PDF herunterladen
CC BY-NC-ND 4.0 · J Reconstr Microsurg Open 2020; 05(02): e36-e42
DOI: 10.1055/s-0040-1713801
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Dynamic Oromandibular Reconstructions Using Chimeric Fibular and Gracilis or Vastus Lateralis Free Flaps

Min Ji Kim
1   Department of Plastic and Reconstructive Surgery, Ajou Medical Center, College of Medicine, Ajou University, Suwon, Republic of Korea
,
Jong Woo Choi
2   Department of Plastic and Reconstructive Surgery, College of Medicine, Seoul Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
,
Woo Shik Jeong
2   Department of Plastic and Reconstructive Surgery, College of Medicine, Seoul Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
,
Soon Yuhl Nam
3   Department of Otolaryngology, College of Medicine, Seoul Asan Medical Center, Ulsan University, Seoul, Republic of Korea
,
Seung Ho Choi
3   Department of Otolaryngology, College of Medicine, Seoul Asan Medical Center, Ulsan University, Seoul, Republic of Korea
› Institutsangaben Funding None declared.
Weitere Informationen

Publikationsverlauf

11. Dezember 2019

17. Mai 2020

Publikationsdatum:
19. Juli 2020 (online)

Auch verfügbar auf
   Lizenzen und Reprints

Abstract

Background Despite efforts of head and neck functional reconstruction, anatomic restoration has been used until now. This article describes our experience of using a chimeric free fibular osteocutaneous flap conjoined with a functional muscle free flap, defined as dynamic oromandibular reconstruction.

Methods Through a retrospective chart review, four consecutive patients who underwent reconstruction with a total fibular free flap were included. The former two patients underwent reconstruction using a conventional osteocutaneous free fibular flap. The latter two patients had an oromandibular defect after cancer resection and underwent dynamic oromandibular reconstruction with a chimeric free fibular flap conjoined with a gracilis free flap or vastus lateralis muscle free flap.

Results In the speech analysis, the dynamic group revealed a satisfactory tongue movement. Protrusion and lateralization were the most different movement changes. The tongue range of motion score was 62.5 in the dynamic group and 25.0 in the control group. On the dynamic magnetic resonance imaging, the contact of the soft palate with the tongue was excellent, and the epiglottis closure during deglutition was complete. In the three-dimensional volumetric analysis of mandibular aesthetic contouring, the dynamic group showed a much smaller difference in hemifacial volume, with a difference of 73.7 mL in the dynamic group and 101.76 mL in the control group.

Conclusion This study is a preliminary trial of dynamic oromandibular reconstruction using chimeric free fibular flaps with functional muscle transfer. We demonstrated the possibility of dynamic oromandibular reconstruction, which enhanced more functional aspects in the patients in this study.

Keywords

oromandibular defect - fibular free flap - chimeric flap - functional head and neck reconstruction - dynamic reconstruction
 

  • References

  • 1 Nakatsuka T, Harii K, Yamada A, Ueda K, Ebihara S. Dual free flap transfer using forearm flap for mandibular reconstruction. Head Neck 1992; 14 (06) 452-458
    CrossrefPubMedSuche in Google Scholar
  • 2 Wei FC, Celik N, Chen HC, Cheng MH, Huang WC. Combined anterolateral thigh flap and vascularized fibula osteoseptocutaneous flap in reconstruction of extensive composite mandibular defects. Plast Reconstr Surg 2002; 109 (01) 45-52
    CrossrefPubMedSuche in Google Scholar
  • 3 Hiiemae KM, Palmer JB. Tongue movements in feeding and speech. Crit Rev Oral Biol Med 2003; 14 (06) 413-429
    CrossrefPubMedSuche in Google Scholar
  • 4 Lass N, McReynolds L, Northern J, Yoder D. Speech, Language, and Hearing, Volume 11, Pathologies of Speech and Language. Philadelphia: WB Saunders Co.; 1982
    Suche in Google Scholar
  • 5 Thexton AJ, McGarrick JD. Tongue movement in the cat during the intake of solid food. Arch Oral Biol 1989; 34 (04) 239-248
    CrossrefPubMedSuche in Google Scholar
  • 6 Hiiemae K, Palmer J. Tongue-jaw linkages: the mechanisms of feeding revisited. Bull Mus Comp Zool 2001; 156 (01) 205-217
    PubMedSuche in Google Scholar
  • 7 Chen HH, Qiu SS, Lin CH, Kang CJ, Liao CT. Fibula osteoseptocutaneous flap: advantages of beginning the harvesting from the posterior approach. Ann Plast Surg 2016; 77 (06) 635-639
    CrossrefPubMedSuche in Google Scholar
  • 8 Lazarus CL, Husaini H, Jacobson AS. , et al. Development of a new lingual range-of-motion assessment scale: normative data in surgically treated oral cancer patients. Dysphagia 2014; 29 (04) 489-499
    CrossrefPubMedSuche in Google Scholar
  • 9 Chikui T, Obara M, Simonetti AW. , et al. The principal of dynamic contrast enhanced MRI, the method of pharmacokinetic analysis, and its application in the head and neck region. Int J Dent 2012; 2012: 480659
    PubMedSuche in Google Scholar
  • 10 Chang EI, Jenkins MP, Patel SA, Topham NS. Long-term operative outcomes of preoperative computed tomography-guided virtual surgical planning for osteocutaneous free flap mandible reconstruction. Plast Reconstr Surg 2016; 137 (02) 619-623
    CrossrefPubMedSuche in Google Scholar
  • 11 Toto JM, Chang EI, Agag R, Devarajan K, Patel SA, Topham NS. Improved operative efficiency of free fibula flap mandible reconstruction with patient-specific, computer-guided preoperative planning. Head Neck 2015; 37 (11) 1660-1664
    CrossrefPubMedSuche in Google Scholar
  • 12 Manktelow RT, Tomat LR, Zuker RM, Chang M. Smile reconstruction in adults with free muscle transfer innervated by the masseter motor nerve: effectiveness and cerebral adaptation. Plast Reconstr Surg 2006; 118 (04) 885-899
    CrossrefPubMedSuche in Google Scholar