A Protocol for the Use of a Combined Microvascular Free Flap with Custom-Made 3D-Printed Total Temporomandibular Joint (TMJ) Prosthesis for Mandible Reconstruction in Children

Applied Sciences

Łukasz Krakowczyk¹  Marcin Kozakiewicz²  Dominika Smyczek³  Krzysztof Dowgierd⁴  Rafal Pokrowiecki⁵  Maciej Borowiec⁵ 

[1] Branch in Gliwice, Oncological and Reconstructive Surgery Clinic, Maria Sklodowska-Curie Institute—Oncology Centre (MSCI), ul. Wybrzeze Armii Krajowej 15, 44-100 Gliwice, Poland;Department of Maxillofacial Surgery, Medical University in Lodz, Pl. Hallera 1, 90-647 Łodz, Poland;Department of Pediatric Surgery and Urology, John Paul II Upper Silesian Child Health Centre, Independent Public Clinical Hospital no. 6 of the Medical University of Silesia in Katowice, ul. Medykow 16, 40-752 Katowice, Poland;Head and Neck Surgery Clinic for Children and Young Adults, Department of Clinical Pediatrics, University of Warmia and Mazury, ul. Oczapowskiego 2, 10-719 Olsztyn, Poland;Head and Neck Surgery Department—Maxillofacial Surgery Department, Craniofacial Center, Regional Specialized Children’s Hospital, ul. Zolnierska 18A, 10-561 Olsztyn, Poland;

关键词: maxillofacial;    pediatric;    surgery;    cancer;    reconstruction;    microsurgery;   

DOI  :  10.3390/app11052176

来源: DOAJ

【 摘 要 】

Extended postoperative mandibular reconstructions due to orofacial disease involving the temporomandibular joint (TMJ) in immature patients remain a challenge as a result of ongoing growth, which is usually affected by the disease and treatment. Current reconstructive techniques based fully on alloplastic total joint replacement fail to meet fully the anatomical and functional requirements for the masticatory system and speech development. Fourteen children aged 12.6 ± 2.6 with tumors or congenital deformities affecting the mandible and TMJ were included in the study. Radical surgical treatment according to our own protocol was performed through microvascular anastomotic flap reconstruction of the soft tissues and bones, together with total TMJ custom replacements. Follow-up lasted 2–6 years. During the follow-up, increases in the mandible body (13% growth) and ramus (12% growth) were observed, both of which were related (p < 0.001). This is the first report concerning the immediate reconstruction of the mandible with ramus and total TMJ in children and adolescents that combines a free vascularized graft and total individual prosthesis of the TMJ. The presented technique enabled optimal function of the TMJ, growth of the mandible, and further rehabilitation of the patients. The technique was demonstrated to be safe, reliable, and provide good functional and cosmetic outcomes.

【 授权许可】

Unknown