[SavageGlow]

The first case was of a 13-year-old adolescent boy from Tanzania. The clinical history was a lesion of the mandible that had increased in size gradually over time, reaching an extensive size (Fig. 1). The patient could not comprehensibly speak, and there were difficulties with eating and swallowing. In the computed tomography (CT) scan, a mixed radiolucent and radiopaque area was shown, occupying the body of the mandible from angle to angle (Fig. 2). A preoperative biopsy was performed, showing the osteoplastic variant of desmoplastic ameloblastoma.

...

In both patients, the treatment plan was as follows: Because of the impossibility of using the inferior arch as a guide for fibular shaping, reconstruction started with the development of a superior dental arch cast. Consequently, an acrylic transparent prosthetic model of the lower dental arch was developed under ideal occlusion with the upper jaw, taking into consideration standard cephalometric points. The latter was used as a template to cut and shape the fibula flap to guarantee the reconstruction of the mandibular physiological shape (Fig. 5).

Mandibulectomy and fibula reconstruction were executed by th emaxillofacial and plastic microsurgical team at the same time. After resection, the fibula was modeled according to the lower dental cast to fit to the surgical defect, and the flap was then fixed to the remaining mandibular bone with prefabricated titanium plates and screws (Fig. 6).

Concerning the first patient, 9 days after the surgical procedure, oral fluids were started, and 15 days later, a soft diet was begun. The patient underwent a 3D CT scan before discharge, in which the reconstruction of the bone was shown (Fig. 7).

In addition, he underwent prosthetic rehabilitation (Fig. 8) 8 months after the operation, when a second-stage surgery was performed to insert the osseo-integrated implants. The same lower jaw prosthesis used during the first surgery was used as a guide for the implants, which were inserted after gingivoplasty to reduce the excess tissue and to remove the fixation devices.

An overdenture was performed, and the prosthesis was cement retained and implant supported. Recommendations for this procedure were a 6-month follow-up, good dental hygiene, and performance of an orthopantomography every 6 months for the first year as well as every 12 months after the first year. Another factor considered was that the patient was still growing; for this reason, the prosthesis needed to be adjusted according to somatic growth.

...

Although the lesions were extensively removed, the aesthetic results obtained were not optimal because the mandibular reconstruction was planned based on a cast derived by the inferior dental arch and not on the bony structure. This resulted in retrusion and asymmetry of the chin.

The patients experienced improvements in their social roles and interactions due to the achieved functional results.

Concerning the first patient, after 5 years had passed since his surgery, no signs of relapse were detected during the follow-up period, and he underwent prosthetic rehabilitation.

[Mr.NoCredit]

Such a better looking smile post op than pre operative. Those teeth were jutting out at all kinds of strange angles..

[marcos_69]

That's just amazing.

[HIGHTECHDUDE]

How the hell did this kid eat?... never mind, I don't want to know.

[azblue81]

He is from a certain tribe.

[kellyhound]

Originally Posted by HIGHTECHDUDE ↗

How the hell did this kid eat?

Or Speak

[shadowstein]

Modern plastic surgeon are either miracle workers or enablers for people with too much money

[Boneshaker]

Some of the Doctors are indeed miracle workers. Many go to places where children suffer with such maladies, and do the work gratis. Thank God, there are people on the planet who do care.