Vertical Distraction Osteogenesis of Fibular Bone Flap in Reconstructed Mandible
Muhitdin Eski MD ,Murat Turegun MD ,Mustafa Deveci MD , Mustafa Sengezer MD, Hasan Suat Gokce DDS
INTRODUCTION: Excellent functional and aesthetic results can be achieved by using free fibular flap for the reconstruction of mandibular bone defect(1). Because of the limited diameter of the fibula flap compared with the height of the mandible, vertical distance between the reconstructed segment and the occlusal plane can be substantial. This is a particular problem in dentate mandible, especially when rehabilitation with dental implants or an tissue borne denture is contemplated. The vertical deficiency of fibular flap and extensive soft tissue scar made dental rehabititaion imposible in some cases and vertical distraction of transplanted fibular flap can be used to overcome this problem (2,3). In our 3 patients we encountered this problem. To overcome this segmental vertical distraction of the reconstructed mandible were performed in these patients.
METHODS: Segmental vertical distraction of the reconstructed mandible were performed for dental rehabilition in 3 patients who had previously mandibular reconstructions with free fibular bone flap due to extensive bone defect result from gun-shot injury. All the patients had a vertical bone deficit of fibular bone flap that prevent dental rehabilitation. Fibular bone segments (40-70 mm) were distracted with using extraoral distraction device after a latency period of 7 days. The rate of distraction was 1mm/day and the rythym was 4 times (4X0.25 mm). Distraction was continued till the desired height was achieved and the distractor left in place for 12 weeks for bony consolidation.
RESULTS: During the removal of distraction device, sufficient new regenerated bone was observed in the distraction gap. No minor or major complication such as insufficient ossification or osteomyelitis were encountered. The amount of vertical height achieved after distraction was between 9 and 13 mm(Table-1). The increase of vertical bone height enabled dental restoration of the patients with mandibular removable partial dentures. Average follow-up period was 13 (7-22 ) months and during this period the increase of vertical bone height was stable and the patients used their prosthesis without any problem.
CONCLUSION: Fibular flap, which used for reconstruction of in extensive bone defect result from gun-shot injury, can be distracted vertically without any complication in order to overcome vertical deficiency causing difficulties for dental restoration.
Patients / Sex and age / Length of distracted segment (mm) / Initial bone height(mm) / Increase in boneheight (mm) / Bone height
(mm) / Follow-up
(month)
1 / M/ 23 / 40 / 12 / 9 / 20 / 22
2 / M/ 32 / 70 / 13 / 13 / 26 / 10
3 / M/ 25 / 60 / 10 / 10 / 20 / 7
Table -1 Data on patients’ initial bone height, increase in bone height and bone height at the end of follow-up period
REFERENCES
1.Cordeiro, P.G., Disa J.J., Hidalgo, D.A., and Hu, Q.Y. Reconstruction of the mandible with osseous free flap: A 10-year experience with 150 consecutive patients.Plast.Reconstr.Surg.104: 1314,1999.
2.Nocini P.F, Wangerin C, Albanese M, et al. Vertical distraction of a free vascularized fibula flap in a reconstructed hemimandible. Journal of Cranio-Maxillofacial Surgery 28:20, 2000
3.Klesper B, Lazar F, Siessegger M, et al. Vertical distraction osteogenesis of fibula transplants for mandibular reconstruction- a preliminary study. Journal of Cranio-Maxillofacial Surgery 30:280, 2002