Reconstruction of the mandible and maxilla

Abstract

Mandibular and maxillary reconstruction is commonly required in clinical practice following major trauma or tumour resection. General principles of reconstruction should be followed: replace like with like and address functional and cosmetic deficiencies. Many reconstructive approaches are applicable to both mandibular and maxillary reconstruction and free vascularized tissue transfer is the accepted standard for both these anatomical sites with flaps such as the fibula or iliac crest. Advances in microsurgery allow high-quality, reproducible reconstructions to be performed by specialist teams. Reconstruction modality will be influenced by a range of factors such as defect site, size, and soft tissue involvement, as well as patient factors such as general health, dentition, age, and further planned treatment. Key factors to consider when reconstructing the midface and jaw include the airway, swallowing, speech, nutrition, and dental rehabilitation. These are also considered in this chapter. Computer modelling and surgical planning based on preoperative computed tomography scanning is now commonly used by many teams and this is also discussed.