CLINICAL RESEARCH OF RESECTION OF MANDIBULAR BENIGN TUMORS AND PRIMARY RECONSTRUCTION WITH AUTOGENOUS BONE GRAFT VIA AN INTRAORAL APPROACH_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HUANGXu ¹ , LIUJianhua ¹ , WANGHuiming ¹ , ZHUHuiyong ¹ , LIZhiyong ¹ ,  TENGLisong ²

1. Department of Stomatology the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou Zhejiang, 310003, P. R. China;
2. Department of Oncology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou Zhejiang, 310003, P. R. China;

Corresponding?author：

TENGLisong, Email: lsteng@hos.zju.edu.cn

Keywords：

Intraoral approach; Benign tumor; Mandibular defect; Vascularized fibular flap transplantation; Repair and reconstruction

DOI：

10.7507/1002-1892.20140041

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Objective To investigate the clinical outcomes of resection of mandibular benign tumors and primary reconstruction with autogenous bone graft via an intraoral approach. Methods Fifteen patients with mandibular benign tumors were treated between January 2009 and September 2012. There were 7 males and 8 females, aged from 18 to 45 years (mean, 30 years). The pathological diagnosis identified 11 cases of ameloblastoma, 3 cases of odontogenic keratocyst, and 1 case of odontogenic myxoma. According to the Urken's CRBS (Condyle, Ramus, Body, Symphysis) classification criteria based on the location of the mandibular defect, there were 3 cases of body type (B type), 3 cases of ramus type (R type), and 9 cases of body and ramus type (BR type). The surgeries were performed via an intraoral approach, except 1 patient with the lesion at the level of sigmoid notch via an auxiliary preauricular incision. To fix the bone grafts to the dissected mandibular defects, reconstructive titanium plates were used, either indirectly according to the computer aided design/computer aided manufacturing mandibular models before surgery (9 patients) or directly according to the exposed mandibles during surgery (6 patients). The patients received benign mandibular tumor resection and primary autogenous bone graft reconstruction with free iliac bones (11 cases) or vascularized fibular flaps (4 cases). The mandibular inferior alveolar nerves were preserved in 6 cases. Results Primary healing of incision was obtained in 14 patients, while secondary healing in 1 patient suffering from bone graft infection. All the patients were followed up 1-4 years (mean, 2.5 years). At last follow-up, no patients showed facial nerve damage; occlusion of remaining teeth was similar to preoperative conditions; the chewing function was satisfactory; mouth opening was 30-35 mm (mean, 33 mm); and swallowing and speaking functions were normal. Only slight extraoral scars caused by the auxiliary incision and the transbuccal appliances were observed, and all the patients were satisfied with the facial appearance. Lower lip numbness was relived in patients with preserved inferior alveolar nerves. There was no tumor recurrence during follow-up period. Conclusion The intraoral approach is a feasible and proper approach for resection of benign mandibular tumors and primary reconstruction with autogenous bone grafts, with the advantages of inconspicuous facial scars, minimum damage to the facial nerve, and expectable aesthetic appearance.

Citation： HUANGXu, LIUJianhua, WANGHuiming, ZHUHuiyong, LIZhiyong, TENGLisong. CLINICAL RESEARCH OF RESECTION OF MANDIBULAR BENIGN TUMORS AND PRIMARY RECONSTRUCTION WITH AUTOGENOUS BONE GRAFT VIA AN INTRAORAL APPROACH. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(2): 192-196. doi: 10.7507/1002-1892.20140041 Copy

1.	Mehta RP,Deschler DG.Mandibular reconstruction in 2004:an analysis of different techniques.Curr Opin Otolaryngol Head Neck Surg,2004,12(4):288-293.
2.	胡朝昶,謝富強,邢占奎,等.69例下頜骨缺損后不同術式重建的臨床回顧性分析.實用口腔醫學雜志,2011,27(5):719-721.
3.	Hou JS,Chen M,Pan CB,et al.Application of CAD/CAM-assisted technique with surgical treatment in reconstruction of the mandible.J Craniomaxillofac Surg,2012,40(8):e432-e437.
4.	Salgueiro MI,Stevens MR.Experience with the use of prebent plates for the reconstruction of mandibular defects.Craniomaxillofac Trauma Reconstr,2010,3(4):201-208.
5.	Leung PC,Chow SK,Ma GF.Primary reconstruction of the mandible after excision of large benign lesions.Br J Plast Surg,1988,41(3):251-254.
6.	Urken ML,Buchbinder D,Weinberg H,et al.Functional evaluation following microvascular oromandibular reconstruction of the oral cancer patient:a comparative study of reconstructed and nonreconstructed patients.Laryngoscope,1991,101(9):935-950.
7.	徐立群.下頜骨重建的原則與規范.中華臨床醫師雜志(電子版),2012,6(19):783-785.
8.	曾益群,陳指蘭.口內進路治療下頜骨骨折.中國美容醫學,2009,18(2):177-178.
9.	黃健,蔡學文,汪麗英.口外與口內進路手術治療下頜骨骨折的臨床比較研究.中國醫學工程,2009,17(2):125-126.
10.	Matsuo A,Chiba H,Toyoda J,et al.Mandibular reconstruction using a tray with particulate cancellous bone and marrow and platelet-rich plasma by an intraoral approach.J Oral Maxillofac Surg,2011,69(6):1807-1814.
11.	Shirani G,Arshad M,Mohammadi F.Immediate reconstruction of a large mandibular defect of locally invasive benign lesions (a new method).J Craniofac Surg,2007,18(6):1422-1428.
12.	García-Díez EM,Cho-Lee GY,Raigosa-García JM,et al.Rhytidectomy approach for mandibular reconstruction with microvascular free flaps after resection of mandibular benign tumors.J Oral Maxillofac Surg,2013,7(12):2156-2168.
13.	李睿婧,張世周.下頜骨重建過程中的髁突原位保留技術研究進展.山東醫藥,2011,51(22):114-115.
14.	王寧,黎明.頜骨缺損后下頜骨重建方法及新材料研究進展.中國實用口腔科雜志,2010,3(1):54-57.
15.	謝富強,孫健.非血管化髂骨移植重建下頜骨缺損的臨床分析.華西口腔醫學雜志,2012,30(4):411-413.
16.	顏光啟,王雪,譚學新,等.應用SurgiCase軟件指導游離腓骨皮瓣修復下頜骨缺損的研究.中國修復重建外科雜志,2013,27(8):1006-1009.
17.	Cho-Lee GY,Naval-Gías L,Martos-Díaz PL,et al.Vertical distraction osteogenesis of a free vascularized fibula flap in a reconstructed hemimandible for mandibular reconstruction and optimization of the implant prosthetic rehabilitation.Report of a case.Med Oral Patol Oral Cir Bucal,2011,16(1):e74-78.
18.	Hayden RE,Mullin DP,Patel AK.Reconstruction of the segmental mandibular defect:current state of the art.Curr Opin Otolaryngol Head Neck Surg, 2012,20(4):231-236.

1. Mehta RP,Deschler DG.Mandibular reconstruction in 2004:an analysis of different techniques.Curr Opin Otolaryngol Head Neck Surg,2004,12(4):288-293.
2. 胡朝昶,謝富強,邢占奎,等.69例下頜骨缺損后不同術式重建的臨床回顧性分析.實用口腔醫學雜志,2011,27(5):719-721.
3. Hou JS,Chen M,Pan CB,et al.Application of CAD/CAM-assisted technique with surgical treatment in reconstruction of the mandible.J Craniomaxillofac Surg,2012,40(8):e432-e437.
4. Salgueiro MI,Stevens MR.Experience with the use of prebent plates for the reconstruction of mandibular defects.Craniomaxillofac Trauma Reconstr,2010,3(4):201-208.
5. Leung PC,Chow SK,Ma GF.Primary reconstruction of the mandible after excision of large benign lesions.Br J Plast Surg,1988,41(3):251-254.
6. Urken ML,Buchbinder D,Weinberg H,et al.Functional evaluation following microvascular oromandibular reconstruction of the oral cancer patient:a comparative study of reconstructed and nonreconstructed patients.Laryngoscope,1991,101(9):935-950.
7. 徐立群.下頜骨重建的原則與規范.中華臨床醫師雜志(電子版),2012,6(19):783-785.
8. 曾益群,陳指蘭.口內進路治療下頜骨骨折.中國美容醫學,2009,18(2):177-178.
9. 黃健,蔡學文,汪麗英.口外與口內進路手術治療下頜骨骨折的臨床比較研究.中國醫學工程,2009,17(2):125-126.
10. Matsuo A,Chiba H,Toyoda J,et al.Mandibular reconstruction using a tray with particulate cancellous bone and marrow and platelet-rich plasma by an intraoral approach.J Oral Maxillofac Surg,2011,69(6):1807-1814.
11. Shirani G,Arshad M,Mohammadi F.Immediate reconstruction of a large mandibular defect of locally invasive benign lesions (a new method).J Craniofac Surg,2007,18(6):1422-1428.
12. García-Díez EM,Cho-Lee GY,Raigosa-García JM,et al.Rhytidectomy approach for mandibular reconstruction with microvascular free flaps after resection of mandibular benign tumors.J Oral Maxillofac Surg,2013,7(12):2156-2168.
13. 李睿婧,張世周.下頜骨重建過程中的髁突原位保留技術研究進展.山東醫藥,2011,51(22):114-115.
14. 王寧,黎明.頜骨缺損后下頜骨重建方法及新材料研究進展.中國實用口腔科雜志,2010,3(1):54-57.
15. 謝富強,孫健.非血管化髂骨移植重建下頜骨缺損的臨床分析.華西口腔醫學雜志,2012,30(4):411-413.
16. 顏光啟,王雪,譚學新,等.應用SurgiCase軟件指導游離腓骨皮瓣修復下頜骨缺損的研究.中國修復重建外科雜志,2013,27(8):1006-1009.
17. Cho-Lee GY,Naval-Gías L,Martos-Díaz PL,et al.Vertical distraction osteogenesis of a free vascularized fibula flap in a reconstructed hemimandible for mandibular reconstruction and optimization of the implant prosthetic rehabilitation.Report of a case.Med Oral Patol Oral Cir Bucal,2011,16(1):e74-78.
18. Hayden RE,Mullin DP,Patel AK.Reconstruction of the segmental mandibular defect:current state of the art.Curr Opin Otolaryngol Head Neck Surg, 2012,20(4):231-236.

Chinese Journal of Reparative and Reconstructive Surgery

CLINICAL RESEARCH OF RESECTION OF MANDIBULAR BENIGN TUMORS AND PRIMARY RECONSTRUCTION WITH AUTOGENOUS BONE GRAFT VIA AN INTRAORAL APPROACH

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