Poster
# 39
Poster |
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6th Internet World Congress for Biomedical Sciences |
BLANCO RUEDA JOSE ANTONIO(1), Miguel Garcia(2), Marta Izquierdo(3), Fe Garcia(4), Luis Redondo(5), REDONDO LUIS (6), Alberto Verrier(7)
(1)(2)(3)(4)(5)(6)(7)HOSPITAL DEL RIO HORTEGA - VALLADOLID. Spain
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[Oral & Maxilofacial Surgery] |
The prosthetics jaw reconstruction constitutes a difficult challenge for the head and neck surgeon. The development of this surgical technique pursues as objective to maintain the anatomical uniformity and to re-establish a normal functionality of the mandibular complex, speech, swallowing and phonation, that permit patient to maintain an acceptable quality of life.
The reliability of this reconstructive mechanism remain limited by a series of conditions as are the intensive lever forces of the mastication the fatigue of the material together with the lacking fabrics tolerance that they may have been irradiated.
Our experience in the utilization of the jaw reconstruction plates has analyzed 41 cases by a retrospective study ,from 1993 until the present time.The results were mensured by different mandible areas, through the classification of Jewell. Jewel and Cabbages established in 1989 the classification HCL, that was dividing the jaw area in three segments:
* Central segment, that encompasses of canine to canine (C)
* Lateral segment without including the mandibular condyle (L)
* Lateral segment that includes the condyle (H).
Of the combination of these three segments is reached the classification of 8 different types of defects,C, L, H, LC, HC, LCL, HCL, and HCH, to those which there will be that to add the loss of skin, mucous or skin and mucous.
We have found 33 cases which were routed to the oncologic reconstruction and 8 cases to the treatment of different types of traumatologic patology. Of 8 traumatologic patients, the indication in 4 cases was by pseudoartrosis, 3 in fractures and one in a mandibular injury by a gunshot. Between 33 oncologic cases, most of the reconstruction plates were used in the sector L (approx. 50%) followed of the sector C (approx. 30%).
At the present time, the aloplastic material more used in the mandibular reconstruction it is the titanium, an excellent resistance material to the corrosion, adaptive to bony surfaces and biocompatible. fig.2
Their application in the badges THORP (Titanium Hollow Screw Reconstruction Plate) it allows to the surgeons the possibility to reconstruct the mandibular arch without autogenous bone. The hollow screws allow the growth of the bone through them, fixing it in a permanent way. The difficulty of removing the holed screws, has forced to create a variant with solid screws.
This THORP system seems to have solved the problems of fractures and loss of the implant. The most weekness of this system is the tendency to fracture if it is leaved during a large time.fig. 3
1. LATERAL DEFECTS:
It is the best method for minimal lateral and posterior mandible defects.
In patient of advanced age, with an extended tumor in oral cavity (T4) or bad quality of life.
As preliminary treatment to the use of microvascularized grafts in susceptible patients of postoperative x-ray treatment. fig. 4, fig. 5
2. ANTERIOR DEFECTS:
The central defects present a high exposition risk in spite of the use of covering flaps. fig. 6
3. The reconstruction mandibular plates can be used to stabilize fractures in patient without teeth or youths patients where an inmediate mandible rehabilitation for eating it is wished.
4. It is possible to cover the plates with free grafts or with a vascular pedicle, being obtained some excellent functional and cosmetic results. fig. 7
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[Oral & Maxilofacial Surgery] |
