Why Preoperative and Post Operative Dental Follow-up Is Important for Jaw Reconstruction?
The subjective assessments by the dental surgeon or the maxillofacial surgeon are one of the most important factors in post-operative treatment planning and follow-ups. This can allow for efficient evaluation and restoration of oral and maxillofacial functions in patients who have been compromised due to dental or oral disease. For example in most major cancers of the jaw or mandibular or lower jaw tumors like aggressive ameloblastoma, oral soft tissue cancers, or salivary gland tumors, not only the functionality of the jaw and the face but even the esthetics of the patient would be severely compromised or debilitated. This is because surgical resection (removal) of such tumors for instance would necessitate the requirement of facial reconstruction to rehabilitate the patient's functional and esthetic needs, post the cancer resection surgery.
Hence, follow-up of patients with 3D (three dimensional) models of the post-operative results that are in fact mostly overlaid with the pre-operative plans by the dental or maxillofacial surgeon can help determine the accuracy and success of jaw reconstruction procedures or facilitate post-operative surgical success. The evaluation phase post oral surgery procedures plays an important role in establishing long-term success rates or outcomes for the oral surgery or dental patient which shall be discussed later in this article.
What Are the Factors Influencing Reconstruction Surgery?
In most tumors, it is the actual mandibular angle and the margins of bony contact that need to be established clearly by the maxillofacial surgeon or the oncologist for the clear post-operative success of the functional establishment. Further, the restoration of important functions such as chewing efficiency or mastication, of restoring oral competence plays the utmost role in retaining oral functionality. Several other situations apart from large jaw tumors or cancers as well would demand a lower jaw or mandibular reconstruction in patients. These are the cases of dental or jaw-based traumatic injuries and fractures, in Individuals impacted by dentofacial defects as a result of accidents, injuries, or trauma of those affected by the condition of osteoradionecrosis (a serious condition that can develop as a complication of radiation therapy used to treat cancer), and more. The factors that are firstly evaluated in the VSP (virtual surgical planning)- CAD-CAM (computer-aided design and computer-aided manufacturing) plan for the resection of tumors are as follows:
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The amount of bony segment overlap.
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The mean service deviation.
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The overall positioning of the mandible or the jaw.
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The osteotomy (a surgical procedure that involves cutting and reshaping bone) site difference.
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The reconstructive plate overlaps.
The clinical evaluation is done accordingly and then correlated by the maxillofacial surgeon or oncologist in the evaluation phase with these functional parameters. The maxillofacial surgeon aims to establish proper bite or occlusion and facilitate healthy chewing or mastication, and speech, in addition to the overall esthetics of the tumor resection. This is where the above-listed factors are of crucial importance in establishing post-operative tumor resolution or long-term success.
What Are the Steps in Jaw Reconstruction?
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A surgeon would first plan the resection of the lesion as well as plan the reconstruction of the maxillary or mandibular jaw defect by using a virtual three-dimensional model of the craniofacial skeleton. This is usually an interdisciplinary collaboration between the managing specialists of the reconstructive teams that is between the maxillofacial surgeon and the oncologist.
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During the surgical phase, the oral-maxillofacial surgeon or the oncologist would subsequently excise the diseased mandible or the maxillary tumor as planned. This can be efficiently done by virtual surgical planning by using prefabricated cutting guides.
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The free fibular osteocutaneous flap or the free fibula flap is deemed currently the gold standard by many maxillofacial surgeons in mandibular reconstruction surgeries. These are harvested by the reconstructive team and with the help of prefabricated templates and guides the reconstructive teams would then ensure the near exact or accurate location along with the angle of osteotomies. The harvested, osteotomized flaps will then be fixed or inserted into the mandibular defects (created because of surgical resection of the oral or jaw tumor or cancer).
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The maxillofacial surgeon ensures that the condylar end of the fixed graft is contoured as accurately as possible to re-establish the patient's chewing efficiency or the functionality of the jaw. This is done by fitting the articular disc of the temporomandibular joint and the operator placed graft back into position.
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The maxillofacial surgeon and the oncologist then successfully reconstruct the oral mucosa next and then by allowing the flap vasculature to be anastomosed, the cancer or the tumor resected sites are usually closed in a layered technique.
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Postoperatively, after surgical completion, a high-resolution CT (computed tomography) scan or CBCT (cone beam computed tomography) scan is obtained to allow for the evaluation of the reconstructive success of the maxilla or the mandible.
What Is the Evaluation Phase in Jaw Reconstruction?
The evaluation phase is the phase that begins in the post-operative period, with a repeat high-resolution CT scan or CBCT scan, with the advent of these technologies that are most commonly utilized both pre-operatively and post-operatively in dentistry and maxillofacial surgery. Just like pre-operative dental or surgical assessment is performed, based on the same preoperative protocols, the patient is evaluated after the oral surgical procedure as well in the same manner. While the method of radiographic evaluation would tend to vary between different operators and even between different clinics hospitals or institutions, a postoperative CT scan or CBCT scan of the dental or oral surgical site primarily allows for a detailed and quantitative evaluation. This offers accuracy to the maxillofacial surgeon regarding the possibility of the surgical outcomes, how successful the dental or oral surgical procedures have been, and how best the post-operative success can be complemented for the patient.
Conclusion
The reconstruction procedures performed by the maxillofacial surgeon or oncologist after tumor reaction surgeries, be it of the maxilla or upper jaw or the mandible or the lower jaw more commonly is hence indeed a challenging and complex surgical task with several complications arising as a result of the compromised or debilitated jaw, due to aggressive cancers or lesions. The post-operative success outcomes hence depend on the interdisciplinary collaboration and team approach by the oral surgeon and the oncologist who needs to address several cosmetic as well as functional challenges after resecting the cancer or tumor. The advent of virtual surgical planning in maxillofacial surgery and oncology has indeed been one of the great additions to charting out an accurate pre-operative as well as post-operative plan.
