[Mandibular reconstruction with calvarial bone and temporalis flap]

Abstract

Eleven patients with reconstruction of a massive mandibular defect with a vascularized full-thickness calvarian bone flap or a free full-thickness calvarian bone flap together with a temporalis muscle flap are reported. In six cases the resection was done because of squamous cell carcinoma, in four cases because of radioosteomyelitis and in one case because of gun shot trauma. In one case we lost the whole calvarian bone because of necrosis and in another case a permanent palsy of the frontal branch of the facial nerve remains. An advantage of using full-thickness calvarian bone flaps is that the donor area is in the same operation field and that the thickness of bone allows insertion of titanium osseointegration posts, which was done in five patients. The transplantation of full-thickness calvarian bone and temporalis muscle is a real alternative to an osseomyocutaneous microvascularized free flap for reconstruction of the mandible in cases where the neck was operated and radiated before, and anastomosis may be critical. Further advantages are virtual absence of postoperative pain in the donor area and an invisible scar. With this method we can reach satisfying functional and esthetic results.