Intraoperative temporary fixation for primary reconstruction of composite mandibular ablative defects

Abstract

a ( t t t t s p w r m enables minimal periosteal (or muscular) stripping to reduce disturbance to the vascular supply of the bony segments in ne of the challenges of the primary reconstruction of comosite mandibular defects caused by oncological ablative urgery is to maintain a functional occlusal relation of the ony segments. During operation, established techniques for andibular fixation include use of a bridging plate that is ent intraoperatively before the jaw is resected1 (not possile when there is extensive buccal extension of tumor into the acial soft tissue), temporary fixation with an external fixator evice,2 and use of a pre-contoured plate based on a threeimensional stereolithographic model.3 Temporary fixation f the condylar segment to the maxilla with a miniplate, and ntermaxillary fixation of the distal dentate segment is another ption. We describe a technique that uses a long (40-hole) iniplate for temporary intraoperative mandibular fixation. he resection margins are initially outlined in the soft and ard tissue with a cutting diathermy and reciprocating saw. he miniplate is then bent into the shape of a bucket handle nd fixed with 2–3 screws on both sides of the bony resection argins (Fig. 1) and a marker suture is placed to allow rientation of the plate after it is removed (Fig. 2). Removal llows free access to the tumor for three-dimensional maniplation and resection. Following segmental mandibulectomy, he pre-bent plate is reapplied to the remaining mandibular egments using the pre-located screw holes. The harvested omposite free flap is then fashioned to reconstruct the defect