i

A

S

rn

Anesthesia

flammatory conditions, cysts, neoplasms, infections andnecrosis of the mandible. A patient’s quality of life aftermandibular reconstruction is negatively impacted by theinability to achieve a balance between esthetics, long-term stability and masticatory function. Alterations tomaxillo-mandibular relationship, occlusion and condyleposition can have a dramatic impact on the prostheticrehabilitation, temporomandibular joint harmony andoverall psyche of reconstruction patients. The goal ofthis technical report is to provide surgeons with anotherintraoperative technique to stabilize mandibular seg-ments during the immediate reconstruction of segmentaldefects to preserve the pre-surgical contours and dento-facial relationships.

Materials and Methods: Patients who require seg-mental resection of the mandible with a planned imme-diate reconstruction can be considered for this tech-nique. After adequate surgical exposure, the externalfixator is applied on either side of the planned defect. Inpatients with malignant neoplasms or those that requirea cervical lymphadenectomy or neck exploration forvascular access for a free tissue transfer, the neck inci-sion will provide direct visualization of the mandible forthe application of the device, resection and reconstruc-tion. Consideration needs to be given to the reconstruc-tion plate position and its contours in relationship to theexternal fixator in order to provide ample room for itsapplication without encroachment into the dentition orinferior alveolar nerve canal. Once adequate stabilizationof the external fixator has been achieved, the resectionand immediate reconstruction is performed after achiev-ing adequate surgical margins. The reconstruction plate isapplied, bone graft or vascularized free tissue transfer issecured and occlusion and bony relationships are verified.In cases where the required osteotomies and fixation aredone at the donor site, the external fixator then providesthe stabilization and maintenance of the proper relation-ships. The external fixator is then removed and adequatewound closure is performed.

Methods of Data Analysis: Patients who underwentsegmental mandibular resection and immediate recon-struction with temporary stabilization with an externalfixator will be reviewed. Statistical analysis will be per-formed using JMP 8.0 software.

Results of Investigation: The use of the externalfixator allowed for maintenance of the premorbid man-dibular contours, joint relationship, and occlusion dur-ing the application of the reconstruction plate and graftor free-flap fixation. This is particularly helpful in non-dentate segments where maxillo-mandibular fixationcannot be utilized for temporary stabilization or the useof internal temporary fixation might hinder the propercontouring and application of the reconstruction plate.

Conclusion: Ginestet first described the application ofan external fixator to the mandible in 1936. Its use in the

management of facial fractures has significantly decreased

AAOMS • 2011

with the advent and improvements in internal fixation. Thisreview describes a technique, which has been utilized forthe temporary stabilization of reconstruction segments butcould be applied in the same manner for the treatment ofedentulous fractures or those involving a non-dentate seg-ment. The added cost for the use of the appliance and thetime spent in its application has to be weighed against thebenefits of this technique.

References:

Goh BT, Lee S, Tideman H, Stoelinga PJ. Mandibular reconstructionn adults: a review. Int J Oral Maxillofac Surg. 2008 Jul;37(7):597-605.

HF Braidy and DB Ziccardi. External Fixation for Mandible Fractures.tlas Oral Maxillofacial Surg Clin N Am. 17: 45-55, 2009

POSTER 22Pectoralis Major Myocutaneous Flap inthe Reconstruction of Defects FromTrauma and Malignancy: A Viable OptionT. Stevens: Loma Linda University

Statement of the Problem: Currently the treatmentof maxillofacial defects secondary to trauma or malig-nacy have largely consisted of free microvascular grafts.This poses a problem to the surgeon who has not ac-quired the needed training to perform the delicate sur-gery and to the patient who may not have these resourcesavailable to him. The pectoralis myocutaneous flap can beutilized in the reconstruction of these defects.

Materials and Methods: Two patients had the pec-torails myocutaneous flap performed to reconstructlarge soft tissue defects from trauma and malignancy.

Methods of Data Analysis:Results of Investigation:Conclusion: The pectoralis myocutaneous flap is a

predictable surgical procedure that can be utilized with-out the need for a free microvascular graft for patientswith maxillofacial defects.

References:

Ariyan S. The pectoralis major myocutaneous flap. Plast Reconstrucurg. 1979;63:73-81

Zbar RI, Funk GF, McCuloch TM, Graham SM, Hoffman HT. Pecto-alis major myoffascial flap: available tool in contemporary head andeck reconstruction. Head Neck. 1997;19:413-418

MAXILLOFACIAL PATHOLOGY &MEDICINE (INCLUDESEPIDEMIOLOGY AND

INFECTION)

e-65