Reconstruction for Mandibular Implant Failure
Mandibular defects may result from tumor ablations, trauma, or radiation necrosis. Significant segmental mandibular loss or hemimandibular loss may sometimes be replaced with mandibular implants by ENT surgeons/oral surgeons/head and neck surgeons. However, this may bring about mandibular implant failure in long-term follow-up. Mandibular implant failures usually manifest as: soft tissue atrophy, mandibular implant extrusion, infection, facial nerve involvement, facial asymmetry, derangement of occlusion and mastication, orocutaneous fistula, etc. Over 30 years, the authors have treated 102 patients with mandibular implant failure. Reconstruction may involve removal of the mandibular implant and immediate replacement of the mandibular defect with a piece of vascularized bone flap, not only to compensate for bone loss but also to replace neighboring soft tissue and possible skin defects. Frequently used flaps have been vascularized iliac bone (89/102) or vascularized fibula grafts (13/102). During follow-up, iliac bone flap reconstruction has yielded more favorable results due to its ample bone bulk and adequate soft tissue coverage. Fibula flaps with osteotomies have been associated with an increasing incidence of malunion/nonunion and subsequent easy deformation.
Part of the book: Issues in Flap Surgery
Finesse in Damage Control Reconstruction for Trauma in Plastic Surgery
Reconstructions of body, extremity and facial resurfacing facial defects are common encounters in plastic surgery. It may be owing to trauma, burn injury, tumor, congenital anomalies, miscellaneous kinds of malignancies. The face has its specific landmarks: the forehead, eyebrows, eyes with upper and lower eyelids, orbit, midface (nose, maxilla, zygoma), upper lip, cheeks, nasolabial folds, lower face (lower lip, mandible with angle), oral mucosa (buccal mucosa, upper lip sulcus, lower lip sulcus), mentum, and neck. Anatomical landmarks include forehead, eyebrow, and eyelids: upper/lower, orbit, midface: nose, maxilla, upper lip, nasolabial folds, and zygoma. Lower face: lower lip, mandible, oral mucosa, buccal mucosa, upper lip sulcus, lower lip sulcus. Strategic approaches include the following: tissue expansion, resection of tumor, and repair with resurfacing, repair of multilayer defect repair for functional purpose. Reconstruction for trauma is commonly encountered in the daily practice in plastic surgery. The trauma may be caused by miscellaneous causes, including traffic accident, fall, cutting, avulsion, contusion, electrical injuries, irradiation injuries, chemical injuries, etc., resulting in disfigurement, deformity and functional disabilities. The strategic approach is to achieve anatomical restoration, functional rehabilitation and aesthetic refinements for the afflicted individuals. Pursuing excellence in plastic surgery, bringing excellence to life is always the ultimate goal for plastic surgeons.
Part of the book: Trauma and Emergency Surgery