Stereolithographic model‑assisted reconstruction of the mandibular condyle with a vascularized fibular flap following hemimandibulectomy: Evaluation of morphological and functional outcomes

Yoshimura,Hitoshi; Matsuda,Shinpei; Ohba,Seigo; Minegishi,Yoshiki; Nakai,Kunihiro; Fujieda,Shigeharu; Sano,Kazuo

doi:10.3892/ol.2017.6909

Stereolithographic model‑assisted reconstruction of the mandibular condyle with a vascularized fibular flap following hemimandibulectomy: Evaluation of morphological and functional outcomes

Authors:
- Hitoshi Yoshimura
- Shinpei Matsuda
- Seigo Ohba
- Yoshiki Minegishi
- Kunihiro Nakai
- Shigeharu Fujieda
- Kazuo Sano
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Affiliations: Department of Dentistry and Oral Surgery, Unit of Sensory and Locomotor Medicine, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan, Department of Regenerative Oral Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan, Department of Plastic and Reconstructive Surgery, University of Fukui Hospital, Fukui, Japan, Department of Otorhinolaryngology Head and Neck Surgery, Unit of Sensory and Locomotor Medicine, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
Published online on: September 7, 2017 https://doi.org/10.3892/ol.2017.6909
Pages: 5471-5483
Copyright: © Yoshimura et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The vascularized fibular flap is one of the standard treatment choices for the reconstruction of the mandible; however, the consequences of condylar restoration have not previously been reported. The use of three‑dimensional models allows for a more predictable reconstruction. The purpose of the present study was to assess the outcome of stereolithographic model‑assisted reconstruction of the mandibular condyle with a vascularized fibular flap. A total of 5 patients underwent mandibular resection including the condyle and immediate reconstruction with a vascularized fibular flap. A stereolithographic model was used to determine the length and angle of the bony reconstruction. In all patients, the temporomandibular joint (TMJ) disc was preserved, and the contoured fibular end was placed directly into the glenoid fossa under the TMJ disc. To investigate the morphological and functional outcomes, radiographic and clinical examinations were performed, and a food scale questionnaire was administered. The mean period of follow‑up was 23 months, and all the flaps were viable. Cosmetic results were generally satisfactory. Radiographic assessment revealed that the end of the fibular graft became round‑shaped. None of the patients had abnormal bone resorption, dislocation or ankylosis. The mean value of maximum mouth opening was 31 mm. No patients exhibited difficulties with occlusion. All patients recovered their ability to ingest nearly the same foods that were ingested prior to surgery. The stereolithographic model‑assisted reconstruction of mandibular condyle with a vascularized fibular flap is therefore useful for morphological and functional reconstructions of the hemimandible, including condylar defects.

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1	Potter JK and Dierks EJ: Vascularized options for reconstruction of the mandibular condyle. Semin Plast Surg. 22:156–160. 2008. View Article : Google Scholar : PubMed/NCBI
2	Iñigo F, Rojo P, Ysunza A and Jimenez Y: Three different techniques for mandibular reconstruction after hemimandibulectomy. J Craniofac Surg. 8:58–64. 1997. View Article : Google Scholar : PubMed/NCBI
3	Wax MK, Winslow CP, Hansen J, MacKenzie D, Cohen J, Andersen P and Albert T: A retrospective analysis of temporomandibular joint reconstruction with free fibula microvascular flap. Laryngoscope. 110:977–981. 2000. View Article : Google Scholar : PubMed/NCBI
4	Guyot L, Richard O, Layoun W, Cheynet F, Bellot-Samson V, Chossegros C, Blanc JL and Gola R: Long-term radiological findings following reconstruction of the condyle with fibular free flaps. J Craniomaxillofac Surg. 32:98–102. 2004. View Article : Google Scholar : PubMed/NCBI
5	Engroff SL: Fibula flap reconstruction of the condyle in disarticulation resections of the mandible: A case report and review of the technique. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 100:661–665. 2005. View Article : Google Scholar : PubMed/NCBI
6	Khariwala SS, Chan J, Blackwell KE and Alam DS: Temporomandibular joint reconstruction using a vascularized bone graft with Alloderm. J Reconstr Microsurg. 23:25–30. 2007. View Article : Google Scholar : PubMed/NCBI
7	González-García R, Naval-Gías L, Rodríguez-Campo FJ, Martínez-Chacón JL and Gil-Díez Usandizaga JL: Vascularized fibular flap for reconstruction of the condyle after mandibular ablation. J Oral Maxillofac Surg. 66:1133–1137. 2008. View Article : Google Scholar : PubMed/NCBI
8	Thor A, Rojas RA and Hirsch JM: Functional reconstruction of the temporomandibular joint with a free fibular microvascular flap. Scand J Plast Reconstr Surg Hand Surg. 42:233–240. 2008. View Article : Google Scholar : PubMed/NCBI
9	Moore EJ and Hamilton SS: Mandibular condyle reconstruction with fibula free-tissue transfer. Ear Nose Throat J. 91:E18–E24. 2012.PubMed/NCBI
10	Wang WH, Zhu J, Deng JY, Xia B and Xu B: Three-dimensional virtual technology in reconstruction of mandibular defect including condyle using double-barrel vascularized fibula flap. J Craniomaxillofac Surg. 41:417–422. 2013. View Article : Google Scholar : PubMed/NCBI
11	Bredell M, Grätz K, Obwegeser J and Gujer AK: Management of the temporomandibular joint after ablative surgery. Craniomaxillofac Trauma Reconstr. 7:271–279. 2014. View Article : Google Scholar : PubMed/NCBI
12	Chao JW, Rohde CH, Chang MM, Kutler DI, Friedman J and Spector JA: Oral rehabilitation outcomes after free fibula reconstruction of the mandible without condylar restoration. J Craniofac Surg. 25:415–417. 2014. View Article : Google Scholar : PubMed/NCBI
13	Hoang MP, Nguyen TT, Nguyen LK and Jeng SF: Ossifying fibroma of the mandible: A case report using vascularized free fibula flap reconstruction. Plast Reconstr Surg Glob Open. 3:e4702015. View Article : Google Scholar : PubMed/NCBI
14	Smith M, Williams F and Ward BB: Hard tissue reconstructionManagement of Complications in Oral and Maxillofacial Surgery. Miloro M and Kolokythas A: 1st. Wiley-Blackwell; Oxford: pp. 283–316. 2012
15	Antony AK, Chen WF, Kolokythas A, Weimer KA and Cohen MN: Use of virtual surgery and stereolithography-guided osteotomy for mandibular reconstruction with the free fibula. Plast Reconstr Surg. 128:1080–1084. 2011. View Article : Google Scholar : PubMed/NCBI
16	List MA, Ritter-Sterr C and Lansky SB: A performance status scale for head and neck cancer patients. Cancer. 66:564–569. 1990. View Article : Google Scholar : PubMed/NCBI
17	Urken ML, Weinberg H, Vickery C, Buchbinder D, Lawson W and Biller HF: 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. 117:733–744. 1991. View Article : Google Scholar : PubMed/NCBI
18	Curtis DA, Plesh O, Miller AJ, Curtis TA, Sharma A, Schweitzer R, Hilsinger RL, Schour L and Singer M: A comparison of masticatory function in patients with or without reconstruction of the mandible. Head Neck. 19:287–296. 1997. View Article : Google Scholar : PubMed/NCBI
19	Vega LG, González-García R and Louis PJ: Reconstruction of acquired temporomandibular joint defects. Oral Maxillofacial Surg Clin North Am. 25:251–269. 2013. View Article : Google Scholar
20	Petruzzelli GJ, Cunningham K and Vandevender D: Impact of mandibular condyle preservation on patterns of failure in head and neck cancer. Otolaryngol Head Neck Surg. 137:717–721. 2007. View Article : Google Scholar : PubMed/NCBI
21	Marx RE, Cillo JE Jr, Broumand V and Ulloa JJ: Outcome analysis of mandibular condylar replacements in tumor and trauma reconstruction: A prospective analysis of 131 cases with long-term follow-up. J Oral Maxillofac Surg. 66:2515–2523. 2008. View Article : Google Scholar : PubMed/NCBI
22	Carlson ER: Disarticulation resections of the mandible: A prospective review of 16 cases. J Oral Maxillofac Surg. 60:176–181. 2002. View Article : Google Scholar : PubMed/NCBI
23	Rosenberg AJ, Van Cann EM, van der Bilt A, Koole R and van Es RJ: A prospective study on prognostic factors for free-flap reconstructions of head and neck defects. Int J Oral Maxillofac Surg. 38:666–670. 2009. View Article : Google Scholar : PubMed/NCBI
24	Nahabedian MY, Tufaro A and Manson PN: Improved mandible function after hemimandibulectomy, condylar head preservation, and vascularized fibular reconstruction. Ann Plast Surg. 46:506–510. 2001. View Article : Google Scholar : PubMed/NCBI
25	Xu LQ, Zhang CP, Poh EH, Yin XL and Shen SK: A novel fibula osteotomy guide for mandibular reconstruction. Plast Reconstr Surg. 129:861e–863e. 2012. View Article : Google Scholar : PubMed/NCBI
26	Hanasono MM and Skoracki RJ: Computer-assisted design and rapid prototype modeling in microvascular mandible reconstruction. Laryngoscope. 123:597–604. 2013. View Article : Google Scholar : PubMed/NCBI
27	Lim SH, Kim MK and Kang SH: Precision of fibula positioning guide in mandibular reconstruction with a fibula graft. Head Face Med. 12:72016. View Article : Google Scholar : PubMed/NCBI
28	Mast G: Techniques of mandibulomaxillary fixation (MMF)Principles of Internal Fixation of the Craniomaxillofacial Skeleton. Ehrenfeld M, Manson PN and Prein J: 1st. George Thieme Verlag; New York, NY: pp. 115–123. 2012
29	Markowitz BL, Roumanas E and Calcaterra T: Surgical stents for composite mandible reconstruction. Plast Reconstr Surg. 96:194–200. 1995. View Article : Google Scholar : PubMed/NCBI
30	Yoshimura H, Ohba S, Yasuta M, Nakai K, Fujieda S and Sano K: Infrazygomatico-coronoid fixation in a segmental mandibular reconstruction with a free vascularized flap: A simple and correct repositioning method without interfering with reconstructive and microsurgical procedures. Head Neck. 38:1679–1687. 2016. View Article : Google Scholar : PubMed/NCBI
31	McDonald F: The condylar disk as a controlling factor in the form of the condylar head. J Craniomandib Disord. 3:83–86. 1989.PubMed/NCBI
32	Hamada Y, Kondoh T, Takada N and Seto K: MRI and arthroscopic findings in the temporomandibular joint after mandibulectomy including the unilateral condyle. Report of two cases. Int J Oral Maxillofac Surg. 29:341–343. 2000. View Article : Google Scholar : PubMed/NCBI
33	Miyamoto H, Kurita K, Ishimaru J and Goss AN: A sheep model for temporomandibular joint ankylosis. J Oral Maxillofac Surg. 57:812–817. 1999. View Article : Google Scholar : PubMed/NCBI
34	Porto G, Vasconcelos B and Silva V Jr: Development of temporomandibular joint ankylosis in rats: A preliminary experimental study. Int J Oral Maxillofac Surg. 37:282–286. 2008. View Article : Google Scholar : PubMed/NCBI
35	Dai J, Ouyang N, Zhu X, Huang L and Shen G: Injured condylar cartilage leads to traumatic temporomandibular joint ankylosis. J Craniomaxillofac Surg. 44:294–300. 2016. View Article : Google Scholar : PubMed/NCBI
36	Xiang GL, Long X, Deng MH, Han QC, Meng QG and Li B: A retrospective study of temporomandibular joint ankylosis secondary to surgical treatment of mandibular condylar fractures. Br J Oral Maxillofac Surg. 52:270–274. 2014. View Article : Google Scholar : PubMed/NCBI
37	Beumer J III, Marunick MT, Silverman S Jr, Garrett N, Rieger J, Abemayor E, Penn R, Nabili V, Rezaee R, Curtis DA, et al: Rehabilitation of tongue and mandibular defectsMaxillofacial Rehabilitation: Prosthodontic and Surgical Management of Cancer-Related, Acquired and Congenital Defects of the Head and Neck. Beumer J III, Marunick MT and Salvatore JE: 3rd. Quintessence Publishing; Hanover Park: pp. 61–154. 2011
38	Brand RW and Isselhard DE: Temporomandibular jointAnatomy of Orofacial Structures. 7th. Mosby, St. Louis: pp. 348–352. 2003
39	Crawford SD: Condylar axis position, as determined by the occlusion and measured by the CPI instrument, and signs and symptoms of temporomandibular dysfunction. Angle Orthod. 69:103–116. 1999.PubMed/NCBI
40	Linsen S, Schmidt-Beer U, Fimmers R, Grüner M and Koeck B: Craniomandibular pain, bite force, and oral health-related quality of life in patients with jaw resection. J Pain Symptom Manage. 37:94–106. 2009. View Article : Google Scholar : PubMed/NCBI
41	Marunick MT and Mathog RH: Mastication in patients treated for head and neck cancer: A pilot study. J Prosthet Dent. 63:566–573. 1990. View Article : Google Scholar : PubMed/NCBI
42	Boretti G, Bickel M and Geering AH: A review of masticatory ability and efficiency. J Prosthet Dent. 74:400–403. 1995. View Article : Google Scholar : PubMed/NCBI
43	Tan ZZ, Liu B, Wei JX, Zou H and Zhao YF: Effects of mandibular odontogenic keratocyst surgery and removable partial prostheses on masticatory performance. J Prosthet Dent. 97:107–111. 2007. View Article : Google Scholar : PubMed/NCBI