[Problems in secondary mandibular reconstruction].
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Surgical or traumatic losses of substances should preferably be made good by autografts, though "alloplastic implants" are a sound alternative. An account is given of the chemical and physical properties of intrinsic and manmade synthetic polymers. The best polymers for the preparation of endoprostheses are indicated, and reference is made to their more common indications in maxillofacial reconstructive surgery.
The use of a modified Kirschner wire splint is described and our experience with this procedure in 25 patients is reviewed. The splint is intended to be a temporary method of maintaining bone fragments in the correct position while intraoral seal is established. After sufficient healing has occurred, a final reconstruction is done by bone grafting.
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The patient must be made to understand that a normal joint cannot be constructed by any surgical procedure and his part in the rehabilitation programme must be specifically stressed and assurance must be obtained from him that he is willing to carry out instructions during the postoperative treatment. The surgeon must be self disciplined enough to demand the best of himself in any situation and never to be satisfied with less. The surgeon must be generally optimistic, but his knowledge of the local anatomy and the surgical pathology must constantly remind him of his limitations. He must know that we cannot construct a normal joint and we must not promise one.
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The author reports of 215 patients with oral malignant tumour of whom 21.5% needed preprosthetic-surgical measures. The indication for preprosthetic-surgical intervention is determined by the site and the size of the tumour and by the method used for the primary operation. Some preferred surgical techniques are discussed.