INTRODUCTION
Mandibular reconstruction after trauma or pathology is one of the
cornerstones of oral and maxillofacial surgery1.This
reconstruction is needed in cases with a large amount of bone loss,
comminuted fractures, severe traumas and infections leading to multiple
bone sequestrations2.
In the case of infections of the bone, different risk factors may
enhance the speed in which the bone is lost, such as age, sex, poor oral
hygiene, comorbidities (diabetes, hyperlipemia, autoimmune diseases) and
drug abuse (cocaine, cannabinoid, tobacco smoking, hepatic cirrhosis due
alcoholism)3, 4, 5, 6, 7-8.
The four basic principles of successful reconstruction are: (1)
establish an ideal orthognathic relationship; (2) a flush bone to
graft/flap contact; (3) stable bony fixation; and (4) adequate,
well-vascularized soft tissue coverage1.
To achieve the previously established principles, the maxillofacial
literature describes different surgical treatment plans. One temporary
option is the use of external fixation of the mandible. It is considered
a closed reduction type and provides semi-rigid fixation for fractured
segments2. One of its main advantages is to minimize
the possible complications when compared to open surgical treatment for
reduction and stabilization of fractures9.
Sometimes the fractured bone contact cannot be achieved due to the level
of damage. In such cases grafts may work as a bridge to achieve fusion.
Oral reconstruction is a difficult task because of the anatomical,
functional and esthetics aspects that have to be taken into account in
the surgery. Autogenous bone is the only graft material that possesses
osteoconductive, osteoinductive, and osteogenic
potential2-10.
This kind of surgical treatment is widely performed in cases such as the
reviewed on this case study. Technology has allowed maxillofacial
dentists to improve surgical processes over the last few
years1. Virtual surgical planning, computer-aided
manufacturing and 3D printing gives the surgeon multiple advantages such
as mirror the anatomy of the unaffected side, plan osteotomies,
manipulate bony segments, fabricate surgical resection guides and create
reconstruction plates1.
This case study reports a jaw reconstruction in a 52-year-old male after
a previous surgical reconstruction due to trauma that leaded to a case
of osteomyelitis with severe bone loss on the body of the mandible.