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Stabilization of Mobile Mandibular Segments in Mandibular Reconstruction: Use of Spanning Reconstruction Plate

Identifieur interne : 000031 ( Pmc/Corpus ); précédent : 000030; suivant : 000032

Stabilization of Mobile Mandibular Segments in Mandibular Reconstruction: Use of Spanning Reconstruction Plate

Auteurs : Yan Lin Yap ; Jane Lim ; Wei Chen Ong ; Matthew Yeo ; Hanjing Lee ; Thiam Chye Lim

Source :

RBID : PMC:3578648

Abstract

The fibular free flap is the gold standard for mandibular reconstruction. Accurate 3-dimensional contouring and precise alignment of the fibula is critical for reestablishing native occlusion and facial symmetry. Following segmental mandibulectomy, the remaining mandibular fragments become freely mobile. Various stabilization methods including external fixation, intermaxillary fixation, and preplating with reconstruction plate have been used. We describe a modification to the preplating technique. After wide resection of buccal squamous cell carcinoma, our patient had an 11-cm mandibular defect from the angle of the left mandible to the right midparasymphyseal region. A single 2.0-mm Unilock® (Synthes, Singapore) plate was used to span the defect. This was placed on the vestibular aspect of the superior border of the mandibular remnants before resection. Segmental mandibulectomy was then performed with the plate removed. The spanning plate was then reattached to provide rigid fixation. The fibular bone was contoured with a single osteotomy and reattached. The conventional technique involves molding of the plate at the inferior border of the mandible. This is time-consuming and not possible in patients with distorted mandibular contour. It is also difficult to fit the osteotomized fibula to the contoured plate. In comparison, the superiorly positioned spanning plate achieve rigid fixation of the mandible while leaving the defect completely free and unhampered by hardware, allowing space for planning osteotomies and easier fixation of the neomandible. Using this modified technique, we are able to recreate the original mandibular profile with ease.


Url:
DOI: 10.1055/s-0032-1313354
PubMed: 23997856
PubMed Central: 3578648

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PMC:3578648

Le document en format XML

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<p>The fibular free flap is the gold standard for mandibular reconstruction. Accurate 3-dimensional contouring and precise alignment of the fibula is critical for reestablishing native occlusion and facial symmetry. Following segmental mandibulectomy, the remaining mandibular fragments become freely mobile. Various stabilization methods including external fixation, intermaxillary fixation, and preplating with reconstruction plate have been used. We describe a modification to the preplating technique. After wide resection of buccal squamous cell carcinoma, our patient had an 11-cm mandibular defect from the angle of the left mandible to the right midparasymphyseal region. A single 2.0-mm Unilock® (Synthes, Singapore) plate was used to span the defect. This was placed on the vestibular aspect of the superior border of the mandibular remnants before resection. Segmental mandibulectomy was then performed with the plate removed. The spanning plate was then reattached to provide rigid fixation. The fibular bone was contoured with a single osteotomy and reattached. The conventional technique involves molding of the plate at the inferior border of the mandible. This is time-consuming and not possible in patients with distorted mandibular contour. It is also difficult to fit the osteotomized fibula to the contoured plate. In comparison, the superiorly positioned spanning plate achieve rigid fixation of the mandible while leaving the defect completely free and unhampered by hardware, allowing space for planning osteotomies and easier fixation of the neomandible. Using this modified technique, we are able to recreate the original mandibular profile with ease.</p>
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<name>
<surname>Yap</surname>
<given-names>Yan Lin</given-names>
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<degrees>M.B.B.S., M.R.C.S., M.M.E.D.(Surg.)</degrees>
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<surname>Lim</surname>
<given-names>Jane</given-names>
</name>
<degrees>M.B.B.S., F.R.C.S.(Plastic Surg.), F.A.M.S.(Plastic Surg.)</degrees>
<xref rid="AF05123-1" ref-type="aff">1</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Ong</surname>
<given-names>Wei Chen</given-names>
</name>
<degrees>M.B.B.S., M.R.C.S., M.M.E.D.(Surg.), F.A.M.S.(Plastic Surg.)</degrees>
<xref rid="AF05123-1" ref-type="aff">1</xref>
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<surname>Yeo</surname>
<given-names>Matthew</given-names>
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<degrees>M.B.B.S., M.R.C.S., M.M.E.D.(Surg.)</degrees>
<xref rid="AF05123-1" ref-type="aff">1</xref>
<xref rid="AF05123-2" ref-type="aff">2</xref>
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<name>
<surname>Lee</surname>
<given-names>Hanjing</given-names>
</name>
<degrees>M.B.B.S., M.R.C.S., M.M.E.D.(Surg.)</degrees>
<xref rid="AF05123-1" ref-type="aff">1</xref>
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<contrib contrib-type="author">
<name>
<surname>Lim</surname>
<given-names>Thiam Chye</given-names>
</name>
<degrees>F.R.C.S., F.A.M.S., M.B.B.S. (Malaya)</degrees>
<xref rid="AF05123-1" ref-type="aff">1</xref>
<xref rid="AF05123-2" ref-type="aff">2</xref>
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<label>2</label>
<institution>Department of Surgery, National University Hospital, Singapore</institution>
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<author-notes>
<corresp id="CO05123-1">
<bold>Address for correspondence and reprint requests </bold>
Yan Lin Yap, M.B.B.S., M.R.C.S., M.M.E.D.(Surg.)
<institution>National University Hospital, Surgery, Division of Plastic, Reconstructive and Aesthetic Surgery</institution>
<addr-line>5, Lower Kent Ridge Road, Singapore 119074</addr-line>
<country>Singapore</country>
<email>yapyanlin@yahoo.com.sg</email>
</corresp>
</author-notes>
<pub-date pub-type="epreprint">
<day>05</day>
<month>06</month>
<year>2012</year>
</pub-date>
<pub-date pub-type="ppub">
<month>09</month>
<year>2012</year>
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<volume>5</volume>
<issue>3</issue>
<fpage>123</fpage>
<lpage>126</lpage>
<history>
<date date-type="received">
<day>14</day>
<month>02</month>
<year>2011</year>
</date>
<date date-type="accepted">
<day>16</day>
<month>06</month>
<year>2011</year>
</date>
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<permissions>
<copyright-statement>© Thieme Medical Publishers</copyright-statement>
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<abstract>
<p>The fibular free flap is the gold standard for mandibular reconstruction. Accurate 3-dimensional contouring and precise alignment of the fibula is critical for reestablishing native occlusion and facial symmetry. Following segmental mandibulectomy, the remaining mandibular fragments become freely mobile. Various stabilization methods including external fixation, intermaxillary fixation, and preplating with reconstruction plate have been used. We describe a modification to the preplating technique. After wide resection of buccal squamous cell carcinoma, our patient had an 11-cm mandibular defect from the angle of the left mandible to the right midparasymphyseal region. A single 2.0-mm Unilock® (Synthes, Singapore) plate was used to span the defect. This was placed on the vestibular aspect of the superior border of the mandibular remnants before resection. Segmental mandibulectomy was then performed with the plate removed. The spanning plate was then reattached to provide rigid fixation. The fibular bone was contoured with a single osteotomy and reattached. The conventional technique involves molding of the plate at the inferior border of the mandible. This is time-consuming and not possible in patients with distorted mandibular contour. It is also difficult to fit the osteotomized fibula to the contoured plate. In comparison, the superiorly positioned spanning plate achieve rigid fixation of the mandible while leaving the defect completely free and unhampered by hardware, allowing space for planning osteotomies and easier fixation of the neomandible. Using this modified technique, we are able to recreate the original mandibular profile with ease.</p>
</abstract>
<kwd-group xml:lang="en">
<title>Keywords</title>
<kwd>mandibular reconstruction</kwd>
<kwd>preplating technique</kwd>
<kwd>spanning reconstruction plate</kwd>
</kwd-group>
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</front>
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