Thursday, March 30, 2023
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Mandibular Plating


The reconstruction of oromandibular defects (mandibular reconstruction) following surgical extirpation of oral cavity carcinoma presents a significant surgical challenge. Mandibular deformities and defects may result from trauma, infections, prior radiation exposure, neoplasms, and congenital defects; most mandibular deformities result from ablative surgery for neoplasms. Approximately 24,000 patients have new cancers of the oral cavity each year.
The resultant changes in normal oromandibular anatomy are often functionally disabling and socially isolating. Once complete resection of the primary and regional metastases has been undertaken, subsequent functional recovery and aesthetics are extremely important when reconstruction is considered.

Within the last 30 years, many advances in head and neck surgical techniques, plate technology, and microvascular surgery have improved the functional restoration in this patient population. However, the expansion in knowledge and the development of techniques have left surgeons with a large number of reconstructive options, few of which are supported by findings from prospective randomized trials.
The purpose of this article is to assist surgeons with the selection of reconstructive techniques and patients to achieve the best possible outcome.

The rationale for reconstruction

Rehabilitation and reconstruction of the oral cavity following the resection of pathologic processes remains a complex challenge. The mandible assists in verbalization, oral competence, mastication, deglutination, and airway support, yet it is also a major aesthetic highlight of the face. With oromandibular pathology, a loss of not only bony support but also neighboring soft tissues, muscles, and nerves is frequently present. Thus, large complex defects can be created during resection. Functional and aesthetic outcomes become less favorable as the extent of resection increases.
Without reconstruction, patients may have functional and cosmetic impairments.

The reconstructive surgeon attempts to redefine the preoperative functions and facial aesthetic units to allow the patient to return to a normal family and social life. The approach includes the placement of dentures or osseointegrated implants to help shape the face and to assist with mastication and verbalization.
Other important factors for rehabilitation are intact motor and sensory functions of the tongue. Loss of these functions, independent of any mandibular continuity defect, can vastly hinder oral function and competence, and many patients receive little benefit in deglutination with aggressive mandibular reconstruction.
Therefore, attention must be given to total reconstruction and postoperative rehabilitation if the patient is to derive maximum benefit.

See the image below.

Preoperative view of patient with floor of mouth s

Preoperative view of patient with floor of mouth squamous cell carcinoma invading the mandible.

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