Understanding Jaw Reconstruction Needs
The jawbone (mandible) plays a critical role in facial appearance, speech, and the ability to eat and swallow. When cancer affects the jaw, significant portions may need to be removed, leading to both functional and aesthetic challenges. Common conditions requiring jaw reconstruction include:
- Oral cavity cancers involving the jawbone
- Primary bone tumors of the mandible
- Osteoradionecrosis (bone damage from radiation therapy)
- Extensive trauma or injury to the jaw
- Congenital deformities affecting jaw development
The goals of jaw reconstruction are to:
- Restore facial contour and symmetry
- Reestablish proper occlusion (bite alignment)
- Maintain or restore the ability to speak clearly
- Enable adequate chewing and swallowing function
- Provide a foundation for dental rehabilitation
- Optimize aesthetic outcomes
At Premier Head and Neck Surgery, we specialize in advanced jaw reconstruction techniques that address both functional and aesthetic concerns.
Microvascular Free Flap Reconstruction
Microvascular free flap reconstruction represents the gold standard for jaw reconstruction after cancer surgery. This advanced technique involves:
- Harvesting bone, soft tissue, or both from a distant part of the body (donor site)
- Completely detaching this tissue with its blood vessels
- Transferring it to the jaw defect
- Reconnecting the blood vessels using microsurgical techniques to establish blood flow
- Shaping and securing the tissue to reconstruct the jaw
The most common free flaps used for jaw reconstruction include:
Fibula Free Flap
- Harvested from the lower leg (fibula bone)
- Provides up to 25 cm of bone for reconstruction
- Includes skin and soft tissue when needed
- Minimal functional deficit at the donor site
- Excellent for dental implant placement
- Ideal for larger jaw defects
Scapular Free Flap
- Harvested from the shoulder blade region
- Provides bone and substantial soft tissue
- Allows for complex three-dimensional reconstruction
- Particularly useful for defects requiring significant soft tissue
- Donor site well-concealed under clothing
Iliac Crest Free Flap
- Harvested from the hip bone
- Provides dense bone with natural contour similar to the jaw
- Good height for dental implants
- Limited in length compared to fibula
- Useful for smaller anterior jaw defects
Radial Forearm Free Flap
- Primarily used for soft tissue reconstruction
- May include a portion of radius bone for small defects
- Thin, pliable tissue ideal for lining the mouth
- Often combined with reconstruction plates for structural support
Computer-Assisted Planning and 3D Technology
At Premier Head and Neck Surgery, we employ advanced technology to optimize jaw reconstruction outcomes:
Virtual Surgical Planning
- Preoperative CT scans converted to 3D models
- Computer simulation of tumor resection and reconstruction
- Precise planning of bone cuts and shaping
- Optimization of dental occlusion and facial symmetry
3D-Printed Cutting Guides
- Custom guides created based on virtual planning
- Ensures precise tumor resection margins
- Guides bone harvesting from donor site
- Facilitates accurate bone shaping to match the defect
Custom Titanium Plates
- Precontoured to the planned reconstruction
- Provides stable fixation of the reconstructed jaw
- Optimizes final jaw position and dental alignment
3D-Printed Models
- Physical models of the patient’s anatomy
- Allows for preoperative plate bending and rehearsal
- Reduces operating time and improves precision
These technologies have revolutionized jaw reconstruction, allowing for more precise outcomes, shorter operating times, and improved functional and aesthetic results.
Dental Rehabilitation After Jaw Reconstruction
Restoring the ability to chew and speak effectively often requires dental rehabilitation after jaw reconstruction. At Premier Head and Neck Surgery, we work closely with specialized prosthodontists and oral surgeons to provide comprehensive dental rehabilitation:
Dental Implants
- Titanium posts surgically placed in the reconstructed jawbone
- Provide a foundation for prosthetic teeth
- Can be placed during jaw reconstruction or as a secondary procedure
- Allow for fixed (non-removable) dental restoration
- Significantly improve chewing function and aesthetics
Implant-Supported Prostheses
- Fixed bridges attached to dental implants
- Provide stable, functional dentition
- Closely resemble natural teeth in appearance and function
- Improve speech clarity and chewing ability
Removable Prostheses
- May be used as an interim solution or in cases where implants aren’t feasible
- Can be designed to attach to remaining natural teeth or implants
- Less stable than fixed options but still improve function
The timing and approach to dental rehabilitation are carefully coordinated with the overall reconstruction plan, ensuring optimal functional and aesthetic outcomes.