• Journal of Dental Anesthesia and Pain Medicine
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• v.16 no.4
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• pp.317-320
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• 2016

A 47-year-old woman was referred for surgical treatment of osteomyelitis of the mandible. She had already undergone three previous surgeries. Pre-anesthetic airway evaluation predicted a difficult airway, due to the thin, retro-positioned mandible, tongue, and atrophic changes in the lips and soft tissue. We inserted packing gauzes in the buccal mucosa for easier mask fitting and ventilation. During direct laryngoscopic intubation with a nasotracheal tube (NTT), fracture of a thin mandible can easily occur. Therefore, we used a fiberoptic bronchoscope to insert the NTT. After surgery, we performed a tongue-tie to protect against airway obstruction caused by the backward movement of the tongue during recovery. The patient recovered without any complications. We determined the status of the patient precisely and consequently performed thorough preparations for the surgery, allowing the patient to be anesthetized safely and recover after surgery. Careful assessment of the patient and airway prior to surgery is necessary.

• Journal of Periodontal and Implant Science
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• v.46 no.2
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• pp.72-83
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• 2016

Purpose: The goal of this study was to evaluate the long-term success of horizontal alveolar crest augmentation of the retromolar region of the mandible with particulated bone, as well as factors affecting subsequent peri-implant bone loss. Methods: A total of 109 patients (68 female, 41 male) suffering from alveolar ridge deficiencies of the maxilla and mandible were included in this study. All patients were treated with particulated retromolar bone grafts from the mandible prior to the insertion of endosseous dental implants. Mesial and distal peri-implant crestal bone changes were assessed at six time points. Several parameters, including implant survival and the influence of age, gender, localisation of the implant, diameter, covering procedures, and time points of implant placement, were analysed to identify associations with bone level changes using the Mann-Whitney U-test, the Kruskal-Wallis test, and Spearman's rank-order correlation coefficient. Results: A total of 164 dental implants were placed in the maxilla (n=97) and in the mandible (n=67). The mean observation period was $105.26{\pm}21.58$ months after implantation. The overall survival rate was 97.6% after 10 years. Overall, peri-implant bone loss was highest during the first year, but decreased over time. The mean amount of bone loss after 10 years was 2.47 mm mesially and 2.50 mm distally. Bone loss was significantly influenced by implant type and primary stability. Conclusions: The use of particulated autologous retromolar bone grafts is a reliable technique for the horizontal reconstruction of local alveolar ridge deficiencies. Our results demonstrate that implants placed in augmented bone demonstrated similar bone level changes compared to implants inserted in non-augmented regions.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.41 no.2
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• pp.78-83
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• 2015

Squamous cell carcinoma (SCC) is the most common malignant tumor in the oral cavity, and it accounts for about 90% of all oral cancers. Several risk factors for oral SCC have been identified; however, SCC associated with odontogenic keratocysts have rarely been reported. The present study describes the case of a 36-year-old man with SCC of the right ramus of the mandible, which was initially diagnosed as a benign odontogenic cyst. He underwent enucleation at another hospital followed by segmental mandibulectomy and fibular free flap reconstruction at our institution. In this case, we introduce a patient with oral cancer associated with odontogenic cyst on the mandible and report a satisfactory outcome with wide resection and immediate free flap reconstruction.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.23 no.2
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• pp.185-190
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• 2001

We described three cases of immediate reimplantation of a frozen-thawed autogenous mandible composed of a mixture of iliac bone, marrow, and particulate hydroxyapatite in tumors of the mandible. Acceptable outcomes were obtained in three patients who underwent immediate autogenous mandibular graft reconstruction. The conditions leading to successful outcome of the procedure are also discussed. Reimplantation of frozen autogenous lesioned mandible was performed in three patients with mandibular tumors. Two reimplanted grafts survived without complications following surgery. One case had postoperative infection that resolved with appropriate antibiotic treatment. There were no recurrences of the primary lesions. Satisfactory facial contour after surgery was achieved. These results are most promising, and we believe that, with further refinement, this technique will offer a new and acceptable modality for facial reconstruction in patients with cancer.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.42
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• pp.37.1-37.13
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• 2020

Background: The human mandible is variable in shape, size and position and any deviation from normal can affect the facial appearance and dental occlusion. Objectives: The objectives of this study were to determine whether the Sassouni cephalometric analysis could help predict two-dimensional mandibular shape in humans using cephalometric planes and landmarks. Materials and methods: A retrospective computerised analysis of 100 lateral cephalometric radiographs taken at Kingston Hospital Orthodontic Department was carried out. Results: Results showed that the Euclidean straight-line mean difference between the estimated position of gonion and traced position of gonion was 7.89 mm and the Euclidean straight-line mean difference between the estimated position of pogonion and the traced position of pogonion was 11.15 mm. The length of the anterior cranial base as measured by sella-nasion was positively correlated with the length of the mandibular body gonion-menton, r = 0.381 and regression analysis showed the length of the anterior cranial base sella-nasion could be predictive of the length of the mandibular body gonion-menton by the equation 22.65 + 0.5426x, where x = length of the anterior cranial base (SN). There was a significant association with convex shaped palates and oblique shaped mandibles, p = 0.0004. Conclusions: The method described in this study can be used to help estimate the position of cephalometric points gonion and pogonion and thereby sagittal mandibular length. This method is more accurate in skeletal class I cases and therefore has potential applications in craniofacial anthropology and the 'missing mandible' problem in forensic and archaeological reconstruction.

• Journal of International Society for Simulation Surgery
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• v.2 no.1
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• pp.1-6
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• 2015

Purpose Bisphophonate-related osteonecrosis of the jaw (BRONJ) is an emerging problem. Extensive osteonecrosis of the jaw needs free flap reconstruction. Free fibular flap is the most useful flap for maxilla-mandibular hard and soft tissue reconstruction. The advantages of fibular free flap are simultaneous soft and hard tissue reconstruction and placing implant in reconstructed mandible and maxilla. In this study, four consecutive BRONJ patients who underwent fibula free flap reconstruction using simulation surgery were reviewed. Materials and Methods Four BRONJ patients who underwent free fibula reconstruction between May 2006 and September 2014 were included in this study. Male to female ratio was 1:3 and average age was 67.3 years old (62-70). All patients need mandibular bone reconstruction. Three patients suffered from osteoporosis and one male patient had multiple myeloma. Postoperative flap survival, functional reconstruction, esthetic results, food taking were evaluated. Results Three osseous flaps and one osteocutaneous flap were used. All the fibular flaps were survived and patients were recovered without complications. Oro-cutaneous fistula was resolved after operation. All patients were satisfied with the esthetic results. Patients reported improved solid food intake after operation with partial denture. One fully edentulous patient had semi-fluid diet after operation. Conclusion Treatment of the BRONJ is difficult due to lack of standard protocol. Fibular free flap using simulation surgery is the workhorse flap for mandibular hard and soft tissue reconstruction, especially in stage III BRONJ patient. In this study, functional and esthetic results were successful in all patients. Normal diet was possible with partial dentures.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.24 no.2
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• pp.361-368
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• 1994

Radiographic planning is needed for implant placement in order to determine implant length, jaw bone volume, anatomical stucture and so on. Radiographic examination includes conventional radiography, conventional tomography and CT scan. The most accurate mesurement can be obtained from CT scan. For the cross-sectional view of mandible, CT scan reconstruction is generally needed. But the cross-sectional view of mandible can be reformed by personal computer. This study was performed to examine the clinical usefulness of reformed image using personal computer in comparison with CT scan reconstructed image. CT axial slices of 4 mandibles of 4 volunteers were used. Digital imaging system was composed of Macintosh Ⅱ ci computer, high resolution Sony XC-77 CCD camera, Quick Capture frame grabber board and 'NIH Image' program. Seven reconstructed cross-sectional images within CT machine(CT group) were obtained. And seven reformed cross-sectional images(PC group) after digitization of CT axial slices into the personal computer were obtained. PC group was compared with CT group in the objective and subjective aspects. The results were as follow: 1. Measurement of mandibular height & width in both group showed insignificant difference(P>0.05). 2. Subjective assessment of the mandibular canal in both group showed insignificant difference(P>0.05). 3. Image reformation using personal computer could provide panoramic view, which could not be obtained in CT scan reconstruction.

• The Journal of Korean Academy of Prosthodontics
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• v.58 no.3
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• pp.268-274
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• 2020

Functional and esthetic recovery through reconstruction of the oral and maxillofacial system is important for patients who underwent mandibulectomy due to lesions such as oral cancer. The fibula free flap, which is frequently used in the reconstruction of the mandible, is easy to prosthetic restoration with implant placement. However, patients with growing periods have difficulty in treatment with implants when the size of the fibula is small and residual growth remains. This case is an 11-year-old female patient who underwent mandibulectomy due to osteosarcoma and reconstruction of the mandible using a fibular free flap. Functional and esthetic recovery were obtained through prosthetic restoration using implant-supported fixed prostheses. Implantation site, number of implants, and type of prostheses were considered. Implant-supported fixed prostheses were delivered at 13 years old, and after an additional 1 year observation, stable results were obtained. However, observing changes in the maxillofacial system through further examinations is necessary.

• Archives of Plastic Surgery
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• v.33 no.6
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• pp.688-694
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• 2006

Purpose: Reconstruction of the craniofacial defects can be carried out with autogenous tissues, allogenic implants, or alloplastic materials. Titanium mesh systems have been used for bony reconstruction in non load-bearing areas. They offer several advantages: immediate availibility without any donor site morbidity, easy handling, stable 3-D reconstruction, and low susceptibility to infection. The aim of this study is to evaluate the usefulness and complications of titanium mesh system in the reconstruction of the craniofacial defects. Methods: From Jan. 2000, to Dec. 2004, we performed reconstruction of craniofacial bone defects in 21 patients who had benign or malignant tumor and fracture events in the cranium, orbit, nasal bone, maxilla, zygoma and the mandible. The size of the defects ranged from $1.0{\times}1.5cm$ to $12{\times}10cm$. Two different mesh systems, micro-titanium augmentation mesh and dynamic mesh was used for bony reconstruction in non load-bearing areas. The patients were evaluated from 1 to 4 yrs clinically and radiographically with a mean follow up period of 1.5 yrs. Results: There were no serious complications, including wound infection, foreign body reaction, exposures or loos of the mesh, central infection and pathologic findings of bone around mesh exception of one patient, who had expired of skull base tumor recurrence. Long-term stability of the reconstructions and the overall functional and aesthetic outcome was excellent. Conclusion: Our experiences demonstrate that the Titanium mesh system is a relatively safe and efficient method in the craniofacial reconstruction and have broadens our choices of therapeutic procedures in the craniomaxillofacial surgery.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.40
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• pp.32.1-32.8
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• 2018

Background: The free vascularized fibula flap presents many advantages such as sufficient length of the bony segment, good vascularization, better quality of the bone, and a long vascular pedicle, but it is also associated with some disadvantages with regard to prosthetic rehabilitation because of its limited height. Improvement in bone height is necessary for ideal dental implant treatment of reconstructed mandibles. Case presentation: For two squamous cell carcinoma patients, mandibular bone reconstruction was performed secondarily with the peroneal flap after tumor resection. Since the bone height was insufficient at the time of implant treatment, occlusion reconstruction by dental implant was performed after vertical distraction osteogenesis. Conclusions: Vertical distraction osteogenesis is a suitable treatment option for alveolar ridge deficiency resulting from fibula transplantation for mandibular reconstruction following tumor surgery.