Jaw defects caused by various reasons often seriously affect appearance and function. The goal of the treatment of oral and maxillofacial tumors should include the cure of the tumor and the restoration of premorbid function. The development of microsurgery and digital surgery technology has promoted the development of jaw reconstruction with vascularized free bone flap. Good appearance and improved predictability could be obtained with the help of preope-rative visual design. How to rehabilitate occlusal function on the reconstructed jaw and improve the quality of life of patients has become an important research direction. This article discusses the challenge of jaw reconstruction, the selection of vascularized bone flap, the choice of implant timing, the treatment of peri-implant soft tissue, and the influence of radiotherapy on implants after jaw reconstruction.
Humans ; Dental Implants ; Plastic Surgery Procedures ; Free Tissue Flaps/surgery* ; Quality of Life ; Dental Implantation, Endosseous ; Fibula/surgery* ; Bone Transplantation ; Mandibular Reconstruction

Masquelet technique is one of the modalities for the treatment of long bone defect. Using cancellous bone graft to fill the bone defect is always a concern in children due to the small size of their iliac crest and open growth plate. We reported a case of 13-year-old male who presented with gap non-union of middle third of tibia. We applied a modified Masquelet technique by using only the cortical fibular graft instead of cancellous bone to fill the space surrounded by induced membrane. Fibula was used as a nonvascularized strut graft and matched stick graft to achieve complete union. We concluded that nonvascularized fibula grafting is an easy and effective option to fill the bone defect in children in the second stage of Masquelet technique.
Male ; Child ; Humans ; Adolescent ; Fracture Healing ; Bone Transplantation/methods* ; Fibula/transplantation* ; Tibia/surgery* ; Ilium/transplantation*

At present, mandibular defect repair and reconstruction is not only a simple sense of mandibular continuity restoration, but also a restoration of the physiologically positional relationship and movement balance of the upper and lower jaws. Eventually, the implantation of osseointegrated dental implants and implant-supported dental restoration should be accomplished to complete the reconstruction of the functional mandible. The technique can integrate multiple procedures such as fibular bone grafting, simultaneous dental implants and traction osteogenesis, and the perfect integration with digital technology can significantly improve the accuracy of digital dental implant traction technique. This paper will summarize and conclude the key points of the application of digital dental implant traction technique in mandibular defect reconstruction, in order to provide new ideas for the development of digital technique.
Humans ; Mandibular Reconstruction ; Dental Implants ; Dental Implantation, Endosseous/methods* ; Mandibular Neoplasms/surgery* ; Fibula/transplantation* ; Bone Transplantation/methods* ; Mandible/surgery*

Objective: To analyse the quality of life of patients receiving repair of bone defect with folded fibula flap after removal of mandibular ameloblastoma. Methods: The case data of 39 patients with ameloblastoma admitted to the First Affiliated Hospital of Zhengzhou University from August 2013 to April 2016 were retrospectively analysed, including 21 males and 18 females, from 18 to 58 years old. 3D printing and digital technology were used in flap preparation before surgery in all patients. The folded fibular flaps were used to repair mandibular defects and the implants were placed between 6-9 months after surgery. The short form-36 health survey questionnaire (SF-36) and the university of Washington quality of life questionnaire (UW-QOL) were applied to evaluate the quality of life of patients before surgery and at 6 months and 24 months after surgery. The higher the score, the better the condition. SPSS 20.0 was adopted for statistical analysis. Results: The SF-36 survey showed that the mean score of body role before surgery (72.4±11.7) was significantly higher than that at 6 months after surgery (39.6±11.1, t=23.580, P<0.05) or that at 24 months after surgery (59.8±6.4, t=8.358, P<0.001). Compared with the preoperative mean scores of Physical Pain (73.0±11.0), General Health (73.4±10.4) and Health Changes (79.2±3.9) before surgery, the mean scores Physical Pain (53.1±7.7), General Health (53.5±7.5) and Health Changes (63.9±11.7) at 6 months after surgery were decreased significantly respectively (t=13.068, 13.756 and 10.880, respectively, all P<0.05), but the mean scores Physical Pain (78.8±14.0), General Health (80.9±12.6) and Health Changes (84.4±4.6) at 24 months after surgery were increased significantly respectively (t=-2.904, -4.027 and -7.586, respectively, all P<0.05), with significant differences in the mean scores of Physical Pain, General Health and Health Changes between 6 and 24 months after surgery (t=-14.241, -16.490, -14.294, respectively, all P<0.001). The UW-QOL survey showed that the mean scores of chewing, language and taste functions decreased at 6 months after surgery (53.1±6.7, 53.0±7.7 and 62.2±9.9, respectively), but improved at 24 months after surgery (67.9±3.9, 63.9±2.9 and 68.4±11.1, respectively), with statistically significant difference (t=-16.765, -11.675 and 2.498, respectively, all P<0.001). Conclusion: The application of folded fibula flaps to repair bone defects after sugery of mandibular ameloblastoma can better meet the needs of language and chewing functions and improve the quality of life of patients.
Adolescent ; Adult ; Ameloblastoma/surgery* ; Bone Transplantation ; Female ; Fibula/surgery* ; Free Tissue Flaps ; Humans ; Male ; Mandible/surgery* ; Mandibular Neoplasms/surgery* ; Middle Aged ; Quality of Life ; Reconstructive Surgical Procedures ; Retrospective Studies ; Young Adult

OBJECTIVE: To investigate the short-term clinical effect of double channel decompression and bone grafting through the greater trochanter combined with allograft fibula propping in the treatment of osteonecrosis of femoral head (ONFH). METHODS: Twenty two patients (23 hips) with osteonecrosis of the femoral head were included from November 2017 to February 2019. According to Association Research Cirulation Osseous(ARCO) staging, there were 13 hips at stageⅡgroup, aged from 20 to 48 years old with an average of(32.5±8.5)years old;10 hips at stageⅢgroup, aged from 18 to 45 years old with an average of(32.7±8.6) years old. A single approach through the greater trochanterwas used for decompression, bone grafting and fibula support. Harris scoring system was used to evaluate the function of hip joint before and after implantation, and the anteroposterior and lateral X-ray films of hip joint were taken at 3, 6, 12 and 18 months after implantation to observe and analyze the progress of femoral head necrosis and regeneration. RESULTS: All patients were followed up, and the duration ranged from 12 to 18 months with an average of (14.6±2.1) months. Harris score of stageⅡand stageⅢpatients increased from 73.2± 5.5 and 66.5±3.4 to 87.6±8.7( CONCLUSION The effect of double trochanteric decompression and bone grafting combined with fibular allograft propping in the treatment of early and middle stage avascular necrosis of the femoral head is good, especially suitable for young and middle aged patients with ARCOⅡstage avascular necrosis of the femoral head.
Adolescent ; Adult ; Allografts ; Bone Transplantation ; Decompression ; Femur Head ; Femur Head Necrosis ; Fibula ; Follow-Up Studies ; Humans ; Middle Aged ; Treatment Outcome ; Young Adult

OBJECTIVE: To investigate the position change of the fibular bone after maxillary reconstruction by free fibular flap and to analyze the factors affecting the position change. METHODS: Patients who underwent maxillary reconstruction by free fibular flap in the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from November 2012 to November 2016 were enrolled in this study. CT scans 1 week and 1 year postoperatively were collected and stored in DICOM format. The ProPlan CMF software was used to reconstruct the CT scans and separate the maxilla and each segment of the fibular flap. The Geomagic Control software was used to measure the long axis direction vector of each fibular segment. And the position change direction was recorded. The patients were divided into groups according to the use of the fibula or titanium plate to reconstruct the zygomaticmaxillary buttress. RESULTS: A total of 32 patients were enrolled. Among them, 21 were in the titanium plate group and 11 in the fibula bone group. The angle between the long axis of the fibular segment and the X axis in the X-Y plane was 95.65°±53.49° and 95.53°±52.77°, 1 week and 1 year postoperatively, and there was no statistical difference (P>0.05). The angle between the long axis of the fibular segment and the X axis in the X-Z plane was 96.88°±69.76° and 95.33°±67.42°, respectively, with statistical difference (P=0.0497). The angular changes of the long axis of the fibular segment in the titanium plate group and the fibular bone group were 3.23°±3.93° and 1.94°±1.78°, respectively, and the angular changes in the X-Z plane were 6.02°±9.89° and 3.27°±2.31°, respectively. There was no significant difference between the groups (P>0.05). The long axis changes of the fibular segment in the X-Y plane for reconstruction of the anterior alveolar, posterior alveolar, and buttress were 3.13°±3.78°, 2.56°±3.17°, and 5.51°±4.39°, respectively. There was a statistical difference (P = 0.023) between the posterior and buttress. In the X-Z plane, theses were 4.94°±4.75°, 5.26°±10.25°, 6.69°±6.52°, respectively. There was no statistical difference among the three groups (P>0.05). The main positional deviation directions of the titanium plate group and the fibular bone group were interior and superior sides, and there was no statistical difference between the two groups (P>0.05). CONCLUSION One year postoperatively, the position of the free fibular flap was changed compared with 1 week postoperatively. The position of the free fibular flap was mainly changed to the interior and superior sides.
Bone Transplantation ; Fibula/diagnostic imaging* ; Free Tissue Flaps ; Humans ; Mandibular Reconstruction ; Maxilla/surgery*

Mandible is an important bone of the head and neck. Mandibular defects not only affect patient's face, but also impede patient's daily functions, such as chewing, speech, and so on. Fibular transplantation for mandibular reconstruction is the common method, which requests high accuracy of bone positioning and posture adjustment. Therefore, a robotic system for mandibular reconstruction surgery with fibula flaps was designed to assist surgeons to hold and locate bones, and the model comparison experiments were conducted. The results showed that the robotic system can assist surgeons for mandibular reconstruction to improve quality of surgery.
Bone Transplantation ; methods ; standards ; Fibula ; transplantation ; Humans ; Mandible ; surgery ; Mandibular Reconstruction ; methods ; Robotics ; standards ; Surgery, Computer-Assisted

This paper reports a case of a 28-year-old male patient with mandibular fibular graft. The patient underwent dental implant surgery. The left portion of the patient's mandible was resected because of ameloblastoma and restored by vascularized fibular grafting. Four implants were implanted in the fibular graft area after 2 years, and the area was restored with a pure titanium casting rod, Locator abutment, and overdenture. This case provides a feasible solution for the restoration of a fibular graft with a dental implant. The characteristics of the restoration method are described. We hope to improve the quality of life of patients with fibular grafts.
Adult ; Bone Transplantation ; Dental Implants ; Dental Prosthesis, Implant-Supported ; Denture, Overlay ; Fibula ; Humans ; Male ; Mandible ; Mandibular Neoplasms ; Quality of Life

Nonunion of the humerus in a severely osteoporotic bone is a likely event especially if the fracture is transverse. The management of such a combination is a challenge. Most of the conventional fixation methods are unlikely to succeed as the bone failure precedes implant failure in osteoporosis. The challenge is further compounded in severe osteoporosis when the cortical thickness is affected more severely. We used a combination of an intramedullary fibula with a locking plate in 5 cases. The results show that it may be a good combination in such situations as the bone strength is augmented and the plate pullout is less likely.
Aged ; Bone Plates ; Female ; Fibula ; transplantation ; Fracture Fixation, Intramedullary ; methods ; Fractures, Ununited ; surgery ; Humans ; Humeral Fractures ; surgery ; Male ; Middle Aged ; Osteoporosis ; complications

The presence of large segmental defects of the diaphyseal bone is challenging for orthopedic surgeons. Free vascularized fibular grafting (FVFG) is considered to be a reliable reconstructive procedure. Stress fractures are a common complication following this surgery, and hypertrophy is the main physiological change of the grafted fibula. The exact mechanism of hypertrophy is not completely known. To the best of our knowledge, no studies have examined the possible relationship between stress fractures and hypertrophy. We herein report three cases of patients underwent FVFG. Two of them developed stress fractures and significant hypertrophy, while the remaining patient developed neither stress fractures nor significant hypertrophy. This phenomenon indicates that a relationship may exist between stress fractures and hypertrophy of the grafted fibula, specifically, that the presence of a stress fracture may initiate the process of hypertrophy.
Adult ; Female ; Fibula ; pathology ; transplantation ; Fractures, Stress ; pathology ; Humans ; Hypertrophy ; Male ; Middle Aged ; Tibia ; surgery ; Tibial Fractures ; surgery