Correction of malocclusion using sliding fibula osteotomy with sagittal split ramus osteotomy after mandible reconstruction
이동훈, 김성룡, Jang Sam, 안강민, 이지호,
소속 상세정보
이동훈 ( Lee Dong-Hun ) - University of Ulsan College of Medicine Asan Medical Center Department of Oral and Maxillofacial Surgery
김성룡 ( Kim Seong-Ryoung ) - University of Ulsan College of Medicine Asan Medical Center Department of Oral and Maxillofacial Surgery
( Jang Sam ) - Coreline Soft
안강민 ( Ahn Kang-Min ) - University of Ulsan College of Medicine Asan Medical Center Department of Oral and Maxillofacial Surgery
이지호 ( Lee Jee-Ho ) - University of Ulsan College of Medicine Asan Medical Center Department of Oral and Maxillofacial Surgery
Abstract
Background: Fibula free flap mandible reconstruction is the standard procedure after wide resection of the mandible. Establishment and maintenance of normal occlusion are important in mandible reconstruction both intraoperatively and after surgery. However, scar formation on the surgical site can cause severe fibrosis and atrophy of soft tissue in the head and neck region.
Case presentation: Here, we report a case of severe soft tissue atrophy that appeared along with scar formation after mandibular reconstruction through the fibular free flap procedure. This led to normal occlusion collapse after it was established, and the midline of the mandible became severely deviated to the affected side that was replaced with the fibula free flap, leading to facial asymmetry. We corrected the malocclusion with a secondary operation: a sagittal split ramus osteotomy on the unaffected side and a sliding osteotomy on the previous fibula graft. After a healing time of 3?months, implants were placed on the fibula graft for additional occlusal stability.
Conclusion: We report satisfactory results from the correction of malocclusion after fibula reconstruction using sliding fibula osteotomy and sagittal split ramus osteotomy. The midline of the mandible returned to its original position and the degree of facial asymmetry was reduced. The implants reduced difficulties that the patient experienced with masticatory function.
키워드
Mandible reconstruction; Fibula free flap; Sagittal split ramus osteotomy
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