Secondary reconstruction of the mandible: technic of intraoral immobilization
Shattuck W. Hartwell, M.D.
Department of Plastic Surgery
Burton P. Siegel, D.D.S.
Dental Consultant, Cleveland, Ohio
COMMON structural disorders of the mandible are partial loss, malunion, and nonunion after operations or fractures (Fig. 1). Impaired function and appearance require reconstruction. This is a discussion, with examples, of mandibular intraoral immobilization that is essential to a successful reconstruction.
The goals in surgical repair of the mandible are twofold: adequate function and acceptable appearance. The principal objective in the secondary reconstruction of the lower jaw is that the patient be able to chew food without discomfort. This means that there must ultimately be adequate motion of the temporomandibular joints, and a rigid mandibular arch to hold existing or prosthetic dentition in a controlled relationship with the upper dental arch. Improved appearance may also be an aim of the reconstruction in patients with segmental mandibular defects or with malunion after fracture. Goals must be reasonable, and the patients must be fully informed of what is possible and of the probable outcome of surgical treatment. The reconstruction of the lower jaw can only be achieved within the limitations of available soft tissue, blood supply, and potential joint motion.
Preoperative planning. It is necessary to plan preoperatively the form and position of the reconstructed lower jaw. Dental impressions are made of the upper and lower arches, and from these impressions study models are constructed and mounted on an articulator (Fig. 2). The lower arch of the study model is shifted into a desirable relationship with the upper jaw. Cutting the mandibular model permits repositioning, and the need for either . . .