS  PubMed  Google Scholar 

  69. Iizuka T, et al. Bi-directional distraction osteogenesis of the alveolar bone using an extraosseous device. Clin Oral Implants Res. 2005;16(6):700–7.

    PubMed  Google Scholar 

  70. Schleier P, et al. Vertical distraction of fibula transplant in a case of mandibular defect caused by shotgun injury. Int J Oral Maxillofac Surg. 2006;35(9):861–4.

    CAS  PubMed  Google Scholar 

  71. Bodde EW, et al. Donor-site morbidity after free vascularized autogenous fibular transfer: subjective and quantitative analyses. Plast Reconstr Surg. 2003;111(7):2237–42.

    PubMed  Google Scholar 

  72. Sassu P, et al. Anatomy and vascularization of the flexor hallucis longus muscle and its implication in free fibula flap transfer: an anatomical study. Ann Plast Surg. 2010;64(2):233–7.

    CAS  PubMed  Google Scholar 

  73. Babovic S, Johnson CH, Finical SJ. Free fibula donor-site morbidity: the Mayo experience with 100 consecutive harvests. J Reconstr Microsurg. 2000;16(2):107–10.

    CAS  PubMed  Google Scholar 

  74. Boyd JB, Mulholland RS. Fixation of the vascularized bone graft in mandibular reconstruction. Plast Reconstr Surg. 1993;91(2):274–82.

    CAS  PubMed  Google Scholar 

  75. Shaw RJ, et al. Comparison of miniplates and reconstruction plates in mandibular reconstruction. Head Neck. 2004;26(5):456–63.

    PubMed  Google Scholar 

  76. Futran ND, et al. Rigid fixation of vascularized bone grafts in mandibular reconstruction. Arch Otolaryngol Head Neck Surg. 1995;121(1):70–6.

    CAS  PubMed  Google Scholar 

  77. Ung F, Rocco JW, Deschler DG. Temporary intraoperative external fixation in mandibular reconstruction. Laryngoscope. 2002;112(9):1569–73.

    PubMed  Google Scholar 

  78. Edwards SP. Computer-assisted craniomaxillofacial surgery. Oral Maxillofac Surg Clin North Am. 2010;22(1):117–34.

    PubMed  Google Scholar 

  79. Kennady MC, et al. Stress shielding effect of rigid internal fixation plates on mandibular bone grafts. A photon absorption densitometry and quantitative computerized tomographic evaluation. Int J Oral Maxillofac Surg. 1989;18(5):307–10.

    CAS  PubMed  Google Scholar 

  80. Jacobson AS, Smith M, Urken ML. Internal mammary artery and vein as recipient vessels in head and neck reconstruction. JAMA Otolaryngol Head Neck Surg. 2013;139(6):623–8.

    PubMed  Google Scholar 

  81. Urken ML. Atlas of regional and free flaps for head and neck reconstruction. 1st ed. New York: Raven Press; 1955.

    Google Scholar 

  82. Nahabedian MY, Tufaro A, Manson PN. Improved mandible function after hemimandibulectomy, condylar head preservation, and vascularized fibular reconstruction. Ann Plast Surg. 2001;46(5):506–10.

    CAS  PubMed  Google Scholar 

  83. Potter JK, Dierks EJ. Vascularized options for reconstruction of the mandibular condyle. Semin Plast Surg. 2008;22(3):156–60.

    PubMed  PubMed Central  Google Scholar 

  84. Khariwala SS, et al. Temporomandibular joint reconstruction using a vascularized bone graft with Alloderm. J Reconstr Microsurg. 2007;23(1):25–30.

    PubMed  Google Scholar 

  85. Shenaq SM, Klebuc MJ. TMJ reconstruction during vascularized bone graft transfer to the mandible. Microsurgery. 1994;15(5):299–304.

    CAS  PubMed  Google Scholar 

  86. Dolwick MF, Aufdemorte TB. Silicone-induced foreign body reaction and lymphadenopathy after temporomandibular joint arthroplasty. Oral Surg Oral Med Oral Pathol. 1985;59(5):449–52.

    CAS  PubMed  Google Scholar 

  87. Bredell M, et al. Management of the temporomandibular joint after ablative surgery. Craniomaxillofac Trauma Reconstr. 2014;7(4):271–9.

    PubMed  PubMed Central  Google Scholar 

  88. Roumanas ED, et al. Reconstructed mandibular defects: fibula free flaps and osseointegrated implants. Plast Reconstr Surg. 1997;99(2):356–65.

    CAS  PubMed  Google Scholar 

  89. Chiapasco M, et al. Clinical outcome of dental implants placed in fibula-free flaps used for the reconstruction of maxillo-mandibular defects following ablation for tumors or osteoradionecrosis. Clin Oral Implants Res. 2006;17(2):220–8.

    PubMed  Google Scholar 

  90. Okay DJ, et al. Computer-assisted implant rehabilitation of maxillomandibular defects reconstructed with vascularized bone free flaps. JAMA Otolaryngol Head Neck Surg. 2013;139(4):371–81.

    PubMed  Google Scholar 

  91. Wei FC, et al. Mandibular reconstruction with fibular osteoseptocutaneous free flap and simultaneous placement of osseointegrated dental implants. J Craniofac Surg. 1997;8(6):512–21.

    CAS  PubMed  Google Scholar 

  92. Levine JP, et al. Jaw in a day: total maxillofacial reconstruction using digital technology. Plast Reconstr Surg. 2013;131(6):1386–91.

    CAS  PubMed  Google Scholar 

  93. Clayburgh DR, et al. Prospective study of venous thromboembolism in patients with head and neck cancer after surgery. JAMA Otolaryngol Head Neck Surg. 2013;139(11):1143–50.

    PubMed  Google Scholar 

  94. Chien W, et al. Effects of aspirin and low-dose heparin in head and neck reconstruction using microvascular free flaps. Laryngoscope. 2005;115(6):973–6.

    CAS  PubMed  Google Scholar 

  95. Ashjian P, et al. The effect of postoperative anticoagulation on microvascular thrombosis. Ann Plast Surg. 2007;59(1):36–9; discussion 39–40.

    CAS  PubMed  Google Scholar 

  96. Lighthall JG, et al. Effect of postoperative aspirin on outcomes in microvascular free tissue transfer surgery. Otolaryngol Head Neck Surg. 2013;148(1):40–6.

    PubMed  Google Scholar 

Download references

Acknowledgment

We would like to thank Dr. Devin Okay, director of maxillofacial prosthodontics, Mount Sinai Beth Israel Medical Center, for his contribution to this manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Daniel Buchbinder DMD, MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Al Shetawi, A.H., Buchbinder, D. (2017). Mandibular Reconstruction. In: Kuriakose, M.A. (eds) Contemporary Oral Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-43854-2_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-43854-2_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43852-8

  • Online ISBN: 978-3-319-43854-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics