Outcomes of Mandibular Reconstruction Using Free Flap After Head and Neck Cancer Resection and Approaches for Improvement
- VernacularTitle:Толгой хүзүүний хавдрын дараах эрүүний согогийг чөлөөт далбангаар нөхөн сэргээсэн үр дүн ба сайжруулах арга замыг эрэлхийлэх нь
- Author:
Unubold E
1
;
Denis S
1
;
Odontungalag Ts
1
;
Yanjinlkham M
1
;
Amarsanaa G
1
;
Tsetsegkhen N
1
;
Gantsetseg G
1
;
Battsengel B
2
;
Gan-Erdene B
1
;
Bat-Erdene M
3
;
Bulganchimeg S
4
;
Ganbaatar Yu
5
;
Odkhuu J
5
;
Enkh-Orchlon B
5
Author Information
1. National Cancer Center of Mongolia, Department of Head and Neck Reconstructive Surgery
2. Mongolian National University of Medical Sciences, School of Dentistry, Department of Oral Health Technology
3. Mongolian National University of Medical Sciences, School of Nursing, Department of Physical Education
4. Intermed Hospital, Department of Head and Neck Reconstructive Surgery
5. Mongolian National University of Medical Sciences, School of Dentistry, Department of Oral and Maxillofacial Surgery
- Publication Type:Journal Article
- Keywords:
Mandibular tumor, reconstructive surgery, 3D planning, microvascular anastomosis
- From:
Mongolian Journal of Health Sciences
2025;87(3):82-89
- CountryMongolia
- Language:Mongolian
-
Abstract:
Background:Reconstruction of mandibular and maxillary defects resulting
from malignant tumors has remained a complex challenge in recent years. Defects
caused by tumors—as well as trauma, inflammatory diseases, and congenital
anomalies—lead to impaired essential functions such as mastication,
swallowing, and speech. Prior to the 1950s, reconstruction of maxillofacial
hard tissue was not commonly performed. Instead, metal plates were used to
reestablish bony continuity, and surrounding tissues were utilized to close soft
tissue defects, without effectively restoring function.
With modern advances in three-dimensional (3D) virtual planning, it is now possible
to accurately plan free bone flaps for reconstructing jaw defects. During
surgery, manually bending reconstruction plates to fit donor bone precisely is
often not feasible. Preoperative 3D planning allows for precise fabrication of
surgical guides and fixation plates, improving accuracy and significantly reducing
operative time. Additionally, incorporating dental implant planning into
the reconstruction process facilitates restoration of both structural and functional
outcomes.
Aim:To evaluate the outcomes of mandibular defect reconstruction using
scapular free flaps in Mongolia and explore potential approaches to optimize
the technique.
Materials and Methods:This was a case study series. Data from reconstructive
surgeries performed at the National Cancer Center of Mongolia, Central
Dental Hospital, and the Mongolia-Japan Hospital were collected. Variables
included patient age and sex, etiology of the mandibular defect, size of the
scapular bone segment, operative time, ischemia time of the free flap, number
of vascular anastomoses performed, and pedicle length.
For 3D planning, CT scans of the patient's head and lower limb (slice thickness
<1 cm) were used to generate 3D models via the 3D Slicer software. Cutting
guides for the mandible and scapula (ASIGA), as well as the reconstruction
models (AMS), were printed using a 3D printer.
Results:A total of 400 free flap reconstructions were performed during the
study period. Of these, 29 cases involved reconstruction of mandibular defects
using scapular free flaps. The mean age of patients was 40.0 ± 18.3 years,
with 52% (15 patients) being female. The etiologies of the defects included
malignant tumors (13 cases, 45%), benign tumors (6 cases, 21%), and pre-existing
defects (10 cases, 34%).
In one case, tumor resection and mandibular reconstruction were performed
using 3D planning. The total operative time was 9 hours and 30 minutes, and
the ischemia time was 2 hours and 40 minutes.
Conclusion:Between 2012 and 2025, a total of 29 mandibular reconstructions
using scapular free flaps were performed in Mongolia. Traditional reconstruction
methods were associated with prolonged ischemia time. The use of
3D surgical planning has shown potential in significantly reducing ischemia
time and improving surgical outcomes.
- Full text:202505232320439847382-89.pdf
