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Special Topics |

Reconstruction of the Mandible and the Maxilla The Evolution of Surgical Technique

Eric M. Genden, MD
Arch Facial Plast Surg. 2010;12(2):87-90. doi:10.1001/archfacial.2010.18.
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ABSTRACT

The upper and lower jaws play an essential role in mastication, articulation, and cosmetic form. The mandible provides support for tongue position and elevation of the larynx during swallowing, while the maxilla provides support for the nasal structures as well as an opposing structure to the mandible during mastication. The evolution of mandibular and maxillary reconstruction dates back to the early 19th century. Before the introduction of free tissue transfer, a variety of local flaps, regional flaps, and prosthetics were introduced, yet each was met with eventual failure. Since the introduction of free tissue transfer, mandibular and maxillary reconstruction has become as much of an art as it has a science. Whether the mandibular or the palatomaxillary defects are a result of trauma, congenital deformity, or tumor extirpation, the resultant effect often disrupts both form and function. With these considerations taken together, jaw reconstruction is a unique undertaking in which the artistic reconstruction of the facial skeleton is met with the science of reestablishing the mechanics of mastication. The site, size, and associated soft-tissue defects represent the 3 most important factors in determining the impact of a given defect on function and aesthetics. There is also an inherent difference between defects that are sustained in a controlled fashion, such as during cancer ablation, and those that result from trauma. The consideration of these complexities in jaw reconstruction is reflected in the wide variety of approaches and techniques that have evolved over the past century.

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Figure 1.

Preoperative (A) and postoperative (B) photographs of a patient who presented with a hemimandibulectomy defect. A, The patient developed a severe cross bite deformity that resulted in chronic pain and restriction to a puree diet. B, The patient underwent dental rehabilitation after surgery and now tolerates a regular diet.

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Figure 2.

Mandible reconstruction with primary placement of osseointegrated implants.

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Figure 3.

These drawings demonstrate the contouring of a scapular free flap for reconstruction of a complete hemimaxillectomy defect. The teres muscle is used to reline the palatal mucosal defect.

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Figure 4.

Reconstruction of the upper jaw with osseointegrated implants provides the optimal cosmetic and functional outcome. A, This photograph illustrates the placement of osseointegrated implants into a fibular bone reconstruction of an infrastructure maxillectomy defect. B, The position and contour of the bone is demonstrated by this 3-dimensional reconstruction of the bony reconstruction. C, This photograph demonstrates an implant-borne denture in place after dental rehabilitation.

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