Reconstruction with free fibula graft for osteoradionecrosis of mandible case report 1
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Reconstruction with free fibula graft for osteoradionecrosis of mandible case report 1
- 1. Reconstruction with free fibula graft for osteoradionecrosis of mandible - case report www.indiandentalacademy.com
- 2. • Cancer –common and dangerous • Head and neck cancer • Oral cancer • Surgery , Chemotherapy and Radiotherapy • Combination of above www.indiandentalacademy.com
- 3. Purpose the potential complications of radiation therapy on maxillofacial skeleton and versatility of vascularized flap. www.indiandentalacademy.com
- 4. “Ionizing radiation damages biologic material in unique manner producing effect on a molecular, cellular,tissue and organ level”. Radiation Therapy - Stephen Ariyan www.indiandentalacademy.com
- 5. USES OF RADIATION THERAPY • Bracytherapy • Teletherapy • Primary therapy • Adjuvant therapy • Palliative therapy www.indiandentalacademy.com
- 6. Advantages of Radiation Therapy • Microscopic clearance • Macroscopic clearance • Better prognosis www.indiandentalacademy.com
- 7. COMPLICATIONS OF RADIATION THERAPY • Mucositis • Atrophic mucosa • Xerostomia • Radiation caries • Osteoradionecrosiswww.indiandentalacademy.com
- 8. Osteoradionecrosis “Is that pathologic process which sometimes follows heavy radiation of bone & characterized by a chronic painful infection and necrosis accompanied by late sequestration and sometimes permanent deformity”. www.indiandentalacademy.com
- 9. Hypovascularity Hypoxia Hypocellularity ….. osteoradionecrosis Triad of irradiation, trauma and infection www.indiandentalacademy.com
- 10. • Osteoradionecrosis - 2.6 to 15% • Mandible is commonly involved ( body ) • Maxilla – rarely www.indiandentalacademy.com
- 11. STAGES OF OSTEORADIONECROSIS • EARLY STAGE- < then 2 years after RT high radiation dose • LATE STAGE- several years after RT due to trauma www.indiandentalacademy.com
- 12. RISK FACTORS FOR ORN • Trauma • Infection • Tobacco • Alcohol www.indiandentalacademy.com
- 13. Pathophysiology destroys Irradition Regenerative powers of the bone Direct effect Osteoblast and osteocytes thrombosis hypovascularity Aseptic necrosiswww.indiandentalacademy.com
- 14. • Severe, deep burning pain • Swelling • Trismus • Soft tissue abscess • Draining sinuses Symptoms www.indiandentalacademy.com
- 16. Prophylactic measures: Sleeper (1950) and Meyer (1958) •Oral hygiene •Infected and non vital teeth •Antibiotic before and after •Fluoride therapy www.indiandentalacademy.com
- 17. Hee kyun et al: risk of ORN following extraction of impacted teeth in irradiated cases of head and neck cancer patients Journal oral maxillofac surg 62:139-144,2004www.indiandentalacademy.com
- 18. limited debridement and HBO therapy .. Effective.. preventing the progression of ORN. they fail to eradicate established ORN, which requires radical surgical resection followed by functional reconstruction with well-vascularised tissue. Br J Plast Surg. 2003 Mar;56(2):92-9. Ang E et al: www.indiandentalacademy.com
- 19. fibula harvesting is associated with low subjective morbidity . Walking during complex tasks and at high velocities reveals that restoration of gait is not complete after partial fibulectomy. Plast Reconstr Surg. 2003 Jun;111(7):2237-42. Bodde et al: www.indiandentalacademy.com
- 21. Conservative •Good oral hygiene •Frequent irrigation of wound •Antibiotic to control acute bacterial infections •Hyperbaric oxygen •Sequestrectomy: Daland (1948) www.indiandentalacademy.com
- 22. Hyperbaric oxygen •As an adjunctive therapy •Decrease in pain,trismus & closure of fistula •Increase in arterial and venous tension •100% of oxygen, 2.4 absolute atmospheric pressure, dive for 90 minutes www.indiandentalacademy.com
- 23. Marx protocol Stage I - 30 HBO dives one per day Stage II - transoral sequestrectomy Stage III - reconstruction after successful resolution of ORN J oral maxfac surg 1983; 41, 351-357www.indiandentalacademy.com
- 24. DISADVANTAGE OF HBO THERAPY • Not able to revitalize the dead bone www.indiandentalacademy.com
- 25. •Curettage of necrotic bone, zinc peroxide & neomycin •Enbloc / marginal mandibular resection •Segmental resection •Maxillectomy /hemimandibulectomy Surgical www.indiandentalacademy.com
- 26. Reconstruction Autogenous bone grafts Rib iliac Tibia microvascular Rib Tibia Fibula www.indiandentalacademy.com
- 27. Alloplastic implants metals non metals Stainless steel Vulcanized rubber Titanium Acrylic www.indiandentalacademy.com
- 28. Case presentation 55 years old Male Complaint- pain in the lower jaw History- Nodule on the soft palate Radiation therapy www.indiandentalacademy.com
- 35. Exposure of ORN mandible www.indiandentalacademy.com
- 43. Fibula adopted to AO plate www.indiandentalacademy.com
- 48. •fistula •wound dehiscence •haematoma •seroma •graft failure •infection Common complications www.indiandentalacademy.com
- 49. Conclusion •EXCELLENT VASCULARITY •EASY TO OSTEOTOMIZE •VERSATILE OSSEOCUTANEOUS UNIT •LOW MORBIDITY •FEASABILITY OF PLACING DENTAL IMPLANTS •LONG BONE •REGULAR DIET, SPEECH, APPEARENCE Plast Reconstr Surg. 2002 Aug;110(2):438-49www.indiandentalacademy.com