Advanced mandibular reconstruction with fibular free flap and alloplastic TMJ prosthesis with digital planning
Abstract Introduction Resection of the mandible and temporomandibular joint (TMJ) without formal reconstruction is a devastating condition that negatively affects all aspects of the patient’s life. We have approached the reconstruction of mandibular defects that include the condyle with simultaneous...
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| Format: | Article |
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SAGE Publishing
2023-07-01
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| Series: | Journal of Otolaryngology - Head and Neck Surgery |
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| Online Access: | https://doi.org/10.1186/s40463-023-00639-4 |
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| author | Justin M. Pyne Clayton M. Davis Ryan Kelm Claudine Bussolaro Walter Dobrovolsky Hadi Seikaly |
| author_facet | Justin M. Pyne Clayton M. Davis Ryan Kelm Claudine Bussolaro Walter Dobrovolsky Hadi Seikaly |
| author_sort | Justin M. Pyne |
| collection | DOAJ |
| description | Abstract Introduction Resection of the mandible and temporomandibular joint (TMJ) without formal reconstruction is a devastating condition that negatively affects all aspects of the patient’s life. We have approached the reconstruction of mandibular defects that include the condyle with simultaneous reconstruction with a vascularized free fibular flap (FFF) using Surgical Design and Simulation (SDS) and alloplastic TMJ prosthesis. The objective of this study is to report the functional and quality of life (QOL) outcomes in a cohort of patients that had undergone our reconstructive protocol. Methods This was a prospective case series of adult patients that underwent mandibular reconstruction with FFF and alloplastic TMJ prosthesis at the our center. Pre-operative and post-operative maximum inter-incisal opening (MIO) measurements were collected, and patients completed a QOL questionnaire (EORTC QLQ—H&N35) during those perioperative visits. Results Six patients were included in the study. The median patient age was 53 years. Heat map analysis of the QOL questionnaire revealed that patients reported a positive clinically significant change in the domains of pain, teeth, mouth opening, dry mouth, sticky saliva, and senses (relative change of 2.0, 3.3, 3.3, 2.0, 2.0, and 1.0 respectively). There were no negative clinically significant changes. There was a median perioperative MIO increase of 15.0 mm, and this was statistically significant (p = 0.027). Conclusions This study highlights the complexities involved in mandibular reconstruction with involvement of the TMJ. Based on our findings, patients can obtain an acceptable QOL and good function following simultaneous reconstruction with FFF employing SDS and an alloplastic TMJ prosthesis. Graphical Abstract |
| format | Article |
| id | doaj-art-17edd6d465664b1d9e7cce1bf4f82137 |
| institution | Kabale University |
| issn | 1916-0216 |
| language | English |
| publishDate | 2023-07-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Journal of Otolaryngology - Head and Neck Surgery |
| spelling | doaj-art-17edd6d465664b1d9e7cce1bf4f821372025-02-02T23:11:28ZengSAGE PublishingJournal of Otolaryngology - Head and Neck Surgery1916-02162023-07-015211810.1186/s40463-023-00639-4Advanced mandibular reconstruction with fibular free flap and alloplastic TMJ prosthesis with digital planningJustin M. Pyne0Clayton M. Davis1Ryan Kelm2Claudine Bussolaro3Walter Dobrovolsky4Hadi Seikaly5Division of Otolaryngology - Head and Neck Surgery, University of Alberta Hospital, University of AlbertaDivision of Oral and Maxillofacial Surgery, Faculty of Medicine and Dentistry, University of Alberta Hospital, University of AlbertaDivision of Oral and Maxillofacial Surgery, Faculty of Medicine and Dentistry, University of Alberta Hospital, University of AlbertaDivision of Oral and Maxillofacial Surgery, Faculty of Medicine and Dentistry, University of Alberta Hospital, University of AlbertaDivision of Oral and Maxillofacial Surgery, Faculty of Medicine and Dentistry, University of Alberta Hospital, University of AlbertaDivision of Otolaryngology - Head and Neck Surgery, University of Alberta Hospital, University of AlbertaAbstract Introduction Resection of the mandible and temporomandibular joint (TMJ) without formal reconstruction is a devastating condition that negatively affects all aspects of the patient’s life. We have approached the reconstruction of mandibular defects that include the condyle with simultaneous reconstruction with a vascularized free fibular flap (FFF) using Surgical Design and Simulation (SDS) and alloplastic TMJ prosthesis. The objective of this study is to report the functional and quality of life (QOL) outcomes in a cohort of patients that had undergone our reconstructive protocol. Methods This was a prospective case series of adult patients that underwent mandibular reconstruction with FFF and alloplastic TMJ prosthesis at the our center. Pre-operative and post-operative maximum inter-incisal opening (MIO) measurements were collected, and patients completed a QOL questionnaire (EORTC QLQ—H&N35) during those perioperative visits. Results Six patients were included in the study. The median patient age was 53 years. Heat map analysis of the QOL questionnaire revealed that patients reported a positive clinically significant change in the domains of pain, teeth, mouth opening, dry mouth, sticky saliva, and senses (relative change of 2.0, 3.3, 3.3, 2.0, 2.0, and 1.0 respectively). There were no negative clinically significant changes. There was a median perioperative MIO increase of 15.0 mm, and this was statistically significant (p = 0.027). Conclusions This study highlights the complexities involved in mandibular reconstruction with involvement of the TMJ. Based on our findings, patients can obtain an acceptable QOL and good function following simultaneous reconstruction with FFF employing SDS and an alloplastic TMJ prosthesis. Graphical Abstracthttps://doi.org/10.1186/s40463-023-00639-4Jaw reconstructionDental rehabilitationOral and maxillofacial surgeryOral neoplasmTemporomandibular joint prosthesisTemporomandibular joint dysfunction |
| spellingShingle | Justin M. Pyne Clayton M. Davis Ryan Kelm Claudine Bussolaro Walter Dobrovolsky Hadi Seikaly Advanced mandibular reconstruction with fibular free flap and alloplastic TMJ prosthesis with digital planning Journal of Otolaryngology - Head and Neck Surgery Jaw reconstruction Dental rehabilitation Oral and maxillofacial surgery Oral neoplasm Temporomandibular joint prosthesis Temporomandibular joint dysfunction |
| title | Advanced mandibular reconstruction with fibular free flap and alloplastic TMJ prosthesis with digital planning |
| title_full | Advanced mandibular reconstruction with fibular free flap and alloplastic TMJ prosthesis with digital planning |
| title_fullStr | Advanced mandibular reconstruction with fibular free flap and alloplastic TMJ prosthesis with digital planning |
| title_full_unstemmed | Advanced mandibular reconstruction with fibular free flap and alloplastic TMJ prosthesis with digital planning |
| title_short | Advanced mandibular reconstruction with fibular free flap and alloplastic TMJ prosthesis with digital planning |
| title_sort | advanced mandibular reconstruction with fibular free flap and alloplastic tmj prosthesis with digital planning |
| topic | Jaw reconstruction Dental rehabilitation Oral and maxillofacial surgery Oral neoplasm Temporomandibular joint prosthesis Temporomandibular joint dysfunction |
| url | https://doi.org/10.1186/s40463-023-00639-4 |
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