An alternative method for reconstructing anterior segmental mandibulectomy defects with a plate and pectoral major muscle flap

Background: Reconstruction of anterior segmental mandibulectomy still remains a challenge. Osteocutaneous free flap remains the ideal choice of reconstruction because it restores cosmesis and function. The use of other locoregional flaps compromises cosmesis and function. Here, we have introduced a unique technique of reconstruction with lingual cortex mandibular plate as an alternate choice for free flap. Method: Six patients aged 12–62 years underwent oncological resection for oral cancer which involved the anterior segment of the mandible. Following resection, they underwent lingual cortex mandibular plating with pectoralis major myocutaneous flap reconstruction. Adjuvant radiotherapy was delivered to all patients. Results: The mean bony defect was 9.2 cm. There were no significant perioperative events related to the surgery. None required tracheostomy and all were safely extubated with no post-surgical complications. The cosmetic and functional outcomes were acceptable. Following the completion of radiotherapy with a median follow-up of 11 months, Plate exposure occurred in one patient. Conclusion: The technique is cheap, quick and simple, and can be effectively applied in resource-constrained and demanding situations. It is possible to consider this as an alternative treatment strategy for osteocutaneous free flap in anterior segmental defects

A simple technique for repositioning of the mandible by a surgical guide prepared using a three-dimensional model after segmental mandibulectomy / 대한악안면성형재건외과학회지

BACKGROUND: Mandibular reconstruction is performed after segmental mandibulectomy, and precise repositioning of the condylar head in the temporomandibular fossa is essential for maintaining preoperative occlusion. METHODS: In cases without involvement of soft tissue around the mandibular bone, the autopolymer resin in a soft state is pressed against the lower border of the mandible and buccal and lingual sides of the 3D model on the excised side. After hardening, it is shaved with a carbide bar to make the proximal and distal parts parallel to the resected surface in order to determine the direction of mandibular resection. On the other hand, in cases that require resection of soft tissue around the mandible such as cases of a malignant tumor, right and left mandibular rami of the 3D model are connected with the autopolymer resin to keep the preoperative position between proximal and distal segments before surgical simulation. The device is made to fit the lower border of the anterior mandible and the posterior border of the mandibular ramus. The device has a U-shaped handle so that adaptation of the device will not interfere with the soft tissue to be removed and has holes to be fixed on the mandible with screws. RESULTS: We successfully performed the planned accurate segmental mandibulectomy and the precise repositioning of the condylar head by the device. CONCLUSIONS: The present technique and device that we developed proved to be simple and useful for restoring the preoperative condylar head positioning in the temporomandibular fossa and the precise resection of the mandible.

Condylar hyperplasia, diagnosis and clinical management: a clinical case report / Hiperplasia condilar, diagnóstico y manejo clínico: a propósito de un caso clínico

ABSTRACT Condylar hyperplasia is a disorder characterized by excessive and progressive growth affecting the condyle, neck, body, and mandibular ramus. Under this condition, mandibular growth occurs in all three planes of space, but more predominantly in one of them. Its etiology is controversial in its own. Some of its suggested causes include: trauma, hypervascularity, infections, and hereditary/intrauterine factors. Treatment protocols are varied, but one of the best treatment choices is high condylectomy. Following is the case of a 16-year-old female patient with this anomaly. The physical exam showed free facial asymmetry with mandibular deviation. Treatment consisted of TMJ surgery and high condylectomy plus a second orthodontic stage. The clinical outcomes at two-year follow-up suggest that a second intervention won′t be necessary. Patient was very satisfied with the results.

RESUMEN La hiperplasia condilar es una alteración caracterizada por crecimiento excesivo y progresivo, que afecta el cóndilo, el cuello, el cuerpo y la rama mandibular. Bajo esta condición, el crecimiento mandibular ocurre en los tres planos del espacio, pero con predominio por alguno de ellos. La etiología de la misma es motivo de controversia. Se sugieren como sus causas: traumatismos, hipervascularidad, infecciones y factores hereditarios e intrauterinos. Los protocolos de tratamiento son variados, pero una de las mejores opciones de tratamiento es la condilectomía alta. Se presenta el caso de una paciente de género femenino de 16 años de edad, portadora de esta anomalía. Al examen físico, se observa una franca asimetría facial con desviación mandibular. El tratamiento consistió en una cirugía de articulación temporomandibular con condilectomía alta y luego una segunda etapa ortodóntica. Los resultados clínicos a dos años de seguimiento sugieren que no será necesario hacer una segunda intervención. La paciente mostró alto grado de satisfacción con los resultados obtenidos.

Mandibular ameloblastoma with lung metastasis 10 years after resection

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To present a case of mandibular ameloblastoma with pulmonary metastasis after ten years and discuss the possible pathophysiology, diagnostic and therapeutic options.<br /><strong>METHODS:</strong><br /><strong> Design:</strong> Case Report<br /> <strong>Setting:</strong> Tertiary Private Hospital<br /><strong> Patient:</strong> One<br /><strong>RESULTS:</strong> A  27-year-old  woman  diagnosed  with  follicular  variant  ameloblastoma  underwent left  segmental  mandibulectomy  with  iliac  bone reconstruction  in  2004.  The  titanium  plates were  removed  in  2008  because  of  a  recurrent  orocutaneous  fistula.  She  was  apparently  well until 2014, when she complained of intermittent, non-radiating, sharp and piercing, right upper back pains. Work-ups revealed multiple bilateral lung nodules.  A CT scan-guided percutaneous needle  biopsy  of  the  right  upper  lung  nodule  revealed  metastatic  ameloblastoma.  Opting  for observation  instead  of  chemoradiation,  she  remains  asymptomatic  on  regular  follow-ups  with medical oncology, pulmonary medicine and otorhinolaryngology.<br /><strong>CONCLUSION:</strong> Though  benign,  ameloblastoma  has  a  high  propensity  for  local  invasion  and  may metastasize.  It  is  difficult  to  predict metastasis, even  with  adequate  treatment  of  the  primary lesion. There is no standard protocol to prevent or detect metastatic ameloblastoma, but regular and close follow up may ensure early diagnosis.</p>

Guide flange prosthesis for early management of reconstructed hemimandibulectomy: a case report

Surgical resection of the mandible due to presence of benign or malignant tumor is the most common cause of the mandibular deviation. Depending upon the location and extent of the tumor in the mandible, various surgical treatment modalities like marginal, segmental, hemi, subtotal, or total mandibulectomy can be performed. The clinicians must wait for extensive period of time for completion of healing and acceptance of the osseous graft before considering the definitive prosthesis. During this initial healing period prosthodontic intervention is required for preventing the mandibular deviation. This case report describes early prosthodontic management of a patient who has undergone a reconstructed hemi-mandibulectomy with modified mandibular guide flange prosthesis. The prosthesis helps patient moving the mandible normally without deviation during functions like speech and mastication.