Department of Oral & Maxillofacial Surgery, University Hospital La Princesa, Madrid, Spain.
Med Oral Patol Oral Cir Bucal. 2011 Jan 1;16(1):e74-8. doi: 10.4317/medoral.16.e74.
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.
游离血管化腓骨瓣被认为是治疗创伤、感染或肿瘤切除后广泛骨缺损（超过 6 厘米）的下颌骨重建的首选方法。但是，当重建涉及有牙下颌骨时，腓骨存在局限性，因为它不能提供足够的骨高度来恢复牙槽弓达到咬合平面。因此，骨高度的不足使得植入物的放置变得不切实际。我们报告了一例游离血管化腓骨瓣的垂直牵引成骨术，用于重建牙源性粘液瘤切除后的半下颌骨，以优化种植体修复。牵引装置在口腔内应用。在潜伏期 10 天后，以每天 0.5 毫米的速度进行牵引方案。随后进行 3 个月的巩固期。之后，拆除牵引装置，并在牵引区域放置 3 个骨整合牙种植体。结果，腓骨和原生半下颌骨之间的垂直差异得到纠正。牵引后获得的垂直高度增加了 17 毫米。垂直骨高度的增加是稳定的，能够在没有任何并发症的情况下放置牙种植体。总之，我们认为游离血管化皮瓣的垂直牵引成骨术是一种可靠的技术，可优化肿瘤手术后下颌骨重建后的种植体定位，实现理想的修复。
