Markov N.M., Grachev N.S., Babaskina N.V., Demenchuk P.A., Vorozhtsov N.V., Krasnov A.S., Novichkova G.A. Case report: fibrotic dysplasia of lower jaw – surgical treatment and rehabilitation. Head and neck. Russian Journal. 2021;9(1):67–78 (In Russian). The authors are responsible for the originality of the data presented and the possibility of publishing illustrative material – tables, figures, photographs of patients.
DOI: https://doi.org/10.25792/HN.2021.9.1.67-78
Relevance. Fibrous dysplasia (FD) is a benign medullary, sporadic fibroblast lesion that involves one or more bones (monostotic and polyostotic forms). The proportion of facial skeleton lesions ranges from 10 to 29% among patients with monostotic fibrotic dysplasia (MFD). Radical excision with simultaneous reconstruction is recommended in case of rapid PD growth. Vascularized autogenous bone flap in combination with microsurgical technique is currently the best option for reconstruction of both upper and lower jaws. Subsequent prosthetics based on dental implants is the most effective way to restore chewing function. Clinical case description. Patient YA., 16 years old, was admitted for treatment in February 2017 in the Department of Oncology and pediatric surgery of Dmitry Rogachev National Medical Research Center Of Pediatric Hematology, Oncology and Immunology with complaints of pain in the left lower jaw area and facial asymmetry. Diagnosis: fibrotic dysplasia of the lower jaw on the left. The plan of treatment and further postoperative rehabilitation included the following stages: 1) preoperative planning; 2) surgical treatment; 3) stabilizing; 4) masticatory function restoration. The preoperative planning stage is necessary for an objective assessment of the resection extent so that the type and size of the graft can be chosen.
Templates for resection and flap modeling were produced at the preoperative planning stage. The surgical stage consisted of a hemimandibulotomy with preparation of recipient vessels and reconstruction of the lower jaw with a vascularized fibular flap. An individual elastic mouthguard was used to maintain the stability of the relative position of jaws and teeth on stabilizing stage. A removable prosthesis was made 1.5 months after surgical treatment performing following functions: stabilizing, aesthetic, chewing on the masticatory function restoration phase. Fixing tutanium plate was removed 6 months after the reconstruction of the lower jaw, simultaneously 4 dental implants in the area of missing teeth were placed. After achieving a stable position of the jaws and forming the vestibule of the oral cavity, a bridge-like structure with a screw type of fixation was performed. Conclusion. Rehabilitation of patients with neoplasms of the maxillofacial region is a complicated and urgent problem and multi-stage treatment is required to solve it successfully. Combining some stages on the one hand saves time spent on rehabilitation but on the other hand increases the risk of possible complications.
Key words: oral rehabilitation; pediatric oncology; fibrous dysplasia; mandible resection; fibular free flap; dental implantation