B.

C. Graft carved and slotted to overlap anterior segment of mandible and remaining part of the vertical ramus.

D. Graft in place wired anteriorly to inner surface of mandible in a lap-joint fashion and posteriorly in a tongue-in-groove fashion.

Clinical Cases

CASE 1 (Photos not Available)

A 54-year-old man had a recurrent squamous cell carcinoma of the mandible and overlying skin after three previous excisions.

This FIGure shows the recurrent lesion and the margins of the proposed resection.

The excisional specimen and the defect are shown. A rim of lower lip was preserved, but the entire mandible, except for the vertical ramus on the right side and all the skin from the lip through the hyoid bone, was excised.

In this drawing, the mandibular replacement is planned on the ipsilateral iliac wing. The curvature of the symphysis was created by subperiosteal splitting of the iliac crest and the insertion of a block of bone to preserve the curvature. The TM joint capsule and master muscles were reapproximated. The osteocutaneous flap measured 28 x 15 cm and the bone segment 21 x 7 cm.

Postoperative results are shown. Bone scans and bone biopsies 5 days after the transplant confirm the viability of the entire graft. The patient has good chin contour, speech, and oral continence. Front view.

Mouth open.

Side view.

CASE 2

A 56-year-old woman underwent resection of a right mandibular squamous cell carcinoma, with neck dissection and radiation therapy.

FIGS.15-7. The patient has marked scarring from previous procedures. Front view.

FIG. 15-08. Side view.

FIG. 15-09. This preoperative panorex shows the bony defect, which included the condyle.

FIG. 15-10. The contralateral hip has been outlined for elevation of an osteocutaneous DCIA flap.

FIG. 15-11. A template of the bony defect is pictured.

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