ObjectiveTo systematically review the survival rate of different vascularized bone flaps in mandibular defect repair and reconstruction by Bayesian network meta-analysis. MethodsThe PubMed, EBSCO, Scopus, Web of Science, Cochrane Library, WanFang Data and CNKI databases were electronically searched to collect clinical studies related to the objectives from inception to February 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. The Bayesian network meta-analysis was carried out applying R software. ResultsA total of 24 studies involving 1 615 patients were included. The results of meta-analysis showed that the respective survival rates of fibula free flap (FFF), deep circumferential iliac artery flap (DCIA), scapula flap, and osteocutaneous radial forearm flap (ORFF) were 95.62%, 94.09%, 98.16%, and 93.75%. Moreover, the network meta-analysis failed to show a statistically significant difference between all comparators. Conclusion Current evidence shows that different vascularized bone flaps have similar survival rates in mandibular defect repair and reconstruction. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objective To examine the mRNA expression of activin A(ACT A) and follistatin(FS) during mandibular lengthening and to elucidate the regulating pattern of during mandibular distractionosteogenesis.Methods Skeletally mature-white New Zealand rabbits were established right mandibular distraction osteogenesis models and the mandibles were lengthened 7 days after osteomy. Atthe end of latency period and the end of distraction period, 10,20, 30, 40 and60 days after fixation, the regenerating tissue of animals’ lengthened mandibles and that of the other side normal mandibles were harvested to extract RNA andto analyse ACT A, FS mRNA by RT-PCR.Results The expression of ACT A mRNA was not detectable in normal bone tissue and ACT A mRNA began to express at the end of latency period. The expression of ACT AmRNA increased gradually along with the beginning of distraction and reached the peak on the 10th and 20th days of distraction which was 5.04 and 4.98 times as much as that of the end of latency period, respectively. The trend of expression of FS mRNA during mandibular distraction osteogenesis was the same as expression of ACT A mRNA. Conclusion ACT A/FS play an important role during rabbit mandibular distraction osteogenesis.
Objective To summary the clinical application of free fibular composite flaps in repair of mandibular defect. Methods Fiftyeight cases of mandibular reconstruction using free fibular flaps, from June 1999 to November 2000, were reviewed, among which there were 37 cases of male and 21 cases of female, aged from 12 to 65 years old. All of the relevant data of the operation, such as the cause of the defect, design of the flaps, the blood vessels of the recipientand the complications, were included and analyzed. Results The fibular flap was 10.9 cm (4-21 cm) averagely in length and was harvested for 2.1 times (1-4 times); the average size of the skin paddle was 5.88 cm×3.13 cm. Of 58 flaps, therewere 56 survived; the overall complication rate was 24.1%.Conclusion It’s safe and reliable to use free fibular flap to reconstruct the mandibular defect.
Objective To systematically review the efficacy of poly-L-lactide (PLLA) material treatment versus titanium plates treatment for mandibular fractures. Methods We searched the Cochrane Library, PubMed, Embase, Chinese Journal Full-text Database, VIP Database, and Wanfang Database to collect literatures about randomized or non-randomized controlled trials using PLLA treatment (the trial group) versus titanium plates treatment (the control group) for mandibular fractures in the last ten years (from January 2007 to March 2017). The quality evaluation and data extraction were carried out by 2 reviewers independently and analyzed by Review Manager 5.3 software. Results A total of 8 literatures including 453 patients with mandibular fractures were included in this Meta-analysis. There was no significant difference in total complications between the two groups [odds ratio (OR)=0.98, 95% confidence interval (CI) (0.55, 1.75), P=0.95], including dislocation healing [OR= 0.96, 95%CI (0.46, 2.01), P=0.90], occlusal disturbance [OR=1.53, 95%CI (0.61, 3.87), P=0.37], infection [OR=0.63, 95%CI (0.23, 1.74), P=0.37], and secondary operation [OR=0.46, 95%CI (0.17, 1.27), P=0.14]. Conclusion There is no significant difference between PLLA and titanium plate in the treatment of mandibular fractures.
ObjectiveTo investigate the effectiveness of mini titanium plate for the treatment of intracapsular condylar fractures-type A. MethodsBetween March 2013 and July 2015, 22 cases (26 sides) of intracapsular condylar fractures-type A were treated with mini titanium plate through anterior auricular approach. There were 13 males and 9 females, aged from 16 to 32 years (mean, 22.7 years). The disease causes were traffic accident injury in 17 cases, falling injury in 4 cases, and heavy impact injury in 1 case. Five cases had intracapsular condylar fractures-type A only, and the other cases were accompanied with fractures of mandible, maxillary, or other part of jaw. All patients had different degrees of limitation of opening mouth, occlusal disorder, and joint pain, and the maximum opening was 5-16 mm (mean, 8.6 mm). All patients received surgical treatment within 2 to 9 days after injury (mean, 4 days). The clinical dysfunction index (DI) of Helkimo index was used to evaluate the mandibular motor function postoperatively. According to the 4 basic criterion of cure about mandibular condylar fractures by the international consensus conference in 1999, and maximal mouth opening by HE Dongmei et al., the surgical treatment effectiveness was evaluated. ResultsAll wounds healed at stage I, with no infection or other complications. All 22 cases were followed up 5-8 months (mean, 6 months). At 1 week after operation, the coronal spiral CT and three-dimensional reconstruction showed that contraposition of fractures was good, and the condyles located in the articular fossa. At 6 months after operation, the maximum opening was 33-42 mm (mean, 35.7 mm). After operation, 3 cases showed the mandible deflected to the affected side when opening, and limited lateral motion. According to the DI evaluation method in Helkimo index, there were 7 sides of DI grade 0, 18 sides of DI grade I, and 1 side of DI grade II. Based on surgical treatment effect of intracapsular condylar fractures-type A, occlusion recovery was obtained in 19 cases (86.36%), maximum opening degree of≥35 mm in 20 cases (90.91%), no symptoms of joint injury in 19 cases (86.36%), and no serious postoperative complications in 22 cases (100%); 17 cases (77.27%) were in accordance with the above 4 items. ConclusionMini titanium plate is one of the most effective approaches to treat intracapsular condylar fractures-type A.
OBJECTIVE: To establish the animal models of mandibular distraction osteogenesis in rabbits and study its osteogenetic mechanism. METHODS: The right mandibles just anterior to the first molars of 12 rabbits were performed osteotomies, and the mandibles were positioned with distractors. The left mandibles were control group without operation. After 1 week, the distractors were stretched 0.9 mm every day for 10 days progressively. One day, 2, 4, 8 weeks after distraction, the mandibles were studied with gross measurement, X-ray, and histological examination. RESULTS: The right mandible were lengthened 8.3 mm on average without bone nonunion and deformity healing. It was observed that the gaps between the distracted bone edges were first occupied by fibrous tissue. Two weeks after distraction, it was found that the gaps were bridged by callus in X-ray, the new bone and the normal bone could not be differentiated clearly after 8 weeks. In histological sections, there were collagen bundles in early distraction, then those collagen bundles were calcificated and become trabeculaes. No Cartilage was found during distraction. CONCLUSION: It suggests that the rabbit mandible can be lengthened by distraction osteogenesis, and the new bone is formed by intramembranous ossification.
【Abstract】 Objective To assess the feasibility and clinical outcomes of artificial condylar process in reconstruction of the temporomandibular joint. Methods Between January 2005 and January 2010, the reconstructions of the temporomandibular joints with artificial condylar process were performed in 10 cases (11 sides, including 7 left sides and 4 right sides). There were 7 males and 3 females with an average age of 50 years (range, 40-68 years). Mandibular condyle defects were caused by mandible tumor in 7 patients with a mean disease duration of 15 months (range, 9-24 months) and by bilateral condylar fractures in 3 patients with the disease duration of 2, 3, and 2 days respectively. According to Neff classification, there were type M and A in 1 case, type M and B in 1 case, and type M in one side and subcondylar fracture in the other side in 1 case. Results Incisions in all patients healed by first intention, and no complication occurred. All cases were followed up 1 to 4 years, showed facial symmetry and good occluding relation, and the mouth opening was 22-38 mm (mean, 30 mm). No temporomandibular joint clicking or pain and no recurrence of tumor were observed. Most of the artificial condylar process were in good position except 1 deviated from the correct angle slightly. All the patients could have diet normally. Conclusion The results of temporomandibular joint reconstruction after tumor resection with artificial condylar process are good, but the clinical outcome for intracapsular condylar fracture is expected to be further verified.
Objective To evaluate the reliability and effectiveness of a deep circumflex iliac artery based iliac-internal oblique musculofascial chimeric flap (DCIA-IIOF) in reconstruction of complex oromandibular defect. Methods Between January 2010 and December 2015, DCIA-IIOFs were used to repair complex oromandibular defects in 11 patients. There were 8 males and 3 females, with an age of 27-75 years (median, 56 years). Original disease was lower gingival squamous cell carcinoma in 7 cases (T3N1M0 in 2 cases, T3N2M0 in 1 case, T4N0M0 in 2 cases, and T4N2M0 in 2 cases), osteoradionecrosis after radiotherapy for nasopharyngeal carcinoma in 2 cases, central mandibular squamous cell carcinoma in 1 case (T4N0M0), and mandibular malignant fibrous histiocytoma in 1 case. The length of mandibular bone defects ranged from 7 to 10 cm (mean, 8 cm), and the area of the mucosal defects ranged from 5 cm×3 cm to 7 cm×4 cm. Preoperative ultrasonic identification of the DCIA and its ascending branch was routinely performed. The DCIA-IIOF was harvested by using an anterograde dissection technique, of which the iliac island was used for segmental mandibular defect repair and the musculofascial island for soft tissue and mucosal defect repair. Results All 11 cases were followed up 15-75 months (median, 37 months). All flaps survived after operation, without necrosis of both iliac island and oblique internal musculofascial island. One patient had a mild submandibular infection which healed after wound drainage and intravenous antibiotics. At 1 month after operation, the color and texture of the musculofascial island were similar to oral mucosa without contracture, and the occluding relation was good for all patients. At 6 months after operation, the mouth opening hardly improved in 2 patients who had osteoradionecrosis; 1 patient who underwent postoperative radiotherapy had restriction of mouth opening; the remaining 8 patients had normal month opening and normal diet. Three patients died of cancer recurrence, 2 patients died of other diseases (encephalorrhagia in 1 case and myocardial infarction in 1 case), and the others survived without recurrence during follow-up. No patient developed abdominal hernia during follow-up. Conclusion DCIA-IIOF is a reliable flap in reconstruction of complex oromandibular defects. The occluding relation after operation is good and the mucosal lining is soft. This technique provides an effective option for moderate complex oromandibular defects repair.
OBJECTIVE To study the anatomical basis of vascularized spina scapular bone flap, which was used in mandibular reconstruction. METHODS Fifteen adult cadavers were adopted in this study. The two common carotid arteries of each cadaver were intubed and perfused with red emulsion respectively. Then the course and distribution of the transverse cervical artery(TCA) and its spina scapular branches were observed on 30 sides. RESULTS The TCA was divided into two segments: the cervical segment originated from the origin of the artery to the superior margin of the trapezius muscle, and the dorsal segment originated from the superior margin of the trapezius muscle to the site where the TCA bifurcated into the superficial and deep branches. The average length and original caliber of the cervical segment were(4.7 +/- 0.1) cm and (4.0 +/- 0.1) mm. The average length and original caliber of the dorsal segment were (5.88 +/- 0.63) cm and (3.30 +/- 0.35) mm. 86.7% spina scapular branches originated from the superficial branch of TCA and 13.3% from TCA. The length of the spina scapular branch was (4.97 +/- 1.68) cm and its external diameter was (2.08 +/- 0.27) mm. It constantly sent 4-8 periosteal branches to spina with 0.20-1.25 mm in caliber. CONCLUSION The spina scapular branch of TCA is one of the main blood supplier to the spina scapular area. The spina scapular flap pedicled with spina scapular branch of TCA may provide a new operation for mandibular reconstruction, whose circumpoint locates at the origin of the dorsal segment and the average length of the pedicle is 10.85 cm which enough to transposite to mandibular area.
Objective To investigate the mode and influential factor of newbone formation following distraction osteogenesis in mandibular lengthening. Methods Corticotomy was performed on bilateral mandibles in twelve adult male goats. A custommade distractor was used to lengthen the mandible at a rate of 1mm/day for 10 days (total 10 mm elongation). Four goats were sampled respectivelyat 2, 4 and 8 weeks after completion of distraction. The lengthening mandibles were examined by roentgenography and histology. Results Newly formed callus was observed in the distraction gap after mandibular lengthening. The new bone exhibited intramembranous ossification generally, but cartilage islands could be found in the specimen that diastractor loosed. Conclusion The above findings indicate that the mode of new bone formation in mandibular lengthening following distraction osteogenesis appears to be intramembranous ossification and that endochondral ossification takes place in case distractor has loosened.