Vertical distraction osteogenesis of a free vascularized fibula flap in a reconstructed hemimandible for mandibular reconstruction and optimization of the implant prosthetic rehabilitation. Report of a case
2011
Free vascularized fibular flap is considered the treatment of choice in mandibular reconstruction for extensive bone
defects (over 6 centimeters) resulting from trauma, infections or tumor resections. But, when the reconstruction
involves a dentate mandible, the fibula has the limit as it does not offer sufficient bone height to restore the alveolar
arch up to the occlusal plane. Therefore, the deficiency in bone height makes implant placement impractical.
We report a case of vertical distraction osteogenesis of a free vascularized fibula flap used to reconstruct a hemimandible
after resection of an odontogenic myxoma, for optimization of the implant prosthetic rehabilitation. The
distraction device was applied intraorally. After 10 days of latency period, distraction protocol was performed at a
distraction rate of 0.5 mm per day. A consolidation period of 3 months followed. Afterwards the distraction device
was removed and 3 osseointegrated dental implants were placed in the distracted area. As a result, the vertical discrepancy
between the fibula and the native hemimandible was corrected. The amount of vertical height achieved
after distraction was 17 milimeters. The increase of vertical bone height was stable and enabled placement of
dental implants without any complications. In conclusion, we consider that vertical distraction osteogenesis of
free vascularized flaps is a reliable technique that optimizes implant positioning for ideal prosthetic rehabilitation,
after mandibular reconstruction following tumor surgery
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