I had the lower right mandible removed and replaced with titanium back in 2007 due to a malignant tumor that originated in my parotid gland. What are some ways that could be used to reconstruct this. I have heard of some type of mesh cage that would grow jawbone back to a more natural shape. What are the choices?
Doctor Answers 3
Mandibular ("Jaw") Reconstruction after Malignancy
Hello, currently you have what appears to be a titanium mandibular reconstruction plate in place providing support for your mandible. If this is the case, although these implants can used for reconstruction after mandibulectomy, they are not always the most optimal. Osteocutaneous free flaps, most notably the fibular osteocutaneous free flap, has revolutionized mandibular reconstruction after cancer removal. They can provide satisfactory reconstruction even in the most non-favorable sites which have been subject to irradiation, poor blood flow, and salivary contamination as seen in mandibular carcinoma defects. I would suggest visiting an institution that takes a team approach to your problem. Such institutions combine the specialties of Otolaryngology/Head & Neck Surgery, Plastic & Reconstructive Surgery, Oncology, and Oromaxillofacial surgery to provide multi-specialty care of cancer and reconstructive dilemmas. I would suggest such institutions as MD Anderson or Memorial Sloan Kettering Cancer Center. Good Luck...Dr. Corrado
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Options for Jaw Defects of Different Sizes and location
Dear klak44252, The titanium plate can be an effective short term option for holding your remaining jaw in position, along with your occlusion (the way your teeth fit together).
One option that you havent mentioned is the use of a free tissue transfer (flap ) from another area of your body (leg, arm, hip, shoulder). This microvascular free flaps provide an excellent option in some patients for mandible (jaw) reconstruction. You may find it useful to discuss this with a facial plastic surgeon, head and neck oncologic recontructive surgeon or plastic surgeon. In Fort Worth, Dr. Jesse Smith would be an excellent option.
Jaw Reconstruction with 3-D Mesh Plate and Bone Graft Reconstruction
Jaw or mandible reconstruction can be done numerous ways depending upon the size of the bone defect and whether one has had radiation or not. Since you appear to have an indwelling titanium plate, this would indicate that it spans the bone defect meaning there is a proximal and distal mandibular segment. A custom designed titanium mesh cage and plate can be made off of a 3-D model fabricated from a CT scan. This is secured onto the proximal and distal mandibular bone ends with the mesh cage spanning the gap. This is is then filled with a bone graft from the marrow in your hip. This can be an excellent method for mandibular reconstruction provided you have no had radiation and there has been no tissue removed from your prior cancer surgery from either inside your mouth or from the skin on the outside. This method will grow a new piece of jaw bone.
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