Abstract

Background: Free fibula reconstruction of segmental mandible defects is a commonly accepted method of rehabilitation following ablation for head and neck squamous cell carcinoma. Fibula reconstruction is made particularly useful by its ability to successfully osseointegrate dental implants, thus allowing for improved functional and aesthetic rehabilitation. However, in cases requiring post reconstruction radiotherapy, the intention to continue with implant placement should be reevaluated. While it is commonly understood that irradiated tissues have much poorer healing qualities than non-irradiated tissues, very little evidence exists as to the specific success rates and risks of placing implants in these neo-mandibles. 

Methods: Three databases were searched for all papers related to implant placement in irradiated free fibula mandible reconstructions.

Findings: Limited studies considered implants in irradiated fibula flaps. Retrospective studies appear to support that these implants have over 80 percent survival. At this stage, the specific associated complications are largely unreported.

Conclusion: Current data on implant success in irradiated free fibula mandible reconstructions is limited. However, present literature suggests that these implants pose a reasonable success rate. This piece found that the survival of implants in these patients is certainly less than the accepted success of implants in non-irradiated free fibula reconstructions. However, the authors of this paper propose that continuing with implant placement in irradiated fibulas is a reasonable and somewhat reliable option for oral rehabilitation.

Keywords: Free Fibula; Databases; Rehabilitation

References

1. von Elm E., et al. “The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies”. International Journal of Surgery (London, England) 12.12 (2014): 1495-1499.
2. Jackson RS., et al. “Evaluation of Clinical Outcomes of Osseointegrated Dental Implantation of Fibula Free Flaps for Mandibular Reconstruction”. JAMA Facial Plastic Surgery 18.3 (2016): 201-206.
3. Ch'ng S., et al. “Osseointegrated implant-based dental rehabilitation in head and neck reconstruction patients”. Head and Neck 38 (2016): E321-327.
4. Salinas TJ., et al. “Clinical evaluation of implants in radiated fibula flaps”. Journal of Oral and Maxillofacial Surgery 68.3 (2010): 524-529.
5. Barber HD., et al. “Evaluation of osseointegration of endosseous implants in radiated, vascularized fibula flaps to the mandible: a pilot study”. Journal of Oral and Maxillofacial Surgery 53 (1995): 640-644.
6. Esposito M and Worthington HV. “Interventions for replacing missing teeth: hyperbaric oxygen therapy for irradiated patients who require dental implants”. The Cochrane Database of Systematic Reviews (2013): Cd003603.
7. Sclaroff A., et al. “Immediate mandibular reconstruction and placement of dental implants. At the time of ablative surgery”. Oral Surgery, Oral Medicine, and Oral Pathology 78 (1994): 711-717.

Citation

Citation: A Varidel., et al. "Implant Success in Irradiated Free Fibula Flaps for Mandible Reconstruction".Acta Scientific Otolaryngology 2.1 (2020): 01-06.

Copyright

Copyright: © 2020 A Varidel., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.