Download PDF
Facial Plast Surg 2008; 24(1): 035-042
DOI: 10.1055/s-2007-1021460
© Thieme Medical Publishers

Aesthetic Considerations in Mandibular Reconstruction

Ryan N. Heffelfinger1 , Prashant S. Malhotra1 , Michael A. Fishman2
  • 1Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
  • 2Jefferson Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
Further Information

Publication History

Publication Date:
20 February 2008 (online)

Also available at
    Permissions and Reprints

ABSTRACT

As free tissue transfer methods have improved, vascular bone grafting has become state of the art for reconstruction of mandibular defects. Prior studies have focused on flap survival and functional outcomes. The reconstructive surgeon should also strive to attain lofty aesthetic goals for this group of patients. The best results are achieved when patient factors, flap selection, treatment planning, and surgical techniques are all considered and properly selected.

KEYWORDS

Mandibular reconstruction - surgical technique - aesthetics - microvascular free flap

REFERENCES

  • 1 Cordeiro P G, Hidalgo D A. Soft tissue coverage of mandibular reconstruction plates.  Head Neck. 1994;  16 112-115
    CrossrefPubMedGoogle Scholar
  • 2 Cordeiro P G, Disa J J, Hidalgo D A et al.. Reconstruction of the mandible with osseous free flaps: a 10-year experience with 150 consecutive patients.  Plast Reconstr Surg. 1999;  104 1314-1320
    CrossrefPubMedGoogle Scholar
  • 3 Hidalgo D A, Pusic A L. Free-flap mandibular reconstruction: a 10-year follow-up study.  Plast Reconstr Surg. 2002;  110 438-449
    CrossrefPubMedGoogle Scholar
  • 4 Disa J J, Pusic A L, Hidalgo D H et al.. Simplifying microvascular head and neck reconstruction: a rational approach to donor site selection.  Ann Plast Surg. 2001;  47 385-389
    Google Scholar
  • 5 Suh J D, Sercarz J A, Abemayor E et al.. Analysis of outcome and complications in 400 cases of microvascular head and neck reconstruction.  Arch Otolaryngol Head Neck Surg. 2004;  130 962-966
    CrossrefPubMedGoogle Scholar
  • 6 Maciejewski A, Szymczyk C. Fibula free flap for mandible reconstruction: analysis of 30 consecutive cases and quality of life evaluation.  J Reconstr Microsurg. 2007;  23 1-10
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Urken M L, Buchbinder D, Costantino P D et al.. Oromandibular reconstruction using microvascular composite flaps: report of 210 cases.  Arch Otolaryngol Head Neck Surg. 1998;  124 46-55
    Google Scholar
  • 8 Hidalgo D A, Rekow A. A review of 60 consecutive fibula free flap mandible reconstructions.  Plast Reconstr Surg. 1995;  96 585-596
    Google Scholar
  • 9 Boyd J B, Gullane P J, Rotstein L E et al.. Classification of mandibular defects.  Plast Reconstr Surg. 1993;  92 1266-1275
    PubMedGoogle Scholar
  • 10 Shpitzer T, Neligan P C, Gullane P J et al.. The free iliac crest and fibula flaps in vascularized oromandibular reconstruction: comparison and long-term evaluation.  Head Neck. 1999;  21 639-647
    CrossrefPubMedGoogle Scholar
  • 11 Holzle F, Kesting M R, Holzle G et al.. Clinical outcome and patient satisfaction after mandibular reconstruction with free fibula flaps.  Int J Oral Maxillofac Surg. 2007;  36 802-806
    CrossrefPubMedGoogle Scholar
  • 12 King T W, Gallas M T, Robb G L et al.. Aesthetic and functional outcomes using osseous or soft-tissue free flaps.  J Reconstr Microsurg. 2002;  18 365-371
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Haughey B H, Wilson E, Kluwe L et al.. Free flap reconstruction of the head and neck: analysis of 241 cases.  Otolaryngol Head Neck Surg. 2001;  125 10-17
    CrossrefPubMedGoogle Scholar
  • 14 Clark J R, McCluskey S A, Hall F et al.. Predictors of morbidity following free flap reconstruction for cancer of the head and neck.  Head Neck. 2007;  , [online ahead of print]
    PubMedGoogle Scholar
  • 15 Chang L D, Buncke G, Slezak S et al.. Cigarette smoking, plastic surgery, and microsurgery.  J Reconstr Microsurg. 1996;  12 467-474
    PubMedGoogle Scholar
  • 16 Reus III W F, Colen L B, Straker D J. Tobacco smoking and complications in elective microsurgery.  Plast Reconstr Surg. 1992;  89 490-494
    PubMedGoogle Scholar
  • 17 Khouri R K, Cooley B C, Kunselman A R et al.. A prospective study of microvascular free-flap surgery and outcome.  Plast Reconstr Surg. 1998;  102 711-721
    Google Scholar
  • 18 Deutsch M, Kroll S S, Ainsle N et al.. Influence of radiation on late complications in patients with free fibular flaps for mandibular reconstruction.  Ann Plast Surg. 1999;  42 662-664
    CrossrefPubMedGoogle Scholar
  • 19 Kroll S S, Robb G L, Reece G P et al.. Does prior irradiation increase the risk of total or partial free-flap loss?.  J Reconstr Microsurg. 1998;  14 263-268
    PubMedGoogle Scholar
  • 20 Hammerlid E, Wirblad B, Sandin C et al.. Malnutrition and food intake in relation to quality of life in head and neck cancer patients.  Head Neck. 1998;  20 540-548
    CrossrefPubMedGoogle Scholar
  • 21 van Bokhorst-de van der Schueren M A, van Leeuwen P A, Kuik D J et al.. The impact of nutritional status on the prognoses of patients with advanced head and neck cancer.  Cancer. 1999;  86 519-527
    CrossrefPubMedGoogle Scholar
  • 22 Gurtner G C, Evans G R. Advances in head and neck reconstruction.  Plast Reconstr Surg. 2000;  106 672-682
    CrossrefPubMedGoogle Scholar
  • 23 Smith R B, Sniezek J C, Weed D T et al.. Utilization of free tissue transfer in head and neck surgery.  Otolaryngol Head Neck Surg. 2007;  137 182-191
    CrossrefPubMedGoogle Scholar
  • 24 Kim P D, Blackwell K E. Latissimus-serratus-rib free flap for oromandibular and maxillary reconstruction.  Arch Otolaryngol Head Neck Surg. 2007;  133 791-795
    CrossrefPubMedGoogle Scholar
  • 25 Said M, Heffelfinger R, Sercarz J A et al.. Bilobed fibula flap for reconstruction of through-and-through oromandibular defects.  Head Neck. 2007;  29 829-834
    CrossrefPubMedGoogle Scholar
  • 26 Mehta R P, Deschler D G. Mandibular reconstruction in 2004: an analysis of different techniques.  Curr Opin Otolaryngol Head Neck Surg. 2004;  12 288-293
    CrossrefPubMedGoogle Scholar
  • 27 Hidalgo D A. Fibula free flap: a new method of mandible reconstruction.  Plast Reconstr Surg. 1989;  84 71-79
    Google Scholar
  • 28 Hidalgo D A. Fibula free flap mandibular reconstruction.  Clin Plast Surg. 1994;  21 25-35
    PubMedGoogle Scholar
  • 29 Blackwell K E. Donor site evaluation for fibula free flap transfer.  Am J Otolaryngol. 1998;  19 89-95
    CrossrefPubMedGoogle Scholar
  • 30 Chen M A, Davidson T M. Scar management: prevention and treatment strategies.  Curr Opin Otolaryngol Head Neck Surg. 2005;  13 242-247
    CrossrefPubMedGoogle Scholar
  • 31 Babin R, Calcaterra T C. The lip-splitting approach to resection of oropharyngeal cancer.  J Surg Oncol. 1976;  8 433-436
    CrossrefPubMedGoogle Scholar
  • 32 Rapidis A D, Valsamis S, Anterriotis D A et al.. Functional and aesthetic results of various lip-splitting incisions: a clinical analysis of 60 cases.  J Oral Maxillofac Surg. 2001;  59 1292-1296
    CrossrefPubMedGoogle Scholar
  • 33 Cilento B W, Izzard M, Weymuller E A et al.. Comparison of approaches for oral cavity cancer resection: lip-split versus visor flap.  Otolaryngol Head Neck Surg. 2007;  137 428-432
    CrossrefPubMedGoogle Scholar
  • 34 Yii N W, Patel S G, Williamson P et al.. Use of apron flap incision for neck dissection.  Plast Reconstr Surg. 1999;  103 1655-1660
    CrossrefPubMedGoogle Scholar
  • 35 Hayter J P, Vaughan E D, Brown J S. Aesthetic lip splits.  Br J Oral Maxillofac Surg. 1996;  34 432-435
    CrossrefPubMedGoogle Scholar
  • 36 Gooris P J, Worthington P, Evans J R. Mandibulotomy: a surgical approach to oral and pharyngeal lesions.  Int J Oral Maxillofac Surg. 1989;  18 359-364
    CrossrefPubMedGoogle Scholar
  • 37 LaFerriere K A, Sessions D G, Thawley S E et al.. Composite resection and reconstruction for oral cavity and oropharynx cancer. A functional approach.  Arch Otolaryngol. 1980;  106 103-110
    PubMedGoogle Scholar
  • 38 Devine J C, Rogers S N, McNally D et al.. A comparison of aesthetic, functional and patient subjective outcomes following lip-split mandibulotomy and mandibular lingual releasing access procedures.  Int J Oral Maxillofac Surg. 2001;  30 199-204
    CrossrefPubMedGoogle Scholar
  • 39 Moscoso J F, Keller J, Genden E et al.. Vascularized bone flaps in oromandibular reconstruction. A comparative anatomic study of bone stock from various donor sites to assess suitability for endosseous dental implants.  Arch Otolaryngol Head Neck Surg. 1994;  120 36-43
    Google Scholar
  • 40 Kim Y, Smith J, Sercarz J A et al.. Fixation of mandibular osteotomies: comparison of locking and nonlocking hardware.  Head Neck. 2007;  29 453-457
    CrossrefPubMedGoogle Scholar
  • 41 Eisele D W, Richtsmeier W J, Graybeal J C et al.. Three-dimensional models for head and neck tumor treatment planning.  Laryngoscope. 1994;  104 433-439
    PubMedGoogle Scholar
  • 42 Kernan B T, Wimsatt III J A. Use of a stereolithography model for accurate, preoperative adaptation of a reconstruction plate.  J Oral Maxillofac Surg. 2000;  58 349-351
    CrossrefPubMedGoogle Scholar
  • 43 Yeung R W, Samman N, Cheung L K et al.. Stereomodel-assisted fibula flap harvest and mandibular reconstruction.  J Oral Maxillofac Surg. 2007;  65 1128-1134
    CrossrefPubMedGoogle Scholar
  • 44 Thoma A, Veltri K, Archibald S et al.. Microsurgical reconstruction of the through-and-through defect in head and neck cancer: is it worth it?.  J Reconstr Microsurg. 1999;  15 401-408
    PubMedGoogle Scholar
  • 45 Takushima A, Harii K, Asato H et al.. Mandibular reconstruction using microvascular free flaps: a statistical analysis of 178 cases.  Plast Reconstr Surg. 2001;  108 1555-1563
    CrossrefPubMedGoogle Scholar
  • 46 Deschler D G, Hayden R E. The optimum method for reconstruction of complex lateral oromandibular-cutaneous defects.  Head Neck. 2000;  22 674-679
    CrossrefPubMedGoogle Scholar

Ryan N HeffelfingerM.D. 

Instructor, Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital

925 Chestnut Street, 6th Floor, Philadelphia, PA 19107