Mandible reconstruction: History, state of the art and persistent problems

Abstract

Background: Mandibular reconstruction has been experiencing an amazing evolution. Several different approaches are used to reconstruct this bone and therefore have a fundamental role in the recovery of oral functions.

Objectives: This review aims to highlight the persistent problems associated with the approaches identified, whether bone grafts or prosthetic devices are used. A brief summary of the historical evolution of the surgical procedures is presented, as well as an insight into possible future pathways.

Study design: A literature review was conducted from September to December 2012 using the PubMed database. The keyword used was "mandible reconstruction." Articles published in the last three years were included as well as the relevant references from those articles and the "historical articles" were referred. This research resulted in a monograph that this article aims to summarize.

Results: Titanium plates, bone grafts, pediculate flaps, free osteomyocutaneous flaps, rapid prototyping, and tissue engineering strategies are some of the identified possibilities. The classical approaches present considerable associated morbidity donor-site-related problems.

Conclusion: Research that results in the development of new prosthetics devices is needed. A new prosthetic approach could minimize the identified problems and offer the patients more predictable, affordable, and comfortable solutions.

Clinical relevance: This review, while affirming the evolution and the good results found with the actual approaches, emphasizes the negative aspects that still subsist. Thus, it shows that mandible reconstruction is not a closed issue. On the contrary, it remains as a research field where new findings could have a direct positive impact on patients' life quality. The identification of the persistent problems reveals the characteristics to be considered in a new prosthetic device. This could overcome the current difficulties and result in more comfortable solutions. Medical teams have the responsibility to keep patients informed about the predictable problems related with each elected approach, even understanding that a perfect reconstruction is a secondary goal when compared with maintenance of life.

Keywords: Mandible reconstruction; dental prosthetics; donor-site morbidity; fibula free flap; free osteocutaneous flap; marginal mandibulectomy.