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A variety of metallic objects may be seen on x-ray films of the head, facial structures, neck or chest. Among them are subperiosteal and endosseous implants, used to replace missing or damaged portions of the maxilla or mandible and to anchor dental prostheses. Wires, condylar head and neck replacements, surgical clips and silver amalgam may also be seen.
Failure of a preformed Silastic chin implant nearly four years after insertion is reported. It is the obligation of all clinicians to report failures as well as successes to provide data for comprehensive evaluation of various techniques and materials.
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In a difficult case of bilateral loss of substance of the body of the mandible, with aplasia of the residual tissue, in an elderly psychotic patient, reconstruction was obtained simply by the insertion of two rib grafts each fixed by a single Kirschner's wire (removed four months later).
The various advantages rendered by the system described enable primary as well as long-term functional stability even in cases in which conventional systems would be insufficient. The evaluation of 49 cases managed in Bern and Sweden confirm the efficiency of this reconstruction system.
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While composite resection remains the fundamental surgical approach to carcinoma of the posterior oral cavity, removal or reconstruction of the adjacent segment of mandible remains contentious. Various grafts have been used with less than satisfactory and unpredictable results. Bone has been brought in, borrowed, reshaped, and implanted into the area of mandibular deficit; mandibular osteotomy has been attempted with primary closure as well. A review of 78 composite resections at Upstate Medical Center reveals that of this number, 61 have undergone primary lateral mandibulectomy without reconstruction while four others have undergone more extended resection without reconstruction at the time of initial surgery. In the others, mandibular reconstruction has been unsatisfactory; mandibular osteotomy in the presence of irradiated tissue has been unsuccessful in all cases. In our experience, satisfactory results, functionally and cosmetically, have been attained with partial mandibulectomy and primary closure of the wound obviating more involved reconstructive procedures. A review of therapy with attention to surgical detail, complications, and results is presented.
Sufficient information concerning the difficulties encountered in reconstructive surgery is rarely provided in the literature. This study, which was performed on 32 patients, points out a high rate of complication; major and minor complications were encountered in 68.8% of the patients. Benign and traumatic lesions caused the fewest problems. Malignant lesions, particularly those receiving radiotherapy, had the greatest incidence of complications. Successful reconstruction was accomplished in 75% of the cases. The use of a corticocancellous autogenous graft is suggested in selected cases of malignant disease.
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