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TABLE OF CONTENTS
Introduction .........................
Objectives ...........................
Recommended Preparation ..............
I. Physical Examination ...........
II. Radiography ....................
III. Extirpative Procedures .........
IV. Reconstructive Procedures ......
V. Segmental Mandibulectomy How I Usually Do It ............
Recommended Follow-up ................
About the Author .....................
1
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3
4
5
6
7
8
NOTE:
INTRODUCTION
This is the second of a series of
programs on mandibular tumors. The first
program
presents
generalities
and
principles in the diagnosis and treatment
of mandibular tumors.
This program is designed to reinforce
the first program as well as to provide
the necessary background for the subsequent parts in the series.
It contains
slides that illustrates physical examination and radiography in the diagnosis of
mandibular tumors;
different types of
extirpative procedures; and the various
types of reconstruction procedures.
OBJECTIVES
At the end of the program, the
is expected to be able to:
user
RECOMMENDED PREPARATION
Before going through this program,
the
user should
have
satisfactorily
completed the first program in the series,
namely:
Joson, RO: Tumors of the Mandible:
Generalities and Principles.
Manila, 1992.
I.
Physical examination of the mandible.
3.
lateral
4.
5.
6.
7.
II.
Radiography of the mandible.
8.
9.
10.
A lateral oblique view of the mandible, which shows the rationale of the
obliquity, which is to enable proper
visualization and study of the two
halves of the mandible.
11.
12.
13.
14.
15.
A
radiolucency,
which
may
be
unilocular or multilocular, at the
crown of an impacted or un-erupted
tooth, which is diagnostic of
a
dentigerous cyst.
16.
the
entire
the
of
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
diagof
of
III.
Extirpative procedures for mandibular
tumors.
27.
Extirpative procedures.
Curettage;
excision; marginal
mandibulectomy;
and segmental mandibulectomy.
28.
An excised specimen of
cyst.
4
radicular
29.
30.
31.
32.
33.
A hemi-mandibulectomy specimen.
34.
Reconstructive
mandible.
35.
A rib graft.
36.
37.
38.
39.
40.
41.
The contour
restored.
of the
chin
has
been
42.
The contour
restored.
of the
face
has
been
43.
44.
A reconstruction using
steel plate.
IV.
procedures
on
of
the
stainless
45.
46.
47.
48.
V.
Segmental mandibulectomy
usually do it.
how
49.
50.
51.
52.
53.
54.
55.
An x-ray
place.
graft
in
56.
is
in
57.
58.
59.
60.
61.
62.
63.
64.
The end.
extirpation
be
and
RECOMMENDED FOLLOW-UP
After
completing
this
selfinstructional program, the user is advised
to discuss this program with his teachers
as well as his peers. He is also strongly
advised to apply what he learns in the
clinics. If he is a surgeon or a surgeonto-be, he can proceed to PART III, which
is on surgical decision-making.
SEGMENTAL MANDIBULECTOMY
WITH
METALLIC PLATE RECONSTRUCTION
1.
From the Division of Head and Neck,
Breast, Esophagus, and Soft Tissue Surgery
of the Department of Surgery, University
of the Philippines College of Medicine and
Philippine General Hospital, we present a
short film on segmental mandibulectomy of
an ameloblastoma with a rreconstruction
using stainless steel plate.
2.
The patient is a 33-year old female
with a radiolucent mass on the mandible,
extending from the right third
molar
across the mentum to the left first molar.
3.
This is an outline of the mandibular
lesion.
A submandibular incision, about
one
centimeter from the rim of
the
mandible is planned.
4.
The incision is performed and carried
down to the platysma up to the rim of the
mandible.
5.
The mandible is exposed. The segment
of the mandible that will be resected is
skeletonized, that is , stripped of all
muscular and soft tissue attachments.
6.
The oral cavity is entered and the
segment of the mandible that will be
resected is freed from any other mucosal
attachments.
7.
The segment of the mandible that will
be resected is now completely free from
any form of soft tissue attachment.
1
8.
Teeth on the resection line are
extracted.
now
9.
A stainless steel plate that will
used in the reconstruction is fitted.
be
10.
A Gigli wire is used to resect the
mandible.
A one-centimeter margin
of
resection is sufficient for ameloblastoma.
11.
The right side of the
been transected.
mandible
has
12.
The left side of the
been transected.
mandible
has
13.
This shows the resected segment of
the mandible with the lesion within it.
14.
This shows the mandibular
which has to be reconstructed.
defect
15.
Holes are now being placed on the
mandibular ends. These holes will be used
for the screws.
16.
This shows the prothesis in place,
stabilized by two screws on one end and
another two screws on the other end.
17.
The chin flap has been
the stainless steel plate.
placed
over
23.
The future plan is to place dental
prosthesis to improve further the contour
of the chin as well as the masticatory
function.
24.
The end.