Can A Custom Designed Mandibular Reconstruction Plate Be Made To Replace A Fractured Jaw Plate After Cancer Removal?
Q: Dear Doctor Eppley, I came across your name after reading article by you. You described the use of a custom designed titanium mesh cage and plate made off of a 3-D model fabricated from a CT scan and using bone marrow from the hip to form bone along the mesh. The reason I’m writing you is that my wife had a mandibulectomy in 2009 and had a titanium plate used to replace the removed part of her mandible. Last week the plate broke so now we are looking for other reconstruction options. We have an appointment with an oral surgeon next week but preliminarily we have been told that his reconstruction options are the use of her fibula or part of her hip bone. Do you think she would be done with a specially designed mandible reconstruction plate alone. I hate the thought of her having to have another big operation. I have attached a panorex which shows her jaw and the broken plate. Any help would be appreciated. Thank you for your time.
A: Thank you for sending your wife’s panorex. The jaw image is quite clear and is a mirror image match of the patient I did about 6 months ago….same exact mandibulectomy defect and location of plate fracture. I am assuming she has not had radiation?? The standard approach, if she has had radiation, would be a fibular free flap. But if she has not, and the long-term goal is not to try and place dental implants into the reconstruction, a metallic reconstruction with iliac marrow graft would be appropriate. It requires a specially designed titanium reconstruction that is much stouter than this simple now fractured reconstruction place which is really just intended to be a temporary stopgap measure. They all will fracture within a year or two due to the stresses that are placed by jaw opening at the angle of the mandible. This is why a custom-designed one is needed to be made off of a 3-D CT model.