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Mandibular reconstruction with full thickness calvarial bone and temporal muscle flap
K W Grätz1, H F Sailer, P E Haers
1Department of Cranio-Maxillofacial Surgery, University Hospital Zurich, Switzerland.
The British Journal of Oral & Maxillofacial Surgery
|October 1, 1996
Summary
This study shows that combining temporal muscle flaps with calvarial bone grafts is an effective method for mandibular reconstruction. This technique offers a viable alternative for patients, especially when neck surgery or radiation complicates other reconstructive options.
Area of Science:
- Oral and Maxillofacial Surgery
- Plastic and Reconstructive Surgery
- Biomaterials Science
Background:
- Mandibular defects often require complex reconstruction.
- Traditional methods like osseomyocutaneous free flaps can be challenging due to prior neck surgery or radiation.
- Alternative techniques are needed for successful mandibular restoration.
Purpose of the Study:
- To evaluate the efficacy of combining pedicled temporal muscle flaps with vascularized or free full-thickness calvarial bone grafts for mandibular reconstruction.
- To assess the outcomes and complications associated with this combined technique.
Main Methods:
- Eleven patients underwent mandibular reconstruction using pedicled temporal muscle flaps and full-thickness calvarial bone grafts (vascularized or free).
- Reconstructions included primary (n=6) and secondary (n=5) cases for indications such as squamous cell carcinoma, radio-osteonecrosis, and trauma.
- Five patients received endosseous implants, either simultaneously or delayed.
Main Results:
- The technique was successful in reconstructing mandibular defects, with low morbidity and minimal postoperative pain.
- Advantages include sufficient bone thickness for endosseous implants, invisible scarring, and a single donor site for soft and hard tissues.
- Major complications were rare, including one case of calvarial bone necrosis and one permanent facial nerve palsy.
Conclusions:
- The combination of pedicled temporal muscle flaps and full-thickness calvarial bone grafts is a viable and advantageous option for mandibular reconstruction.
- This method provides a reliable alternative to microvascular free flaps, particularly in patients with compromised neck conditions.
- The technique facilitates implant placement and offers excellent aesthetic and functional outcomes.