Role of residual mandibular teeth after computer-assisted mandibular reconstruction using a fibular flap
Koreyuki Kurosawa,
Akira Ohkoshi,
Ryo Ishii,
Naoko Sato,
Hitoshi Miyashita,
Takayuki Harata,
Toshiro Imai,
Masanobu Hayashi,
Shinyo Ishi,
Miki Shoji,
Yoshimichi Imai
Affiliations
Koreyuki Kurosawa
Department of Plastic and Reconstructive Surgery, Tohoku University Graduate School of Medicine, 2-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan; Corresponding author. Koreyuki Kurosawa M.D, PhD, 2-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan. Tel: +81-22-717-7332; Fax: +81-22-717-7335.
Akira Ohkoshi
Department of Otorhinolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 2-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan
Ryo Ishii
Department of Otorhinolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 2-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan
Naoko Sato
Maxillofacial Prosthetics Clinic, Tohoku University Hospital, 2-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan
Hitoshi Miyashita
Department of Dentistry and Oral Surgery, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1 Fukumuro, Miyagino-ku, Sendai 983-8512, Japan
Takayuki Harata
Dental Laboratories, Central Clinical Facilities, Tohoku University Hospital, 2-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan
Toshiro Imai
Department of Plastic and Reconstructive Surgery, Tohoku University Graduate School of Medicine, 2-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan
Masanobu Hayashi
Department of Plastic and Reconstructive Surgery, Tohoku University Graduate School of Medicine, 2-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan
Shinyo Ishi
Department of Plastic and Reconstructive Surgery, Tohoku University Graduate School of Medicine, 2-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan
Miki Shoji
Department of Plastic and Reconstructive Surgery, Tohoku University Graduate School of Medicine, 2-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan
Yoshimichi Imai
Department of Plastic and Reconstructive Surgery, Tohoku University Graduate School of Medicine, 2-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan
Summary: Background: Computer-assisted mandibular reconstruction after mandibulectomy enables accurate reconstruction of the occlusal positions between the maxilla and mandible. Understanding the remaining teeth condition is essential for sensory mastication in patients with numerous tooth loss. However, no studies have examined the dental status of the remaining mandible after computer-assisted mandibular reconstruction using a fibular flap. This study evaluated the role of residual teeth and other factors in effective acquisition of oral intake after computer-assisted mandibular reconstruction using a fibular flap. Patients and Methods: Postoperative oral intake and associated factors were retrospectively examined in 57 consecutive patients. Oral intake was assessed using the Functional Oral Intake Scale. Multivariate analysis was performed to evaluate the remaining teeth arrangement (Eichner's classification), mandibular dentures, extent of resection (Brown's classification), age, performance of glossectomy, history of radiation therapy, and computer-assisted methods. Results: Multivariate analysis revealed that Eichner's classification had a positive (p<0.001) and radiation therapy had a negative (p<0.05) impact on oral intake. The patients with dentures anchored to the remaining teeth in the occlusal support area (i.e., premolar and molar) had higher Functional Oral Intake score than those with dentures anchored to the remaining teeth in the non-occlusal support area (6.78±0.03 vs. 6.10±0.07, p<0.005). Conclusion: In computer-assisted mandibular reconstruction with accurate occlusion, the residual teeth in the occlusal support area are essential for good postoperative oral intake with dentures. During mandibulectomy, if oncologically acceptable, these teeth should be preserved, and selective placement of dental implants in the occlusal support area should be considered.
