Prinsip Eksisi Dan Rekonstruksi Tumor Mandibula

PRINSIP EKSISI DAN REKONSTRUKSI
TUMOR MANDIBULA
REFERAT
Dr. Mohamad Rachadian Ramadan

Dr. Almahitta C.P,, SpBP-RE (K)
BACKGROUNDS
MANDIBLE FUNCTION GOAL
Key role in: mastication, swallowing,

speech, and smiling.
Aesthetically: shape, contour, and
vertical height of the lower third of the
face.
Soft-tissue involvement => more
complicated defects => require delicate
shaping of the hard- and soft-tissue
components of the flaps used for
reconstruction.
STRUCTURE ERADICATED BY WIDE
EXCISION
the oral lining,
the tongue
floor of the mouth,
the external skin of the cheek,
the lower lip,
the masseter muscle,
the buccal fat pad,
the parotid gland,
the partial maxilla.
GOALS OF RECONSTRUCTION
restoration of the bony scaffold,

adequate oral continence and
deglutition
obliteration of dead space
re-establishment of optimal
cosmesis.
AVOID DEAD SPACES
Dead space => due to excision of

masticator muscles, the buccal fat pad,
and the parotid gland
lead to fluid accumulation and
infection.
soft-tissue losses => sunken
appearance from soft-tissue
contracture, trismus, plate exposure,
and impaired speech and swallowing
function.
Worsen by postoperative radiotherapy
EXCISION PRINCIPLES
TUMOR MANDIBULA
Karsinoma sel squamosa (KSS)

Karsinoma sel basal ( Basal Cell Carsinoma
/ BCC)
Fibrosarkoma
Neurosarkoma
Karsinoma mukoepidermoid
Karsinoma adenoid kistik
Tumor jinak ectodermal
Tumor jinak tepi jaringan periodontal
EKSISI BLOK
HEMIMANDIBULEKTOMI
Gambar 2.3 Reseksi Mandibula A. Dengan keterlibatan kondilus B.Tanpa pembuangan kondilus (Keith DA.
Atlas of Oral and Maxillofacial Surgery. Philadelphia; W.B. Saunders Company, 1992: 244)
HEMIMANDIBULEKTOMI
Gambar 2.3 Reseksi Mandibula A. Dengan keterlibatan kondilus B.Tanpa pembuangan kondilus (Keith DA.
Atlas of Oral and Maxillofacial Surgery. Philadelphia; W.B. Saunders Company, 1992: 244)
RECONSTRUCTION
PRINCIPLES
WITH THE NORMAL IN MIND, (A PLASTIC
SURGEON) MUST ANALYZE THE DEFECT
AND DETERMINE WHAT IS MISSING, WHAT
IS PRESENT, AND WHAT CAN BE USED TO
MAKE WHAT IS WANTED.
- RALPH MILLARD JR
MANDIBLE RECONSTRUCTRION
PRINCIPLES
Ming-Huei Cheng and Jung-Ju Huang. Oral cavity, tongue, and mandibular reconstructions. Nelligan Plastic Surgery
DEFECT CLASSIFICATION
SOFT TISSUE
FLAPS
- LOCAL
- SUBMENTAL
FLAP
SOFT TISSUE FLAPS, REGIONAL, DELTOPECTORAL
FLAP
SOFT TISSUE FLAPS, REGIONAL, PM
MYOCUTANEOUS FLAP
FREE FASCIOCUTANEOUS or MUSCULOCUTAEOUS
FLAP
Radial Forearm Flap
Ulnar Forearm Flap,
Lateral Arm Flap,
Rectus Abdominis Musculocutaneous flap,
ALT flap,
Thoracodorsal atery perforatir flap,
Medial sural artery perforator flap.
BONE CARRYING FLAPS, PEDICLED
OSTEOCUTANEOUS
pectoralis major osetomuculocutaneous flap,
trapezius osteomusculocutaneous flap,
temporalis osteomuscular flap.
BONE CARRYING FLAPS, VASCULARIZED
OSTEOCUTANEOUS
Circumflex illiac osteocutanous flap,
Scapular osteomusculpcutaneous flap,
radius with radial forearm flap,
fibula osteoseptocutaneous flap.
BONE CARRYING FLAPS, VASCULARIZED
OSTEOCUTANEOUS
A: scapula
B: Ilium
C: radius
D : fibula
BONE CARRYING FLAPS, CIRCUMFLEX ILLIAC
OSTEOCUTANEOUS
BONE CARRYING FLAPS,
SCAPULAR
OSTEOMUSCULOCUTANE
OUS
BONE CARRYING FLAPS, FIBULA
OSTEOSEPTOCUTANEOUS
MANDIBLE DEFECT MICROVASCULAR RECONSTRUCTION
ALGORHYTM
Described by Benjamin et al 2016

Composite mandibular reconstruction => bony
stabilization with autogenous, nonvascularized
bone grafts or vascularized bone grafts and soft-
tissue coverage.
Defects require a large => harvesting bone from
distant donor sites
choice of depends on pedicle length requirement
and the availability of donor tissue.
focuses on mandibular functional subunits
Iliac crest or fibular free flaps are ideal choices
Benjamin D. et al B.A.Classification of Mandible Defects and Algorithm for Microvascular Reconstruction

ALGORHYTM
Type 1 Type 2 Type 3 Type 4

Unilateral unilateral involves bilateral bilateral
dentoalveolar dentoalveolar defects dentoalveolar
defect extending of the defects extending
defect that does
beyond dentoalveolar beyond
not cross the angle regions without either one or both
the midline extending angles
beyond either
angle

ALGORHYTM
Ipsilateral vasculature is available (A) or not

available (B) for anastomosis (contralateral) neck
vasculature.
proposed free flap in algorithm is based on the
required pedicle length

ALGORHYTM

SAMPLE CASE
The left fibula osteocutaneous flap is transferred to left mandibular defect
type II-a
type II-a
type II-a
type II-a
The left fibula osteocutaneous flap is transferred to a right mandibular
defect type II-a
defect type II-a
defect type II-a
The right fibula osteocutaneous flap is transferred to a left mandibular
defect type II-a
defect type II-a
defect type II-a
Thank You

Prinsip Eksisi Dan Rekonstruksi Tumor Mandibula

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PRINSIP EKSISI DAN REKONSTRUKSI

Dr. Mohamad Rachadian Ramadan

Key role in: mastication, swallowing,

restoration of the bony scaffold,

Dead space => due to excision of

Karsinoma sel squamosa (KSS)

Described by Benjamin et al 2016

Benjamin D. et al B.A.Classification of Mandible Defects and Algorithm for Microvascular Reconstruction

Type 1 Type 2 Type 3 Type 4

Benjamin D. et al B.A.Classification of Mandible Defects and Algorithm for Microvascular Reconstruction

Ipsilateral vasculature is available (A) or not

Benjamin D. et al B.A.Classification of Mandible Defects and Algorithm for Microvascular Reconstruction

Benjamin D. et al B.A.Classification of Mandible Defects and Algorithm for Microvascular Reconstruction

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