Surgical options for rehabilitation of mandible after oral cancer - Dr. Surindher D S A скачать в хорошем качестве

Surgical options for rehabilitation of mandible after oral cancer - Dr. Surindher D S A

Cancer of the oral cavity is becoming common because of severe smoking, pan chewing, tobacco chewing and pouches that you keep in the mouth. Apart from that they can be benign because of the cyst in the mandible called as the adamantinoma which might also cause a cyst in the jaw bone because of which the jaw has to be removed. Usually the part of the jaw is removed in oral cancers. Sometimes it come in such late stages that only removing the skin part is not required, it is already involving the tooth, bone and the other structures. So you have to do a composite resection. Here the skin outside, the muscles, the nerves, the glands, the mandible, the teeth and the mucosa have to be removed and that is called as the composite resection. Here there is a large defect through and through which goes in from the skin to the inside of the oral cavity. Sometimes if the tongue is involved you might want to remove the tongue also. So what are the options when you do that? Usually when there is a composite resection planned for the cancer the plastic surgeons are involved right from the time of planning. So we plan to reconstruct during the same procedure. It is not like in olden days where you just cut and put some skin to cover it and do the deformity correction later on. It is a long surgery. The resection may take to about three to four hours and reconstruction simultaneously starts and that takes around another 6 to 7 hours. The option for mandible reconstruction re quite varied but the most popular option nowadays is the fibula reconstruction by microvascular anastamosis. In the leg you have two bones the tibia and the fibula. The tibia is the smaller bone which is the supporting bone. So that bone has its own blood supply. That bone is taken as a whole segment along with a little bit of muscle and skin and that whole thing is supplied by one vascular unit which is basically the artery and the vein. Because it is a non weight bearing bone it doesn’t cause any harm to your normal activities. So that bone is harvested and the fibula is along tubular bone we break it and shape it into the shape of the mandible depending on which segment is removed by CT reconstruction we find out what is the size is and then we already create a template and keep and once the bone is removed, we break it and fix it to give you the shape of the mandible and once that is done it is fixed to the remaining part of the mandible and the blood vessel that is supplying the whole segment is again anastamosed and joined to one of the blood vessels in the neck. So what this does is it gives you live viable bone basically which is surviving because of the direct blood supply which is coming and the healing is faster and there are multiple layers like you have the skin, the muscle and the inside lining. So you can do a composite reconstruction. Because it ahs its own blood supply the healing and the integration is much better and the final and the most important part is that because it is the live bone we can implant teeth into it. Once the first 6 months are done and the fibula has settled in well, the blood supply is established well then you have these screws with those implants which can be directly implanted to the mandible, the new fibula bone. Because it is vascular bone it will not fall off. It holds the screws well and so you can do a reconstruction for the teeth as well. So there is a whole composite reconstruction that is possible and that is done most commonly by using the free fibula. It is called the free fibula mandible reconstruction and it is done with microvascular anastamoses.