Current concepts in mandibular reconstruction by microsurgical free flaps.

Area of Science:

• Oral and Maxillofacial Surgery
• Reconstructive Surgery
• Biomedical Engineering

Background:

• Composite oro-mandibular resections, especially involving the symphysis, pose significant reconstructive challenges.
• Anterior mandibular arch loss leads to severe impairment of oral functions and striking cosmetic disfigurement (the "Andy Gump" deformity).
• Deforming forces from residual muscles cause anterior and medial deviation of mandibular segments.

Purpose of the Study:

• To highlight the challenges in restoring form and function after composite oro-mandibular resections.
• To emphasize the need for composite tissue replacement in preventing the "Andy Gump" deformity.
• To identify complex defects requiring trilaminar reconstruction.

Main Methods:

• Review of reconstructive surgical principles for oro-mandibular defects.
• Analysis of pathomechanics leading to the "Andy Gump" deformity.
• Discussion of composite reconstruction techniques involving bone, skin, and mucosa.

Main Results:

• Loss of the anterior mandibular arch results in significant functional and cosmetic deficits.
• Specific muscle forces contribute to the characteristic "Andy Gump" deformity.
• Complex defects necessitate trilaminar replacement of tissues.

Conclusions:

• Restoration of form and function after symphysis resection is a major surgical challenge.
• Composite replacement of bone, skin, and mucosa is often required to prevent the "Andy Gump" deformity.
• Challenging defects, including those crossing the midline with extensive soft tissue loss, require sophisticated reconstructive strategies.