A patient undergoing secondary correction by distraction osteogenesis of the mandible reconstructed with a revascularized scapular osteocutaneous flap

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  • HIBI Hideharu
    Department of Oral and Maxillofacial Surgery, Nagoya University Graduate School of Medicine Center for Genetic and Regenerative Medicine, Nagoya University Hospital
  • KINOSHITA Kazuhiko
    Department of Oral and Maxillofacial Surgery, Nagoya University Graduate School of Medicine
  • MIZUNO Daiki
    Department of Oral and Maxillofacial Surgery, Nagoya University Graduate School of Medicine
  • YAMAMOTO Noriyuki
    Department of Oral and Maxillofacial Surgery, Nagoya University Graduate School of Medicine
  • YAMADA Yoichi
    Center for Genetic and Regenerative Medicine, Nagoya University Hospital
  • UEDA Minoru
    Department of Oral and Maxillofacial Surgery, Nagoya University Graduate School of Medicine Center for Genetic and Regenerative Medicine, Nagoya University Hospital

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  • 骨延長法により2次修正をした血管柄付き肩甲骨による下顎再建の1例
  • コツ エンチョウホウ ニ ヨリ 2ジ シュウセイ オ シタ ケッカンヘイ ツキ ケンコウコツ ニ ヨル カガク サイケン ノ 1レイ

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Abstract

We describe secondary correction by distraction osteogenesis of the mandible reconstructed with a revascularized scapular osteocutaneous flap. A 40-year-old woman with an edentulous mandible and shortened rami caused by condylar fractures and a malformed mandibular body due to a comminuted fracture reconstructed with an osteocutaneous flap, was referred for occlusal reconstruction. The reconstructed mandible was asymmetric, and micrognathia was present. The mandible was considered too small and malformed to place artificial teeth.Distraction osteogenesis was sequentially performed in both rami vertically for a distance of 10 mm, and the body horizontally for 20 mm and then vertically for 15 mm. The distraction protocol was 0.25-0.5 mm twice daily following a latency period of 7 days. The final outline of the mandible was contoured with a green stick fracture of the regenerated bone in the horizontally distracted region, which was fixed with a reconstruction plate. Six dental implants were placed in the distracted mandibular body.<br>Osseointegration was achieved, and the palatal mucosa was grafted around the implants for vestibuloplasty. The six implants have supported a cross-arch superstructure for occlusal reconstruction. Four years after the last session of distraction osteogenesis, the contoured mandible has retained a stable size and shape. Distraction osteogenesis was considered effective in contouring the grafted bone orthognathically.

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