Clinical Case: Distraction Osteogenesis in Secondary Microsurgical Mandible Reconstruction
Lei Li, MD, DMD; Felix Blake, MD, DMD; Eva Gudewer, MD; Rainer Schmelzle, MD, DMD, PhD; Ali Gbara, MD, DMD
Fibula, ilium and scapula were the preferred donor areas for the vascularised bone grafts. For secondary mandible reconstruction, especially in radiated cases, compromises often have to be made as a result of the poor quality of the covering soft tissue and recipient vessels. Callus distraction osteogenesis is a complementary method promoting an optimisation of the intermaxillary relationship and from an aesthetical point of view, the facial profile.
Thirteen distractions were performed following microsurgical mandible reconstruction in seven patients over a period of four years, from one surgeon. Intra-oral distraction devices were predominately used. After a 7 day healing period, the callus distraction was begun, involving two rotations per day of 0.5 mm each. The distraction devices were removed after a consolidation phase of approximately 4 to 5 months. Of the thirteen distractions, the medical course often proved uneventful with an average bone lengthening of 20 mm during a follow-up time of 6 to 47 months (average 27 months). An improved in the intermaxillary relationship and of the facial profile was achieved in all cases. Distraction plate fractures, screw loosening and no new bone formation were the complications encountered in three patients. In respect to the high complication rate, the predictability of a successful outcome cannot be considered high. Subsequently, when including this procedure into the possible therapy alternatives available to the clinician, the indication should be set stringently.
