Clinical example of the upper and lower jaws right-sided oropharyngeal block resection with one-stage

The article describes a clinical case of a patient with the diagnosis: “myoepithelioma of the right submandibular salivary gland with destruction of the right half of the lower and upper jaws, spreading to the right half of the periopharyngeal space and oropharynx.” A technique was chosen to use two revascularized combined peroneal skin-musculoskeletal grafts for the reconstruction of the resected halves of the jaws, with dental implantation and immediate loading with artificial crowns for the rehabilitation of the dentition and stabilization of the reconstructed dentoalveolar system, due to the presence of a lower jaw as a movable structure. A modified radical bilateral cervical lymphadenectomy, median vertical mandibulotomy were performed through a collar-shaped incision along the cervical fold, passing into the submental region and the lower lip; osteotomy was performed at the base of the right condylar process according to the preoperative planning model. The next step was the mobilization and resection of the tumor  in the periopharyngeal space and the right upper jaw en bloc. Due to direct communication with the major vessels of the neck after the resection of the oral cavity, there were direct indications for the elimination of the wound defect. Simultaneously, two teams of surgeons performed the isolation of free peroneal grafts and their subsequent modeling, according to the intraoperative template with dental implantation and the installation of temporary crowns. Then  the patient was referred for radiation therapy.

Our experience has shown that the simultaneous reconstruction for vital indications with the simultaneous collection of two free peroneal skin-musculoskeletal grafts can be considered as a method of choice in the case of defects  of comparable size both after various injuries and after previous surgical interventions or for one-stage reconstruction. After assessing the associated risks of surgical intervention, it is possible to reduce the patient’s rehabilitation time and allow him to go through treatment with minimal social disadaptation.

Key words: jaw defect, free peroneal flap, microsurgical autotransplantation, dental implantation, fixed prosthetics, 3D modeling, 3D implantation, immediate loading during implantation

Conflicts of interest. The authors have no conflicts of interest to declare.

Funding. There was no funding for this study.