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Building Hope

Times of India
26 June 2010
Pune, India

Rare surgery helps replace lower jaw with leg bone
A rare surgery, performed at a city–based dental college, helped replace the lower jaw of a 22–year–old woman with a piece of leg bone.

The surgery provides new hope for patients of oral and jaw cancer who need the jaw replaced for cosmetic uplift and speech enhancement.

The 14–hour marathon operation was conducted by a team of doctors from the M A Rangoonwala College of Dental Sciences & Research Centre under Dr Satyajit Dandagi, who was assisted by Amit Sangale, Deepak Kaul and Purushottam Chavan. Pavitra, who hails from a remote village in Karnataka, had lost the entire lower jawbone (mandible) in a previous surgery.

"The entire mandible was removed surgically three years ago to treat peripheral malignant nerve sheath tumor. She was disease–free and wished to have the mandible along with the teeth back," said Dandagi during a press conference on Tuesday.

"Replacement of the jaw bone and prosthetic rehabilitation of the teeth of resected lower jaw which mimics form, shape and function of chewing or mastication, is a challenge. The replacement was planned using free fibula flap (bone from the lower extremity) along with blood vessels (artery and vein) with subsequent placement of dental implants in the bone to provide dental prosthesis." he said.

Although small segments of the lost jaw were replaced using the same procedure, the main challenge was to get adequate length of the bone to replace the entire jaw and create a horse shoe shape from a straight bone, which mimics the original mandible. The structure was then made ready to receive dental implants and adequate length of blood vessels.

"Blood vessels of the bone were joined to those in the neck and face to facilitate flow of blood to the jaw bone. Microvascular surgical procedures require utmost expertise. Pavitra will receive dental implants after a month and teeth will be replaced a little later," said Dandagi.

Though the doctors have been performing free microvascular flaps to replace small segments of the jaws, it is for the first time they have reconstructed the entire jaw.

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