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Mandibular reconstruction in elderly patients.

Shimpei Miyamoto1, Takuya Higashino2, Minoru Sakuraba2,3

  • 1Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan.

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|May 16, 2018
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Summary

This study proposes an algorithm for elderly patients needing mandibular reconstruction. It guides the choice between vascularized bone grafts, reconstruction plates, or soft-tissue flaps based on defect location and patient factors.

Keywords:
eichner indexelderlyfibulamandibular reconstructionreconstruction platescapula

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Area of Science:

  • Oral and Maxillofacial Surgery
  • Reconstructive Surgery
  • Geriatric Medicine

Background:

  • Segmental mandibular defects in elderly patients present complex reconstructive challenges.
  • Current reconstructive techniques for this demographic remain a subject of debate.
  • An evidence-based approach is needed to guide surgical decision-making.

Purpose of the Study:

  • To develop an algorithm for selecting the optimal mandibular reconstruction method in elderly patients (≥65 years).
  • To compare perioperative outcomes of different reconstructive techniques.
  • To identify factors influencing the choice of reconstruction.

Main Methods:

  • Retrospective evaluation of 121 elderly patients undergoing immediate microvascular mandibular reconstruction.
  • Categorization of patients into three groups: vascularized bone graft, mandibular reconstruction plate with soft tissue flap, and soft-tissue flap alone.
  • Analysis of perioperative complications and influencing factors for reconstructive technique selection.

Main Results:

  • No significant difference in postoperative complication rates among the three reconstruction groups.
  • Mandibular reconstruction plates were suitable for anterior defects.
  • Soft-tissue flaps were effective for posterior defects, particularly in patients ≥75 years or with a low Eichner index.

Conclusions:

  • Mandibular reconstruction plates and soft-tissue flaps are viable alternatives to vascularized bone grafts in the elderly population.
  • The developed algorithm effectively utilizes defect type, patient age, and Eichner index for technique selection.
  • This algorithm aids in optimizing reconstructive strategies for elderly patients with mandibular defects.