[Reconstruction of mandible with silastics after tumor resection].
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In radical operations of tumors in the cavum oris and oropharynx partial mandibulectomy is sometimes necessary. With inter-maxillary ligatures using the fixation aids described (splints, prostheses and rubber rings) it is possible to achieve sufficient immobilization to permit the wound to heal, training of the mouth-opening muscles and a long-term treatment to prevent the scar from shrinking. Examples of the good functional and cosmetic results are presented with photos.
A case of "cryptogenetic osteolysis of the mandible" is reported. This is a rare affection as only 13 cases of "phantom mandible" are known, but other sites exist (91 cases of phantom bone are known). The diagnosis is suspected after radiography, and confirmed by anatomopathological examination. No treatment for this affection has been described.
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The symphyseal region of the mandible is the commonest site of location of ameloblastoma in Nigerian patients. The hazards of resection of the lesion together with the aesthetic defects and problems of reconstruction are discussed in light of the authors' experience.
An overview of the field of maxillofacial prosthetics has been presented. Current advances in the field have been discussed in brief. Soliciting the expertise of the prosthodontist preoperatively can greatly augment the total therapy of the head and neck cancer patient.
Surgical stents have improved and simplified our ability to predictably restore maxillomandibular relationships after composite oromandibular resections. Bimaxillary relationships are optimized, the aesthetic result is enhanced, and successful dental rehabilitation follows.
The use of an autogenous cancellous bone and marrow graft for subtotal reconstruction of the mandible is illustrated with a case report. The rationale of the treatment plan and the operative technique are discussed. Three years of postreconstruction follow-up examinations show good results with this technique.
A series of 14 mandibular reconstruction in 13 patients with chips of autogenous, cancellous bone and marrow supported by a titanium mesh tray is presented. The mandibular defects were the results either of operation for carcinoma of the tongue and the floor of the mouth or trauma. Satisfactory rehabilitation was accomplished in 11 patients. The advantages of this technique are ease of accomplishment, ability to replace long and awkardly shaped segments, less shrinkage due to bone resorption, and shorter intermaxillary fixation.
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The work is planned in three parts. The first reviews the various modification of the surface-treatment procedures for medical implants. A separate section deals with procedures involving the application of material or the removal of material, and those is which material is not applied or removed. Special consideration is paid to the surface-treatment procedures for facial or mandibular implants, and techniques involving calcium phosphate and hydroxylapatite coatings.
It has been demonstrated previously that many individuals requesting chin enlargement have small or retruded mandibles. A weak chin may be only one aspect of this particular class II skeletal deformity, the other components being a procumbent, retrusive lower lip, excessive labiomental fold depth, and decreased to normal lower face height. To avoid unaesthetic results, the chin should not be advanced beyond the retrusive lower lip, the only component over which osseous genioplasty has no control. This may result in residual sagittal "weakness" of the lower face, for which visual compensation can be achieved by vertical overelongation of the chin. Thirty-two patients requesting chin enlargement presented with the aforementioned class II deformity. Twenty patients had decreased lower face height and 12 patients had normal lower face height. Preoperative soft-tissue cephalometric analysis documented physical findings. The extent of sagittal chin movement was planned to advance the soft-tissue pogonion no further than the lower lip. Vertical chin movement was intentionally designed to overelongate the lower face relative to the midface in all patients. Radiographs were repeated at a mean 8.2 months following surgery to document skeletal displacements. Mean chin advancement was a modest 4.2 mm (2- to 7-mm range), and chin vertical displacement was a mean 7.9 mm (5.5- to 9-mm range). All patients had residual sagittal disproportion of the pogonion relative to the subnasale (-7.6 mm mean) and newly created vertical disproportion with mean lower face heights of 69.8 mm compared with mean midface heights of 64 mm.(ABSTRACT TRUNCATED AT 250 WORDS)
This is the first of two articles concerning the surgical and prosthodontic rehabilitation of patients who have undergone surgery for cancer of the mouth. This article discusses the morbidity associated with treatment and its effect on quality of life. The second article will consider aspects of the prosthodontic rehabilitation particularly with regard to obturator construction following maxillectomy.
Bony reconstruction of the mandible and maxilla is accomplished through the application of three general approaches: cancellous marrow grafts, cranial bone grafts, and microvascular transfers. This article discusses each of these techniques in detail.