Clinical Research Of Mandibular Reconstrucition

Objecive: To investigate the method selection, rigid fixation and post-operative complications related to the mandibular reconstruction. To give information to clinical treatment. Methods: Three retrospective studies were underwent to study the cases of mandibular reconstruction in the School of Stomatology, Wuhan University. To analyse the factors related to method selection, evaluate the rigid fixation, analyse the character of post-operative complications and the treatment. Results: In the first study, 283 patients underwent mandibular reconstruction were collected, in whom 206 (72.8%) patients underwent autogenous free bone transplantation, 16 patients underwent free vascularized bone transplantation, 61 (21.5%) patients underwent substitution insertion. 265 (93.6%) patients underwent immediate mandibular reconstruction, 12 (4.2%) patients underwent delayed mandibular reconstruction, 6 patients underwent secondary mandibular reconstruction after temporary reconstruction. In the second study, 367 rigid fixation plates were inserted in 83 cases. There were 79 (97.5% ) cases achieved successful effect. The forms of the mandibles were resumed. The "stress shielding" was observed in 15 cases (18.6%) 6 months after operation without serious complications. In the third study, 63 patients occurred post-operative complications in all 665 cases. The transplant of 18 cases were taken out. 46 (6.9%) patients occurred infection or other complications compound with infection. Dehiscence occurred in 19 cases, in whom 14 patients occurred inter-oral dehiscence, 4 patients occurred extral-oral discence. The transplant exposure occurred in 21 patients. Serious resorption of transplant bone occurred in 5 patients. 43 patientsoccurred more than one complications.20 patients occurred only one kind of complications. Conclusions: 1. Immediate mandibular reconstruction was possible in nearly all mandibular defects. The methods selection of mandibular reconstruction should based on careful consideration of many cardinal variables. Vascularized bone transplantation is an ideal method, but not necessary in all patients. Autogenous free bone transplantation represent a good outcome based on careful patients selection. Substitution insertion is an alternative method, but not advocated as the first selection routinely. 2. The effects of rigid fixation applied in mandibular reconstruction were perfect in the healing and plasty of the transplant bone. "Stress shielding" can be observed without serious complications. Routine removal of the titanium plates after healing of the transplant bone was not advocated. 3. Infection is the most common cause that distribute to postoperative complications. The most complications occur within 1 month. Transplant bone can be preserved by correct treatment in time.