Abstract
Maxillomandibular ablation and reconstruction includes a series of procedures that can be disfiguring and emotionally traumatic for a patient while treating maxillofacial disease. Often times, the process of regaining full form and function may take months to years for a patient. With the advent of modern day technology and virtual surgical planning, some patients may benefit from a single operation that includes disease ablation, microvascular reconstruction, and immediate dental rehabilitation, also known as “Jaw in a Day”.
Highlights
Maxillomandibular ablation and reconstruction include a series of intensive procedures aimed at removing lesions of either the maxilla or mandible and reconstructing the jaws to appropriate form and function
A combination of sharp and blunt dissection should be used with diligent nerve monitoring to preserve the branches of the seventh cranial nerve
The prosthodontist selects and places appropriate intermediary abutment (IA) onto the dental implants (DIs) which come in various heights and angle degrees to correct for skew and create a path of draw for the provisional dental prosthesis
Summary
Maxillomandibular ablation and reconstruction include a series of intensive procedures aimed at removing lesions of either the maxilla or mandible and reconstructing the jaws to appropriate form and function. Once the DIs have been placed, the fibula osteotomies are completed to create the necessary fibular segments that are affixed to the custom reconstruction plate to orient the flap into the shape of the reconstructed jaw At this time, the prosthodontist selects and places appropriate IAs onto the DIs which come in various heights and angle degrees (as described earlier) to correct for skew and create a path of draw for the provisional dental prosthesis. We planned for segmental mandibulectomy, tooth extractions, right inferior alveolar nerve lateralization, left osteocutaneous free fibular flap reconstruction, reconstruction of the mandibular defect with a custom plate, DI placement, provisional dental prosthesis delivery, and immediate loading of DIs. Further workup included a computed tomography (CT) maxillofacial with 0.5 mm slicing per surgical planning company (Medical Modeling Inc., Golden, Colorado) and customized medical device company (Stryker Corporation, Kalamazoo, MI) guidelines [Figure 6]. He has been seen for continual follow up, through 2021 and is currently undergoing post-surgical modifications in preparation for his definitive prosthesis [Figure 9]
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