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Minimally Invasive Mandibular Microsurgery: A Systematic Review and Meta-analysis.

Kerilyn N Godbe1, Michaela K O'Connor2, Lauren M Sinik1

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Minimally invasive microvascular mandibular reconstruction (MIMMR) offers safe and effective options for patients. Different approaches provide good aesthetic and functional outcomes with comparable complication rates.

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Area of Science:

  • Oral and Maxillofacial Surgery
  • Microsurgery
  • Reconstructive Surgery

Background:

  • Microsurgical advancements enable minimally invasive techniques for mandibular reconstruction.
  • A comparative analysis of all minimally invasive microvascular mandibular reconstruction (MIMMR) treatment options is currently lacking.

Purpose of the Study:

  • To systematically review and compare all available minimally invasive microvascular mandibular reconstruction (MIMMR) treatment options.
  • To analyze patient demographics, MIMMR types, methodologies, and clinical outcomes.

Main Methods:

  • A systematic review adhering to Preferred Reporting Items for Systematic Reviews, Meta-Analyses (PRISMA) guidelines.
  • Analysis of 47 MIMMR cases, categorizing by approach: submandibular (SM), modified facelift/retroauricular (MFL/RA), or intraoral (IO).
  • Statistical analysis using Fisher exact and Kruskal-Wallis tests to compare outcomes.

Main Results:

  • Ameloblastoma was the most frequent pathology treated across all MIMMR approaches.
  • MFL/RA was exclusively used for squamous cell carcinoma; SM and IO approaches were used for large, bilateral defects.
  • Facial artery was the common recipient vessel for IO and SM, while superior thyroid/external carotid vessels were used for MFL/RA. Virtual planning was utilized in IO and SM approaches but not MFL/RA.
  • All patients achieved good aesthetic and functional outcomes with no significant difference in complication rates.

Conclusions:

  • Minimally invasive approaches are safe and effective for mandibular microsurgery, particularly for benign conditions.
  • Specific vascular and surgical access considerations exist for each MIMMR approach (IO/SM vs. MFL/RA).