Revascularized fibula free flap reconstruction and curviline
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The revascularized fibula free flap (RFFF) is the most popular method of post-maxillectomy reconstruction. This article proves that the use of curvilinear transport distraction osteogenesis (CTDO) is an efficacious way in closing large defects in the maxilla and a superior alternative to The revascularized fibula free flap. In a prospective cohort study of six post-maxillectomy patients, curvilinear transport distraction osteogenesis was applied and the new bone (regenerate) was compared with the parent bone from which it had been regenerated. These results were compared with a retrospective group of six participants of similar age and sex who had undergone The revascularized fibula free flap reconstruction as external control. Clinical measurements taken at the depth of the alveolar vestibule were recorded at three different exact points juxtaposed, namely (A) lateral incisor, (B) first premolar, and (C) first molar.

These areas of interest were similar to those chosen on the CT scans. Impressions were taken from all the patients and stone casts were made. The width of the alveolar bone was computed based on the measurements made from the stone casts. The stone casts were then used to calculate the width and depth of the soft tissue and bone in the maxilla in the (A), (B), and (C) regions. The regenerate possessed anatomical and physiological characteristics equal to the parent bone. For the curvilinear transport distraction osteogenesis patients, prosthetic rehabilitation of the dentition was supported by dental implants after osseointegration of the latter into the newly created bone and soft tissue.

The production of the curvilinear bone and soft tissue along a horizontal plane has been demonstrated. The new alveolar bone achieved the correct width and depth to create a physiological vestibule and a functional/esthetic zone for the placement of dental implants. In addition, the shape of the palatal vault was also maintained. The curvilinear transport distraction osteogenesis method is a reliable method of maxillary reconstruction and has a better anatomical and functional outcome than the revascularized fibula free flap.

Based on the clinical and radiological findings, the following can be concluded:

The clinical appearance is appraised as follows: the lack of a bony palatal vault is unsightly and a major drawback of revascularized fibula free flap, such as the flatness of the palate reduces the space required for phonation and deglutition and the lack of a vestibule interferes with animation of facial musculature and a neutral zone for dental implant placement. All of the above issues make the revascularized fibula free flap unattractive as a gold standard, whereas, in contradistinction, the curvilinear transport distraction osteogenesis method complies with all of the above requirements.

Where the alveolar height is concerned, it has been shown that the alveolar height responsible for the formation of the depth of the sulcus/vestibule was indeed poor in revascularized fibula free flap as compared to the curvilinear transport distraction osteogenesis cases. Histologically, the curvilinear transport distraction osteogenesis-generated bone appeared superior to the parent bone. These results reinforce the notion that the new bone created can function and appear as good as the bone that it replaces, mainly in the area of implantology.

Source:https://www.amsjournal.com/article.asp?issn=2231-0746;year=2020;volume=10;issue=2;spage=304;epage=311;aulast=Hendricks
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