Publication date: Available online 9 May 2019
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Lei Zheng, Wenjie Wu, Yan Shi, Jianguo Zhang
ABSTRACT
Purpose
This study aimed to evaluate the intraoral anastomosis of a deep circumflex iliac artery (DCIA) flap in combination with computer-assisted techniques for mandibular reconstruction.
Materials and Methods
Between December 2015 and March 2018, 4 patients with mandibular discontinuity defects caused by ablative tumor surgery were included in the study. Mandibular reconstruction was performed with a DCIA flap using computer-assisted and intraoral anastomosis techniques. A CAD/CAM cutting guide, a reconstruction stereomodel and a prebent reconstruction plate were used for mandibular reconstruction in each patient. The anastomosis was performed on the facial artery and vein using the deep circumflex iliac vessels through an intraoral approach. The resulting error-grade color map was used to evaluate repeatability between the preoperative design and postoperative results.
Results
Mandibular reconstruction with a DCIA flap using computer-assisted and intraoral anastomosis techniques was successful in the 4 patients. All flaps survived with no severe complications. Satisfactory cosmetic outcomes and occlusion with sufficient bone height for implants were achieved postoperatively. Repeatability between the virtual plan and postoperative result was 81.1±8.2% within 1 mm, 85.8±8.1% within 2 mm, and 89.6±6.7% within 3 mm.
Conclusions
The utilization of intraoral anastomosis and computer-assisted techniques with DCIA flaps for mandibular reconstruction without additional facial scarring is feasible and advantageous. However, the findings should be interpreted cautiously due to the relatively short follow-up time and limited number of patients involved in this study.
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