Temporomandibular joint’s and mandible reconstruction after segmental mandibulectomy in oncological practice
https://doi.org/10.17650/2222-1468-2024-14-4-24-32
Abstract
Introduction. Segmental mandibulectomy with exarticulation and single-step reconstruction is an important problem of craniomaxillofacial surgery. Revascularized autotransplants (iliac crest, fibula free flaps) are used to reconstruct defects of the mandible and restore joint function.
Aim. To evaluate functional, esthetic and oncological results of fragmental mandibular resection with exarticulation and single-step reconstruction using bone flaps.
Materials and methods. The study included 52 patients who underwent segmental mandibular resection with exarticulation and single-step reconstruction using bone flaps. For defects of the ramus and head of the mandible, reconstruction was performed using iliac crest free flap (5 cases); defects of the ramus and body of the mandible, fibula free flap was used (47 cases).
Results. Total necrosis of the flap was observed in 1 (4.7 %) case. Iliac crest free flap was modelled taking into account the size of mandibular ramus defect (usually to the angle of the mandible), mandibular head was formed from the distal part. At least one osteotomy was preformed on the autotrasplant near the angle, on the distal part the head was formed. Follow-up period varied between 1 and 5 years. Disease progression in the form of recurrence was observed in 15 (34.9 %) cases, in the form of distant metastases in 6 (13.9 %) cases.
Conclusion. For small defects of the ramus of the mandible, revascularized iliac crest free flap should be used, for large defects the method of choice is fibula free flap. Temporomandibular joint can be formed from the distal end of a bone autotransplant with its subsequent adaptation during functional load.
About the Authors
M. A. Kropotov
N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
Russian Federation
Russian Federation
Mikhail Alekseevich Kropotov
24 Kashirskoe Shosse, Moscow 115522
O. A. Saprina
N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
Russian Federation
Russian Federation
24 Kashirskoe Shosse, Moscow 115522
V. Z. Dobrokhotova
N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia; Sechenov University, Ministry of Health of Russia
Russian Federation
Russian Federation
24 Kashirskoe Shosse, Moscow 115522
Bld. 2, 8 Trubetskaya St., Moscow 119991
A. D. Shturma
N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
Russian Federation
Russian Federation
24 Kashirskoe Shosse, Moscow 115522
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Review
For citations:
Kropotov M.A., Saprina O.A., Dobrokhotova V.Z., Shturma A.D. Temporomandibular joint’s and mandible reconstruction after segmental mandibulectomy in oncological practice. Head and Neck Tumors (HNT). 2024;14(4):24-32. (In Russ.) https://doi.org/10.17650/2222-1468-2024-14-4-24-32
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