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Mandibulectomy with fibula graft

Implementation

Neck/jaw

The extent of the surgery depends on the disease. Sometimes half of the jaw must be removed. A cervical dissection is always performed on the same side, where a donor vessel is also found.

  • The lip is split in the midline and the skin is placed to the side.
  • The bite is immobilized intramaxillarily.
  • The skin of the cheek is resected.
  • The resection will depend on the extent of the tumor. Soft tissue content is resected and the mandible is resected with adequate margins.
  • Frozen sections are made from bone marrow, among others.

Leg

  • Surgical tourniquet to reduce bleeding
  • The incision is drawn lateral to the fibula.
  • Resect fibula with blood supply and any possibly overlying skin which is used for the covering in the mouth. The length of the fibula graft will depend on the defect in the mandible to be replaced. 

Reconstruction

Jaw surgeon

  • The free transplant from the fibula is adapted for the mandible.
  • The specimen is attached with plates on each side.

Hand surgeons

  • Microvascular anastomosis is performed to cervical vessels, usually the facial artery or superior thyroid artery. 
  • On the venous side, the facial vein or other branches is used.

ENT surgeons

  • The soft tissue over the graft is closed either primarily with mucosa or covered with full-thickness skin from the graft, or possibly with partial skin on muscle/soft tissues. 
  • The incision is closed.

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