Restoration of Continuity Medical Assignment Help

Resotration of Continuity

Control of residual mandibular segments. When a continuity defect is present, the muscles of mastication attached to the residual mandibular fragments will distract them in different directions unless efforts were
made to stabilize the remaining mandible in its normal position at the time of partial resection. Mamtaining relationships of the remaining mandible fragments after resection of portions of the mandible is a key principle
of mandibular reconstruction. This is important for both occlusal and temporomandibular joint (TM]) positioning. When the residual fragments are left to drift, Significant facial distortions can occur from deviation
of the residual mandibular fragments (Fig. 28-3). Metal bone plates inserted at the time of resection are useful for controlling the position of the mandibular fragments (see Fig. 28-2. fl. They are of sufficient “strength to obviate the need for maxillomandibular fixation, permitting active use of the mandible in the immediate postoperative period. In older individuals or
those with significant medical compromise, this may be the final form of reconstruction. It provides soft tissue support to maintain facial symmetry. When the mandibular symphysis has been removed, the tongue
can be sutured to the plate, maintaining its forward position to prevent airway obstruction (see Fig. 28-2, E). The bone plate can be left in place when .the mandible is secondarily reconstructed with bone grafts,
permitting mobility of the mandible during the bone graft’s healing phase (see Fig. 28-2, /)

FIC..2ts-3 Patient whose left mandibular ramus and posterior body was removed 10 years previously to! malignant disease (A'). The deviation of the chin to the left side is ~sualiled. Postsurgical radiotherapy was also usee! during therapy. The patient underwent hyperbaric oxygen treatments before bone graft reconstruction. B, Panoramic radiograph showing residual mandible.

FIC..2ts-3 Patient whose left mandibular ramus and posterior body was removed 10 years previously
to! malignant disease (A’). The deviation of the chin to the left side is ~sualiled. Postsurgical radiotherapy
was also usee! during therapy. The patient underwent hyperbaric oxygen treatments before
bone graft reconstruction. B, Panoramic radiograph showing residual mandible.

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FIC..2ts-3 Patient whose left mandibular ramus and posterior body was removed 10 years previously to! malignant disease (A'). The deviation of the chin to the left side is ~sualiled. Postsurgical radiotherapy was also usee! during therapy. The patient underwent hyperbaric oxygen treatments before bone graft reconstruction. B, Panoramic radiograph showing residual mandible.

FIG..2ts-3 Patient whose left mandibular ramus and posterior body was removed 10 years previously
to! malignant disease (A’). The deviation of the chin to the left side is ~sualiled. Postsurgical radiotherapy
was also usee! during therapy. The patient underwent hyperbaric oxygen treatments before
bone graft reconstruction. B, Panoramic radio graph showing residual mandible.

 

FIG. 28-3-cont'd C, Maximum opening of mouth shows gross deviation to resected side. D, Intraoral photograph showing' the crossbite relationship from the deviation of the mandible to the left side.

FIG. 28-3-cont’d C, Maximum opening of mouth shows gross
deviation to resected side. D, Intraoral photograph showing’ the crossbite
relationship from the deviation of the mandible to the left side.

When the position of the residual mandibular fragments have not been maintained during the resection, realignment is more difficult during the reconstructive surgery. Over time the muscles of mastication become
atrophic. fibrotic, and nonpliable. which makes realignment of the fragments extremely difficult, During the reconstructive surgery, it may be necessary to strip several muscles off the mandibular fragments to
release the bone from their adverse pull. ,\ coronoidectorny is usually performed to remove he Srior pull of the ternporaljs muscle. Before

 

 

 

 

 

 

 

 

 

Posted by: brianna

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