Experience with 220 cases of mandibular reconstruction

Area of Science:

• Oral and Maxillofacial Surgery
• Biomaterials Science
• Oncology

Background:

• Extensive mandibular resections for tumors (malignant or recurrent ameloblastomas) cause significant functional and aesthetic impairments.
• Reconstruction aims to restore form and function, often necessitating complex surgical approaches.
• Traditional bone grafting may not always be suitable due to patient condition or tumor recurrence risk.

Purpose of the Study:

• To evaluate the efficacy of two types of implants in mandibular reconstruction following extensive resections.
• To compare outcomes between early and later periods of implant use, reflecting evolving techniques and indications.
• To assess the impact of implant materials and surgical strategy on reconstruction success.

Main Methods:

• Two types of implants were utilized: metallic-plastic (methyl-methacrylate and durallium) and fully metallic (durallium).
• Metallic-plastic implants were used for patients unable to support bone grafts or with high recurrence risk.
• Metallic implants served to stabilize bone grafts.
• Outcomes were analyzed across two distinct periods: 1955-1967 and 1967-1974.

Main Results:

• The initial period (1955-1967) demonstrated a relatively high failure rate of 25%.
• The subsequent period (1967-1974) showed a significant improvement, with failure rates reduced to 13%.
• This improvement is attributed to more judicious selection of operative indications and refined surgical techniques.

Conclusions:

• Mandibular reconstruction with implants offers a viable solution to functional and aesthetic challenges post-resection.
• Advances in surgical technique and patient selection are critical for improving outcomes in mandibular reconstruction.
• The use of biocompatible implant materials like methyl-methacrylate and durallium is essential for successful integration and reduced failure rates.