Mandible reconstruction using a 2-phase transport disc distraction osteogenesis: A case report

Mandible reconstruction using a 2-phase transport disc distraction osteogenesis: A case report
February 2005
Lee M. Whitesides, DMD, MMSc * *
Robert C. Wunderle, DDS ÇƒÜ
Cesar Guerrero, DDS Çƒ?
Journal of Oral and Maxillofacial Surgery Online
Reconstruction of hard and soft tissue defects of the mandible created by ablative tumor surgery or trauma presents the reconstructive surgeon with a plethora of challenges. Because the mandible is the focal point of the lower one third of the face, it must be reconstructed in specific, 3-dimensional facial proportions to produce proper esthetics. The mandibleÇƒÙs function as a primary anatomic structure in speech and mastication dictate that the reconstructed anatomy provides the proper foundation for mastication, deglutition, and communication. When form and function are ignored in the reconstructive process, the patient may be left with an undesirable outcome and debilitating condition.1ÇƒÏ3
Many techniques have evolved over the years to reconstruct the mandible. The traditional method of reconstruction by use of autogenous cancellous cellular bone grafts in conjunction with metal plates and screws often produces adequate hard tissue, but may result in inadequate soft tissue coverage.1,2,4,5 Reported complications of cancellous cellular bone include donor and/or graft site infection, pain, postoperative gait disturbance, seroma, hematoma, resorption of graft, and nerve damage.6ÇƒÏ8
Since the 1990s, reconstruction of the grossly deficient mandible with free tissue transfer graft has become more common.2,3,9ÇƒÏ11 Although the vascularized fibula transfer is the most widely used free-flap for mandibular reconstruction, vascularized tissue transfer of the scapula, ilium, radial forearm, and galeoparietal bone have been described.3,11,12 Each of these free tissue transfer flaps (FTTF) has its proponents and has been shown to work well in the mandible reconstructive process. However, as multiple authors have pointed out, each of these flaps has shortcomings when one considers the operating room time, the length of hospital stay, prosthodontic rehabilitation, and the esthetic outcome of the patient.1,3,5,9,10,13
Distraction osteogenesis (DO) provides the reconstructive surgeon with another method to reconstruct hard and soft tissue defects of the mandible. The orthopedic literature has shown that DO can be used successfully to reconstruct large defects of the long bones.14 Recent reports have illustrated the use of DO to regenerate the bone and soft tissue of the mandible.15ÇƒÏ20
One challenge in DO has been to perform reconstruction for a curved structure such as the mandibular symphysis.
We present a case of reconstruction of the patientÇƒÙs mandible using the principles of transport disc distraction osteogenesis (TDDO) to gradually transport a segment of native mandible across a curved surgical defect in 2 phases. Phase 1 involves the surgical separation of a transport disc from native mandible, application of a custom distraction device, followed by gradual distraction of the segment through the surgical defect. Phase 2 involves the sectioning of the transport disc, rotation of the distraction device 180¨?, followed by gradual distraction of the most proximal segment of the transport disc across the surgical defect. The distraction was completed in 2 phases to permit the formation of a curved anterior mandible structure, thus restoring the mandible to normal form and function.
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