Mandible Reconstruction

Reconstruction of hard and soft tissue defects of the mandible created by ablative tumor surgery or trauma presents the reconstructive surgeon with plethora of challenges. Since the mandible is the focal point of the lower one-third of the face, it must be reconstructed in specific, three-dimensional facial proportions to produce proper esthetics. The mandible’s function as a primary anatomical structure in speech and eating dictate that the reconstructed anatomy provides the proper foundation. When form and function are ignored in the reconstructive process, the patient may be left with an undesirable outcome and debilitating condition.

Many techniques have evolved over the years to reconstruct the mandible. The traditional method of reconstruction with bone grafts (CCB) in conjunction with metal plates and screws often produces adequate hard tissue, but may result in inadequate soft tissue coverage. Additionally, many times such reconstruction leaves the patient a dental cripple by not providing sufficient quantity and quality of bone for dental implants

Since the 1990’s reconstruction of the grossly deficient mandible with free tissue transfer grafts has become more common. Although the vascularized fibula transfer is the most widely employed free-flap for mandibular reconstruction, vascularized tissue transfer of the scapula, hip, and radial forearm have been described Each of these free tissue transfer flaps has their proponents and has been demonstrated to work well in the mandible reconstructive process. However, as multiple authors have pointed out, each of these flaps has shortcomings when one considers the operating room time, the length of hospital stay, prosthodontic rehabilitation, and the aesthetic outcome of the patient.

Distraction osteogenesis surgery provides the reconstructive surgeon with another method to reconstruct hard and soft tissue defects of the mandible. Such cases are difficult and must be evaluated on an individual basis.