Avulsion of the mandibular body and its reconstruction: Report of a case

Abstract

This case involved avulsion of the mandibular body with extensive lacerations of the lower third of the face and bilateral fractures of the mandible. The soft tissues of the left cheek, the lower lip, part of the oral floor, and the mandibular body with its teeth formed a complex that was attached only to the right cheek by a cyanotic pedicle 4 cm. wide. The blood supply of the detached complex was poor. The inferior alveolar arteries and veins (and nerves) were avulsed bilaterally and could not be restored. All collaterals from the left cheek and the floor of the mouth, both intraand extraorally, were severed. Only the blood supply from the right check was intact. Repositioning and immobilization of the body of the mandible and plastic closure of all soft tissue wounds was, of course, possible, but there was a question of whether the collateral blood supply would develop fast enough and would be effective enough to prevent massive bone and soft-tissue necrosis. Fortunately, the only necrotic area which developed was in the skin of the mental region; this was followed later by a mild osteomyelitis around the fracture lines, which could be dealt with effectively. The final outcome was functionally and cosmetically satisfactory.