Download PDF
Facial Plast Surg 2003; 19(1): 087-094
DOI: 10.1055/s-2003-39138
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Enhancement of the Fibula Free Flap by Alveolar Distraction for Dental Implant Restoration: Report of a Case

Lawrence Levin1 , Lee Carrasco1 , Amin Kazemi2 , Ara Chalian3
  • 1University of Pennsylvania Hospital, Department of Oral and Maxillofacial Surgery
  • 2Private practice, Cherry Hill, NJ
  • 3University of Pennsylvania Hospital, Department of Otorhinolaryngology
Further Information

Publication History

Publication Date:
09 May 2003 (online)

Also available at
    Permissions and Reprints

ABSTRACT

We describe the utilization of distraction osteogenesis in the free fibular microvascular bone graft to the mandible for increasing bone height for future osseointegrated dental implants. Successful reconstruction of a resected mandible requires restoration of both function and esthetic form. Although current reconstructive techniques restore anterior-posterior and lateral projection, often the graft's vertical height is not sufficient for the placement of osseointegrated dental implants and subsequent oral prosthesis. The patient was a sixteen-year-old male who was found to have a large desmoplastic fibroma of the left mandible, which was resected. The defect was successfully restored with a free fibular microvascular bone graft and reconstruction plate. Nevertheless, the patient had persistent problems with mastication and it was decided to perform a segmental osteotomy of the neomandible. Two internal vertical distraction devices were then placed in the mandible. The appliances were then activated five days postoperative, twice a day, for a total of 14 days. At that time 1.5 cm of distraction had occurred and the patient was placed in a consolidation phase for four months. The patient then had sufficient bone height and was restored with 8 osseointegrated dental implants.

KEYWORDS

Alveolar distraction - fibula graft - dental implants - mandibula reconstruction

REFERENCES

  • 1 O'Brien B M, Morrison W A. Reconstructive Microsurgery. Edinburgh: Churchill Livingstone 1987: 315-324
    Search in Google Scholar
  • 2 Taylor F I, Miler G DH, Ham F J. The free vascularized bone graft. A clinical extension of microvascular techniques.  Plast Reconstr Surg . 197;  55 533-544
    PubMedSearch in Google Scholar
  • 3 Chen Z W, Yan W. The study and clinical application of the osteocutaneous flap of fibula.  Microsurgery . 1983;  4 11-16
    CrossrefPubMedSearch in Google Scholar
  • 4 Yoshimura M, Shimamura K, Yoshinobu I, Yamauchi S, Ueno T. Free vascularized fibular transplant.  J Bone Joint Surg . 1983;  65A 1295-1301
    PubMedSearch in Google Scholar
  • 5 Hidalgo D A. Fibula free flap: a new method of mandible reconstruction.  Plast Reconstr Surg . 1989;  84 71-79
    Search in Google Scholar
  • 6 Hidalgo D A. Discussion of 'fibula osteoseptocutaneous flap for reconstruction of composite mandibular defects' by Wei FC, Seah CS, Tsai YC, Liu SJ, Tsai MS.  Plast Reconstr Surg . 1994;  93 305-306
    PubMedSearch in Google Scholar
  • 7 Wolff K D, Ervens J, Herzog K, Hoffmeister B. Experience with the osteocutaneous fibula flap: an analysis of 24 consecutive reconstructions of composite mandibular defects.  J Caniomaxillofacial Surg . 1996;  24 330-338
    PubMedSearch in Google Scholar
  • 8 Beppu M, Hanel D P, Jonston G F, Carmo J M, Tsai T M. The osteocutaneous fibula flap: an anatomic study.  J Reconstr Microsurg . 1992;  8 215-223
    Thieme ConnectPubMedSearch in Google Scholar
  • 9 Urken M L, Sullivan M J. Fibular osteocutaneous. In: Urken ML, Cheney ML, Sullivan MJ, Biller HF, eds. Atlas of Regional and Free Flaps for Head and Neck Reconstruction New York: Raven Press 1995: 291-306
    Search in Google Scholar
  • 10 Wei F C, Seah C S, Tsai Y C, Liu S J, Tsai M S. Fibula osteoseptocutaneous flap for reconstruction of composite mandibular defects.  Plast Reconstr Surg . 1993;  93 294-304
    PubMedSearch in Google Scholar
  • 11 Marx R, Schiff W, Sanders T. Reconstruction and rehabilitation of cancer patients.  Maxillofacial Reconstruction Section V;chapter 31:1057-1111.
    PubMed
  • 12 Pogrel M A, Podlesh S, Anthony J. A comparison vascularized and non-vascularized bone grafts for reconstruction of mandibular defects.  J Oral Maxillofacial Surg . 1997;  55 1200-1206
    PubMedSearch in Google Scholar
  • 13 Burwell R G. Studies in the transplantation of bone.  J Bone Joint Surg Br . 1966;  48 532
    PubMedSearch in Google Scholar
  • 14 Hidalgo D A, Rekow A. A review of 60 consecutive fibula free flap mandibular reconstructions.  Plast Reconstr Surg . 1995;  96 585
    Search in Google Scholar
  • 15 Hayter J P, Cawood J I. Oral rehabilitation with endosteal implants and free flaps.  Int J Oral Maxillofacial Surg . 1996;  25 3
    PubMedSearch in Google Scholar
  • 16 Fonseca R J, Davis W H. Reconstructive Preprosthetic Oral and Maxillofacial Surgery. Philadelphia, PA: WB Saunders 1986
    Search in Google Scholar
  • 17 Misch C E. Contemporary Implant Dentistry. St. Louis, MO: Mosby 1993
    Search in Google Scholar
  • 18 Branemark P I. Osseointegeration and its experimental background.  J Prosthet Dent . 1983;  50 399
    PubMedSearch in Google Scholar
  • 19 Branemark P I. Osseointegrated implant in the treatment of the edentulous jaw, experience from a 10-year period.  Scand J Plast Reconstr Surg . 1977;  16 1
    PubMedSearch in Google Scholar
  • 20 Lavelle C, Wedgeweed D, Love W B. Some advances in endosseous implants.  J Oral Rehab . 1981;  8 319
    PubMedSearch in Google Scholar