Jaw Reconstruction with Vascularized Cranial Bone

Abstract

The total rehabilitation of the patient with loss of the mandible remains one of the most difficult reconstructive problems. This is especially true where the bony loss is massive and there are unfavorable local soft tissue circumstances resulting from either radiation or scarring. The ideal solution would allow reconstitution of the entire mandible, providing osseous union even in a scarred tissue bed. Having created a semblance of normal mandibular anatomy, it would allow for rehabilitation of speech, swallowing, and mastication. Ideally, the surgical procedure would have a low rate of failure and would result in minimal donor site deformity. Alloplastic implants, homologous bone grafts, and autologous bone grafts have limited application in these cases. Microvascular free tissue transfers of bone and soft tissue have broadened the horizons of reconstruction, but these techniques are limited primarily to unilateral or modest bilateral problems, and substantial donor site deformity is associated with many of them. There is also significant risk of failure with microvascular techniques, especially when the recipient site is affected by previous radiation or scarring.