• Archives of Craniofacial Surgery
• /
• v.15 no.2
• /
• pp.75-81
• /
• 2014

Background: The fibular free flap has been used as the standard methods of segmental mandibular reconstruction. The objective of mandibular reconstruction not only includes restored continuity of the mandible but also the recovery of optimal function. This paper emphasizes the advantage of the fibular free flap reconstruction over that of locking mandibular reconstruction plate fixation. Methods: The hospital charts of all patients (n=20) who had a mandibular reconstruction between 1994 and 2013 were retrospectively reviewed. Eight patients had plateonly fixation of the mandible, and the remaining 12 had vascularized fibular free flap reconstruction. Complications and outcomes were reviewed and compared between the 2 groups via statistical analysis. Results: Overall complication rates were significantly lower in the fibular flap group (8.3%) than in the plate fixation group (87.5%; p =0.001). Most (7/8) patients in the plate fixation group had experienced plate-related late complications, including plate fracture or exposure. In the fibular flap group, no complications were observed, except for a single case of donor-site wound dehiscence (1/12). Conclusion: The fibular free flap provides a more stable support and additional soft tissue support for the plate, thereby minimizing the risk of plate-related complications. Fibular free flap is the most reliable option for mandibular reconstruction, and we believe that the flap should be performed primarily whenever possible.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.47 no.3
• /
• pp.233-236
• /
• 2021

A mandibular continuity defect can be repaired using either a prosthetic device or autogenous bone. A titanium reconstruction plate can be used with a localized or vascularized flap over the defect of the mandible. Unfortunately, the plate may fail due to plate exposure, screw loosening, fracture, or infection, and will need to be removed. Plate exposure though the skin or mucosa is one of the main reasons for failure. In the present work, the authors introduced a lingually positioned reconstruction plate fabricated via three-dimensional printed bending support. This custom reconstruction plate can avoid plate re-exposure as well as reduce surgical errors and operation time.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.28 no.3
• /
• pp.231-233
• /
• 2002

Temporary reconstruction of the mandibular continuity defect resulting from the ablative tumor surgery with a reconstruction plate can be used for the preservation of normal facial contour and oral function and for periodic follow up of recurrence. Reconstruction plates are adapted to the bone before the resection and provisionally fixated with some screws. Accurate contouring and adaptation are very important for the prevention of displacement of bony stumps and decubituous skin ulcer. However, if there is large expanding buccal tumor mass in mandible, it is very difficult or even impossible to contour the plate before resection. I, therefore, introduce the reconstruction plate application technique using a simple condylar repositioning miniplate after segmental mandibular resection.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.30 no.6
• /
• pp.513-517
• /
• 2008

Purpose: This study aimed to evaluate distribution and maximal value of mechanical stresses on the reconstruction plate, bridging mandibular symphysis defect, and to optimize the most appropriate locations of the plate to distribute the stress causing the fracture of the plate. Materials and methods: Four types of reconstruction were constructed by different number and location of the reconstruction plates on the 3 D finite element model (FEM) of a human edentulous mandible; Type I: one plate on the inferior border of the anterior mandible, Type II: one plate on the middle of the anterior mandible, Type III: one plate on the superior border of the anterior mandible, and Type IV: two plates on the inferior and superior border of the anterior mandible. Results: The results showed that the maximal stress of type I (234.29 Mpa) was lower than that of type II (260.91 Mpa) and type III (247.37 Mpa), but higher than that of type IV (186.64 Mpa). We could also observe that the stresses are tending to focus on the inner side and inferior part of the plate which connected proximal segment from the vertical load. Conclusions: On the basis of the findings, it was concluded that using a plate on the inferior border of mandible or two plates on the inferior and superior border of mandible are more favorable to distribute mechanical stresses, which could reduce the fracture of the plate.

• Journal of International Society for Simulation Surgery
• /
• v.4 no.1
• /
• pp.13-16
• /
• 2017

Fibular free flap reconstruction is the flap of the choice in long-span mandibular bone reconstruction. The most common disadvantage of the fibular flap is short bone height to install dental implant. Double barrel fibular flap has been tried, however, bulky flap in the oral cavity hinder its use. Titanium reconstruction plate has been used simultaneously with the free fibular flap to stabilize occlusion and to fix the fibular flap. In this study, titanium reconstruction plate was fixed in the lower border of the mandible and the fibular free flap was fixed in the superior border of the titanium plate to improve implant-crown ratio. This new technique improved the longevity of the dental prosthodontics with dental implants.

• Korean Journal of Computational Design and Engineering
• /
• v.21 no.3
• /
• pp.234-241
• /
• 2016

Conventional bent plate used in mandibular reconstruction surgery needs safety verification since its mechanical properties are changed due to the plastic deformation during the bending process. In this study we investigate stability of the plastically deformed plate and the plate with the same shape without plastic deformation through the finite element analysis(FEA). First we simulate the process of plate bending to fit the defect in patient. Then, the other plate is modelled to represent a customized plate with the same shape of the plastically deformed one, but without any residual stresses from plastic deformation. After binding these plates to the mandible, we conduct the masticatory simulation. Finally, we compare the resulting Von Mises stress of the customized plate and of the bent plate. The bent plate shows much higher stress than the customized one due to the residual stresses form the bending process. The study shows that plastic deformation in the plate may decrease the safety of the reconstruction surgery.

• Journal of Biomedical Engineering Research
• /
• v.19 no.2
• /
• pp.133-142
• /
• 1998

In Bayesian SPECT reconstruction, the incorporation of elaborate forms of priors can lead to improved quantitative performance in various statistical terms, such as bias and variance. In particular, the use of higher-order smoothing priors, such as the thin-plate prior, is known to exhibit improved bias behavior compared to the conventional smoothing priors such as the membrane prior. However, the bias advantage of the higher-order priors is effective only when the hyperparameters involved in the reconstruction algorithm are properly chosen. In this work, we further investigate the quantitative performance of the two representative smoothing priors-the thin plate and the membrane-by observing the behavior of the associated hyperparameters of the prior distributions. In our experiments we use Monte Carlo noise trials to calculate bias and variance of reconstruction estimates, and compare the performance of ML-EM estimates to that of regularized EM using both membrane and thin-plate priors, and also to that of filtered backprojection, where the membrane and thin plate models become simple apodizing filters of specified form. We finally show that the use of higher-order models yields excellent "robustness" in quantitative performance by demonstrating that the thin plate leads to very low bias error over a large range of hyperparameters, while keeping a reasonable variance. variance.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.29 no.5
• /
• pp.429-438
• /
• 2007

Transport distraction osteogenesis has been introduced recently to correct skeletal malformations and discrepancies in the maxillofacial area. To reconstruct 3-dimensitonal mandibular shape, this transport distraction can be considered with the use of reconstruction plate. A 23-years-old male having unilateral mandibular body and angle defects, who had been operated of partial mandibular resection due to unicystic ameloblastoma, was treated by transport distraction procedures with ThreadLock transport $distractor^{(R)}$ (KLS Martin Co., Germany) through the rail of reconstruction plate (Osteomed Co., USA). After being distracted 35 mm defect from mandibular angle to body, and consolidated for 16 weeks, allogenic bone graft on docking site was performed with removal of transgingival pin. For more than 13 weeks follow up period after consolidation period, gradual increase of radiopacity in the radiographic examination was shown, and the curved mandibular continuity according to the reconstruction plate was made firmly. These transport distraction osteogenesis in the mandible was able to be considered as the good and minimally invasive technique for the reconstruction of mandibular discontinuity. Young patient was also very satisfactory for these results.

• Archives of Reconstructive Microsurgery
• /
• v.24 no.2
• /
• pp.68-74
• /
• 2015

Purpose: The reconstruction of femur and tibia defects following tumor resection remains a surgical challenge. The clinical outcome of free vascularized fibula graft (VFG) reconstruction with locking plate for massive femur and tibia defects of more than 10 cm that were secondary to skeletal tumor resection is reported. Materials and Methods: Thirteen patients with a mean follow-up of 3.3 years were reviewed. Seven patients received vascularized fibula grafts in the femur and six in the tibia. The mean bony defect of the femur and tibia was more than 10 cm and the length of the grafted fibula was more than 15 cm. All defects were stabilized with long locking plates. Results: All patients were free of disease at final follow-up; All VFGs were transferred successfully. All patients had a successful outcome with bony union. Stress fractures of the grafted fibula had occurred but the locking plate stabilized the fracture and healed until the last follow-up. All patients were able to walk without a brace after a mean of 9 months postoperatively. Conclusion: VFG with locking plate is a reliable reconstructive procedure for massive femur and tibia defects.

• Journal of Chest Surgery
• /
• v.7 no.1
• /
• pp.67-72
• /
• 1974

This is a case report of total sternal resection and successful reconstruction of the sternum applying Tantalum plate in multiple myeloma. The patient was a 57 year old male with a tumor located on the middle sternum invading the manubrium and the body of the sternum developing symptoms after a contusion of the anterior sternum. The sternum resected with left and right. from first to sixth costochondral cartilages, and then Tantalum plate was fixed to the all fragments of the ribs with wire sutures. After reconstruction of the sternum applying Tantalum plate, the patient has had good breathing movements of the chest wall and also maintenance of respiratory function was satisfactory. Histopathologically, the tumor was consisted of a tissue of plasma cells, which was identical to multiple myeloma. Postoperative chemotherapy with Endoxan for multiple myeloma was administered. No recurrent symptoms of multiple myeloma could be observed during one year follow up period.