Maxillofacial Plastic and Reconstructive Surgery

  • Volume 39
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  • Pages.16.1-16.6
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  • 2017
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  • 2288-8101(pISSN)
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  • 2288-8586(eISSN)
Korean Association of Maxillofacial Plastic and Reconstructive Surgeons (대한악안면성형재건외과학회)
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A simple technique for repositioning of the mandible by a surgical guide prepared using a three-dimensional model after segmental mandibulectomy

  • Funayama, Akinori (Department of Tissue Regeneration and Reconstruction, Division of Reconstructive Surgery for Oral and Maxillofacial Region, Niigata University Graduate School of Medical and Dental Sciences) ;
  • Kojima, Taku (Department of Tissue Regeneration and Reconstruction, Division of Reconstructive Surgery for Oral and Maxillofacial Region, Niigata University Graduate School of Medical and Dental Sciences) ;
  • Yoshizawa, Michiko (Department of Oral and Maxillofacial Surgery, Matsumoto Dental University School of Dentistry) ;
  • Mikami, Toshihiko (Department of Tissue Regeneration and Reconstruction, Division of Reconstructive Surgery for Oral and Maxillofacial Region, Niigata University Graduate School of Medical and Dental Sciences) ;
  • Kanemaru, Shohei (Department of Tissue Regeneration and Reconstruction, Division of Reconstructive Surgery for Oral and Maxillofacial Region, Niigata University Graduate School of Medical and Dental Sciences) ;
  • Niimi, Kanae (Department of Tissue Regeneration and Reconstruction, Division of Reconstructive Surgery for Oral and Maxillofacial Region, Niigata University Graduate School of Medical and Dental Sciences) ;
  • Oda, Yohei (Department of Tissue Regeneration and Reconstruction, Division of Reconstructive Surgery for Oral and Maxillofacial Region, Niigata University Graduate School of Medical and Dental Sciences) ;
  • Kato, Yusuke (Department of Tissue Regeneration and Reconstruction, Division of Reconstructive Surgery for Oral and Maxillofacial Region, Niigata University Graduate School of Medical and Dental Sciences) ;
  • Kobayashi, Tadaharu (Department of Tissue Regeneration and Reconstruction, Division of Reconstructive Surgery for Oral and Maxillofacial Region, Niigata University Graduate School of Medical and Dental Sciences)
  • Received : 2017.03.14
  • Accepted : 2017.04.11
  • Published : 2017.12.31
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Abstract

Background: Mandibular reconstruction is performed after segmental mandibulectomy, and precise repositioning of the condylar head in the temporomandibular fossa is essential for maintaining preoperative occlusion. Methods: In cases without involvement of soft tissue around the mandibular bone, the autopolymer resin in a soft state is pressed against the lower border of the mandible and buccal and lingual sides of the 3D model on the excised side. After hardening, it is shaved with a carbide bar to make the proximal and distal parts parallel to the resected surface in order to determine the direction of mandibular resection. On the other hand, in cases that require resection of soft tissue around the mandible such as cases of a malignant tumor, right and left mandibular rami of the 3D model are connected with the autopolymer resin to keep the preoperative position between proximal and distal segments before surgical simulation. The device is made to fit the lower border of the anterior mandible and the posterior border of the mandibular ramus. The device has a U-shaped handle so that adaptation of the device will not interfere with the soft tissue to be removed and has holes to be fixed on the mandible with screws. Results: We successfully performed the planned accurate segmental mandibulectomy and the precise repositioning of the condylar head by the device. Conclusions: The present technique and device that we developed proved to be simple and useful for restoring the preoperative condylar head positioning in the temporomandibular fossa and the precise resection of the mandible.

Keywords

References

  1. Tei K, Totsuka Y, Iizuka T, Ohmori K (2004) Marginal resection for carcinoma of the mandibular alveolus and gingiva where radiologically detected bone defects do not extend beyond the mandibular canal. J Oral Maxillofac Surg 62:834-839 https://doi.org/10.1016/j.joms.2003.09.014
  2. Vayvada H, Mola F, Menderes A, Yilmaz M (2006) Surgical management of ameloblastoma in the mandible: segmental mandibulectomy and immediate reconstruction with free fibula or deep circumflex iliac artery flap (evaluation of the long-term esthetic and functional results). J Oral Maxillofac Surg 64:1532-1539 https://doi.org/10.1016/j.joms.2005.11.065
  3. Fattore L, Marchmont-Robinson H, Crinzi RA, Edmonds DC (1988) Use of a two-piece Gunning splint as a mandibular guide appliance for a patient treated for ameloblastoma. Oral Surg Oral Med Oral Pathol 66:662-665 https://doi.org/10.1016/0030-4220(88)90313-1
  4. Ueda K, Tajima S, Oba S, Omiya Y, Byun SI, Okada M (2001) Mandibular contour reconstruction with three-dimensional computer-assisted models. Ann Plast Surg 46:387-393 https://doi.org/10.1097/00000637-200104000-00006
  5. Fleming ID, Morris JH (1969) Use of acrylic external splint after mandibular resection. Am J Surg 118:708-711 https://doi.org/10.1016/0002-9610(69)90217-7
  6. Reece GP, Martin JW, Lemon JC, Jacob RF (1993) Mandible fragment fixation during reconstruction: the splint-and-plate technique. AnnPlast Surg 31:128-133
  7. Ameerally PJ, Hollows P (2004) Use of an external fixator to stabilise the proximal mandibular segments during reconstruction. Br J Oral Maxillofac Surg 42:354-356
  8. Iwai S, Moriyama T, Amekawa S, Katagiri W, Nakazawa M, Yura Y (2006) A modified repositioning system for segmental resection of the mandible. Int J Oral Maxillofac Surg 35:270-273 https://doi.org/10.1016/j.ijom.2005.10.001
  9. Mohindra A, Blanco-Guzman MM (2009) Temporary mandibular stabilisation during reconstruction: an alternative technique. Br J Oral Maxillofac Surg 47:399-400 https://doi.org/10.1016/j.bjoms.2008.09.010
  10. Tominaga K, Yoshioka I, Yamashita Y, Habu M, Iwanaga K, Khanal A, Nishikawa T (2009) A novel modification of a bone repositioning device and a new technique for reestablishing facial contours after mandibular resection surgery. Int J Oral Maxillofac Surg 38:377-381 https://doi.org/10.1016/j.ijom.2009.02.014

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