Imaging Studies

CT assists in the definition of the extent of the required resection. Evidence of bone resorption is best appreciated by the direct examination of specific bone-enhancing images (bone windows). The printout of life-sized images (1:1 reproductions) and the creation of templates have been described as useful in mandibular reconstruction. These templates can assist the surgeon with molding and recontouring the flap, but these techniques are not widely available and can be costly.

A panoramic radiograph is reportedly effective in predicting bone involvement by overlying squamous cell carcinoma. The additional benefit of demonstrating the presence of dental pathology, which may alter the decision to extract or maintain teeth, also should be considered.

Treatment & Management

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Media Gallery

Iliac crest tissue transfer. Exposure of the external oblique fascia. Note the planned incision 2.5 cm medial to the iliac crest.
Iliac crest tissue transfer. Incision of the external oblique allows exposure of the internal oblique. The dissection is in an avascular plane and extends to the costal margin superiorly and the linea semilunaris medially.
Iliac crest tissue transfer. The vascular pedicle is shown with the lateral femoral cutaneous nerve lying just beneath it.
Iliac crest tissue transfer. The donor site is managed by direct approximation of the iliacus and transversalis muscles. The closure is completed by securing a mesh to the residual ilium and the external oblique fascia.
Iliac crest tissue transfer. The harvested flap before contouring.
Iliac crest tissue transfer. Flap inset to the mandibular defect. Note opening osteotomies are filled with cancellous bone particles. The muscle is then wrapped around the bone to provide a soft-tissue coverage and a seal of the oral cavity.
Iliac crest tissue transfer. An early postoperative film demonstrates that the bone harvest can equal the dimensions of the resection site.

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Author

Neeraj N Mathur, MBBS, MS, DNB, MAMS, FAMS Professor and Head, Department of ENT, Amrita Hospital and Amrita Institute of Medical Sciences, Faridabad, India

Neeraj N Mathur, MBBS, MS, DNB, MAMS, FAMS is a member of the following medical societies: Association of Otolaryngologists of India, Cochlear Implant Group of India, Indian Medical Association, National Academy of Medical Sciences (India), Neuro-Otological and Equilibriometric Society of India, Royal Society of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

David W Stepnick, MD Associate Professor, Departments of Otolaryngology-Head & Neck Surgery and Plastic Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center

David W Stepnick, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, Society of University Otolaryngologists-Head and Neck Surgeons, American College of Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan; Ryte; Neosoma; MI10<br/>Received income in an amount equal to or greater than $250 from: Neosoma; Cyberionix (CYBX)<br/>Received ownership interest from Cerescan for consulting for: Neosoma, MI10.

Additional Contributors

Terance (Terry) Ted Tsue, MD Vice-Chairman for Administrative Affairs, Professor, Residency Program Director, Department of Otolaryngology-Head and Neck Surgery, University of Kasnas School of Medicine

Terance (Terry) Ted Tsue, MD is a member of the following medical societies: Alpha Omega Alpha, Association for Research in Otolaryngology, American Head and Neck Society, Johns Hopkins Medical and Surgical Association, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, Missouri State Medical Association, Phi Beta Kappa, Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Nothing to disclose.