Case Study PK

Our patient is a 25-year-old healthy female who initially presented to our office in August of 1997 regarding a large tumor in her right lower jaw. Biopsy of the tumor determined it to be a MYXOMA. The tumor was removed in September of 1997.

In January of 1998 the patient’s lower jaw was reconstructed using an irradiated cadaver mandible and bone graft from her hip. This failed secondary to infection and in December of 1998 the entire graft was removed.

The various option of reconstruction were discussed with the patient including a free tissue transfer graft &/or another cadaver graft. After much discussion amongst the doctors of Atlanta Oral & Facial Surgery and a consultation with Dr. Cesar Guerrero of Caracas, Venezuela it was decided to utilize the principle of transport distraction osteogenesis to reconstruct the patient’s lower jaw and provide adequate quantity and quality of bone for dental implants.

In May of 2000, while she was under general anesthesia, part of the remaining lower jaw was cut to make a transport disc and a modified transport distraction device was affixed to the transport disc and the mandible. After a week of healing the segment of lower jaw bone was distracted the length of the device (approximately 30mm).

Once the device had reached its limit the patient was taken back to the operating room and the transport disc was cut in half. One half was secured to the reconstruction bar and the other half was affixed to the distraction device. This half was then transported another 30 mm around the curvature of the lower jaw.

The remaining part of the patient’s lower jaw was reconstructed using a hip graft after approximately 2 months of healing time from the last distraction.

The patient is currently 5 years after reconstruction with implants and doing well. Restoration of the dental implants was done by Dr. Warren Bern of Woodstock, Georgia.

 

Fig 1: panorex of tumor	Fig 2; panorex of bone graft
Fig 3: panorex after graft removed	Fig 4: 3-D image of patient's facial skeleton
Fig 5: panorex after placement of distraction device	Fig 6: panorex during distraction
Fig 7: Intra-operative picture of sectioning of transport disc	Fig 8: panorex after distraction and final hip graft
Fig 9: Clinical photo of reconstructed mandible	Fig 10: Clinical photo of implants in reconstructed mandible
Fig 11: Lower denture affixed to implants	Fig 12: Patient's occlusion
Fig 13: panorex of reconstructed mandible with reconstruction bar sectioned and implants in place