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.
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.
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