Prosthetic Replacement of the Hemisected Mandible

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RECONSTRUCTION of one half of the mandible including its condyle is a formidable surgical problem. Ideally it should be possible to graft a piece of bone that will unite with the remaining bone segment at one end, and form an articulating condyle at the other. Unfortunately, the graft does not behave in this ideal fashion, and for practical purposes is unsatisfactory. Because of this difficulty, many surgeons believe that the mandibular fragment is better left unsupported after hemisection. They consider the inevitable collapse of the pharynx neither disabling nor dangerous if a tracheostomy is maintained for a sufficiently long period, and they argue that the secondary deformity associated with abnormal mobility of the jaw fragment is inconsequential.

Despite these arguments, there is no question that pharyngeal collapse, even if it does not increase the chance of mortality, is most unpleasant to the patient, particularly if it is prolonged. Furthermore, while a majority of patients will tolerate a jaw segment that, when chewed with, wanders across much of the lower half of the face, they are most grateful if reasonably normal function can be established. For these reasons, the remaining portion of mandible should be supported in its normal position at the time of resection, if such support is possible.

Probably every surgeon who has removed a number of jaws has attempted such reconstruction. Because of a long history of bone-graft failures, most of these attempts have been carried out with prosthetic devices of inert metal or plastic, shaped to resemble. . .



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