A man in 5th decade of life complained of a huge odontogenic tumor, diagnosed as Adenomatoid Odontogenic Tumor sought removal of the lesion. His concern was post-operative defect and preferred not to have a scar in his face. The size of the tumor can be appreciated in the CT scan while OPG would show the shifting of the teeth due to tumor. 

The treatment plan was to remove the entire tumor with adequate marginal clearance through his mouth thereby avoiding unsightly scar. A gingival crevicular incision was placed along the entire length of the tumor exposing the entire tumor. 
An appropriate plane of cleavage was identified and the tumor was completely isolated by blunt incision. To facilitate and minimize post-operative defect,preservation of mucosa was desired. This would also prevent formation of fistulas and also help in proper feeding and speech. 

The tumor was slowly mobilized in segments and the tumor was removed as a full mass. The margins were trimmed and the sinus lining was cleaned. The sharp bony margins were trimmed.
The defect was stuffed with cotton gauze dipped in Betadine. One free end of the gauze was retrieved through the nares, so that it could be removed three days latter. The mucosa was closed in layers. The gauze ensured prevention/ accumulation of blood as also reduced the chance of hematoma. Three days after, the gauze was removed. 

The correction of the defect could be appreciated in the post operative image.

A 60 year old male sought reconstruction of his mandible. Three years earlier, he had been operated on for squamous cell carcinoma. He lost a large part of his mandible, floor of mouth and adjacent tissues. He lost a substantial amount of oral tissues. Hence a rotated deltoid, myocutaneous petrolis Major flap was used to close the defect after tunneling the flap. 
Before the surgery presence of resiudal tumor was ruled out by PET scan and other investigations. 

As the scar tissue was compressing the entire area, there was no space. hence the first goal was to create a sufficient space. For creation of this space, a custom made distractor was fabricated. This was used to perform distraction histogeneisis. This resulted in formation of new tissues in the center. After adequate space by formation of new tissues, a bilateral transport distraction was planned. 

After careful dissection, the cut end of the mandible were identified. Old rigid fixation plates were removed. A section was cut from the buccal cortex while preserving lingual cortex. After adequate split, the custom fashioned long plate was adapted to his mandible. This titanium plate was fixed to the mandible. After ensuring fixation at both ends, in the split portion of mandible, the distractors were screwed with small screws. The opening and closing of the distractors were checked.At the end, the lingual splits were partially completed.  

After 5 days, the distractors were activated resulting in formation of new bone at the split ends at a rate of 1 mm per day. The partial lingual split ensured adequate blood supply to the newly forming bone.