Physical Address
304 North Cardinal St.
Dorchester Center, MA 02124
Lower Facial Reconstruction
Clinical Presentation
A 40-year-old White male had previously sustained a gunshot wound to his mandible and left mandibular bony reconstruction was unsuccessful. He had a significant deformity of his left lower face and desired a “good” mandibular reconstruction, not only to improve his lower face contour and deformity but also to have possible future reconstruction for osteointegrated dental implants ( Figs. 5.1 and 5.2 ). A preoperative CT scan of his mandible was performed.
Operative Plan and Special Considerations
This patient was also evaluated by our oral surgery service. After a careful preoperative evaluation of the mandible including a dental model, a large, approximately 10-cm mandibular bony gap of the mandible was identified ( Fig. 5.3 ). Because of the need for mandibular bony reconstruction, the future need for osteointegrated dental implant reconstructions and anticipated need for a skin coverage of the newly reconstructed mandible, a free fibula osteocutaneous flap reconstruction was offered to this patient. Because the dental model had already been made, a prebent 2.4-mm reconstruction plate was made preoperatively for secure occlusion and time saving in the operating room for plating the vascularized fibular bone graft. A preoperative angiogram was also performed to confirm a normal vascular anatomy of the left lower extremity.
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