Postradiotherapy Prosthetic Management of Mandible Reconstructed With Fibular Graft.

Intraoral defects secondary to resection of mandible leading to mandibular discontinuity are very complicated to treat as the muscles exert forces on the residual portion of the mandible. Primarily this leads to disfigurement of the face. These forces also make mastication difficult due to imbalance. Ultimately it leads to poor quality of life for the patient. Apart from that the clinical outcome and prognosis of prosthetic rehabilitation of such patients is very poor. The composite fibular flap is the preferred donor site for reconstruction of most complex orofacial-mandibular defects. The addition of a skin island allows for absolute tension-free intraoral closure that enhances tongue mobility. After reconstruction with free fibula graft, planning for prosthodontic rehabilitation by various methods can be carried out. Treatment strategy is dependent on the intraoral situation and patient's acceptance. This article reports various treatment considerations for implant retained prosthetic rehabilitation in a patient who had undergone mandibular reconstruction with free fibula flap.

Facial trauma: a recurrent disease? The potential role of disease prevention.

PURPOSE: The objectives of this investigation were to determine a profile of facial trauma patients presenting to the emergency department of University Hospital, University of Medicine and Dentistry of New Jersey, Newark, NJ, and to assess patient interest in violence or stress reduction programs. MATERIALS AND METHODS: A prospective study of the patients was conducted with the aid of a data collection form generated specifically for the purpose of this study. Data regarding patient age, race, gender, various aspects of social history, mechanism, and nature of injury were collected over a period of 1 year. In addition, all patients were asked to respond to 4 health promotion questions. All patients for whom the oral maxillofacial surgery service was consulted were included in the study. Descriptive statistical analysis of the data was used. RESULTS: A total of 92 patients were enrolled, of whom 80% were males. The mean age of patients enrolled was 30.5 years with the peak incidence of injury occurring in the 20- to 30-year-old age group (n = 30). The most frequent etiology was assault (75%), followed by motor vehicle accidents (18.5%). The most frequently occurring injury was mandible fracture (46.7%), followed by lacerations (42.4%). Within the study sample, 42.4% had previous injuries. Patients with facial injuries were 1.5 times more likely to have experienced previous interpersonal violence. This patient group also expressed an overwhelming willingness to change their behavior patterns (91.3%). CONCLUSIONS: The findings of this investigation indicated that most facial trauma patients are between the ages of 20 and 30 years and male. Assault is the most common etiologic agent resulting in facial trauma. Mandible fractures and lacerations are the most likely injuries in the facial trauma patient. Patients experiencing recurrent trauma due to assault are more responsive to violence reduction programs than those experiencing only 1 assault.

Rehabilitation of a patient with severe dentoalveolar injuries: a case report with a 10-year follow-up.

This clinical report describes the emotional and physical rehabilitation of a young man. The impact of the injuries sustained and repeated failure of traditional dental treatment methods had caused the patient to become quite withdrawn. A successful outcome followed surgical placement of multiple titanium plasma-sprayed cylindrical fixtures in severely damaged dental supporting tissues to serve as intermediary abutments for complex maxillary and mandibular fixed prostheses. The loss of crestal bone during the postprosthetic years is determined. The advantages only implant dentistry could bring are identified.