Occlusal function-guided mandibular reconstruction with vascularized folded fibula flap after benign tumor resection
10.3760/cma.j.cn115330-20250304-00125
- VernacularTitle:以咬合功能重建为导向的游离折叠腓骨修复下颌骨良性肿瘤术后缺损
- Author:
Zhenghao MA
1
;
Luwen SONG
;
Mingming YAN
;
Xuji WANG
;
Dongkun YANG
;
Peijun SONG
;
Lina JIANG
;
Jiancheng LI
Author Information
1. 蚌埠医科大学第一附属医院口腔颌面外科，蚌埠 233004
- Publication Type:Journal Article
- Keywords:
Reconstructive surgical procedures;
Occlusal guidance;
Functional jaw reconstruction;
Implant restoration;
Fibular graft
- From:
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
2025;60(11):1419-1425
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate clinical outcomes of occlusion-guided vascularized folded fibula flap reconstruction with delayed implant restoration for mandibular defects after benign tumor resection.Methods:A total of 12 patients with benign mandibular tumors underwent free folded fibula flap reconstruction at the First Affiliated Hospital of Bengbu Medical University between January 2020 and December 2023, including 7 males and 5 females, aged 21-52 years. Six months after mandibular reconstruction, the internal fixation titanium plates were removed, and dental implants were placed using a preoperatively fabricated occlusal guide, followed by second-stage implant surgery and prosthetic restoration. Mandibular CT scans were obtained 6 months after reconstruction to compare the fitting accuracy between the preoperative virtual design and the actual reconstructed mandible. The implant stability quotient (ISQ) was measured 3 months after implant placement. Masticatory efficiency and Enneking lower limb function scores were evaluated at the following time points: before tumor surgery (T1), before implant placement (T2), 6 months (T3) and 9 months (T4) after implant crown restoration. One-way repeated measures ANOVA was used to analyze the masticatory efficiency and lower limb function scores.Results:The free folded fibula grafts were successfully performed via an intraoral approach in all 12 patients, with a 100% of survival rate. Mandibular defects included Brown class I in 6 cases, class II in 2 cases, and class III in 4 cases. A total of 42 implants were placed with successful osseointegration. The ISQ measured at 3 months post-placement was 64.10±4.18. At 6 months postoperatively, morphological analysis comparing the preoperative virtual surgical design with the actual postoperative reconstructed mandible revealed a reconstruction accuracy of 84.27%±4.23%. Significant differences were observed in Enneking scores and masticatory efficiency across all four time points (all P<0.001). Masticatory function showed significant improvement at T4 compared that at T2 [(88.06±3.66)% vs. (65.44±3.82)%, P<0.05]. Conclusion:Occlusal function-guided mandibular reconstruction with vascularized folded fibula flap after removal of benign mandibular tumors is a reliable method, which is associated with minimal donor-site morbidity and enables patients to restore precise occlusion and to achieve favorable masticatory efficiency.
