Mandible Defect Reconstruction by Intraoral Anastomosis of Iliac Crest Bone Flap

doi:10.13701/j.cnki.kqyxyj.2024.01.005

Abstract

Abstract: Objective: To introduce the operation and advantages of intraoral vascular anastomosis technology combined with vascularized iliac crest flap transplantation in mandibular reconstruction during the era of digital surgery, and to explore the clinical application of intraoral vascular anastomosis technology. Methods: Three patients with benign tumors of jawbones who underwent jawbone resection and simultaneous repair in the Department of Oral and Maxillofacial Surgery, School of Stomatology, Wuhan University in 2022 were selected. Preoperative CT scans of the mandible and ilium were performed on the patients. Virtual surgical planning was made and osteotomy cutting guides were designed and produced. Tumors in two cases were resected through intraoral approach and in one case was resected through extra-oral approach. Iliac crest flap with pedicle was harvested. The facial artery and vein were used as recipient vessels to perform vascular anastomosis with the vascular pedicle of the iliac crest flap to reconstruct and repair the mandibular defect. Follow-up visits were conducted to evaluate the postoperative recovery of patients. Results: All three surgeries were successful. Two patients had no extraoral incision, and one patient had only extra-oral incision because of the primary lesion resection. Patients recovered well postoperatively. The mandibular structure was basically symmetrical and aesthetic. Conclusion: The combination of intraoral anastomosis technology, iliac crest flap, and virtual surgical planning can achieve good postoperative results. Intraoral anastomosis technology can not only reconstruct mandibular lesions after intraoral resection, but also has certain advantages for cases requiring extra-oral approach to resect lesions.

Key words: intraoral vascular anastomosis, iliac crest bone flap, mandibular reconstruction

BU Linlin, ZHANG Hongyu, CAO Leiming, LIU Bing, JIA Jun. Mandible Defect Reconstruction by Intraoral Anastomosis of Iliac Crest Bone Flap[J]. Journal of Oral Science Research, 2024, 40(1): 23-28.

References

[1] Shestak KC, Myers EN, Ramasastry SS, et al. Microvascular free tissue transfer for reconstruction of head and neck cancer defects [J]. Oncology (Williston Park), 1992, 6(5): 101-110; discussion 110, 115-116, 121.
[2] Gaggl A, Bürger H, Virnik SA, et al. An intraoral anastomosing technique for microvascular bone flaps in alveolar ridge reconstruction: first clinical results [J]. Int J Oral Maxillofac Surg, 2009, 38(9): 921-927.
[3] Abul-Hassan HS, Von Drasek Ascher G, Acland RD. Surgical anatomy and blood supply of the fascial layers of the temporal region [J]. Plast Reconstr Surg, 1986, 77(1): 17-28.
[4] Nkenke E, Agaimy A, Von Wilmowsky C, et al. Mandibular reconstruction using intraoral microvascular anastomosis following removal of an ameloblastoma [J]. J Oral Maxillofac Surg, 2013, 71(11): 1983-1992.
[5] Nkenke E, Agaimy A, St Pierre M, et al. Intraoral microvascular anastomosis for segmental mandibular reconstruction following removal of an ameloblastoma [J]. J Craniofac Surg, 2013, 24(3): e265-e270.
[6] Brandtner C, Bürger H, Hachleitner J, et al. The intraoral anastomosing technique in reconstructive surgery of the face - A consecutive case series of 70 patients [J]. J Craniomaxillofac Surg, 2015, 43(9): 1763-1768.
[7] Landes C, Cornea P, Teiler A, et al. Intraoral anastomosis of a prelaminated radial forearm flap in reconstruction of a large persistent cleft palate [J]. Microsurgery, 2014, 34(3): 229-232.
[8] Rysz M, Nowakowski F, Mazurek M. Facial vessels course in the cheek in open mouth position for intraoral microvascular anastomoses purposes [J]. J Plast Reconstr Aesthet Surg, 2022, 75(1): 439-488.
[9] Sosin M, Sinada GG, Rodriguez ED, et al. Intraoral microvascular anastomosis of an Iliac free flap for maxillary fibrous dysplasia [J]. J Oral Maxillofac Surg, 2015, 73(10): 2068.e1-5.
[10] Zhang HY, Shao Z, Jia J, et al. Analysis of intraoral microvascular anastomosis in maxillofacial defects reconstruction [J]. J Craniomaxillofac Surg, 2023, 51(1): 31-43.
[11] Zheng L, Lv X, Shi Y, et al. Intraoral anastomosis of a vascularized iliac-crest flap in maxillofacial reconstruction [J]. J Plast Reconstr Aesthet Surg, 2019, 72(5): 744-750.
[12] Zheng L, Wu W, Shi Y, et al. Mandibular reconstruction with a deep circumflex iliac artery flap using computer-assisted and intraoral anastomosis techniques [J]. J Oral Maxillofac Surg, 2019, 77(12): 2567-2572.
[13] Zheng HP, Zhuang YH, Zhang ZM, et al. Modified deep iliac circumflex osteocutaneous flap for extremity reconstruction: anatomical study and clinical application [J]. J Plast Reconstr Aesthet Surg, 2013, 66(9): 1256-1262.
[14] Mücke T, Loeffelbein DJ, Kolk A, et al. Comparison of outcome of microvascular bony head and neck reconstructions using the fibular free flap and the iliac crest flap [J]. Br J Oral Maxillofac Surg, 2013, 51(6): 514-519.
[15] Escandón JM, Bustos VP, Escandón L, et al. The versatility of the DCIA free flap: A forgotten flap? Systematic review and meta-analysis [J]. J Reconstr Microsurg, 2022, 38(5): 378-389.
[16] 杨鑫,吕明明,李军,等.虚拟手术计划在经口内入路行下颌骨切除及精确重建中的应用:附9例报道[J].中国口腔颌面外科杂志,2021,19(5):469-473.
[17] Jie B, Yao B, Li R, et al. Post-traumatic maxillofacial reconstruction with vascularized flaps and digital techniques: 10-year experience [J]. Int J Oral Maxillofac Surg, 2020, 49(11): 1408-1415.
[18] van Mulken TJM, Schols RM, Qiu SS, et al. Robotic (super) microsurgery: Feasibility of a new master-slave platform in an in vivo animal model and future directions [J]. J Surg Oncol, 2018, 118(5): 826-831.
[19] van Mulken TJM, Schols RM, Scharmga AMJ, et al. First-in-human robotic supermicrosurgery using a dedicated microsurgical robot for treating breast cancer-related lymphedema: a randomized pilot trial [J]. Nat Commun, 2020, 11(1): 757.