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Casella A., Lavorgna G., Pisano R., Navarro Cuellar C., Cuesta Gil M., Navarro Vila C.
Background and aim. If not reconstructed, mandibular defects resulting from oncological surgery can leave major functional and cosmetic sequelae which may impede these patients from returning to professional and family life. Reconstruction may be immediate or deferred, but the authors clearly recommend immediate reconstruction.
Methods. An analysis is made of the different techniques used for the reconstruction of mandibular defects, specifying those which are currently used and the situations in which they are applied. The advantages and disadvantages of microsurgical flaps and pedicled flaps are emphasised. The immediate use of endosseous implants is also discussed.
Results. The results of the various types of reconstruction are compared from a cosmetic and functional point of view. The latter includes a study of the quality of speech, deglutition, mastication and labial competence. Mastication is studied in two types of patients: those with osteointegrated implants with neomandibular reconstruction and those in whom osteointegrated implants were not used. All these patients survived 5 years after surgery.
Conclusions. The authors recommend the immediate reconstruction of mandibular defects. Microsurgical flaps and pedicled flaps can be used for this purpose. Bone flaps may be used for endosseous titanium implants, whereas osseous flaps which do not provide a sufficient guarantee of rehabilitation should not be used. Implants should be inserted during oncological surgery, since postoperative radiotherapy may alter osteointegration of titanium implants are then used. The overall survival of these patients depends on the margins of local resection which are much wider using these techniques.