Management
The subscapular system free flaps (SSSFF) may be ideal in frail and/or elderly patients, as SSSFF allows for early mobility and does not alter gait [PMID:34387289].
In qualifying (i.e., limited, lateral) defects, soft tissue only reconstructions should be strongly considered when ossification is not critical [PMID:34387289].
In a biomechanical ex vivo study [PMID:24057940], conventional six-hole miniplates demonstrated significantly superior performance in fixation compared to locking plates, showing less rotational interfragmentary movement (7.45° ± 1.46° vs 12.16° ± 2.37°) under loads up to 300 N.
Although locking plates showed higher movement, both osteosynthesis systems provided adequate stabilization at loads up to 300 N in biomechanical testing [PMID:24057940].
In a study involving 14 patients with mandibular defects from neoplastic diseases and osteomyelitis, the use of 4 to 8 mg of rhBMP-2 (1.5 mg per cc concentration) alone in a collagen carrier led to successful osseous restoration [PMID:18355584].
Complications
Limited contemporary literature highlights unpredictable bone graft perfusion and poor long-term functional outcomes with pedicled segmental mandibular reconstructions [PMID:34387289].
The study indicated that locking plates exhibited greater rotational interfragmentary movement compared to conventional plates, which could theoretically correlate with a higher risk of complications [PMID:24057940].
The paper highlights that the technique using rhBMP-2 avoided common complications such as those typically associated with autogenous bone grafting, including postoperative pain and difficulty in ambulation [PMID:18355584].
Prognosis & Follow-up
Follow-up over 6 to 18 months indicated successful osseous restoration and restoration of occlusal function with implant-borne or conventional prostheses in all cases [PMID:18355584].
References
1 Rubin SJ, Sayre KS, Kovatch KJ, Ali SA, Hanks JE. Segmental mandibular reconstruction in patients with poor lower extremity perfusion, vessel-depleted necks and/or profound medical frailty. Current opinion in otolaryngology & head and neck surgery 2021. link 2 Trainotti S, Raith S, Kesting M, Eichhorn S, Bauer F, Kolk A et al.. Locking versus nonlocking plates in mandibular reconstruction with fibular graft--a biomechanical ex vivo study. Clinical oral investigations 2014. link 3 Herford AS, Boyne PJ. Reconstruction of mandibular continuity defects with bone morphogenetic protein-2 (rhBMP-2). Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 2008. link