China Journal of Oral and Maxillofacial Surgery ›› 2018, Vol. 16 ›› Issue (3): 193-198.doi: 10.19438/j.cjoms.2018.03.001

• Leading Articles • Previous Articles     Next Articles

Resection of mandibular benign tumors by transoral approach and use of intraoral microvascular anastomosis for segmental mandibular reconstruction with vascularized fibula osseous flap: a pilot study in 4 consecutive patients

SUN Jian1, SHEN Yi1, LV Ming-ming1, LI Feng2, WANG Hui-shan1, BAI Shi-zhu3, WANG Liang1, YANG Xin1, LI Jun1.   

  1. 1.Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; National Research Center of Stomatology; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology. Shanghai 200011;
    2.Department of Anatomy and Physiology, School of Basic Medical Science, Shanghai Jiao Tong University School of Medicine. Shanghai 200025;
    3.State Key Laboratory of Military Stomatology,Department of Prosthodontics, School of Stomatology, the Fourth Military Medical University. Xi'an 710032, Shaanxi Province, China
  • Received:2018-04-10 Revised:2018-04-20 Online:2018-05-20 Published:2018-06-12

Abstract: PURPOSE: To introduce our experience in transoral segmental mandibulectomy of benign tumor and intraoral microvascular anastomosis for mandibular reconstruction with vascularized fibula osseous flap. METHODS: Between January and March 2018, transoral segmental mandibulectomy of benign tumor and intraoral microvascular anastomosis for mandibular reconstruction with vascularized fibula osseous flap were performed in 4 patients in our department. Preoperative virtual surgical planning, prebending of reconstruction plate and intraoperative navigation for confirmation of neomandibular site were performed in 3 patients. Facial artery and vein were exposed to protect at intraoral buccal region prior to segmental mandibulectomy and shaping of grafted fibula. Intraoral microvascular anastomosis of facial artery and peroneal artery in an end-to-end fashion, whereas facial vein and peroneal vein in an end-to-end fashion with the Coupler. Conventional postoperative monitoring of blood flow signal was conducted with hand-held ultrasound doppler. Panoramic radiographs were taken to assess the neomandible on day 7 postoperatively. RESULTS: Successful transoral segmental mandibulectomy was completed in 4 patients and intraoral microvascular anastomosis for mandibular reconstruction with vascularized fibula osseous flap was completed in 3 patients. Microvascular anastomosis at submandibular region was done in another patient because intraoral facial vein was not suitable. Normal blood flow signal was displayed on hand-held ultrasound Doppler. Intraoral and donor site wounds were healed uneventfully. Ideal neomandible and good occlusion were observed in postoperative panoramic radiographs. Symmetric facial appearance and no restriction of mouth opening were achieved in all patients. All patients were satisfied with the surgical results. CONCLUSIONS: It is feasible to avoid extraoral incision by transoral segmental mandibulectomy of benign tumor and intraoral microvascular anastomosis for mandibular reconstruction with vascularized fibula osseous flap. The same postoperative results of transoral approach as that of extraoral approach can be achieved.

Key words: Transoral approach, Segmental mandibulectomy, Intraoral microvascular anastomosis, Mandibular reconstruction, Vascularized fibula osseous flap

CLC Number: