Rehabilitación mandibular implanto-soportada sobre injerto microvascularizado de peroné. Empleo de la cirugía guiada por ordenador

Abstract

Introduction: In the treatment of the patients with malignant tumours of the oral cavity, the surgery combines the resection and immediate reconstruction with the aim of preserving the functions concentrated in the oral cavity (phonation, deglutition, mastication, aesthetics). The use of microvascularised flaps is a common practice in these patients in order to replace the resected tissues. Dental rehabilitation of these patients is usually very complex, and the use of guided implant surgical systems avoids many of the problems that occur in these patients. Clinical case: A patient who underwent hemimandibulectomy without reconstruction and adjuvant treatment with radiotherapy, who is sent for reconstruction. Initially, a microvascularised fibula flap is performed that provides bone and soft tissues. Subsequently, he is rehabilitated with a hybrid prosthesis over implants, which is placed by means of a mucosa-supported surgical ferrule after planning with the FacilitateTM tool. Discussion: The microvascularised fibula flap is the key process in mandibular reconstruction of cancer patients. Its principal disadvantage is the difficulty in the placement of the dental implants and subsequent rehabilitation. The use of guided implant surgery prevents many of these problems. Conclusions: The reconstruction of the oral cavity of the cancer patient by means of microvascularised grafts, and the subsequent dental rehabilitation with osseointegrated implants allow offering the patient an acceptable quality of life.