Classification of Mandible Defects and Algorithm for Microvascular Reconstruction. Issue 4 (April 2015)

• Record Type: Journal Article
• Authors: Schultz, Benjamin D.; Sosin, Michael; Nam, Arthur; Mohan, Raja; Zhang, Peter; Khalifian, Saami; Vranis, Neil; Manson, Paul N.; Bojovic, Branko; Rodriguez, Eduardo D.
• Is Part Of: Plastic and reconstructive surgery. Volume 135:Issue 4(2015:Apr.)
• Publication Date: 2015-04
• Subjects: Surgery, Plastic -- Periodicals; 617.95205
• DOI: 10.1097/PRS.0000000000001106
• Languages: English
• ISSNs: 0032-1052

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background:</title> <p>Composite mandibular tissue loss results in significant functional impairment and cosmetic deformity. This study classifies patterns of mandibular composite tissue loss and describes a microvascular treatment algorithm.</p> </sec> <sec> <title>Methods:</title> <p>A retrospective review of microvascular composite mandibular reconstruction from July of 2005 to April of 2013 by the senior surgeon at the R Adams Cowley Shock Trauma Center and at The Johns Hopkins Hospital yielded 24 patients with a mean follow-up of 17.9 months. Causes of composite mandibular defects included tumors, osteoradionecrosis, trauma, infection, and congenital deformity. Patients with composite tissue loss were classified according to missing subunits.</p> </sec> <sec> <title>Results:</title> <p>A treatment algorithm based on composite mandibular defects and microvascular reconstruction was developed and used to treat 24 patients. A type 1 defect is a unilateral dentoalveolar defect not crossing the midline and not extending into the angle of the mandible. A type 2 defect is a unilateral defect extending beyond the angle. A type 3 defect is a bilateral defect not involving the angles. A type 4 defect is a bilateral defect with extension into at least one angle. Type 2 defects were the predominant group. Patients had microvascular reconstruction using either fibula flaps (<italic>n</italic> = 19) or iliac crest flaps (<italic>n</italic> = 5). Complications included infection, partial necrosis, plate fracture, dehiscence, and microvascular thrombosis.</p> </sec> <sec> <title>Conclusion:</title> <p>This novel classification system and treatment algorithm allows for a consistent and reliable method of addressing composite mandibular defects and focuses on recipient vasculature and donor free flap characteristics.</p> </sec> <sec> <title>CLINICAL QUESTION/LEVEL OF EVIDENCE:</title> <p>Therapeutic, IV.</p> </sec> </abstract>