期刊
JOURNAL OF MAXILLOFACIAL & ORAL SURGERY
卷 15, 期 2, 页码 256-267出版社
SPRINGER INDIA
DOI: 10.1007/s12663-015-0833-y
关键词
Osteoradionecrosis (ORN); Hyperbaric oxygen therapy (HBOT); Mandibular reconstruction; Titanium reconstruction plate/bar; Pectoralis major myocutaneous flap (PMMC)
Introduction Osteoradionecrosis of the jaws produces a considerable amount of esthetic as well as functional deficits seriously affecting quality of life of the patient. Cases are often notoriously difficult to treat and manage owing to associated comorbidities of the patient, post irradiation fibrosis and decreased vascularity at the site, which complicates free tissue flap and graft transfer, that subsequently succumb to failure. Hyperbaric oxygen therapy (HBOT), in which 100 % oxygen is administered by mask under 2.4 atm pressure, in a hyperbaric oxygen chamber, helps by increasing local vascularity. Aim and Methods It was the aim of this study to show that a particularly refractory, compromised and challenging case of osteoradionecrosis can be managed successfully even without HBOT, by mandibular segmental resection followed by reconstruction using a titanium reconstruction plate enveloped within a pedicled Pectoralis Major Myocutaneous flap. Result Post operative recovery of the patient was excellent with good functional and esthetic rehabilitation of the patient with and practically nil donor site morbidity. Conclusion It is important to have a thorough knowledge of the clinical, radiographic, histopathologic, CT and MRI features of osteoradionecrosis of the jaws in order to make a quick and accurate confirmatory diagnosis and to overcome possible diagnostic dilemmas. The strategy of reconstruction of a large mandibular defect using a bridging titanium plate sandwiched by a healthy vascularized myocutaneous flap, following ablative surgery for ORN, has proved to be a safe and reliable option for composite mandibular defects, with gratifying long term functional and cosmetic results.
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