Medicaltalks about 7 years ago

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Jaw cancer

Jaw cancer reconstruction with an outstanding result!! Post-op photos will follow if the demand is shown. This is a unique case of a resected squamous cell carcinoma that has invaded invaded through the mandible and skin. The picture shows a missing potion of the mandible following a segmental mandibulectomy and reconstruction using a stainless steel titanium plate with 4 screws on either side of the mandibulectomy! Mandibulectomy is a procedure that is used to eradicate disease that involves the lower jaw or mandible. This procedure is used in various settings, including infectious etiologies (eg, osteomyelitis), osteoradionecrosis, or a benign (eg, ameloblastoma) or malignant neoplastic process (eg, invasive squamous cell carcinoma) that involves the jaw. Segmental mandibulectomy is indicated for the resection of tumors with gross bone invasion. The cancellous bone of the mandible offers no barrier to the progression of squamous cancer through the bone. A full-thickness segmental mandibulectomy will result in a through-and-through bony defect of the jaw. As a result, the discontinuity of the mandible presents significant problems with occlusion, mastication, the position of the chin, oral competency, and pain. For these reasons, reconstruction of the jaw after segmental mandibulectomy is preferred. The most common and effective mandibular reconstruction is with free-tissue transfer, such as a fibular or scapular free flap. Reconstruction plates without bone grafts will invariably extrude if they span the anterior arch, but they may work well for small, lateral defects if they are covered by regional or free flaps. Free bone grafts of rib or iliac crest may suffice for some small, lateral defects when there is excellent soft tissue and no radiation, but they are much less reliable than free-tissue transfer.