|Surgery duration||12 hrs|
|Residency||from 12 days|
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Anatomy of the mandible
The mandible has the same functions as the maxilla. It participates in chewing, swallowing, breathing, vocalization and distribution of the load on teeth.
The mandible is attached to the skull by the condylar process.
The teeth are attached to the lower alveolar process of the mandible.
Inside the mandible, lower alveolar nerve and blood vessels pass through the mandibular canal. The lower alveolar nerve ensures the sensitivity of teeth, gums and skin on the chin.
Mandibulectomy is a surgery in which a part of the mandible is removed.
There are two main types of mandibulectomy: marginal and segmental.
Marginal mandibulectomy is used when cancer has not spread beyond mucous membrane; in this case, it is possible to remove the whole tumour leaving the bone intact.
If the cancer cells affected the bone, they can spread to other parts of the bone. That is why in such cases it is vital to remove the whole segment of the mandible, breaking its integrity. This type of surgery is called segmental mandibulectomy.
In segmental mandibulectomy, the lower alveolar nerve is also removed, so the loss of sensitivity of the skin on the chin and of the lower gum occurs.
Preparation to the surgery
The surgery is planned on a computer. A plastic surgeon determines how to cut out the flap, how to remove the tumour and how to implant the flap. If a patient is going to get teeth implants, then an orthodontic surgeon specialized in implants joins the surgery.
The removal of the tumour, the reconstruction and implantation are all performed in the process of the same surgery.
Variants of access
There are three variants of access for mandible reconstruction:
1. Incision along the chin and along the neck plica is a classical access. It is rarely used and considered to be obsolete.
2. “Invisible” incision within the nuchal fold
3. The access through the mouth, without external incisions, is used for marginal mandibulectomy.
Fibula bone is a side bone in the leg that does not carry body weight
Fibular flap consists of bone, vessels and muscles.
This flap is often used for mandible and maxilla reconstruction and is ideal for further teeth implants.
The removal of the flap does not affect the patient’s quality of life. After the surgery, the patient is able to walk, run and wear high heels.
Phases of the surgery:
1. A plastic surgeon removes the tumour and the adjacent part of the mandible with soft tissues.
2. The surgeon separates a fibular flap for transplantation.
3. The bone taken from donor area will be formed to match the removed part of the mandible precisely.
4. Blood vessels that carry nutrition to the flap will be connected to the circulatory system with the use of microsurgical techniques.
5. The new bone will be attached firmly to the mandible, with screws and plates.
Mandible reconstruction price list
With a fibular flap taken from the patient’s leg
|Operation||647 000 rub|
|Narcosis, 12 hrs||156 000 rub|
|Semiprivate room, 12 days||120 000 rub|
|Индивидуальное наблюдение анестезиолога||20 000 rub|
|Total||943 000 rub|
The surgery is focused on reconstructing the shape and functions of the mandible with the use of patient's own tissues.