Abstract
We describe one case of the rehabilitation for large mandibular defect by the combined application of internal curvilinear and linear distraction osteogenesis. In the first operation, the transport discs were produced on both sides of the defect. The internal curvilinear and linear distraction were then performed Three months later, the defect was reduced by half, then in the second operation, the internal linear distraction osteogenesis bilateral to the residual defect was started. Another three months later, the newly-formed bone was evident in the distraction gaps, then in the third operation, the distracted transport bony discs were connected by a small local bone graft. By the steps, the 70 mm defect was reconstructed. This might be a practical way for the synchronous reconstruction of bony and soft tissue for large mandibular defects that do not require bone grafts from other anatomic areas.
Mandibular defects can create serious cosmetic and functional handicaps for the patients. In our case, the combined application of internal linear and curvilinear distraction osteogenesis were used for the ]reconstruction of large mandibular defect.
1
Case report
The patient was a 25-year-old man who had suffered from large odontogenic cyst of the right mandible. Before the treatment, the institutional ethical clearance was obtained and the patient informed consent was signed.
In the first operation, the segmental mandibulectomy was performed from right canine to mandibular ramus with the alveolar process and treated teeth preserved, which resulted in a large mandibular defect about 70 mm in length. The vertical osteotomy in the midline and the horizontal osteotomy below the roots of the central and lateral incisors were performed, creating the 1-cm mesial transport disc, and the semiburied curvilinear distractor [ ] was fixed. Then, the distal transport disc was also produced in the anterior margin of residual mandible ramus and fixed with semiburied linear distractor ( Fig. 1 ). After 7 days’latency, the 2 transport discs were moved at 1.05 mm/day for 18 consecutive days. Three months later, the new bone formed well in the distraction gaps and the defect was reduced to 35 mm in length ( Fig. 2 ). Then, in the second operation, following the removal of the distractors, the variable transport discs were made bilateral to the defect again and two semiburied linear distractors were fixed. Distraction was performed as before for 15 days. Three months later, the third operation was done to remove the distractors and one piece of 5 mm bone was harvested from the front area of the mandible and plugged into the docking site following the removal of the intervening tissue, then fixed with titanium miniplate.
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