A 30 year old man from Bangladesh reported to us seeking reconstruction of left side of his lower jaw. Intraorally, a bone graft was exposed and huge infection with pus discharge adjacent to the exposed region was noticed. He gave a history of dentigerous cyst in the left side of the lower jaw, the affected portion of the lower jaw along with the involved teeth were removed elsewhere and the jaw was reconstructed with fibular and iliac bone graft with bone plate thrice, 2 years back. He was frustrated due to repeated surgeries, that too which had subsequently failed.
Difficulties faced – in patient’s words
- Not feeling proper bonding of the bone graft internally at the operated site. Sound of friction type when moving lower jaw
- Shift of lower jaw to the left during mouth-opening
- Left side of lower lip is numb
- Have been chewing food only on right side for last 8-9 years, cannot chew on the left side (sometimes feels pain in right side lower jaw)
- Concerned about the functionality of the upper left teeth & gums
Maxillofacial Surgeon Dr. S. M. Balaji planned to remove the failed infected bone graft done elsewhere and to reconstruct the lower jaw in a single surgery. He approached the surgical site intraorally and removed the dislodged bone graft and sequestrum completely. Adjacent infected bone was removed with bone curette. A rib graft was taken and fixed to the lower jaw left side to reconstruct the defect. rhBMP-2 was placed to increase the efficiency of new bone formation. Mucosal flaps were approximated in layers. The patient is very happy to have entire surgery done in single stage without any scar on the face. The functionality of the lower jaw was also regained efficiently.
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